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Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, which affects approximately 11% of the global population. It is associated with several digestive symptoms, such as abdominal pain, bloating, excessive flatulence, and altered bowel habits, and can severely decrease a person’s quality of life.
Causes of IBS
Functional gastrointestinal disorders, such as IBS, are caused by an abnormally functioning GI tract. This means that it is difficult to diagnose the condition because there are no biomarkers that can determine whether a person has IBS.
Healthcare professionals, therefore, have to rely on patient reports on specific criteria.
Despite the exact cause not being fully understood, several hypotheses have been put forward in the scientific literature. These include GI tract infections, psychological stress, gut mobility abnormalities and problems with the gut-brain axis.
There are no cures for IBS but the symptoms can be managed through prescription medications, dietary changes, and nutritional supplementation.
Medications include serotonin agonists/antagonists, antispasmodics, and antidepressants. Although these can address some of the issues in IBS, the wide variety of symptoms, no medication can resolve all of them.
Also, long-term use of these medications is associated with several side effects.
Due to these problems, researchers have explored alternatives for the condition. As patients often report certain foods can cause more symptoms than others and therefore several dietary interventions have been investigated.
Dietary interventions for IBS
A particularly common dietary intervention for IBS is a low-FODMAP diet. FODMAP stands for “Fermentable, Oligo-saccharides, Di-saccharides, Mono-saccharides, and Polyols.”
These are short-chain carbohydrates, which are poorly digested and absorbed by the small intestine. This means that they travel to the large intestine where they are fermented by the bacteria that colonize it, which causes gases such as hydrogen and methane to be formed.
Restricting foods that are high in these short-chain carbohydrates can therefore potentially improve IBS symptoms.
Some studies have suggested that this dietary intervention can be effective at reducing symptoms in people with IBS (1). However, further research is needed which includes more patients and is conducted over a longer period to be able to draw more firm conclusions about its effectiveness.
Also, as the diet can be highly restrictive, it may be difficult for patients to adhere to over the long term and has the potential to contribute or worsen disordered eating behavior.
Stress reduction for IBS
IBS symptoms are often worsened by stress. This is because the largest concentration of neurons outside the brain and spinal cord is in the gastrointestinal tract.
Stress hormones can impact movement through the gastrointestinal tract, either by speeding it up or slowing it down and can cause the muscles in intestines to spasm. Stress-reduction techniques can, therefore, be useful in managing IBS symptoms.
Studies have highlighted two stress-reduction techniques as being potentially helpful: meditation and mindfulness-based interventions. However, more randomized placebo‐controlled trials are needed to determine their effectiveness for IBS (2).
In light of the issues with prescription medications, and lack of long-term evidence on dietary interventions and stress-reduction techniques, nutritional supplementation can sometimes be useful for managing the symptoms of IBS. These can help to alleviate current IBS symptoms and or help lessen the intensity of future symptoms. Here are the best supplements for IBS:
ⓘ We strongly recommend that you consult with your healthcare provider before taking any supplements to ensure there are no contraindications and that they are right for you. This information is not intended to replace professional advice or meant to be used to prevent, diagnose, or treat any disease or illness.
6 Most Helpful Supplements for IBS
Peppermint (Mentha piperita) is a hybrid plant from watermint and spearmint, often used for its aroma and taste. It was initially used for culinary and food manufacturing purposes but has subsequently been used for its therapeutic benefits.
The oil component of peppermint appears to be the most beneficial element of the plant, and it contains a large amount of methanol, which is considered to be the main bioactive ingredient.
Peppermint is used for its ability to relax the muscles in the stomach and digestive tract. It seems to be able to speed up the early phase of digestion in the stomach while reducing colonic motility.
How does peppermint help IBS?
A double-blind randomized placebo-controlled study found that peppermint oil taken 3 times per day for 6 weeks was able to significantly reduce abdominal pain in those with IBS compared to placebo (3). However, these benefits were no longer seen 2 weeks after ceasing supplementation, which highlights the usefulness of taking peppermint oil on an ongoing basis for IBS.
A prospective double-blind placebo-controlled randomized trial found that two enteric-coated capsules taken twice per day for 4 weeks were able to significantly reduce a range of IBS symptoms compared with placebo (4).
Symptoms evaluated included abdominal bloating, abdominal pain or discomfort, diarrhea, constipation, feeling of incomplete evacuation, pain at defecation, the passage of gas or mucus and urgency at defecation. After 4 weeks, 75% of patients in the peppermint oil group showed a greater than 50% decrease in IBS symptoms, compared with only 38% in the placebo group.
How do I take peppermint oil?
To obtain the benefits of peppermint oil for IBS, it is recommended to consume between 450 and 750 mg of the oil per day in 2 or 3 divided doses. This is equivalent to 0.1 and 0.2 ml of the oil per dose and reflects a menthol content of between 33% and 55%.
