6 Best Supplements for IBS
Whether or not you have ‘officially’ been diagnosed with IBS, you know how disruptive digestive issues can be: they’re uncomfortable, painful and embarrassing and can significantly impact your day to day.
It’s only natural to want to try as many solutions as you possibly can.
You may even have a cupboard filled with expensive probiotics and enzymes that haven’t made any real difference - because they may not have been addressing your specific imbalances. You don’t need all the things to heal the gut - you just need to find the right solutions for you and your body.
Before supplementing for IBS it’s important to realize these main principles:
Digestion Principle #1: If you’re not eating well, supplements probably won’t help.
There are several supplements recommended below that will help to improve your digestion and balance your microbiome ... But if you’re still eating foods that are inflammatory, the supplements either (1) will not work or (2) will act as a bandaid solution instead of a sustainable one for your IBS.
Cleaning up the diet reduces the burden on the gut. If you have no idea where to start, download the free gut health guide here.
Gut Principle #2: Even if you have similar symptoms as someone else, you probably still need different supplements.
No two bodies are alike - especially when it comes to improving digestion.
While two people may be experiencing similar issues, their approaches may be completely different because they have different:
Physical and nutritional imbalances
Lifestyle and diets
For example, I have two clients with very similar symptoms but different treatment approaches:
Client #1 is her early 30s … when she first came to see me she was extremely bloated and had both constipation and diarrhea. She was eating everything from burgers to sushi to salads and didn’t know where to start with her gut health.
Client #2 is also in her early 30s, also had many symptoms associated with undiagnosed IBS: bloating, burping and constipation. She was also suffering from some anxiety and tinnitus (both signs of nervous system issues). She was committed to a vegan lifestyle and ate a clean, plant based diet.
While they both had IBS symptoms that overlapped, their treatment approaches were completely different.
The first client responded well to a few small changes: we replaced the inflammatory foods in her diet like wheat / gluten, dairy and sugar with veggies, whole grains and high quality proteins. These shifts completely resolved her gut issues.
In contrast my second client needed a lot more hands on support. She was eating an already very clean diet and we worked to reduce the fermentation load of her diet (via a low FODMAP diet), which was a big contributor for her gas and bloating. We also needed to support her digestion - specifically stomach acid and pancreatic enzymes, which were also likely related to the tinnitis and anxiety!
Although these two women had pretty similar digestive complaints on paper, their approaches and what worked for them was radically different. Something to keep in mind on your health journey!
What works for you may be different than what works for someone else (and visa versa!)
Gut Principle #3: Investigating WHY you are experiencing IBS is the best way to treat IBS
Sounds simple, right?
But a lot of approaches to gut health and nutrition use a bandaid approach. Constipated? Take a laxative. Have diarrhea? Take some imodium.
Before you layer your laxatives, antidiarrheals and pepcid, know that there’s a better approach to controlling your GI symptoms.
When you understand why you are experiencing IBS and create a plan to address the underlying reason, you are more likely to find sustainable solutions.
I separated the suggestions below by physiological action in your gut.
For simplicity, I created two main categories for supplement action: digestive factors and microbiome support. These are the most common issues and imbalances I see and the best areas to start!
This article isn’t meant to diagnose or treat and medical conditions. Some of the following suggestions may interfere with medications. Please consult with your doctor or health professional before embarking on a new diet or supplement program.
Digestion is the process of breaking down foods so that you can absorb their nutrients. Not only is digestion important to help nourish you properly, but it is also essential for preventing downstream effects of poor digestion, like bacterial overgrowth and leaky gut.
Here are some of my favorite digestive supportive supplements, and how they work …
#1 Betaine HCl
Betaine HCl is a digestive aide that mimics acid production in the stomach. The pH of the stomach should be around 1-2, which is extremely acidic. This jumpstarts many digestive processes like:
Activating pepsin (the first step in protein digestion)
Free minerals like iron and magnesium that are found in foods,
Support vitamin B12 digestion and absorption
... among many other functions!
Symptoms of low stomach acid include reflux, burping, heart burn, fullness after eating, nausea and bloating. Stomach acid jumpstarts the rest of digestion that takes place in the small intestine.
Drugs that are used to suppress stomach acid like proton pump inhibitors, H2 blockers and over the counter acid-lowering medications (ex: Zantac and Pepcid) are over-prescribed and over-used in the US. These medications neutralize stomach acid, which compromises digestion even more. This is ironic because these acid suppressing drugs are supposed to control acid overproduction, but this is a bandaid approach to reflux (for most people - reflux is actually caused by low stomach acid!!) and contributes to even more digestive issues, bacterial overgrowth, nutrient imbalances and malnutrition.
Use caution with Betaine HCl if you have a gastric or duodenal ulcer or are on an acid suppressant (weaning off often these meds requires gradually lowering your dose under the care of a physician).
#2 Digestive Enzymes
While the stomach jumpstarts the majority of digestion*, the bulk of digestion happens when food reaches the small intestine. Pancreatic enzymes target different macronutrients in food (like carbs, protein and fat) to break them into smaller components so that they can be properly absorbed.
