What to Know About Complementary Treatments for IBD

One of the hallmarks of inflammatory bowel disease (IBD) is its unpredictability. Flares come and go, often with little rhyme or reason. Especially for people with moderate-to-severe IBD, most conventional forms of treatment—namely prescription drugs—are not enough to prevent flares or symptoms entirely.

In an effort to better control their IBD, many people with the condition turn to complementary and alternative treatments, also known as “CAM.” Definitions of CAM vary, but it usually includes herbal medicines or supplements, mind-body techniques like meditation, and Eastern medicine practices such as acupuncture. By some estimates, up to 60% of IBD patients have attempted to treat their condition with one or more of these CAM approaches. A broader definition of CAM could also include lifestyle adjustments revolving around sleep, stress, diet, or exercise—many of which have been embraced by gastroenterologists and other IBD clinicians.

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While there was a time when most doctors would have discouraged CAM approaches to IBD, experts say that’s no longer the case. “People don’t necessarily tell their doctor because they feel it may not be welcome news, but I think many doctors are more open to it than people would think,” says Dr. Joshua Korzenik, an IBD specialist and gastroenterologist at Brigham and Women’s Hospital in Boston. He says IBD care providers understand their patients’ need to explore CAM treatments, and he doesn’t discourage them. “As much as the medicines we have are amazing, they have their risks and side-effects,” he says. “We all want to find something in the alternative realm that is effective with very little toxicity.”

Despite the huge interest in CAM treatments for IBD—among both patients and their care providers—a lot of these approaches have not been thoroughly studied. “For many of these alternative treatments, the data just aren’t there for or against them,” says Dr. Joseph Feuerstein, an IBD researcher and associate professor of medicine at Harvard Medical School. “This is why a lot of doctors don’t bring these up with their patients,” he adds. “They’re not going to recommend something without sufficient evidence.” However, some CAM approaches are supported by solid research. Others appear to be at the very least safe, and may be worth a shot. “It’s important to bring these up with your doctor,” Feuerstein says. Many IBD specialists will have some familiarity with the latest CAM research, and they can help patients identify safe and evidence-supported options while avoiding those that may be risky—or just a waste of time and money.

Here, you’ll find a breakdown of the most popular or promising CAM treatments. From acupuncture to yoga, here’s what the latest science has to say.

Supplements, botanicals, and herbal therapies

Humans have used botanical medicines for thousands of years, and experts say there are multiple herbs and botanicals that have shown promise for the treatment of IBD. “Probably the best studied with the most good data is curcumin, which is found in turmeric root,” Korzenik says. Research has found that curcumin has potent anti-inflammatory effects, and that it can significantly reduce disease activity among people with IBD, particularly those with ulcerative colitis. “I’ve had a lot of patients use it and have success,” Korzenik says. Chamomile, Indian frankincense, and wheatgrass juice are some other botanical treatments that research has found to be safe and possibly beneficial among people with IBD. Exploring these (with a care provider’s supervision) may be worthwhile.

Cannabis is another plant that has undergone a lot of scientific scrutiny for the treatment of IBD. “Marijuana comes up a lot,” Feuerstein says. “Crohn’s is one of the conditions that can qualify a person for a medical cannabis card, though long-term safety and efficacy studies are lacking.” Some research comparing marijuana cigarettes containing THC (the psychoactive substance in cannabis) to a THC-free placebo found that smoking marijuana with THC led to significantly more symptom improvements. “Trials show improvement in symptoms and subjective disease severity, and anecdotally I can say patients tell me they feel better,” he says. “That said, the studies have shown consistently there is no improvement in healing or underlying inflammation.” In other words, cannabis seems to help manage IBD symptoms in some people, but it is not treating the underlying disease. (Due to the lack of safety data, Feuerstein says he does not specifically recommend this treatment to his patients.)

Probiotics and prebiotics are another hot area of interest, both among researchers and IBD patients. These are substances that may support the growth or spread of healthy gut bacteria. Probiotics are themselves packed with “good” bacteria, while prebiotics are foods or supplements that provide sustenance for healthy bacteria. “I think that, conceptually, probiotics and prebiotics make sense,” Feuerstein says. “The problem is that it’s not one-size-fits-all.” Each type of probiotic or prebiotic is different, and so each may act differently in a given person.

There’s now a mountain of research showing that the community of microorganisms that live in the human gut—often referred to as the gut microbiome—is critical to the health and functioning of the gastrointestinal tract. These microorganisms also help regulate inflammation and other aspects of immune functioning. However, experts today have only a very hazy grasp of what a healthy microbiome looks like, and using probiotics or prebiotics to alter the microbiome in ways that can treat IBD appears to be a highly individualized process—meaning what works for one person may not work for another.