Most studies have used enteric-coated capsules so that the capsule does not break too early in the digestive process. The muscle-relaxing effects of peppermint oil can affect the esophagus if the capsule breaks prematurely. It is therefore recommended to take peppermint oil in enteric-coated capsule form for IBS. However, it is also available in liquid form.
Check it out: Top 10 Peppermint Supplements!
Pycnogenol is a patented formulation of Pine Bark Extract which is standardized to contain 65-75% of Procyanidin compounds by weight. Procyanidins are chain-like structures which consist of catechins similar to those found in green tea.
Pycnogenol is similar to grape seed extract and cocoa polyphenols, which together are the 3 most common sources of Procyanidins.
It has several effects on the body such as increasing blood flow (as a result of increasing nitric oxide levels) and improving blood glucose control.
How does pycnogenol help IBS?
An open-label study found that 150 mg of pycnogenol taken daily for 3 weeks was able to significantly reduce pain compared with control groups (5). One of the control groups was taking 10 mg of Buscopan (an antispasmodic) when needed and the other group was taking Antispasmina col forte, 50 mg of papaverine hydrochloride and 10 mg belladonna extract when needed. Mild pain and abdomen pressure decreased in all the treatment groups, suggesting that antispasmodics can also be moderately effective in alleviating IBS symptoms.
How do I take pycnogenol?
To obtain the benefits of pycnogenol for IBS, it is recommended to consume 150 mg per day. Doses between 40 and 60 mg are effective but a higher dose is recommended for optimal effectiveness.
Studies have used both twice-daily dosing and single daily dosing. Both strategies seem to be effective but they have not yet been directly compared in the research literature. Pycnogenol can be taken with or without food.
Berberine is an alkaloid extracted from several plants used in traditional Chinese medicine. It is primarily used to reduce insulin resistance and improve biomarkers in people with type II type 2 diabetes, such as fasting glucose and HbA1c.
Berberine activates an enzyme called Adenosine Monophosphate-Activated Protein Kinase (AMPK) while inhibiting Protein-Tyrosine Phosphatase 1B (PTP1B), which increases insulin sensitivity. It also protects β-cells, regulates hepatic gluconeogenesis, and reduces inflammatory cytokine signaling.
How does berberine help IBS?
A randomized double‐blind placebo‐controlled clinical trial found that 400 mg of berberine hydrochloride taken twice per day for 8 weeks was able to significantly reduce the frequency of diarrhea, abdominal pain frequency and the urgent need to defecate compared with placebo (6). Other benefits of berberine supplementation included a decrease in overall IBS symptoms, reduced depression and anxiety and improved IBS-related quality of life compared with placebo. Berberine was also well-tolerated in all participants.
How do I take berberine?
To obtain the benefits of berberine for IBS, it is recommended to take 400 mg twice per day. It is important to split the dose as too much at once can cause digestive issues, such as an upset stomach, cramping, and diarrhea.
Although it can be taken at any time, if wanting to obtain the blood glucose benefits of berberine, it is recommended to take it with a meal or shortly after. This takes advantage of the glucose and lipid increase that naturally occurs when eating.
Check it out: Top 10 Berberine Supplements!
Curcumin is the yellow pigment found in turmeric, a flowering plant of the ginger family often used as a spice in curries. It’s a polyphenol that has anti-inflammatory properties and can increase the number of antioxidants the body produces.
Curcumin and the other curcuminoids found in turmeric can be extracted to produce supplements that have a much higher potency than turmeric. However, curcumin is absorbed poorly during the digestive process so several different formulations have been created to boost its bioavailability. It is often combined with a black pepper extract called piperine. It can also be combined with lipids and is found in the patented products BCM-95® and Meriva®. These additional substances make a significant difference in terms of effectiveness. For example, one study found that the absorption of curcumin was increased by up to 2000% when combined with piperine (7).
How does curcumin help IBS?
A randomized placebo‐controlled study found that two capsules of curcumin and fennel essential oil (42 mg of curcumin and 25 mg of fennel essential oil), taken daily for 30 days was able to significantly reduce IBS symptoms, including abdominal pain, compared with placebo (8). The percentage of symptom-free patients was also significantly higher in the curcumin and fennel seed oil group than the placebo group. IBS-related quality of life was also improved following supplementation with curcumin and fennel seed oil.
A meta-analysis of studies investigating the use of curcumin for IBS found that its antioxidant and anti-inflammatory properties both act to reduce IBS symptoms (9). Also, the meta-analysis reported that curcumin is well-tolerated, with no evidence of adverse events occurring in the studies included.
How do I take curcumin?
To obtain the benefits of curcumin it is recommended to pair supplementation with either piperine, BCM-95® or Meriva®.