You may benefit from pancreatic enzymes if you are bloated and gassy after meals, experience stomach pain or foul smelling stools. Individuals with bacterial overgrowth, like SIBO, will also benefit from enzymes.
If you feel like you have trouble digesting certain foods, it will be most helpful for you to supplement based on the foods you don’t tolerate. For example, there are general pancreatic enzymes like amylase, lipase and proteases for general macronutrient support versus getting more specific enzymes for digesting dairy (lactase) versus beans and veggies (alpha galactosidase) or phytic acids in wheat and grains (phytase).
*Digestion technically begins in the mouth: chewing food is a mechanical breakdown of food and saliva contains amylase, which is an enzyme that helps break down starches and carbohydrates.
#3 Digestive bitters
Digestive bitters are a class of bitter herbs that support digestion.
Digestive bitters are great because they have a dual action - they stimulate the release of stomach acid (so they can serve as an alternative to Betaine HCl); while also supporting bile production (supports fat digestion and lowers cholesterol levels).
You may benefit from bitters if you have both symptoms of low stomach acid (burping, GERD, nausea) in addition to fat maldigestion such as greasy, floating or foul-smelling stool.
Follow the same precautions for Betaine HCl mentioned above.Do not take bitters if you are suffering from too much stomach acid - for example in ulcers or if you are on acid lower medications, discussed above. Start with half of the recommended dose and slowly increase to the recommended dose, as tolerated. Mix in water 10-15 minutes before meals.
We have 300 trillion bacteria in our gut (that’s about 3 pounds!!I), which play a key role in digestive health and beyond. Imbalances in the microbiome can activate the immune system and research has linked the role of the microbiome to developing IBS.
The following supplements directly impact the bacterial balance in the gut and can be used therapeutically to improve symptoms associated with IBS.
To note: depending on your specific symptoms these can improve or worsen symptoms. Each body is unique and has different underlying imbalances. Remember what works for one person is going to be different than what works for you!
One of the first steps in healing the gut is to eliminate the overgrowth of harmful organisms.
Berberine is an anti-microbial compound extracted from the barberry plant that inhibits the growth of bacteria and other organisms like fungi and protozoa that can be causing or contributing to IBS. It also stimulates the release of bile acids, which supports digestion and is another way it can be helpful for IBS.
Berberine has been used both traditionally and clinically for IBS and helps with IBS symptoms like stomach upset, heartburn, constipation and diarrhea.
Avoid unnecessary or long term supplementation with berberine - just like it eliminates the ‘bad guys’ it also impacts good bacteria and improper use can cause a host of other imbalances.
The best way to identify if you need to eliminate the overgrowth of micro-organisms is by running a breath or stool test. This is something I offer in my 1-1 services - more information can be found here.
You might be wondering why these weren’t at the top of my list. While they are important, they are certainly not a cure-all for all digestive issues.
The most common misperception about probiotic supplementation is that taking a probiotic repopulates the gut with good bacteria. It’s really important to understand that this is not how probiotics work!!
The bacterial species thats found in probiotics don’t “repopulate” the gut because the species in supplements are different than indigenous populations in the gut. Read more about that here.
But probiotics are wonderful for regulating the environment in the gut and for getting a specific therapeutic action. For example, there are probiotics that are good for IBS-C (constipation) versus IBS-D (diarrhea), some work better for Crohn's disease, while others that help with gut lining integrity (re: leaky gut).
Probiotics can also be helpful for the prevention of digestive issues. Taking a broad spectrum probiotic is especially helpful to control rebound effects of antibiotics.
If you’re wanting to repopulate the gut with good bacteria, you will need to include prebiotics. For example, if you have low growth of bifidobacteria (another thing you can discover by testing your poo!), you can either eat or supplement with functional fibers that help to feed and grow your bifidobacteria.
Learn more about probiotics and prebiotics here.
#6 Partially Hydrolyzed Guar Gum
Partially Hydrolyzed Guar Gum (PHGG) is one of my FAVORITE supplements for IBS because it is inexpensive and effective in several ways. It is a gel-forming fiber that come from the seeds of the guar plant and is good for those with IBS-D, IBS-C and IBS-M.
Constipation - PHGG has a bulk laxative effect - meaning that it draws water into the colon and adds bulk to the stool. When this happens, the colon expands and it stimulates a bowel movement.
Diarrhea - PHGG also works for diarrhea. As it forms a gel it can has a binding ability and can reduce diarrhea.
PHGG is also good for the microbiome - it produces ‘short chain fatty acids’ when its produced in the gut - this nourishes colon cells, lowers the pH of the gut and promotes the growth of beneficial bacteria.
This is one we can all use more of in our diet! Mix 5-10 grams per day in water or in morning smoothie.
There are so many supplements available for improving gut health and marketed towards IBS. Understanding what you need can easily become overwhelming can easily become overwhelming, but it’s important to listen to what your body is saying and then respond accordingly.
A combination of shifting the diet, investigating and individualizing your nutrition through testing and supplements often works wonders for IBS.
If you’re looking for more guidance and support, check out my 3-month coaching package here where we completely customize your nutrition plan to resolve your discomfort and help you get your life back.