Feuerstein also says that supplement quality control and consistency is a major issue. “You could buy a type of bacteria that studies have linked to benefits, but depending on the manufacturer, two products could be completely different,” he says. “These products aren’t regulated by the [U.S. Food and Drug Administration.]” It’s also not clear whether benefits people derive from these products are durable or curative. On the other hand, research suggests probiotics and prebiotics are relatively safe. “What I tell people is if you’re going to try something like this, talk with your doctor first and try it for at least three months,” Feuerstein says. He also recommends sticking with one product to improve the odds that what you’re giving your gut is consistent. “Changing your microbiome takes a commitment, so you have to give it time to work,” he adds.

Read More: 6 Myths About IBD, Debunked

Mind-body practices

Not long ago, Western medicine tended to treat the mind and body as separate. Diseases of the gut were thought to have little to do with the state or health of a person’s mind. But thanks in part to work on the connection between psychological stress and physical illness, medical science now has a greater appreciation of the interrelationship between mental and physical health. There’s good evidence that psychotherapy and other forms of mental health treatment can help people with IBD. Likewise, many clinicians now recommend therapeutic mind-body practices for these conditions.

“Stress seems to play a huge role in IBD,” Feuerstein says. Stress can contribute to inflammation and microbiome disturbance, research shows, and periods of high stress can trigger IBD flares. “We encourage approaches that can help people control stress.”

Research has found that many popular mind-body techniques for stress reduction—namely mindfulness practices (including mindfulness-based stress reduction), yoga, tai chi, and breath work—are all associated with quality-of-life improvements among people with IBD. “One yoga class of 90 minutes per week has a significant impact on the course of the disease, as well as on symptoms,” says Dr. Jost Langhorst, professor and chair of integrative gastroenterology at the University of Duisburg-Essen in Germany.

Acupuncture also has a fair amount of research supporting both its safety and efficacy among people with IBD. “It’s something we use, and we know it’s something we can add on top of conventional medicine to help people improve their quality of life and control their symptoms,” Langhorst says.

The role of diet and exercise

At Langhorst’s clinic, he and his colleagues prioritize a “multimodal” approach to IBD care. That means they attempt to treat IBD with a range of therapies that target not just the gut, but also the patient’s overall health and well-being. “These are conditions that can be influenced by a lot of lifestyle factors,” he says. “We know that strengthening a person’s overall health makes a big difference.”

To that end, he says that improving a patient’s diet and exercise habits is something he and his team often prioritize. “Diet is of enormous importance,” he says. “We know things like ultra-processed foods or high portions of red meat, sugar, or alcohol contribute to a higher burden of disease.” However, offering very precise dietary advice can be tricky. Most dietary guidelines for people with IBD recommend “limiting” the items Langhorst mentioned, but they stop short of offering more specific recommendations because the truth is this is going to vary from person to person. “We tell everyone to avoid artificial sweeteners as they can cause diarrhea, but in general it’s hard for us to identify diets or food that are triggering a person’s flares,” says Harvard’s Feuerstein. “Until we know more, it’s probably best to eat a healthy balanced diet versus any specific fad diet.”

Exercise comes in for many of the same hedges and caveats. Every expert recognizes its benefits, but offering very specific recommendations is tough based on the existing research. A 2019 research review in the journal BMC Gastroenterology summed up the state of the science quite well: “Exercise interventions in IBD patients can be assumed to be safe and beneficial for the patients‘ overall-health, and IBD specific physical and psychosocial symptoms. But there is still a high demand for more thoroughly conducted studies.”

How to approach complementary treatments for IBD

There are many treatment options that fall into the CAM bucket. While all of the remedies mentioned above are supported by research, there are plenty more that could ultimately prove to be beneficial—or bogus. How is a person with IBD supposed to navigate this space? Experts say that asking for your care provider’s help is the best approach. Not only can your care team help you identify safe and potentially helpful complementary treatments, but they can also steer you away from things that may be dangerous.

“Everyone in my field is getting away from this picture of IBD where you come in, you take your medications, and that’s it,” Korzenik says. “We’re all looking at the broader context of the disease and the effects of reducing stress, getting more sleep, getting more exercise, etcetera.”

Finally, experts stress that if you’re going to attempt complementary treatments, they should truly be complementary. In other words, don’t abandon the medications or other treatments your IBD care team has prescribed. “For people who want to do something more for themselves, in addition to the standard medical therapies, I think conceptually a lot of CAM make sense and are worth exploring,” Feuerstein says. “Just be sure to bring them up with your doctor.”