What is gastrointestinal health?

Overview

The gastrointestinal (GI) system includes the esophagus,
stomach, intestines, colon, rectum, and anus. Many other organs assist in the
digestive process of the GI system; they include the gallbladder, pancreas, and
liver.

GI conditions are often chronic, can cause various degrees of discomfort, and can affect a person’s quality of life. Millions of people look to complementary and alternative medicine (CAM) as an adjunct to or a substitute for traditional medical therapy. While many CAM therapies do relieve symptoms, one should use them with caution because some therapies and dietary supplements can affect other modes of care and can lead to adverse reactions.

A National Health Interview Survey showed that 3.7 percent of Americans use CAM for GI care. Many persons with GI problems do not disclose their use of CAM to their doctor, which may also impact optimal care.

GI disorders may be functional (the system appears normal but does not “work” properly) or structural (the system includes swelling, obstruction, or other visual symptom). Constipation and irritable bowel are common functional disorders, and hemorrhoids and cancer are examples of structural disorders.

Common CAM Therapies

The National
Center for Complementary and Alternative Medicine (NCCAM),
part of the National Institutes of Health, categorizes CAM into four
major categories: biologically based (supplementing the diet with nutrients,
herbs, particular foods, or extracts), manipulative and body-based (using
touch and manipulation such as chiropractic or massage), mind/body
(connecting the mind to the body and spirit with practices such as yoga and
meditation), and energy therapies (aiming to restore balance to the body’s
energy with therapies such as qigong and Reiki). Other whole, ancient medical
systems include traditional Chinese medicine, Ayurveda,
homeopathic
medicine, and naturopathic medicine.

Common Gastrointestinal Conditions

The most common GI health issues addressed by CAM include nausea and vomiting, dyspepsia, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), diarrhea and constipation, liver disease (hepatitis B and C and alcohol-related disease), and cancer.

Nausea and vomiting. Nausea and vomiting can be quite unsettling.
They often arise in pregnancy, with an infection, or during medical treatment.
Certain CAM therapies have been used for the relief of symptoms, including
relaxation for chemotherapy-induced nausea and vomiting and the herb
ginger, the most commonly employed supplement to relieve
nausea and vomiting. Some studies have demonstrated that ginger improves GI
motility and acts as an antiemetic (blocks serotonin receptors in the GI tract and
in the central nervous system). Ginger also has been used with some success for
morning sickness, motion sickness, chemotherapy, and postoperative nausea.

Acupuncture and acupressure have been shown to reduce
symptoms of nausea and vomiting, and their use has been supported by much research
on their effectiveness. Many hospitals have acupuncturists on staff.

Dyspepsia. Mild dyspepsia is often self-managed with CAM therapeutic agents, including bananas, red pepper, peppermint, caraway, and turmeric. Most have shown efficacy over placebo in randomized-control trials and are common in the average home. Other lesser-known herbs also have shown promise. These include celandine, liu-jun-zi-tang, shenxiahewining, and STW 5.

Irritable bowel syndrome. Irritable bowel syndrome
(IBS) affects about 5 to 10 percent of Americans, mostly
women. Many CAM therapies have been investigated to relieve the discomfort.
Bulking agents such as psyllium have been most studied and prescribed. Psyllium, a
first-line of treatment for many, has been shown to speed up bowel movements.
Allergic reactions to psyllium are possible, but rare.

Many other CAM therapies have been used for IBS, including acupuncture, Ayurvedic medicine, Chinese herbal medicine, homeopathy, hypnotherapy, peppermint oil, probiotic therapy, and STW 5. Randomized-control trials have shown positive results for many of these therapies.

Diarrhea and constipation. Several herbal supplements are commonly used to improve colonic health. These supplements include aloe, apple pectin, cascara sagrada, chamomile, clove, echinacea, fennel, fenugreek, ginger, hibiscus, magnesium citrate, marshmallow, oat bran, Oregon grape, papaya, psyllium, raspberry, rhubarb, senna, spirulina, valerian, and yellow dock. Nearly all of these herbs stimulate action and have a laxative effect. Few adverse reactions have been reported. Some of these herbs, however, may interfere with other blood-thinning medications and should be discussed with a doctor before use.

