by John & Barbara Connor, M.Ac., L.Ac.
John & I thought we would write a little bit today about the benefits of acupuncture, moxibustion, herbs and nutrients in the treatment of irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD). If you or someone you love suffers from either of these conditions we hope you find this article helpful.
Acupuncture and Moxibustion for Irritable Bowel Syndrome and Inflammatory Bowel Diseases
Many clinical studies have demonstrated the efficacy of acupuncture-moxibustion in treating IBS. Increasing attention has been paid to research regarding the action mechanisms of acupuncture-moxibustion for irritable bowel syndrome (IBS), and the adoption of modern techniques has achieved some progress. This article reviews the latest advances among action mechanism studies from the perspectives of gastrointestinal motility, visceral hypersensitivity, the brain-gut axis, the neuroendocrine system, and the immune system. It is shown that acupuncture-moxibustion can effectively regulate the above items, and thus, this treatment should have a high efficacy in the treatment of IBS. (Ma et al 2014)
Six randomized, placebo-controlled clinical trials met the criteria and were included in the meta-analysis. Using the two different systems of STATA 11.0 and Revman 5.0, we confirmed the significant efficacy of acupuncture for treating IBS. Acupuncture exhibits clinically and statistically significant control of IBS symptoms. (Chao & Zhang 2014)
This systematic review and meta-analysis suggests that moxibustion may provide benefit to IBS patients although the risk of bias in the included studies is relatively high. Future studies are necessary to confirm whether this finding is reproducible in carefully-designed and conducted trials and to firmly establish the place of moxibustion in current practice. (Park et al 2013)
Acupuncture and moxibustion therapy demonstrates better efficacy than oral sulphasalazine (SASP) in treating inflammatory bowel diseases (IBD). However, given the limitations of this systematic review and the included literature, definitive conclusions regarding the exact efficacy of acupuncture and moxibustion treatment for IBD cannot be drawn. Extant RCTs still cannot provide sufficient evidence and multicentre, double-blind RCTs with large sample sizes are needed to provide higher-quality evidence. (Ji et al 2013)
Eleven researches were included with a total of 969 patients. Meta analysis shows that the effective rate of the combined methods of acupuncture and moxibustion [RR = 1. 27, 95% CI ( 1.09, 1.49)] is superior to conventional western medication treatment. Acupuncture-moxibustion for irritable bowel syndrome is better than the conventional western medication treatment. (Pei et al 2012)
After 4 weeks of twice-weekly acupuncture and moxibustion treatment, average daily abdominal pain/discomfort improved whereas the control group showed minimal reduction. This between-group difference adjusted for baseline difference was statistically significant. The intestinal gas, bloating, and stool consistency composite score showed a similar pattern of improvement. The findings indicate that Acu/Moxa treatment shows promise in the area of symptom management for IBS. (Anastasi et al 2009)
Herbs and Nutrients for Irritable Bowel Syndrome and Inflammatory Bowel Diseases
Aloe vera – Oral aloe vera taken for 4 weeks for the treatment of mildly to moderately active ulcerative colitis produced a clinical response more often than placebo; it also reduced the histological disease activity and appeared to be safe. Further evaluation of the therapeutic potential of aloe vera gel in inflammatory bowel disease is needed. (Langmead et al 2004)
Arginine and Glutamine – Combined pharmacological doses of arginine (Arg) and glutamine (Gln) decreased TNFalpha and the main proinflammatory cytokines release in active colonic Crohn’s disease (CD) biopsies via NF-kappaB and p38 MAPK pathways. These results could be the basis of prospective studies evaluating the effects of enteral supply of combined Arg and Gln during active CD. (Lecleire et al 2008)
Chinese herbal formula IBS-20 – These data indicate that the anti-inflammatory activities of IBS-20 (Bai Zhi, Yin Chen, Bau Zhu, Mu Xiang, Chai Hu, Chen Pi, Dang Shen, Yi Yi Ren, Huang Lian, Qin Pi, Zi Gan Cao, Hou Po, Bai Shao, Che Qian Zi, Guan Huang Bo, Buang Huo Xiang, Fu Ling, Fang Feng, Wu Wei Zi and Pao Jiang) may contribute to the beneficial effects of the herbal extract in patients with IBS, providing a potential mechanism of action for IBS-20. In addition, IBS-20 may be a potential therapeutic agent against other Th1-dominant gut pathologies such as inflammatory bowel disease. (Yang et al 2012) The Seven Forests formula Peony 9 contains 7 of the ingredients of IBS-20 in it.
