Supplements for Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common gastrointestinal complaint. Symptoms often include abdominal pain that changes after a bowel movement, changes in the frequency of bowel movements or a change in stool consistency. It’s commonly divided into constipation, diarrhea or mixed subtypes.
While standard treatments, including medication and fiber, may help reduce discomfort, patients often have residual symptoms. Other treatments are worth considering, including dietary strategies and supplements. Of the researched supplements, a few appear to be fairly consistent in their potential benefits:
- Probiotics
- Specific types of fiber
- Peppermint oil
Probiotics
A study compared standard medications to probiotics and found that, in general, probiotics provided a greater measure of relief than medications. However, the authors caution that it is hard to draw firm conclusions due to the diversity of products studied and the variability of subtypes of IBS and their responses to treatment (Geest 2022).
A recent analysis of over 100 studies on probiotics for IBS also had some interesting findings. Probiotics that contained specific types of bacteria, including Lactobacillus rhamnosus and Lactobacillus acidophilus had the highest efficacy for improving symptoms (Ceccherini 2022). A separate analysis that included fewer studies concluded that Bacillus coagulans had the highest probability of providing relief (Zhang 2022). While this doesn’t mean other probiotics can’t or won’t help, it may be worth trying products that contain one or more of these bacteria first.
Keep in mind that numerous types of probiotics exist and different probiotics can have vastly different effects. While some people may react positively to a specific probiotic, someone else could have uncomfortable side effects to the same product.
Fiber
Fiber is a standard recommendation for irritable bowel symptoms. Similar to probiotics, there are many different types of fiber with some having potentially more benefits than others.
Psyllium Husk
Probably the most recommended fiber for improving irritable bowel syndrome is psyllium husk. Psyllium husk is a source of soluble fiber often sold over the counter as a general fiber supplement.
A study compared psyllium, bran and placebo for irritable bowel syndrome. At one month, almost 60% of patients on psyllium had an adequate treatment response with relief of symptoms for at least two of the past four weeks (Luther 2010). However, a review from 2011 found limited and conflicting data overall for the recommendation of psyllium for irritable bowel syndrome (Chouinard 2011). A more recent study in children with irritable bowel syndrome found a reduction in abdominal pain with psyllium fiber supplementation (Shulman 2017).
While it is worth trying psyllium to see if it helps symptoms, some people might experience increased gas, pain and bloating with its use. If psyllium is not providing symptom relief, other fibers may be more effective.
Partially Hydrolyzed Guar Gum (PHGG)
Guar gum is a fiber from guar beans often used as a thickener in different types of foods. As a source of fiber it is very rich in soluble fiber. A version of guar gum that is partially broken down by water has been studied as a treatment for irritable bowel syndrome among other gastrointestinal conditions. Partially hydrolyzed guar gum (PHGG) has the advantage of dissolving completely in water and being virtually tasteless. As such, it is much easier to take as a supplement than other types of fiber.
One of the first studies compared PHGG to wheat bran for patients with irritable bowel syndrome. Analysis showed higher success in reducing symptoms with PHGG as compared to wheat bran (Parisi 2002). In addition, patients appeared to prefer PHGG, likely due to it being easier to take. A double-blind, placebo-controlled trial found that PHGG significantly decreased gas and bloating over placebo. Overall severity of symptoms, quality of life and abdominal pain also improved in patients on PHGG, but not more significantly than those on placebo (Niv 2016). The most recent trial on PHGG found that it improves stools by regulating the types of bacteria living throughout the gastrointestinal tract (Yasukawa 2019).
Acacia Gum or Gum Arabic
While not as well studied, acacia gum (also called gum arabic) has been historically used for gastrointestinal symptoms. A study from 2012 that added acacia fiber and probiotic bacteria to yogurt found better results for treating irritable bowel syndrome than yogurt alone (Min 2012).
A placebo-controlled trial found that acacia gum was more effective at improving overall symptoms and quality of life as compared to placebo in patients with irritable bowel syndrome (Elaati 2007). Dosing was quite high in the study, with subjects taking 15 grams twice daily. In my clinical experience, acacia gum is usually better tolerated than some other types of fiber, but dosing should still be increased slowly to minimize side effects. Quality of acacia gum is also important, with lighter colored powders being of higher quality and better purity than brown-colored powders.
Nopal Cactus Fiber
While the research is limited, the results of a published study suggest significant potential for treating irritable bowel syndrome with nopal cactus fiber. The study divided patients into receiving different doses of nopal cactus fiber or placebo. Somewhat astonishingly, 87% of patients receiving 20 grams of nopal cactus fiber a day had adequate symptom relief (Remes-Troche 2021). While more research is needed, nopal cactus has long been used as a food and should present minimal safety concerns. For patients looking for other potential treatments, nopal cactus fiber may be worth considering. Nopal cactus is also referred to as prickly pear.
Enteric-Coated Peppermint Oil
Peppermint has a history of use for calming the stomach. And trials of peppermint oil suggest that it may have a place in irritable bowel treatment. One of the first trials of peppermint oil was in 1979. The small study found that enteric-coated peppermint oil, capsules designed to open beyond the stomach, provided greater relief of abdominal symptoms than placebo. However, they noted that some patients appeared to have heartburn from peppermint oil treatment (Rees 1979).
Since then, studies on peppermint oil have been somewhat variable, with a higher degree of side effects seen in patients taking peppermint oil as compared to placebo. An overall analysis of the published studies still suggests benefits, with one in four patients improving significantly with supplementation (Ingrosso 2022).
Conclusion
Irritable bowel syndrome can be a challenging condition to treat. While patients may get partial relief with standard treatment, many are still left with residual symptoms. Some supplements appear to have significant potential for helping to treat irritable bowel syndrome, including probiotics, different types of fiber and enteric-coated peppermint oil. In my experience, when combined with dietary strategies, it is often possible to improve symptoms and quality of life in patients looking for relief.
