About IBS (Irritable Bowel Syndrome)
Irritable Bowel Syndrome (IBS) is a common disorder in which the bowel is irritated and does not function properly. IBS impacts 10-15% of the U.S. population and is the second leading cause of absenteeism, after the common cold.1,2 It is an underdiagnosed, undermanaged, and often frustrating condition that frequently reoccurs over time.1 Only a small portion of IBS sufferers seek medical attention or even know that IBS can be managed.
IBS for individual patients can be a multi-year journey of symptoms that may remit and then relapse or persist on a steady basis. The symptoms may change at different times.
Measures to manage IBS on a daily and proactive basis can help reduce the frustration felt by many IBS patients in their multi-year journeys with IBS.
IBS is usually associated with the disruption in the gut mucosal barrier and an impaired ability to digest and absorb food nutrients. People who have IBS often experience distressing symptoms† at various times, including some or all of the following*:
- Abdominal pain
- Discomfort or cramping
- Bloating or gas
- Bouts of diarrhea interrupted by constipation
- Urgency of bowel movement
- Sense of an incomplete bowel movement and pain during bowel movements
The symptoms of IBS often occur within 90 minutes of meals.5 This reflects the time it takes for the food to reach the small intestine.6 Some of these symptoms can be severe or unbearable.
Important new knowledge and new products for IBS in the past 10 years have created new options to manage IBS.
What Are The Symptoms of IBS?
In addition to impacting the digestion and absorption of food nutrients, the symptoms† of IBS include, at varying times, some or all of the following*:
- Abdominal pain, discomfort, or cramping
- Bloating or gas
- Diarrhea, constipation, or bouts of diarrhea interrupted by constipation
- Urgency of bowel movement
- The sense of an incomplete bowel movement
- Pain during bowel movement
IBS symptoms can usually be sensed below the navel, in the belly.
What Causes IBS?
IBS can be triggered by food, stress, environment, infections, and genetic predisposition.3 In the absence of a known organic cause, it is thought that IBS is associated with the disruption in the lining of the gut (gut mucosal barrier) and reversible, localized, often temporary, low-grade immune activation, which can result in impaired ability to digest and absorb food nutrients.4 This inability to absorb food nutrients, or intestinal malabsorption, can trigger IBS symptoms, often after a meal. Another factor is the invasion of unwelcome bacteria, SIBO (small intestinal bacterial overgrowth). SIBO may also trigger maldigestion and malabsorption of nutrients.
If IBS is suspected, consult with a physician about confirming IBS and then developing a program to manage it.
Where Do the Symptoms of IBS Occur in the Digestive System?
Recent scientific and clinical evidence suggests the small intestine is the site of the disruption in the lining of the gut (gut mucosal barrier) and reversible, often temporary, localized, low-grade immune activation, and is where transit time can also be disrupted.4 Thus, food can move too fast or too slow, causing diarrhea, constipation or both. This is also the site where abdominal pain originates, probably from irritated nerve endings in the gut or from trapped gas.
IBgard® is designed to deliver its ingredients in the small intestine – the site of the gut mucosal barrier disruption.
The most widely used physician recommended approaches to managing IBS are:
Physicians often recommend gradually increasing fiber intake, starting with 2-3 grams per day. Fiber may reduce the constipation caused by IBS because it makes the stool softer and easier to pass. Fiber is found in foods such as whole-grain breads and cereals, beans, fruits, and vegetables.
Physicians may also recommend exclusionary IBS diets such as excluding or reducing high-fat foods, sugars, caffeine, and alcohol. According to the American College of Gastroenterology (ACG) IBS 2018 Monograph, diet alone may not be practicable to manage your IBS long term.7 Where possible, sustainable dietary improvements that do not create long-term nutrient imbalances should be part of an overall IBS program implemented with your physician.
Physicians may recommend common stress management tools including regular exercise, taking time to relax, and getting an adequate amount of sleep every night.
Physicians may either prescribe medications or recommend nonprescription products to manage IBS. Commonly prescribed and recommended products can include laxatives, anti-diarrheals, and antispasmodics. Almost all currently offered medications can have side effects or drug interactions, so always consult a physician about any resulting side effects, or if the product is not providing relief from symptoms.
Physicians now increasingly recommend IBgard®, a medical food specially formulated for the dietary management of IBS. IBgard® capsules contain individually triple-coated, sustained-release microspheres of Ultramen®, an ultrapurified peppermint oil. When taken daily and proactively 30 to 90 minutes before meal(s), IBgard® has been shown, in peer-reviewed publications, to be effective in managing IBS symptoms§7 in as early as 24 hours, and this positive effect expanded at 4 weeks.†† Since food is a common trigger, IBgard® is recommended to be taken 30 to 90 minutes before meal(s).
The Distinctive Nutritional Requirements for People Who Have IBS
Food intake in IBS is disturbed because 90% of patients alter their diet in response to IBS symptoms.7 This may create nutritional imbalances.
In many ways, food uptake is also disturbed.
People with IBS usually suffer from diarrhea, constipation or both. These conditions reflect the movement of food through the GI tract that is either too fast or too slow. This irregular movement can cause poor digestion, malabsorption of nutrients and loss of electrolytes. IBS is associated with growth of bad bacteria and excess mucus in the gut, which can disrupt the digestion and absorption of essential nutrients.8 IBS is also associated with low absorption of certain sugars, and healthcare professionals recommend restricting sugars while gradually increasing fiber in the diet, starting with 2-3 grams per day.