Conjugated linoleic acid (CLA) – Dietary activation of PPARγ by fiber, probiotics as well as other naturally occurring compounds such as CLA, CLnAs* and ABA** represents an efficacious and safe approach for the prevention and amelioration of IBD. (PUA, also known as trichosanic acid, is a conjugated triene fatty acid naturally found at high concentrations in the seed of Punica granatum (Punicaceae, pomegranate) and Trichosanthes kirilowii. PUA constitutes 64% to 83 % of the PSO, but it also contains minor amounts of α-eleostearic acid (ESA), catalpic acid (CAA) and jacaric acid (JAA). All these acids are collectively known as conjugated linolenic acids *(CLnAs) (**ABA is an isoprenoid phytohormone discovered in the early 1960s that has received some recent attention due to its medicinal applications.) (Viladomiu et al 2013)
Coriander, lemon balm and spearmint leaves – The observed antibacterial activity of ethanolic extracts of coriander, lemon balm and spearmint leaves suggests a mechanistic explanation for the efficacy of a mixture of coriander, lemon balm and mint extracts against IBS in a published clinical trial. (Thompson et al 2013)
Curcumin – Recent studies have shown that curcumin ameliorates multiple sclerosis, rheumatoid arthritis, psoriasis, and inflammatory bowel disease in human or animal models. Curcumin inhibits these autoimmune diseases by regulating inflammatory cytokines such as IL-1beta, IL-6, IL-12, TNF-alpha and IFN-gamma and associated JAK-STAT, AP-1, and NF-kappaB signaling pathways in immune cells. (Bright JJ 2007) In Botanical Treasures & Vital Adapt.
Dietary fiber – Overall, consumption of soluble fiber resulted in a decrease in global IBS symptoms and constipation, whereas insoluble fiber demonstrated a less significant effect. Neither intervention, however, decreased abdominal pain in IBS patients. (Yoon et al 2011)
Elimination diets – Alterations in diet have been used as a treatment for IBD.The use of elimination diets has also been studied. These typically involve the use of a food diary, with elimination of symptom provoking foods, or the use of a basic diet with reintroduction of potentially problematic foods one food type at a time. This approach was shown to be beneficial in inducing remission in six of nine studies. (Kotlyar et al 2014)
Elimination diet – Patients with IBS were found to have significantly more subjective lactose intolerance complaints (bloating, distention, and diarrhea) than those without IBS and to have increased likelihood of lactose malabsorption than the general population. Thus,decreased intake of lactose can benefit some IBS patients. (Yoon et al 2011)
Germinated barley foodstuff – This study showed the consumption of germinated barley foodstuff (GBF) (a prebiotic product derived from the aleurone and scutellum fractions of germinated barley and consists of insoluble glutamine-rich protein and dietary fiber) along with routine medication in attenuates the inflammation and appears to be an effective and safe treatment in UC. The consumption of GBF in ulcerative colitis (UC) patients resulted in the reduction of some inflammatory markers such as serum CRP level. (Faghfoori et al 2014)
Glutamine – These data demonstrate the therapeutic potential of glutamine (GLN) as a “pharmacologically acting nutrient” in the setting of experimental IBD. GLN sufficiency is crucial for the colonic epithelium to mount a cell-protective, antiapoptotic, and anti-inflammatory response against inflammatory injury. The enhanced heat shock protein (HSP) expression observed following GLN treatment may be responsible for this protective effect. (Xue et al 2011)
Laminaria japonica (an edible seaweed used to regulate digestive symptoms) aqueous extract was effective in inducing protection against colitis in mice and acted synergistically with probiotics. (Ko et al 2014)
L-Arginine – These preclinical studies indicate that L-Arginine supplementation could be a potential therapy for IBD, and that one mechanism of action may be functional enhancement of iNOS activity. (Coburn et al 2012)
