Introduction
Irritable bowel syndrome (IBS) is a common digestive disorder that affects millions of people worldwide. While there is no cure for IBS, certain supplements may help manage symptoms when used under medical supervision. This comprehensive guide will explore the evidence behind five key supplements for IBS: probiotics, fibre, peppermint oil, digestive enzymes, and prebiotics/synbiotics.
IBS is characterised by chronic abdominal pain, bloating, and altered bowel habits, such as constipation or diarrhoea. The exact cause of IBS is unknown, but factors like gut-brain interactions, visceral hypersensitivity, and alterations in the gut microbiome may play a role (Patel, 2021). Managing IBS often involves a combination of lifestyle changes, dietary modifications, and targeted supplements.
While supplements can be a helpful addition to an IBS management plan, it’s crucial to consult with your doctor or dietitian before starting any new supplement regimen. Some supplements may interact with medications or have side effects, so personalised guidance is essential. This article will provide an overview of the current research on supplements for IBS, but it should not replace individual medical advice.
Probiotic Supplements
Probiotics are live microorganisms that can provide health benefits when consumed in adequate amounts. They are often referred to as “good” or “helpful” bacteria because they help maintain a healthy gut microbiome. Research suggests that certain probiotic strains may be particularly beneficial for managing IBS symptoms.
Key Points
- Probiotics may improve altered bowel habits, abdominal pain, bloating, and gas in IBS patients (Patel, 2021).
- Matching specific probiotic strains to an individual’s symptoms is important for effectiveness.
- Consistency in taking probiotics daily matters more than the time of day they are taken.
- Allow at least 4 weeks of consistent use to assess potential benefits.
A 2021 review by Patel found that probiotics can be an effective adjunctive therapy for IBS. The study highlighted that probiotics may improve altered bowel habits, abdominal pain, bloating, and gas in IBS patients. However, the review also emphasised the importance of matching specific probiotic strains to an individual’s symptoms for optimal effectiveness (Patel, 2021).
When taking probiotics for IBS, consistency is key. It’s more important to take probiotics daily than to focus on the specific time of day they are consumed. Experts recommend allowing at least 4 weeks of consistent use to assess potential benefits, as it takes time for the probiotics to colonise the gut and exert their effects (Patel, 2021).
Strain-Specific Evidence
- Combinations of Lactobacillus, Bifidobacterium, and Streptococcus species show benefits, but optimal strains are unclear (Patel, 2021).
- Specific products like Bio-K IBS Pro and Culturelle Digestive Health Daily Probiotic have clinical evidence supporting their use for IBS (Probiotic Guide Canada app).
While research suggests that combinations of Lactobacillus, Bifidobacterium, and Streptococcus species can be beneficial for IBS, the optimal strains and combinations are still unclear based on current evidence (Patel, 2021). Some specific probiotic products with clinical evidence supporting their use for IBS include Bio-K IBS Pro and Culturelle Digestive Health Daily Probiotic, according to the Probiotic Guide Canada app.
A 2020 systematic review and meta-analysis by Dale et al. found that multi-strain probiotics were more effective than single-strain probiotics for improving overall IBS symptoms and abdominal pain. The review also noted that probiotics containing Bifidobacterium species, particularly B. longum, B. bifidum, and B. infantis, showed the most promise for IBS symptom improvement (Dale et al., 2020).
Fibre Supplements
Fibre supplements, especially soluble fibres like psyllium, can help normalise bowel habits in IBS. Soluble fibre absorbs water and forms a gel-like substance, which can help soften stools and promote regular bowel movements.
Key Points
- Psyllium is the only fibre supplement with adequate evidence for improving IBS symptoms (Ford et al., 2014).
- Start at a low dose (1/2 tsp) and gradually increase to 1-2 tbsp as tolerated.
- Take fibre supplements at least 2 hours apart from other medications or supplements to prevent interactions.
- Stay well-hydrated when increasing fibre intake to avoid constipation.
A 2014 systematic review and meta-analysis by Ford et al. found that psyllium was the only fibre supplement with adequate evidence for improving IBS symptoms, particularly for those with constipation-predominant IBS (IBS-C). The review also noted that insoluble fibres, like wheat bran, may actually worsen IBS symptoms in some individuals (Ford et al., 2014).
