11/12/10

1

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

11/12/10

2

PartialListofCarminativesandSecondaryBenefits

Catmint Nervinerelaxant

PartialListofCarminativesandSecondaryBenefits

Cinnamon Reducesinsulinresistance

PartialListofCarminativesandSecondaryBenefits

Dill Lactagogue

PartialListofCarminativesandSecondaryBenefits

Fennel URI Congestion Cough

PartialListofCarminativesandSecondaryBenefits

Ginger Prokinetic Antiemetic

PartialListofCarminativesandSecondaryBenefits

Lemonbalm Anxiolytic

11/12/10

3

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

11/12/10

4

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.

11/12/10

5

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