Roger Greenlaw, MD, clinical professor of medicine, University of Illinois College of Medicine, Rockford.

NEW YORK—It works for cardiovascular disease, why not chronic gastrointestinal disorders as well?

A small but growing number of conventional gastroenterologists are starting to think holistically about the digestive diseases they treat. Modalities from herbal medicine to acupuncture and stress management were up for discussion at this year’s meeting of the American College of Gastroenterology.

“It would be really nice if we in gastroenterology could develop a comprehensive multimodal approach for irritable bowel syndrome (IBS) as Dean Ornish did in cardiovascular disease,” said Roger Greenlaw, MD, clinical professor of medicine, University of Illinois College of Medicine, Rockford. “The Ornish program is a good example of the impact alternative medicine can have.”

There is some evidence from the Ornish program itself that the same regimen that reverses cardiovascular risks—no more than 10% of total calories from fat, moderate aerobic exercise, stress management training, support groups and smoking cessation—can also reduce gastrointestinal complaints.

Dr. Greenlaw pointed to a small cohort of 20 graduates of the Ornish program who had GI symptoms in addition to heart disease prior to entering the program. The digestive complaints included colitis, constipation, diarrhea, diverticulitis, heartburn, hemorrhoids, hiatal hernia, indigestion and spastic colon. Seven of the 20 had two or more.

After completing the Ornish program, 14 patients reported digestive system improvement. Some were able to discontinue GI medications including Pepcid, Immodium, Zantac, Prilosec and Colace.

These findings are merely a starting point, said Dr. Greenlaw. But they do suggest that many common digestive complaints can be reduced with non-pharmacologic, non-surgical means.

“We know we have a new stomach lining every 7 days, a new liver every 45 days, and new red blood cells every 120 days. If we can teach our patients that what they do and what they eat will influence the process, then we can teach them that it is possible to control their diseases.”

Turning his attention to IBS, Dr. Greenlaw said that holistic modalities alone are not likely to be sufficient for severe flares. But a comprehensive, holistic approach can go a long way in preventing exacerbations during relatively asymptomatic periods.

In his own clinical experience, he has found the following to be helpful for patients with IBS:

Deglycyrrhizinated licorice root is a safe and soothing anti-inflammatory and antispasmodic herbal medicine. © 2000 stevenfoster.com.

• Stress Reduction: Given the high density of nerves in the gut, and number of cytokines and inflammatory mediators that can be released, it is not surprising that emotional stressors can trigger IBS flares. Any number of stress reduction practices, including yoga, meditation, visualization, Tai Chi, Qi Gong, or plain old aerobic exercise can be very helpful. The choice depends largely on patient preference.

• Elimination of Dietary Irritants: Many IBS patients have trouble with coffee, dairy products, alcohol, fatty foods, and concentrated sugars. Dr. Greenlaw advises his meat-eating IBS patients to cut down to 3 oz daily of lean meat—organically raised and hormone-free whenever possible.

	The root of the marshmallow plant safely provides anti-inflammatory and antispasmodic effects. © 2000 stevenfoster.com.

• Botanical Medicines: In his experience, deglycyrrhizinated licorice, 750 to 1,500 mg, taken thrice daily between meals, is a very safe, soothing anti-inflammatory and anti-spasmodic herbal medicine. Marshmallow root, two capsules, thrice daily has a similar effect and is equally safe.

• Omega-3 Fatty Acids: Ground flax seeds or flax seed oil is an excellent source of supplemental omega-3’s, which has anti-inflammatory effects at a dose of 1 tablespoon daily.

• Digestive Enzyme Supplements: Pancreatin, USP 10X, at a dose range of 500 to 1,000 mg, before meals, can occasionally benefit some patients, and is worth a try in those with a lot of digestive difficulties.

• Probiotics: Many IBS sufferers benefit from supplementation with acidophilus, bifidus, and other “friendly” gut bacteria. These so-called probiotics can improve digestion by promoting an overall healthier gut flora. Friendly flora were the subject of a recent supplement to the American Journal of Gastroenterology (“Functional Significance of the Bowel Microflora in Gastrointestinal Health,” Jan. 2000, Vol. 95, No. 1).

• Acupuncture and Traditional Chinese Medicine: Chinese medicine offers many potential benefits for patients with irritable bowel and other digestive disorders. But Dr. Greenlaw emphasized that achieving optimal outcomes is dependent on knowing a well-trained, highly-experienced practitioner.