When starting a psyllium supplement, it’s best to begin at a low dose, such as 1/2 teaspoon, and gradually increase up to 1-2 tablespoons per day as tolerated. To prevent potential interactions, take psyllium at least 2 hours apart from other medications or supplements. Staying well-hydrated is also important when increasing fibre intake to avoid constipation (Ford et al., 2014).
Evidence
- Soluble fibres like psyllium are recommended for IBS-C (Ford et al., 2014).
- Konsyl Organic Psyllium Fibre is a readily available psyllium supplement option.
A 2018 monograph by the American College of Gastroenterology recommends soluble fibre supplements, like psyllium, as a first-line therapy for IBS-C (Ford et al., 2018). Konsyl Organic Psyllium Fibre is one readily available psyllium supplement that can be found in many pharmacies and health food stores.
It’s important to note that while fibre supplements can be beneficial for some individuals with IBS, they may worsen symptoms in others. Working closely with a healthcare provider to find the right type and amount of fibre is crucial for successful IBS management.
Peppermint Oil
Enteric-coated peppermint oil capsules can act as an antispasmodic to relieve abdominal pain and bloating in IBS. The active ingredient, menthol, helps relax smooth muscles in the gastrointestinal tract.
Key Points
- The active ingredient menthol relaxes smooth muscles in the GI tract.
- Enteric coating prevents heartburn by delivering the peppermint oil to the intestines.
- Take 30-60 minutes before meals or 2 hours after, starting with 1 dose daily up to 3 doses.
- Avoid peppermint oil if you have significant reflux or heartburn.
Peppermint oil works by relaxing the smooth muscles in the intestines, which can help reduce abdominal pain and cramping associated with IBS. The enteric coating on peppermint oil capsules is important because it prevents the oil from being released in the stomach, which can cause heartburn. Instead, the coating ensures that the peppermint oil is delivered to the intestines, where it can exert its beneficial effects (Cash et al., 2016).
Peppermint oil is typically taken 30-60 minutes before meals or 2 hours after. It’s recommended to start with 1 dose daily and increase up to 3 doses per day if needed. However, those with significant reflux or heartburn should avoid peppermint oil, as it may exacerbate these symptoms (Cash et al., 2016).
Evidence
- Enteric-coated peppermint oil is recommended for overall IBS symptom improvement (Ford et al., 2018).
- IBgard is an example of an evidence-based peppermint oil supplement for IBS.
A 2018 monograph by the American College of Gastroenterology recommends enteric-coated peppermint oil for overall IBS symptom improvement (Ford et al., 2018). A 2016 randomised, double-blind, placebo-controlled trial by Cash et al. found that IBgard, a specific enteric-coated peppermint oil supplement, significantly improved IBS symptoms, including abdominal pain, bloating, and stool urgency, compared to placebo (Cash et al., 2016).
While peppermint oil can be a helpful addition to an IBS management plan, it’s important to use enteric-coated capsules and follow dosing instructions carefully to minimise the risk of side effects like heartburn or anal burning.
Digestive Enzyme Supplements
Digestive enzymes help break down harder-to-digest foods to reduce IBS symptoms from malabsorption. However, the evidence supporting their use for IBS is limited.
Key Points
- Enzymes are specific to the macronutrient they break down (carbohydrate, protein, or fat).
- Take digestive enzymes immediately before the first few bites of a meal.
- Use occasionally for known trigger foods, not for every meal.
- Work with a dietitian to find an evidence-based, targeted enzyme supplement.
Digestive enzymes are naturally produced by the body to help break down food into smaller, more easily absorbed components. Some individuals with IBS may have difficulty digesting certain foods, leading to symptoms like bloating, gas, and abdominal pain. Supplementing with digestive enzymes may help alleviate these symptoms by improving the digestion and absorption of trigger foods (Patel, 2021).
It’s important to note that digestive enzymes are specific to the macronutrient they break down (carbohydrate, protein, or fat), so it’s crucial to match the enzyme to the known malabsorbed nutrient for the best chance of success. Digestive enzymes should be taken immediately before the first few bites of a meal and used occasionally for known trigger foods rather than at every meal (Patel, 2021).
