The American College of Gastroenterology has published new guidelines for the management of irritable bowel syndrome (IBS).

Let’s focus on their view of herbals, acupuncture, and diet.

Herbal therapies

  • Most studies of herbals in IBS are of Chinese mixtures.
  • It was not possible to combine these study results for a meta-analysis of the data.
  • The variability of the components and purity of these mixtures confounds any attempt to make evidence-based recommendations.
  • The reviewers were also concerned over the lack of any reports of negative findings (publication bias?).


  • ACG refers to a Cochrane review that found 6 poor quality studies of acupuncture vs sham acupuncture.
  • The effectiveness of this treatment is not clear.


  • About 60% of IBS patients believe that food makes their symptoms worse.
  • Research suggests that allergy to certain foods could trigger IBS symptoms.
  • In 5 studies, dietary changes resulted in a positive response in 13% to 67% of patients.
  • Unfortunately, the absence a control group makes it impossible to know if these findings were no better than a placebo response.
  • Studies designed to determine if patients are able to identify foods that cause symptoms have conflicting results.

The bottom line?
The authors concluded, “Further work is needed before any recommendations on acupuncture or herbal therapy can be made.

For the time being, here’s a list of dietary changes that many patients have found helpful, according to the University of Michigan.

  • Avoid or limit gas-producing foods (eg, beans, onions, broccoli, cabbage) or any other foods that can aggravate IBS symptoms.
  • Eat slowly and avoid overeating.
  • Avoid carbonated drinks, because they can cause bloating or abdominal discomfort.
  • Avoiding dairy products may help reduce gas, bloating, cramping, and diarrhea.
  • Avoid large quantities of other sugars such as fructose or sorbitol, which can worsen IBS symptoms.
  • Add fiber in the form of psyllium to manage constipation-related symptoms.

12/19/08 19:25 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.