To supplement curcumin with piperine, it is recommended to take 500 mg of curcumin with 20 mg of piperine three times per day, equivalent to a total of 1500 mg of curcumin and 60 mg of piperine daily.
To supplement BCM-95® (a patented combination of curcumin and essential oils), it is recommended to take 500 mg twice a day, equivalent to a total of 1000 mg daily.
Curcumin can be taken at any time of the day but should be consumed with food.
Check it out: Top 10 Curcumin Supplements!
Synbiotics are a combination of prebiotics and probiotics that synergistically promote gastrointestinal health by improving the survival and adherence of live microbial dietary supplements.
Although the exact cause of IBS is unknown, gut bacteria are known to play a large role (10). Although some studies have highlighted the potential of probiotics to alleviate IBS symptoms, others have not found them to have any benefit. Also, methodological issues with existing studies mean that their potential effectiveness is unclear (11,12). For this reason, increasingly researchers have explored the potential of synbiotics for IBS.
How do synbiotics help IBS?
A double-blind, randomized controlled design study investigated the dose-dependent effects of synbiotics on gastrointestinal symptoms of and fatigue in IBS (13). Participants were allocated into 1 of 3 groups: a high-dose group who received 2 capsules of synbiotics, a low-dose group who received 1 capsule of synbiotics and 1 placebo capsule, or a placebo group who received 2 placebo capsules. Each capsule of synbiotics contained 10 billion colony-forming units (CFU) of probiotic bacteria comprising six strains of Lactobacillus (rhamnosus, acidophilus, casei, bulgaricus, plantarum, and salivarius) and two strains of Bifidobacterium (bifidum and longum). Each capsule also contained 175 mg of fructooligosaccharides, 150 mg of Ulmus davidiana (Slippery elm bark powder), 10 mg of Geum urbanum (herb bennet) powder, and 100 mg of inulin powder as prebiotics.
After 8 weeks of supplementation, it was found that abdominal discomfort, abdominal bloating, frequency of formed stool, and fatigue were all significantly improved in the high-dose group compared with the placebo group. Results suggested a small dose-dependent effect of synbiotics on IBS symptoms.
How do I take synbiotics?
To obtain the benefits of synbiotics for IBS, it is recommended to consume 2 capsules of 10 billion CFU per day. These can be taken at any time of the day but should not be taken with a hot drink as this will destroy the beneficial bacteria in the supplement.
Psyllium consists of fibers taken from the plant known as Plantago ovata. It is sometimes called Plantago psyllium. It is water-soluble (hydrophilic) and gel-forming, while possessing low fermentability. Psyllium is commonly known by the brand name Metamucil.
Psyllium has been shown to increase fecal size and moisture. Compared with other sources of dietary fiber, it appears to be more effective at forming feces and is one of the few fiber sources not associated with excessive flatulence.
How does psyllium help IBS?
A review of studies found that long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium, can help in managing IBS symptoms. Dietary fiber achieves these benefits through several different mechanisms, including increased fecal mass with mechanical stimulation/irritation of the colonic mucosa with increasing secretion and peristalsis, and the actions of fermentation by-products, such as short-chain fatty acids, on the intestinal microbiota, immune system and the neuroendocrine system of the gastrointestinal tract. The review also concluded that it is safe and effective in improving IBS symptoms globally.
How do I take psyllium?
As psyllium is so high in fiber, it is recommended to start on the lower side of dosing when using the supplement for IBS. It is best to begin by taking 5 g of psyllium is taken once with meals alongside at least 200 ml of liquid.
Evidence suggests that doses of up to 30 g are well tolerated if sufficient water is consumed but it is best to taper up to this amount gradually to avoid negative digestive effects.
If using psyllium for the fecal forming properties, taking 5 g three times per day is a recommended starting point, which can then be adjusted upwards or downwards depending on the effect observed.
Check it out: Top 10 Psyllium Supplements!
IBS can be a highly challenging condition to manage, physically and mentally, and can take a significant toll on a person’s quality of life. However, there are several ways to help alleviate symptoms.
As many medications can cause negative side effects, and dietary interventions can be challenging to adhere to, many people with IBS seek out alternatives. These include implementing stress-reduction techniques, such as mindfulness and meditation.
Also, several supplements can help to reduce IBS symptoms and improve quality of life, making the condition much easier to deal with daily.
ⓘ Any specific supplement products & brands featured on this website are not necessarily endorsed by Emma.
Stock Photos from Emily frost / Shutterstock
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About the Author
Emma Green has a PhD, MSc and BSc in Psychology and is a certified personal trainer. She currently works as a freelance writer, producing on content on science, health and fitness for a number of online platforms. She also coaches clients online on a one-to-one basis to help them achieve their health and fitness goals. Contact Emma.