Evidence
- There is little research showing combination enzyme products are effective for IBS.
- Matching the enzyme to the known malabsorbed nutrient may increase success.
Currently, there is limited research supporting the use of combination digestive enzyme supplements for IBS. A 2021 review by Patel noted that while some studies have shown promise for specific enzymes like alpha-galactosidase for gas and bloating related to legume consumption, the evidence for broad-spectrum enzyme blends is lacking (Patel, 2021).
Working with a registered dietitian to identify specific trigger foods and find a targeted enzyme supplement may increase the likelihood of success. However, more research is needed to determine the overall effectiveness of digestive enzymes for IBS management.
Prebiotic and Synbiotic Supplements
Prebiotics are non-digestible food components that feed beneficial gut bacteria, while synbiotics combine prebiotics with probiotics. However, the evidence for their use in IBS is mixed.
Key Points
- Certain prebiotics like inulin may worsen IBS symptoms in some individuals.
- There is insufficient evidence to recommend prebiotics for IBS currently.
- Two small trials on synbiotics for IBS showed improvement but were not statistically significant (Ford et al., 2018).
Prebiotics are often touted for their ability to promote the growth of beneficial gut bacteria, but their effects on IBS symptoms are unclear. Some prebiotics, like inulin, may actually worsen IBS symptoms in certain individuals due to their fermentation in the colon, which can lead to increased gas and bloating (Wilson & Whelan, 2017).
Currently, there is insufficient evidence to recommend prebiotics for IBS management. A 2018 monograph by the American College of Gastroenterology concluded that there is low-quality evidence for the use of prebiotics in IBS, and more research is needed to determine their efficacy (Ford et al., 2018).
Evidence
- Fructooligosaccharide and galactooligosaccharide prebiotics have not consistently improved IBS symptoms in trials (Ford et al., 2018).
- Larger, high-quality studies on prebiotics and synbiotics for IBS are still needed.
Synbiotics, which combine prebiotics and probiotics, have been studied in two small trials for IBS. While both trials showed improvement in symptoms, the results were not statistically significant (Ford et al., 2018). Larger, high-quality studies are still needed to determine the efficacy of prebiotics and synbiotics for IBS.
A 2017 systematic review by Wilson and Whelan found that fructooligosaccharide and galactooligosaccharide prebiotics did not consistently improve IBS symptoms in clinical trials. The review also noted that some studies even reported worsening of symptoms, particularly bloating and gas, with prebiotic supplementation (Wilson & Whelan, 2017).
Given the lack of consistent evidence and the potential for symptom exacerbation, it’s important to approach prebiotic and synbiotic supplements with caution. Working closely with a healthcare provider to weigh the potential risks and benefits is essential for those considering these supplements for IBS management.
Conclusion
In conclusion, while there is no cure for IBS, certain supplements may provide symptom relief when used under the guidance of a healthcare professional. The strongest evidence supports the use of enteric-coated peppermint oil and soluble fibre like psyllium for managing IBS symptoms. Peppermint oil acts as an antispasmodic to relieve abdominal pain and bloating, while psyllium helps normalise bowel habits, particularly in those with constipation-predominant IBS.
Specific probiotic strains, particularly combinations of Lactobacillus, Bifidobacterium, and Streptococcus species, have also shown promise in improving IBS symptoms like abdominal pain, bloating, and altered bowel habits. However, more research is needed to determine the optimal strains and dosages for IBS management. Digestive enzymes and prebiotics/synbiotics currently have limited evidence supporting their use for IBS, and some prebiotics may even worsen symptoms in certain individuals.
Ultimately, the most effective approach to managing IBS with supplements is to work closely with a doctor or dietitian to develop a personalised plan. By considering individual symptoms, triggers, and medical history, healthcare professionals can recommend targeted supplements with the greatest potential for symptom relief while minimising the risk of adverse effects. As with any new treatment, it’s essential to monitor progress and adjust the plan as needed to optimise IBS management and overall quality of life.