Lonicera japonica, curcumin and green tea polyphenols – Several herbal preparations are considered useful by some in the treatment of inflammatory disorders. Lonicera japonica is a Korean traditional treatment, and has been shown to decrease histamine release from mast cells and inhibit inflammatory pathways, including the NF-κB and AP-1 pathways. Lonicera may be an attractive agent for future clinical trials in both IBD and allergic disease. In addition, curcumin and green tea polyphenols have been shown to be potent antioxidants and have anti-inflammatory activity in mice. In one study, 35.5% of mice treated with trinitrobenzene (TNBS) died after developing an ulcerative colitis-like disease; however, no mice died in a group preventively given a 2% curcumin solution. In addition, mice given doses of curcumin after TNBS-induced colitis demonstrated histologic improvement of colonic mucosa. (Kotlyar et al 2014)
Mentha longifolia, Cyperus rotundus and Zingiber officinale – Patients with IBS showed significant improvements in their IBS symptoms after 8-weeks of treatment with the herbal combination and did not report any adverse effects during their treatment. These results support the efficacy and safety of the herbal combination for the treatment of IBS. (Sahib AS 2013)
NAC – Dietary supplementation with 500 mg/kg NAC (n-acetyl cysteine) alleviated acetic acid-induced ulcerative colitic injury in piglets. Because intestinal physiology and physiopathology are very similar between pigs and humans, our study helps to identify a beneficial role for dietary NAC supplementation as an adjuvant therapy for ulcerative colitis. (Wang et al 2013)
Naringenin is a major polyphenol isolated from citrus fruits. Basic scientific studies using animals and cell cultures have demonstrated that naringenin provides various physiological effects, including antioxidative, antiinflammatory, and anticarcinogenic effects. Our observations regarding intestinal barrier function and inflammation in dextran sulfate sodium (DSS)-induced colitic mice fed naringenin represent novel information on the physiological effects of naringenin. Feeding naringenin attenuates the DSS-induced colitis at least partly through the protection of intestinal tight junction barrier function, and additional underlying mechanisms are also suspected to exist. (Azuma et al 2013)
Nutritional supplementation – Data from animal and cell studies suggest that supplementation with specific amino acids including arginine, glutamine, glutamate, threonine, methionine, serine, proline, and the amino acid-derived compounds, polyamines can favorably influence mucosal healing (MH). Short-chain fatty acids, which are produced by the microbiota from undigested polysaccharides and protein-derived amino acids, also exert beneficial effects on the process of intestinal MH in experimental models. Regarding supplementation with lipids, although the effects of ω-3 and ω-6 fatty acids remain controversial, endogenous prostaglandin synthesis seems to be necessary for MH. Finally, among micronutrients, several vitamin and mineral deficiencies with different frequencies have been observed in patients with inflammatory bowel diseases and supplementation with some of them (vitamin A, vitamin D3, vitamin C, and zinc) are presumed to favor MH. Future work, including clinical studies, should evaluate the efficiency of supplementation with combination of dietary compounds as adjuvant nutritional intervention for MH of the inflamed intestinal mucosa. (Lan et al 2014)
Omega-3 Fatty Acids – Other potential therapies in the treatment of IBD include the use of polyunsaturated fatty acids (PUFA). These acids, including omega-3 fatty acids, decrease inflammation as their derivatives, including eicosapentaenoic acid, and leukotriene derivatives, downregulate neutrophil trafficking and thereby decrease edema formation. Twelve studies with n-3 PUFA, mostly from fish oil, showed benefit in IBD patients, with a decreased need for steroids, diminished disease activity and a lower relapse rate. (Kotlyar et al 2014)