Over 90% of nutrient digestion and absorption takes place in the small intestine.9 As mentioned earlier, with IBS, this digestive and absorptive process is disrupted in several ways. The bile acid flow is disrupted as part of the IBS cascade of disruption.10 Peppermint oil (primary component: l-Menthol) helps restore secretory function such as bile flow.11 The German Commission E Monograph for peppermint oil lists its use as an antispasmodic for bile ducts, allowing them to restore their normal function in digestion and absorption.12 IBgard’s (through peppermint oil) anti-inflammatory13, antispasmodic14, visceral analgesic15, carminative (anti-gas)16 and anti-bacterial17,18 properties calm the angry gut and help bring digestion of food and absorption of nutrients back to balance (homeostasis).This and other known activities of peppermint oil are helpful in digestion and absorption.
IBgard® is specifically formulated to meet the distinctive nutritional requirements of IBS that cannot be met with dietary modification alone. IBgard® supplies microspheres of peppermint oil to the small intestine, which helps to manage the symptoms of IBS and thereby enables proper digestion of food and enhanced absorption of nutrients.
By improving gut health in the first place, IBgard® helps prevent nutritional problems later.
1 Hungin APS, Chang L, Locke GR, Dennis EH, Barghout V. Irritable bowel syndrome in the United States: Prevalence, symptom patterns and impact. Aliment Pharmacol Ther. 2005;21(11):1365-1375. doi:10.1111/j.1365-2036.2005.02463.x.
2 Cash B, Sullivan S, Barghout V. Total costs of IBS: employer and managed care perspective. Am J Manag Care. 2005;11(1 Suppl):S7-16. doi:2834 [pii].
3 Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol Hepatol. 2016;1(2):133-146. doi:10.1016/S2468-1253(16)30023-1.
4 González-Castro AM, Martínez C, Salvo-Romero E, et al. Mucosal pathobiology and molecular signature of epithelial barrier dysfunction in the small intestine in Irritable Bowel Syndrome. J Gastroenterol Hepatol. 2017;32:53-63. doi:10.1111/jgh.13417.
5 Ragnarsson G, Bodemar G. Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS): Patients’ description of diarrhoea, constipation and symptom variation during a prospective 6-week study. Eur J Gastroenterol Hepathology. 1998;10(5):415-421.
6 Hellmig S, Von Schöning F, Gadow C, et al. Gastric emptying time of fluids and solids in healthy subjects determined by 13C breath tests: Influence of age, sex and body mass index. J Gastroenterol Hepatol. 2006;21(12):1832-1838. doi:10.1111/j.1440-1746.2006.04449.x.
7 Ford AC, Moayyedi P, Chey WD, et al. American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome. The American Journal of Gastroenterology. Published online 2018:S1–S18. doi:10.1038/s41395-018-0084-x
8 DiBaise J. Nutritional consequences of small intestinal bacterial overgrowth. Pract Gastroenterol. 2008;(December):15-28.
9 Dr. Ananya Mandal MD. What Does the Small Intestine Do? https://www.news-medical.net/health/What-Does-the-Small-Intestine-Do.aspx.
10 Kamath PS, Gaisano HY, Phillips S, et al. Abnormal gallbladder motility in irritable bowel syndrome: evidence for target-organ defect: Am J Physiol. 1991;260(6):G815-G818.
11 Zong L, Qu Y, Luo di X, et al. Preliminary experimental research on the mechanism of liver bile secretion stimulated by peppermint oil. J Dig Dis. 2011;12(4):295-301. doi:10.1111/j.1751-2980.2011.00513.x.
12 Balakrishnan A. Therapeutic uses of peppermint –A review. J Pharm Sci Res. 2015;7(7):474-476.
13 Juergens U, Stober M, Vetter H. The anti-inflammatory activity of L-menthol compared to mint oil in human monocytes in vitro: a novel perspective for its therapeutic use in inflammatory diseases. Eur J Med Res. 1998;3(12):539-545.
14 Hawthorn M, Ferrante J, Luchowski E, Rutledge A, Wei X, Triggle D. The actions of peppermint oil and menthol on calcium channel dependent processes in intestinal, neuronal and cardiac preparations. Aliment Pharmacol Ther. 1988;2:101-118.
15 Liu B, Fan L, Balakrishna S, Sui A, Moris JB, Jordt S-E. TRPM8 is the Principal Mediator of Menthol-induced Analgesia of Acute and Inflammatory Pain. Pain. 2013;154(10):2169-2177. doi:10.1016/j.pain.2013.06.043.TRPM8.
16 Harries N, James KC, Pugh WK. Antifoaming and carminative (anti-gas) actions of volatile oils. J Clin Pharm Ther. 1977;2(3):171-177.
17 Işcan G, Ki̇ri̇mer N, Kürkcüoǧlu M, Hüsnü Can Başer, Demi̇rci̇ F. Antimicrobial Screening of Mentha piperita Essential Oils. J Agric Food Chem. 2002;50(14):3943-3946. doi:10.1021/jf011476k.
18 Jeyakumar E, Lawrence R, Pal T. Comparative evaluation in the efficacy of peppermint (Mentha piperita) oil with standard antibiotics against selected bacterial pathogens. Asian Pac J Trop Biomed. 2011;1(SUPPL. 2). doi:10.1016/S2221-1691(11)60165-2.