Incorporating complementary, alternative medicine is the ‘wave of the future’ in GI care
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A patient with long-standing irritable bowel syndrome came to her gastroenterologist after a flare, indicating that she had stopped responding to her medication.
She didn’t know what to do with the stress anymore and wanted to try a more natural method. The physician looked at her blankly and said, “We don’t offer any of that here.”
We can do better.
Chronic gastrointestinal disorders can be multi-faceted, and patients may not always respond to conventional care. I think we can all agree that psychosocial factors have a profound impact on GI functioning and there is mounting evidence supporting the negative impact that stress has on gut health. Thus, it is not surprising that GI patients are more commonly pursuing complementary and alternative medicine (CAM) approaches.
However, some GI providers are not aware of CAM options and others may not know how to broach the topic in the exam room. There may be concerns ranging from how effective a given approach might be, to a lack of reputable resources and/or services, to worry about interactions between natural products and medication.
In this article, I am going to introduce some of the most common CAM approaches, which will not only allow providers to broaden their clinical toolbox but will also facilitate confidence and promote more productive patient-provider conversations.
CAM approaches for GI patients
First, meditation, relaxation and meditative-movement practices are becoming more mainstream. Some of these approaches originated thousands of years ago from eastern traditions, but they’ve become more popular across the globe. Practices such as guided imagery (focusing on a visual image or scene), mindfulness (maintaining focus on the present moment in a nonjudgmental way), diaphragmatic breathing, and/or breath-focused mediations may be commonly utilized by GI patients and are often integrated with standardized brain-gut psychotherapies such as cognitive behavioral therapy.
Patients may find these approaches particularly beneficial because they promote relaxation, which can reduce GI symptoms and enhance overall well-being. Research in this area is growing.
For example, there is emerging evidence demonstrating the benefit of mindfulness-based stress reduction in reducing IBS symptom severity.
Meditative movement practices, such as yoga, have ancient Indian origins, but have popularized in the west as a form of stress-relieving exercise. There are many different forms of yoga, including asanas (physical postures), pranayama (breathwork) and dhyana (meditation). Some yoga traditions include poses that may be specifically beneficial for GI symptoms, but there is not one single form of yoga that is formally recommended.
Most GI-focused yoga trials have been conducted among patients with IBS, with positive findings overall. When yoga was compared with conventional treatment in a systematic review, patients had significantly decreased bowel symptoms, IBS severity and anxiety. However, methodological limitations among studies have made it difficult to make concrete recommendations about the use of yoga for this population.
Other approaches, such as tai chi and qi gong, are a good alternative to yoga. These ancient Chinese practices involve postures and gentle movements alongside breathing, relaxation and a focused mental state. Tai chi has an added element of self-defense. There are specific movements that may be particularly beneficial for GI patients, but few have empirically studied these approaches. One group did a study of a virtual Tai chi program for patients with IBS (constipation-predominate) and found preliminary evidence demonstrating a reduction in IBS symptom severity for individuals following the intervention, showing promise for this approach, although more research is needed to fully understand the benefits.
Less active approaches include mind-body modalities, such as massage, which involves manipulating soft tissues. There are many forms of massage that have been utilized across cultures throughout history. Among patients with GI disorders, abdominal massage may have particular value. One review of patients with IBS (constipation-predominate) highlighted that massage can stimulate peristalsis, decrease colonic transit time and increase bowel movement frequency, as well as decrease pain and discomfort, which is encouraging.
Another mind-body modality is acupuncture, which has origins in Chinese medicine, and involves inserting thin metallic needles at identified points to balance the flow of energy and life force. Preliminary evidence shows a benefit of acupuncture across a wide spectrum of GI disorders, but again, methodological limitations make it difficult to draw firm conclusions.
Natural products may be incorporated with more standardized dietary approaches or as stand-alone methods. Among GI patients, ginger, peppermint, caraway and magnesium are some of the most commonly used natural products. More research needs to be done to fully understand the benefit of natural products.
Below are some tips for cultivating productive CAM discussions between patients and providers.
CAM discussions early on can facilitate optimal care
Having conversations with patients about all the different approaches they use is important and doing it early is essential. CAM can have both risks and benefits, and it is helpful for patients and providers to mutually agree on best courses of care.
Sometimes patients may not tell the provider what they’re doing outside of the clinic, so it is important to ask so that this information is not missed. On the other hand, sometimes patients do bring up their CAM use, and they want to have informed discussions with their providers.
As a GI psychologist, I often encounter CAM discussions interwoven into sessions and I listen openly to understand all aspects of their care, so I can best aid in their care plan and healing process.
Understand your patient’s goals with CAM
Patients may be interested in how CAM approaches can be integrated with their conventional care methods. Or, with a chronic GI disorder, they may feel stuck and are seeking out alternative care options. There may also be other reasons for why patients feel drawn toward CAM approaches.
Understanding why patients are pursuing CAM can help providers identify appropriate CAM options. Further, when providers get a sense of their patient’s goals, patients are more likely to feel supported.
Share the evidence, provide resources
Highlighting the evidence for CAM approaches is important so patients can make informed decisions about what to try. In addition, having a network of reputable resources and referral options can help patients get appropriate care.
Guiding patients in an evidence-based way can promote patient-centered care and enhance trust and rapport. Further, when patients take an active role in their healing process, it is helpful to applaud them for their efforts, as this will empower them to continue to have autonomy and engage in self-management outside the clinic.
Collaborative care is the best care
Although CAM providers are not always a part of a traditional care team, communication with CAM providers as part of the team may be warranted. Care coordination can help providers determine the most optimal treatment methods and promote whole person health (physical, emotional, social, spiritual factors), which is at the core of integrative care.
Lastly, although GI-focused CAM research is limited, CAM approaches are becoming increasingly popular among GI patients. Identifying and implementing CAM approaches alongside more standardized care is the wave of the future, so it is imperative that we start these conversations now.
References:
- Schumann D, et al. Clin Gastroenterol Hepatol. 2016;doi:10.1016/j.cgh.2016.04.026.
- Sinclair M. Bodyw Mov Ther. 2011;doi:10.1016/j.jbmt.2010.07.007.
- Sung JJ, et al. Gut. 2002;doi:10.1136/gut.51.5.617.
- Staller K, et al. Neurogastroenterol Motil. 2022;doi:10.1111/nmo.14429.
- Zernike KA, et al. Int J Behav Med. 2013;doi:10.1007/s12529-012-9241-6.
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