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Gastrointestinal Health – Chronic Digestive Discomfort

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Medically reviewed by
Dr. Christopher Knee, ND
Protocols Fullscript Protocols
Gastrointestinal Health – Chronic Digestive Discomfort

Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence.

A
Systematic review or meta-analysis of human trials
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study

Gastrointestinal Health – Chronic Digestive Discomfort

Dysfunctional gastrointestinal processes vary widely. Chronic abdominal pain with persistent or recurrent tendencies may be associated with abnormalities in bowel function and structure. The prevalence of gastrointestinal problems presenting in this way ranges anywhere from 5 to 20% of people being affected.7

Depending on the symptoms presented, there are a variety of ways to help ameliorate symptoms. For example, antispasmodics such as peppermint oil can help with pain associated with digestive dysfunction.11 Both probiotics and fiber contribute to improving stool consistency through the mechanism of creating a healthy microbiota.9,19 which can lend to easier passing as well as serving as an indicator for digestive health. Having integral intestinal permeability helps the body absorb nutrients and dispose of waste properly; the amino acid glutamine helps to improve this function and may contribute to better digestion.17,20

Based on current research findings, the ingredients in the protocol below have demonstrated efficacy in improving a variety of factors associated with gastrointestinal upset or digestive dysfunction.

Peppermint oil

Dosing: 180 mg, three times per day, minimum four weeks3; other dosages may vary

  • 42.4% of patients with IBS were pain free after 8 weeks of supplementation with delayed-release peppermint oil, compared to 22.2% in placebo. The proportion of patients reporting persistent pain decreased from 42% to 15% in the peppermint oil group, whereas it increased from 33% to 52% in the placebo group.11
  • Peppermint oil supplementation ameliorated symptoms of IBS at 24 hours shown by a decrease in Total IBS Symptom Score (TISS) of 19.6%, compared to 10.3% in the placebo group; after 4 weeks, the decrease in TISS scores were 40% in the treatment group, compared to 24.3% in placebo group3
  • 75% of patients treated with enteric coated peppermint oil capsules for four weeks experienced at least a 50% reduction in TISS scores compared to 38% in the placebo group2
Peppermint oil in the Fullscript catalog

Soluble dietary fiber

Dosing: Ranges widely, from 4.1-40.0 g per day for 3-16 weeks as per this systmatic review12

  • A systematic review of 22 studies with dose ranging 4.1-40.0 g/day for 3-16 weeks determined that soluble (but not insoluble) fiber supplementation resulted in a significant improvement in global assessment of symptoms (RR 1.49) as well as abdominal pain scores12
  • In patients with tendency toward diarrhea (IBS-D), 5 g/day of soluble fiber of partially hydrolyzed guar gum improved and normalized bristol stool scale ratings after 3 months compared to placebo19
  • After 10 g/day for 12 weeks, symptom severity improved by 90 points in psyllium group (RR 1.60), compared to 29 points in placebo and 58 points in bran groups, in patients with IBS aged 18 to 65; it is notable that the group receiving bran had a high dropout rate due to symptoms of IBS worsening1
  • A systematic review of 14 studies involving 906 patients found that soluble fiber (but not insoluble fiber) significantly improved IBS symptoms (RR 0.86)6
Fiber in the Fullscript catalog

Probiotics

Dosing: 50 billion CFU, twice per day, minimum 12 weeks15 or 25-50 billion CFU, one to three times per day, as per this systematic review5

Note: Dosages vary widely across studies and product formulations; depending on the patient’s individual needs, we recommended referring to our Probiotics Guide Part 1, which provides a detailed look at the various strains that benefit gastrointestinal conditions.

  • A systematic review of 15 studies with 1793 patients found that probiotics reduced pain and symptom severity scores in patients with IBS; relative risk (RR) of general symptom improvement for 7 of the key trials was 2.14, in favor of probiotics over placebo5
  • Another systematic review of 43 RCTs found that probiotics reduced the risk of persistent symptoms compared to placebo (RR 0.79); benefits were seen among global IBS, abdominal pain, bloating, and flatulence scores6
  • A recent systematic review showed that 7/11 of the included studies reported improved IBS symptoms from probiotic supplementation compared to placebo; multi-strain probiotics with an intervention of 8 weeks or more were more likely to have a benefit4
  • Female patients with IBS-D (diarrhea predominant IBS) and IBS-C (constipation predominant IBS) improved quality of life, stool frequency and consistency when supplemented with 2 capsules per day of probiotics containing 50×10^9 cfu of live organisms of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2 for 12 weeks15
Probiotics in the Fullscript catalog

Ginger

Dosing: 1200 mg 1 hour before eating, as needed8,18

  • Patients with mild to moderate ulcerative colitis experienced a decreased severity of disease activity as well as in improvement in quality of life scores after 12 weeks of supplementation at 2000 mg/day, compared to placebo; malondialdehyde levels (but not total antioxidant capacity) also decreased at both 6 and 12 weeks13
  • Digestion improved in two RCTs as shown by a faster gastric half-emptying time and increased antral contractions in treatment group (1200 mg/day ginger capsule) compared to placebo8,18
  • Patients with a history of motion sickness experienced a delayed onset of nausea after vection cessation as well as a decrease in tachygastria activity and vasopressin release10
Ginger in the Fullscript catalog

Glutamine

Dosing: 5 g, three times daily, for eight weeks20; dosages may vary

  • Intestinal hyperpermeability improved in burn victims given 0.5 g/kg/day for 14 days, compared to placebo14
  • Acute glutamine administration at 0.25-0.9 g/kg fat-free mass 2 hours prior to running in a heat chamber has been shown to reduce GI permeability in a dose-dependent manner16
  • Adults with IBS-D symptoms following a GI infection were given 5 g/t.i.d. Glutamine or placebo for 8 weeks; 79.6% of patients in the glutamine group experienced at least a 50 point reduction in IBSS scores, compared to 5.8% in the placebo group20
Glutamine in the Fullscript catalog

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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References

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