Home' Australian Pharmacist : Australian Pharmacist October 2012 Contents 810 Australian Pharmacist October 2012 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
THE COMPLEMENTARY APPROACH
especially those with constipation, may
improve with increased intake of soluble
bre, but insoluble bre may aggravate
some people. The usefulness of prebiotic
bres and food-derived probiotics
(e.g. live-culture yogurt) has not been
Although food allergy is unlikely, food
sensitivity/intolerance may occur and
this may be the result of abnormal
fermentation of food residues in the
colon.29 Gasses produced during the
fermentation process are thought to
contribute to abdominal bloating and
discomfort. In some cases, simple changes
in eating habits may assist in ensuring
that foods are broken down (both
mechanically and chemically) into their
smallest parts to improve absorption
and reduce the risk of fermentation.
Such advice generally includes chewing
food thoroughly and avoiding excessive
uids around meal times that may dilute
digestive secretions. It may also include
recommendations for consuming smaller
portion sizes in individual sittings as well
as restricting high fat or bre foods30 that
may slow digestive processes.
In practice, it can be di cult to con rm
whether an adverse food reaction is
contributing to symptoms. Practitioners
will often use an 'eliminate and challenge'
process. This will generally follow a period
where the patient keeps a food journal.
This record should take account of the
type and quantity of food consumed
as well as the timing and nature of
symptoms, including the frequency
and consistency of bowel movements.30
This can assist in identifying the most
likely culprit/s. Of key interest to the
practitioner are lactose, fructose and
sorbitol-containing foods as well as
fermentable carbohydrates including
legumes (dried beans/peas, lentils, etc.)
and cruciferous vegetables (cabbage,
brussels sprouts, etc.).30 During the
eliminate and challenge process patients
are asked to eliminate the suspect food or
food group for a period of several weeks,
noting any changes in the condition.
If this restriction results in a nutritional
insu ciency, care must be taken to
ensure that alternative food sources of
such nutrients are consumed. The suspect
foods are then reintroduced, starting
with small amounts and progressively
increasing to determine whether an e ect
is noted. In some cases food reactions
may be delayed by up to several days or
when the o ending substance reaches a
Identifying and appropriately addressing
adverse food reactions in people with
IBS may improve overall wellbeing and
quality of life in this group.31 However,
care should always be taken to ensure
that all nutritional requirements are
adequately met and that options
are provided that are palatable and
Cautions and counselling points
• Dietary alterations should generally
be conducted under the guidance of
an appropriately trained practitioner
who can ensure that overall nutrition is
IBS is a condition which compromises
the quality of life of many Australians.
A previous issue focussed on some
of the most common CAM therapies:
peppermint oil, bre and probiotics.
In this issue herbal formulations and
dietary strategies were considered.
As there appears to be no 'one-size- ts
all' treatment for IBS, such individualised
approaches can be of bene t to many
patients but can prove challenging to
study in controlled trials.
1. Ford AC, Vandvik PO. Irritable bowel syndrome. Clin Evid
(Online) 2012;Jan 6. pii: 0410.
2. Drossman DA. The functional gastrointestinal disorders and the
Rome III process. Gastroenterology 2006;130(5):1377--90.
3. Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre,
antispasmodics, and peppermint oil in the treatment of
irritable bowel syndrome: systematic review and meta-analysis.
4. Atkinson W, Lockhart S, Whorwell PJ, et al. Altered
5-hydroxytryptamine signaling in patients with constipation-
and diarrhea-predominant irritable bowel syndrome.
5. Suares NC, Ford AC. Diagnosis and treatment of irritable bowel
syndrome. Discov Med 2011;11(60):425--33.
6. Jellema P, van der Windt DA, Schellevis FG, et al. Systematic
review: accuracy of symptom-based criteria for diagnosis of
irritable bowel syndrome in primary care. Aliment Pharmacol
7. Wong RK, Palsson OS, Turner MJ, et al. Inability of the
Rome III criteria to distinguish functional constipation
from constipation-subtype irritable bowel syndrome. Am J
8. McKenzie YA, Alder A, Anderson W, et al. British Dietetic
Association evidence-based guidelines for the dietary
management of irritable bowel syndrome in adults. J Hum
Nutr Diet 2012;25(3):260--74.
9. Rahimi R, Abdollahi M. Herbal medicines for the management
of irritable bowel syndrome: a comprehensive review. World J
10. Wald A, Rakel D. Behavioral and complementary approaches
for the treatment of irritable bowel syndrome. Nutr Clin Pract
11. Merat S, Khalili S, Mostajabi P, et al. The effect of enteric-coated,
delayed-release peppermint oil on irritable bowel syndrome.
Dig Dis Sci 2009;55(5):1385--90.
12. Ruepert L, Quartero AO, de Wit NJ, et al. Bulking agents,
antispasmodics and antidepressants for the treatment of
irritable bowel syndrome. Cochrane Database of Systematic
Reviews 2011, Issue 8. Art. No.:CD003460.
13. Bijkerk CJ, Muris JW, Knottnerus JA, et al. Systematic review:
the role of different types of fibre in the treatment of irritable
bowel syndrome. Aliment Pharmacol Ther 2004;19(3):245--51.
14. Rogers NJ, Mousa SA. The shortcomings of clinical trials
assessing the efficacy of probiotics in irritable bowel syndrome.
J Altern Complement Med 2012;18(2):112--9.
15. Ford AC, Moayyedi P. Meta-analysis: factors affecting placebo
response rate in the irritable bowel syndrome. Aliment
Pharmacol Ther 2010;32(2):144--58.
16. Holtmann G, Adam B, Vinson B. [Evidence-based medicine
and phytotherapy for functional dyspepsia and irritable bowel
syndrome: a systematic analysis of evidence for the herbal
preparation Iberogast]. Wien Med Wochenschr 2004;154(21--
17. Liu JP, Yang M, Liu YX, et al. Herbal medicines for treatment of
irritable bowel syndrome. Cochrane Database of Systematic
Reviews 2006, Issue 1. Art. No.: CD004116.
18. Liang ZF, Chen RH, Xu YS, et al. [Tiaohe Ganpi Hexin Decoction
in treatment of irritable bowel syndrome with diarrhea: a
randomized controlled trial]. Zhong Xi Yi Jie He Xue Bao
19. Pan F, Zhang T, Zhang YH, et al. Effect of Tongxie Yaofang
Granule in treating diarrhea-predominate irritable bowel
syndrome. Chin J Integr Med 2009;15(3):216--9.
20. Gao WY, Lin YF, Chen SQ, et al. [Effects of Changjishu soft
elastic capsule in treatment of diarrhea-predominant irritable
bowel patients with liver-qi stagnation and spleen deficiency
syndrome: a randomized double-blinded controlled trial].
Zhong Xi Yi Jie He Xue Bao 2009;7(3):212--7.
21. Saller R, Pfister-Hotz G, Iten F, et al. [Iberogast: a modern
phytotherapeutic combined herbal drug for the treatment of
functional disorders of the gastrointestinal tract (dyspepsia,
irritable bowel syndrome) -- from phytomedicine to
"evidence based phytotherapy". A systematic review]. Forsch
Komplementarmed Klass Naturheilkd 2002;9 Suppl 1:1--20.
Key learning points
The experience of IBS varies amongst
individuals and the exact processes
involved remain unclear.
Patients may bene t from a more
individualised approach which may
include herbal formulations and/or
'As there appears to
be no 'one-size-fits
all' treatment for IBS,
approaches can be
of benefit to many
patients but can prove
challenging to study
in controlled trials.'
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