Key Highlights and Actionable Tips
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Probiotic supplements can improve IBS symptoms by positively changing gut microbes, motility, visceral hypersensitivity, and the gut-brain axis. Match specific strains to your symptoms and take at the effective dose noted in the evidence.
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Fibre supplements like psyllium can help manage IBS if you’re not getting enough fibre through food. Start at a low dose and increase slowly while staying well hydrated.
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Be cautious with prebiotic supplements for IBS as there is insufficient evidence and some types may worsen symptoms, especially those containing rapidly fermented inulin.
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Peppermint oil can reduce abdominal pain, bloating and discomfort. Look for enteric coated capsules, take 30-60 mins before meals or 2 hrs after, starting with 1 dose daily up to 3 doses. Avoid if you have reflux.
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Digestive enzymes aid digestion but are meant for occasional use with harder-to-digest meals, not routinely. Find an evidence-based enzyme targeted to the macronutrient that triggers your symptoms.
How long should I trial a probiotic supplement before deciding if it works for my IBS?
It’s recommended to give a probiotic supplement at least four weeks to show its effectiveness. If you notice an improvement in your IBS symptoms, continue taking it for another eight weeks. If there is no clear benefit after four weeks, consider working with a dietitian to explore alternative interventions that may be more suitable for your individual needs.
Are there any potential risks or side effects associated with taking fibre supplements for IBS?
While fibre supplements can be beneficial for managing IBS symptoms, it’s important to start at a low dose and increase gradually. Taking too much fibre too quickly may lead to bloating, gas, and abdominal discomfort. Additionally, be sure to drink plenty of water when increasing your fibre intake to prevent constipation. If you experience persistent side effects or worsening of your IBS symptoms, discontinue use and consult with your healthcare provider.
Can I take peppermint oil supplements if I suffer from acid reflux or heartburn?
Peppermint oil may exacerbate symptoms of acid reflux and heartburn in some individuals. If you have a history of these conditions, it’s best to exercise caution when considering peppermint oil supplements. To reduce the risk of aggravating reflux symptoms, opt for enteric coated or slow-release formulations, which are designed to dissolve in the intestines rather than the stomach. However, if you notice a worsening of your reflux or heartburn while taking peppermint oil, it’s advisable to discontinue use.
How do I know which digestive enzyme supplement is right for my specific IBS triggers?
To select the most appropriate digestive enzyme supplement, it’s helpful to identify which macronutrient (carbohydrates, proteins, or fats) seems to trigger your IBS symptoms. If you’re unsure, consider keeping a food and symptom diary to help pinpoint potential triggers. Once you’ve identified the problematic macronutrient, look for a digestive enzyme supplement that contains high enough amounts of the specific enzyme needed to break down that macronutrient. For example, if fat triggers your symptoms, a supplement with lipase enzymes may be beneficial. Working with a registered dietitian can help guide you in finding the most targeted and evidence-based enzyme supplement for your needs.
Is it safe to take multiple supplements simultaneously for IBS symptom management?
While it may be tempting to try several supplements at once to address your IBS symptoms, it’s crucial to exercise caution. Some supplements can interact with each other or with medications you may be taking, potentially leading to adverse effects. Before combining supplements, it’s essential to consult with your healthcare provider or a registered dietitian who can assess the safety and suitability of the supplements based on your individual health status and medical history. They can also help you prioritise which supplements to trial first and guide you on appropriate dosing and timing to minimise the risk of interactions.
References
Ford, A. C., Moayyedi, P., Chey, W. D., Harris, L. A., Lacy, B. E., Saito, Y. A., & Quigley, E. M. (2018). American College of Gastroenterology monograph on management of irritable bowel syndrome. The American Journal of Gastroenterology, 113(Suppl 2), 1–18. https://doi.org/10.1038/s41395-018-0084-x
Ford, A. C., Quigley, E. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M., & Moayyedi, P. (2014). Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: Systematic review and meta-analysis. The American Journal of Gastroenterology, 109(10), 1547–1562. https://doi.org/10.1038/ajg.2014.202
Patel, N. V. (2021). Let food be thy medicine: Diet and supplements in irritable bowel syndrome. Clinical and Experimental Gastroenterology, 14, 555–564. https://doi.org/10.2147/CEG.S336772