Omega-3 Fatty Acids – Fish oil (FO) derived long chain n-3 PUFA exert anti-inflammatory effects and have been shown to enhance remission of chronic intestinal inflammation. Moreover, an estimated 50% of IBD patients utilize self-prescribed oral complementary alternative medicines/diets, such as FO. Dietary n-3 PUFA accumulate in cell membranes, partly at the expense of AA, thereby reducing the available substrate for the synthesis of AA-derived eicosanoids while concomitantly serving as substrates for the production of n-3 PUFA-derived anti-inflammatory resolvins, docosatrienes, and neuroprotectins. Further, n-3 PUFA have been demonstrated to reduce splenic CD4+ T cell ex vivo polarization into Th1and Th17 cells. Therefore, n-3 PUFA may suppress colitis-associated Th17 cell activation, in part, by reducing mucosal AA-derived eicosanoid levels. Our observations demonstrate the utility of antagonizing colonic AA-derived eicosanoids as a mechanism to reduce inflammatory T cell activation and improve colitis-associated immunopathology. Moreover, these results suggest that dietary n-3 PUFA could be used alone, or as an adjunctive therapy, in improving the clinical outcome of colonic mucosal Th17 cell-mediated pathologies. (Monk et al 2014)
Omega 3 Fatty Acids – By virtue of their anti-inflammatory action, omega-3 polyunsaturated fatty acids (PUFA) may be beneficial in inflammatory diseases. A large body of evidence supports a protective effect of omega-3 PUFA in experimental animal and ex-vivo models of Crohn’s disease (CD), Ulcerative colitis (UC) and rheumatoid arthritis (RA). Although fish oil supplementation in patients with IBD results in omega-3 PUFA incorporation into gut mucosal tissue and modification of inflammatory mediator profiles, the evidence of clinical benefits of omega-3 PUFA is weak. On the other hand, more convincing data support the efficacy of omega-3 PUFA in reducing pain, number of tender joints, duration of morning stiffness, use of non-steroidal anti-inflammatory drugs and improving physical performance in RA patients. (Ruggiero et al 2009) In Beyond Essential Fats
Omega 3 Fatty Acids – There have been a number of clinical trials assessing the benefits of dietary supplementation with fish oils in several inflammatory and autoimmune diseases in humans, including rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis and migraine headaches. Many of the placebo-controlled trials of fish oil in chronic inflammatory diseases reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs. (Simopoulos 2002) In Beyond Essential Fats
Probiotics – While the etiological underpinnings of inflammatory bowel disease (IBD) are highly complex, it has been noted that both clinical and pathophysiological similarities exist between IBD and both asthma and non-pulmonary allergic phenomena. Histamine and mast cell activity show common behaviors in both IBD and in certain allergic disorders. IgE also represents a key immunoglobulin involved in both IBD and in certain allergic pathologies, though these links require further study. Probiotics remain a critically important intervention for both IBD subtypes as well as multiple allergic phenomena. (Kotlyar et al 2014)
Probiotics – appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain. (Moayyedi et al 2010)
Vitamin B6 – In addition to data showing that inflammation can deplete plasma vitamin B6, Benight et al. 2011 report that B6 inadequacy can attenuate inflammation. They demonstrated that the consumption of a diet lacking vitamin B6 (and B12) reduced the risk of mortality as well as disease activity score, weight loss and mucosal expression of iNOS, TNF-α and IL-10 compared to mice. The findings of our deficiency arm parallel those of our colleagues, but to the best of our knowledge, this is the first report of the suppression of IBD with supplemental B6. (Selhub et al 2013)
Vitamin D – We demonstrate that vitamin D levels inversely correlate with disease activity in patients with Crohn’s disease (CD). Consistent with the literature, we report that patients with active CD exhibit lower serum vitamin D levels than those in clinical remission. (Ham et al 2014)
Zinc, Vitamin A, Selenium and Copper – Decreased serum concentrations of zinc and vitamin A are frequently seen in active Crohn’s disease. Serum selenium levels are lower and serum copper levels are higher in patients with Crohn’s disease. (Wasko-Czopnik & Paradowski 2012)
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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-3475-1005..
