Reviewed: Pourmasoumi M, Ghiasvand R, Darvishi L, Hadi A, Bahreini N, Keshavarzpour Z. Comparison and assessment of flixweed and fig effects on irritable bowel syndrome with predominant constipation: A single-blind randomized clinical trial [Published online September 11, 2018]. Explore. doi: 10.1016/j.explore.2018.09.003.
Individuals with irritable bowel syndrome (IBS) have bloating and abdominal pain or discomfort that can lead to work absences, increased health care expenses, and decreased quality of life. Constipation-predominant IBS (IBS-C) is defined as constipation accompanied by abdominal pain, which typically can be relieved by a bowel movement. Flixweed (Descurainia sophia, Brassicaceae) seed and fig (Ficus carica, Moraceae) fruit are rich in soluble and insoluble fiber. They have a long history of use in Iranian traditional medicine for constipation and other gastrointestinal problems. The authors conducted a single-blind, randomized clinical trial to examine the effects of flixweed and fig on symptoms of IBS-C and on the inflammation marker C-reactive protein (CRP).
Patients aged 18 to 70 years who were referred to the gastrointestinal research center of Isfahan University of Medical Sciences or to private medical practices in Isfahan, Iran, and were diagnosed with IBS-C were eligible for the study. The 150 patients chosen for the study were randomly and equally assigned to the flixweed, fig, or control group for the four-month intervention study. According to group assignment, patients took 30 g of dried flixweed or 45 g of dried fig with a glass of water before breakfast and before lunch daily, or continued with their normal diet in the control group. Anthropometric indices were measured at baseline and at the end of the study. Dietary intake and physical activity were evaluated, and all patients were monitored for any adverse effects during the study.
The authors used the IBS Severity Scoring System (IBS-SSS) at baseline and at the end of the study to assess frequency and severity of abdominal pain, severity of abdominal distention, dissatisfaction with bowel movements, and interference of IBS with life in general. Total scores were rated as mild, moderate, or severe, with higher scores indicating greater severity. The Bristol Stool Chart was used to determine the frequency of bowel movements and hard stools. The effects of IBS on quality of life were measured by examining the patients’ answers to 34 questions about dysphoria, interference with activity, body image, health concerns, food avoidance, social reactions, sexual concerns, and relationships. Higher scores indicated better quality of life.
Of the 50 patients in the flixweed group, one patient lost interest in completing the study, and one patient withdrew because of influenza. In the fig group, one patient did not consume the fig product as instructed, and three patients were not interested in completing the study. In the control group, one patient moved, and one patient did not want to complete the study. The number of patients who completed the study totaled 142, with 48 each in the flixweed and control groups and 46 in the fig group. No adverse effects were reported during the study.
At baseline, the mean age of the patients was approximately 57.6 years, 75% of the patients were women, and 65% had moderately severe IBS-C. The three groups were similar in terms of dietary intake, physical activity, and anthropometric measures at baseline and at the end of the study.
The authors report that total IBS-SSS scores significantly improved in the flixweed and fig groups compared with baseline and with the control group (P < 0.05 for each). All individual items, except for abdominal pain severity, significantly improved in both the fig and flixweed groups compared with baseline and with the control group at the end of the study (P < 0.05 for each). Although abdominal pain severity improved in both the flixweed and fig groups compared with baseline, the improvement was not statistically significant. Improvements in defecation and hard stool frequency in both intervention groups were significant compared with the control group (P < 0.05 for each). Overall quality of life significantly improved in both intervention groups after four months compared with baseline and with the control group (P < 0.05 for each). Comparing the improvements observed in the fig and flixweed groups, no significant differences were found in overall IBS-SSS score, IBS symptoms, or quality of life. CRP levels did not significantly change in any of the three groups.
According to the authors, limitations of the study include the lack of a placebo group, the use of only CRP as a marker of inflammation, and the focus only on the fiber component of fig and flixweed and how it affected IBS-C symptoms.
The authors concluded that “consumption of flixweed and fig among IBS-C patients may have positive effects on IBS-C symptoms, and that these natural products could be considered as a safe therapy for this syndrome.”
By Shari Henson