Probiotics, good bacteria found in a healthy gut, are also
used to prevent diarrhea and constipation. They are essential to overall gut
health. Infection, the use of antibiotics, and even modern-day stress can lower
healthy amounts of good bacteria in the gut. Antibiotics
can disturb the balance of the gut’s ecosystem by killing friendly bacteria. It
appears that the regular use of probiotics can generally improve the health of the
GI system by stocking the gut with healthy bacteria and making less room for
harmful bacteria and yeasts. Certain strains of Lactobacillus
were shown to help restore colonic health after a course of antibiotics.
L. casei Shirota and L. rhamnosus  are
helpful bacteria for treating chronic constipation. Also, a mixture of 
Bifidobacteria  and Lactobacilli was shown to improve
symptoms. In another study, a combination of B.
lactis and B. longus showed promise for improving
bowel regularity in persons in nursing homes. In a six-week double-blind,
placebo-controlled trial of 274 people with constipation-predominant IBS, the use
of a probiotic formula containing B. animalis significantly
improved stool frequency.

Cultured dairy products such as yogurt and kefir are good sources of acidophilus and other probiotic bacteria. Supplements are widely available in powder, liquid, capsule, or tablet form. Grocery stores and natural-food stores both carry milk that contains live acidophilus.

In addition to probiotics, related substances known as prebiotics may enhance the colonization of healthy bacteria in the intestinal tract. It is important to note that many products sold on the market may not contain viable cultures at the time of purchase. A study reported in 1990 found that most acidophilus capsules on the market contained no living acidophilus. The situation has improved in subsequent evaluations, but some products still have no living organisms and therefore will provide no benefit. Some container labels guarantee the units of living organisms at the time of purchase, not just at the time of manufacture.

Other CAM therapies that have been used to treat IBS include biofeedback,
abdominal massage, homeopathy, and colonic irrigation.

Mind/Body Therapies

The power of the mind to heal and bring about well-being has been demonstrated
in self-reported quality-of-life measures. Strong evidence in the form of
randomized-control trials is lacking, in part because of the difficulty in
devising placebo/sham therapies and because of funding obstacles. Many practices,
such as yoga, meditation, and Tai Chi, are
said to help reduce abdominal symptoms and bring about a sense of relaxation.

Deep breathing and yoga are often used by persons with IBS. Stress can exacerbate symptoms, so any sort of practice that reduces stress and helps one cope with stress can reduce symptoms. Yoga focuses on a healthy spine for a healthy body and incorporates deep-breathing exercises. Different poses and movements involving twist and balance are said to stimulate the nerves along the spine and promote circulation and the flow of energy.

Many professional athletes practice some form of yoga for increased flexibility. It is often incorporated into cross-training exercise routines. Some adolescents are embracing mind/body forms of CAM. One study showed that adolescents between the ages of twelve and nineteen with IBS were likely to engage in or consider meditation or prayer, or both, for symptom management.

Energy Therapies

Acupuncture is commonly employed to reduce GI symptoms. While acupuncture may be helpful for some people and for certain conditions, the evidence for its effectiveness is unclear. Studies have shown no difference in acupuncture versus sham acupuncture. Several well-designed studies have shown both sham and treatment groups improving at the same rate. Modern science is still not clear how or if acupuncture works.

Chinese medicine has outlined hundreds of meridians, or channels, along the body that are thought to stimulate certain organs or systems. According to Chinese medicine, these channels conduct the flow of energy, or qi, a vital force that flows through the body. It is thought that blockages along the vital channels can result in pain or illness. Acupuncture is thought to remove blockages from the system and restore the normal circulation of qi. There is no scientific evidence, however, for the existence of the meridians or of qi. These channels have never been seen under a microscope or mapped, and they do not correspond to major nerve pathways.

Bibliography

Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 8th ed. 2 vols. Philadelphia: Saunders/Elsevier, 2006. A comprehensive textbook of gastrointestinal diseases and physiology. Contains excellent chapters and endoscopic photographs.

Micozzi, Marc S., ed. Fundamentals of Complementary and Integrative Medicine. 3d ed. St. Louis, Mo.: Saunders/Elsevier, 2006. A good overview of complementary, alternative, and integrative medicine basics.

National Center for Complementary and Alternative Medicine. http://nccam.nih.gov. A comprehensive U.S. government resource for articles, scientific studies, and general consumer information about complementary and alternative medicine.