ibs‐c carminatives · benefits basil anti‐inflammatory ... side effects of bulking agents...
TRANSCRIPT
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IBS‐C
• Individualsexperiencearangeofsymptomsinadditiontoconstipation(strainingandhardstools)butalsoreportabdominalpainandbloatingasparticularlytroubling.
Carminatives
• Estimatedaverageprevalenceofbloatingis64%inIBS.
• Noapprovedtreatmentsthatspecificallyaddresstreatmentofbloatingand/orgasinIBS.
• Carminativesarespicesandherbsthathavetraditionallybeenusedforbloatingandgas.
PartialListofCarminativesandSecondaryBenefits
• Anise– URI,congestion,cough
• Basil– Anti‐inflammatory
• Caraway– SlowsGItransittime
• Catmint– Nervinerelaxant
• Cinnamon– Reducesinsulinresistance
• Dill– Lactagogue
• Fennel– URI,congestion,cough
• Ginger– Prokinetic,antiemetic
• Lemonbalm– Anxiolytic
• Peppermint– SlowsGItransittime
• Sage– Hotflashes,sorethroats
• Thyme
– Cough,colds,congestion
PartialListofCarminativesandSecondaryBenefits
Anise URI Congestion Cough
PartialListofCarminativesandSecondaryBenefits
Basil Anti‐inflammatory
PartialListofCarminativesandSecondaryBenefits
Caraway SlowsGItransittime
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PartialListofCarminativesandSecondaryBenefits
Catmint Nervinerelaxant
PartialListofCarminativesandSecondaryBenefits
Cinnamon Reducesinsulinresistance
PartialListofCarminativesandSecondaryBenefits
Dill Lactagogue
PartialListofCarminativesandSecondaryBenefits
Fennel URI Congestion Cough
PartialListofCarminativesandSecondaryBenefits
Ginger Prokinetic Antiemetic
PartialListofCarminativesandSecondaryBenefits
Lemonbalm Anxiolytic
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PartialListofCarminativesandSecondaryBenefits
Peppermint SlowsGItransittime
PartialListofCarminativesandSecondaryBenefits
Sage Hotflashes Sorethroats
PartialListofCarminativesandSecondaryBenefits
Thyme
Cough
Colds
Congestion
Ginger(Zingiberofficinale)
• Mostwidelycultivatedspice
• Anti‐inflammatory
• Warmingagent
• Forcoughs,congestion,colds– Invitroactivityagainstavarietyofrhinovirus.
Gastroparesis
• Gingermaybeofbenefitinpatientswithgastroparesis,whichcanpresentwithsignsandsymptomssuchasheartburn,gastroesophagealreflux,earlysatiety,abdominalbloating,andnauseaand/orvomitingseveralhoursaftereatingameal.
Ginger(Zingiberofficinale)
• Compoundsingingerare5‐HT3antagonists;gingerisaprokineticandantiemeticagent.
• Astudyof24healthyhumanvolunteersfoundthat1200mgdriedgingeracceleratedgastricemptyingandstimulatedantralcontractionsgreaterthanplacebo.
WuKL,etal.EurJGastroenterolHepatol.2008
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GingerforMorningSickness
• SixRCTshowginger(1.0‐1.5g/d)issafeandeffectiveforreducingNVP.
• Twoadditionalstudiesfoundginger(1000mg/dand650mgTID)superiortovitaminB6(40mg/dand25mgTID)fornauseaandequalforvomitingepisodes.
• Onetrialfounddimenhydrinate(50mgBID)superiortoginger(500mgBID)forvomitingepisodesfirst48hours,nodifferencedays3‐7.
Borrelli,etal.ObstetGynecol2005;105(4):849‐56
Ensiyeh,etal.Midwifery2008Feb11
PongrojpawDetal.JMedAssocThai.2007;90:1703‐9
ChittummaP,etalJMedAssocThai2007;90(1):15‐20.
ChemotherapyInducedNausea
• NCIfundedstudyfoundifpatientstake0.5–1.0gramsgingerthreedaysbeforeandafterchemotherapyalongwithprescriptionanti‐emetics,reducednauseabyadditional40%.
• Studiesthatdidnotgivegingerbeforethechemotherapywasadministereddidnotseethesameresults.
RyanJL.Gingerforchemotherapy‐relatednauseaincancerpatients:Arandomized,double‐blind,placebo‐controlledclinicaltrialof644cancerpatients.2009ASCOAnnualMeetingMay14.Abstract#9511.
ZickSM,etal.PhaseIItrialofencapsulatedgingerasatreatmentforchemotherapy‐inducednauseaandvomiting.SupportCareCancer.2009May;17(5):563‐72.
Thisisrightproductformorningsickness ConcentratedExtract
IspaghulaHuskPlantagoovata;P.psyllium
• Thebulkingagentwithbestevidenceisispaghulahusk‐efficaciousinthetreatmentofconstipationsymptoms,suchasstrainingandformedstools.
• Commonsideeffectsofbulkingagentsincludebloating,intestinalgasandadditionalabdominalpain.
QuarteroAO,etal.CochraneDatabaseSyst.Rev.CD003460(2005).
Psyllium
• Psylliumismainlyusedasadietaryfiber,whichisnotabsorbedbythesmallintestine.
• Mechanicalactionofpsylliummucilageistoabsorbexcesswaterandstimulatenormalbowelelimination.
• Althoughprimaryuseisaslaxative,itisatruedietaryfiberandcanhelpreducesymptomsofbothconstipationandmilddiarrhea.
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Triphala
• CommonAyurvedicremedyforconstipationisTriphala,madefromthedriedfruitsofthreefruits:
– Terminaliachebula– Terminaliabelerica
– Phyllanthusembelica• IuseforIBS–constipationordiarrhea• Childrenandelderswithhard,drystools.• 1‐2gramsperdayfor5‐7days,increaseto3‐4gramsper
dayifneeded.
FlaxSeed(Linumusitatissimum)
• Richinomega‐3fattyacids
• Mucilaginous• 1‐2Tbspflaxseedssteepedin2cupswaterfor5‐10minutes.Strain.Drinkthroughoutday.
Magnesium
• MagnesiumisoftenmychoiceinIBS‐Cbecause:– Manypeoplehavelowleveldeficiency– Usefulandeffectivestoolsoftener– Itcanhelpwithsleepiftakeninevening– Reducesinsulinresistance– Helpsmaintainhealthybloodpressureandstabilizesheartrhythm
– Caneliminatemenstrualcramping– Canhelpreducefrequencyofmigraines
• Doseistypically300‐600mgperday.• Aspartate,bisglycinate,chelate‐preferred