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As if managing irritable bowel syndrome (IBS) wasn’t confusing enough, these days social media is flooded with hundreds of supplements that claim to “heal your gut”, “drastically improve your IBS”, and well, basically change your life. The truth? Treating IBS is not that easy (although we wish it was). IBS is an incredibly complex condition that, according to the American College of Gastroenterology, is best controlled when diet and lifestyle changes are prioritized as a first-line approach. However, some individuals may benefit from a multi-pronged approach that includes a personalized supplement regimen (key word being personalized). At Alyssa Lavy Nutrition & Wellness, we’re experts on digestive health, so we know a few things about supplementation and IBS. From digestive enzymes, to probiotics, and everything in-between, we’re giving you the low down on five of the most commonly asked-about supplements for IBS management. As always, ask your doctor or dietitian before adding any new supplements to your daily routine.
1. Probiotics Probiotics are all the rage in the wellness world—but are they really as powerful in treating your IBS as your favorite Instagram influencers claim? The truth is that there are many different probiotic strains, and while some, such as Bifidobacterium longum 35624, have been linked to improved symptoms and quality of life in patients with IBS, the research on this topic remains inconclusive. Additionally, some probiotics may have adverse effects for those with IBS that also suffer from SIBO or have FODMAP sensitivities as many probiotics also contain high-FODMAP prebiotics. So, instead of heading to your local drugstore and grabbing the first probiotic supplement you see, we recommend consulting with your healthcare team to; (a) determine if a probiotic supplement is appropriate for you and (b) identify the strain(s) that will be most beneficial. Most importantly, focusing on identifying dietary triggers, improving meal hygiene, and better managing stress should all be considered before taking a probiotic supplement. For more information on probiotic use for IBS, check out our blog post here.
2. Digestive Enzymes
The human body naturally produces various digestive enzymes that break down food molecules into smaller, more easily digestible materials. Many individuals produce all enzymes needed for digestion, but if you have an enzyme deficiency or specific dietary IBS triggers, targeted digestive enzyme supplements may be of help (key word being targeted). The key here is to first identify the specific foods and/or FODMAP groups that trigger your IBS. This will allow your dietitian to choose a supplement that contains the specific digestive enzyme(s) in the correct amount needed to better digest your trigger foods. These types of supplements particularly come in handy when avoiding or limiting trigger foods is especially challenging, such as while traveling or dining out, but they can also be an effective way to liberalize your diet overall. You can simply take the digestive enzyme supplement right before eating your trigger foods and will likely find that you can better tolerate them.
So, you’re saying I shouldn’t take a general digestive enzyme supplement that multiple enzymes to cover all my bases? The short answer is no. We don’t recommend these supplements as they often contain inadequate amounts of the enzyme(s) that targets your trigger foods as well as additional, unnecessary enzymes. Their combination of enzymes and compounds may also not be well researched and long-term side effects may be unknown. Working with a GI specialized dietitian can help you to identify your specific dietary triggers and, therefore, the digestive enzyme(s) most suited for you!
3. Soluble Fiber Supplements (AKA: Bulk Forming Laxatives) Soluble fiber is a type of fiber that absorbs water and forms a gel-like substance in the GI tract. In doing so, it slows GI transit time, adds bulk to stool, and helps promote more complete bowel movements. This makes soluble fiber a digestive hero as it can be helpful in alleviating both constipation and diarrhea – so, basically, it can help to keep you regular. Food sources of dietary soluble fiber include oats, legumes, citrus fruits, etc., and should be prioritized over supplements, however soluble-fiber supplements can be very effective for many with IBS. When starting a soluble fiber supplement, it’s important to start with small amounts and increase gradually and as tolerated. Additionally, always pair any fiber supplementation with adequate hydration to prevent bloating and other GI discomfort. Different brands may use different soluble fiber sources, so it is important to work with your healthcare provider to choose the soluble fiber supplement that would be best suited for your needs.
Magnesium plays many crucial roles in the body, including supporting digestive health. A specific kind of magnesium, called magnesium citrate, can be highly effective for those with constipation-predominant IBS and is typically mild and safe for use. Magnesium citrate has a laxative effect on the body, pulling water into the intestines and therefore making stool softer and easier to pass. Most individuals will benefit from around 400mg of magnesium citrate, however dosing can be titrated up as needed and as tolerated under the supervision of a healthcare provider. While other forms of magnesium exist, we often recommend magnesium citrate specifically for constipation, as it tends to be comfortable and effective.
5. Peppermint Oil
If we’re being honest, no matter how in control of your IBS you may be, flare-ups will occur from time to time. In these cases, we have many strategies up our sleeve to help reduce flare-up severity and length, including taking a peppermint oil supplement. Peppermint oil acts as an antispasmodic and may reduce cramping and overall abdominal pain. It can be helpful for those with both constipation and diarrhea predominant IBS, however those with reflux may experience worsened upper GI symptoms. The key is to choose a peppermint oil supplement that comes in an enteric coated tablet, which allows it to survive the acidity of the stomach and make its way to the intestine. You may also find a cup of peppermint tea to be helpful in calming symptoms—and we love the taste too!
In short, there is no one supplement that will be best for everyone – and it is certainly not necessary (or recommended!) to use every supplement you hear about! This blog post does not provide personalized medical advice, but hopefully it shows you that there are evidence-based options out there and you can ask your healthcare provider about which options may be appropriate for you.
This blog post was written with the help of Lauren Pappalardo, a dietetic intern completing her MS/DI at Pace University.