Welcome to episode 22 of the Inside Knowledge with me, Anna Mapson. Today, I’m going to talk a bit about supplements for IBS.
Generally, most people I work with come to me and are on quite a few supplements already. Not everybody, but a lot of people have tried to take things and try to implement changes to their gut health through using supplements.
The most supplements I ever had of a client was 19 different products that were taken each day! That was a lot, so I think that’s probably the most.
I’ve also had somebody who was taking psyllium husk for 25 years every single day.
So sometimes we can latch onto a supplement and think it’s going to solve everything, think it’s going to be the thing that makes things better.
Supplements for IBS should be extra to a good diet
But what I want to start off by saying is that there are lots of options, but they should all be supplemental to your diet. They should be fulfilling a need that food cannot. Rather than be the thing that changes your digestion.
When are supplements useful?
So supplements are particularly useful during restrictive diets. Like if you’re going through the low FODMAP diet, for example, or other elimination diets where you’re cutting out a lot of things from your normal food intake. It may be helpful to add in particular supplements to plug those gaps.
For example, if you’re on a vegan diet, like that is really important to take B12, and you may need other things like omega 3. Potentially being aware of other key nutrients as well for a vegan diet. But, today, talking about IBS and what you can take for various gut health symptoms.
My top 5 IBS supplements
There are so many supplements I could be talking about I’m just going to focus on
- probiotics,
- digestive enzymes,
- partially hydrolyzed guar gum,
- digestive bitters,
- and a beneficial yeast called Saccharomyces boulardii.
So these are the ones you’re going to hear about in this episode. I may do another deep dive into probiotics for IBS at a later date.
Probiotics for IBS
But just to start off with probiotics, I’m going to give a bit of an overview and a little bit of insight.
Probiotics have a particular action or benefit associated with each strain. Some are researched for constipation, others are more for bloating, and taking one probiotic won’t necessarily give you the same results as taking another.
Some of them have much better marketing than others. I’m not going to go into any particular products right now, but there is a brand that has very good marketing and is everywhere. Everyone talks about it, and you have to get it on a subscription. So you have to sign up for months at a time. I have a bit of an issue with this because I don’t think you should take the same probiotic for a long time.
Don’t take the same probiotic for ever
I generally suggest rotating them every couple of months, and that is because we want a wide variety and diversity in our gut health.
What are probiotics?
There is a definition of probiotics that is from the World Health Organization. That is, they’re “live microorganisms that when administered in adequate amounts, confer a health benefit to the host.”
And this is really important.
They have to be live micro-organisms
Firstly, that they have to be live. So these live microorganisms, they have to be alive when you take them, not just when they were put into the capsule and into the bottle, good brands will guarantee that the microorganisms, mostly bacteria, will actually be alive until the date it says best before.
It’s no good if they’re bottled and they’re live then, but by the time they get to you and get to your body, they’re dead. That’s not a definition of a good probiotic.
The probiotic count should be adequate
Then the other key thing with this definition is that they have to be administered in adequate amounts. We have to take enough of them in order to get a result.
Sometimes, the research studies are using very high quantities of probiotics that are not mirrored in products on your shelf, in your local health store. So, you have to have quite a high dose. Um, not always, but… Often they’re using very, very high doses. Probiotics are counted in colony forming units, CFU.
And that’s what you’ll probably see on the bottle. So they’re in the billions, obviously it’s, it’s big, big numbers, adequate amounts. You know, it will be different again for different strains, some probiotic strains, you don’t need as much of, and some you need more of.
The probiotic should be beneficial
Then the final part of that definition was that they confer a health benefit to the host.
There has to be a linked or known benefit to taking certain strains of probiotics.
When you think about dogs, they have the category of animal, then they have, species of a mammal, and then within that you have dog. Then within dog you have the difference between a Pomeranian and a big Labrador or a Doberman.
These are very, very different animals and yet they all fall under dog, they all fall under mammal, and they all fall under animal.
With probiotics, we’re talking about different bacteria and they each have like a family. And then within that they have a species and then you have a strain. So this is getting more and more specific. And you think about the dogs, we’re going down into more specific categorization of the species and the strain and the strain level is generally where we see research.
Common probiotics
So for example, the large families are often lactobacillus, bifidobacterium, and then there’s a bacillus one as well. And these are the most common strains that you’d see on the products in your health store. Now, what is key is thinking about the particular strains, and normally good brands will tell you the actual strain that is used, which will help if you needed to go and see whether there’s research for the condition that you want to take it for.
So, for example, under bifidobacterium, there are a couple of Main groupings, which are commonly used in probiotics. So we have Bifidobacterium infantis, Bifidobacterium lactis, and Bifidobacterium brevi. And these all have then substrains as well. And these are the ones that are tested for different conditions and different symptoms to see what happens.
Now often, with probiotics, the challenge is you’re putting them into a gut and we don’t necessarily know what other bacteria or microbes or parasites are there. And that can change the way that your body receives these additional bacteria. When you take probiotics as well, they don’t stay in your gut forever.
They are transient, which means as things are coming through every day. We’re passing the stool a lot of food waste, and a lot of the food waste is actually dead bacteria. A huge proportion of it, I think, is something like a third of it is dead bacteria. So a lot of transit, a lot of movement. So taking additional bacteria doesn’t mean that they stay in you forever.
How probiotics can support IBS
Probiotics can do though, is they may influence the colonies of microbes that are already there. Either by adding missing populations or slightly changing the environment. Generally, when we’ve got good amounts of beneficial bacteria, it decreases the pH level in the colon. This makes it more acidic. And this is a good thing.
It helps you absorb nutrients like iron and other minerals. It can also help to stimulate the smooth muscle that actually contracts to create a good poo. So it helps us with that movement, and sort of regulating it. And also it can reduce sensitivity.
Probiotics produce Short Chain Fatty Acids
Some probiotics have been shown to reduce bowel sensitivity and many of these probiotics, these good helpful bacteria, produce short chain fatty acids which are the byproducts of the bacteria metabolizing fibre from our diet.
And this helps to stimulate motility and reduce inflammation. These short chain fatty acids are fuel for the colon cells. They help to create a healthy colon. They’ve been actually shown to travel around the body as well and reduce inflammation more systemically.
So they’re definitely good things that we want more of. By adding in probiotics to create more of these short chain fatty acids, sometimes that in itself can change the environment. That could lower down the pH, making it more acidic, which then means more probiotics want to grow and hang out in your gut.
You need to support the probiotics with your diet
The thing is, though, you have to eat fibre in order for them to want to hang around. If you’re not eating fibre that can be fermented by the bacteria, they aren’t going to stay.
They can’t reproduce and multiply and make your gut their home. So it’s important to add fibre. And add some prebiotics if you aren’t eating any fibre. Ideally, you’ll get this through your diet though.
When are probiotics a good idea?
- A good time to take probiotics is during or after you’re taking antibiotics. Because if you’re taking some systemic antibiotics that knock out your good bacteria. It’s a good idea to replenish them. And you can take them alongside antibiotics, but don’t take them at the same time. Normally a couple of hours apart.
- After doing the low FODMAP diet or any other strict elimination diet because you may have reduced some fermentable fibers.
- And if you’ve taken some SIBO antimicrobial treatments such as oregano oil or berberine something like that It can also be good to replenish the good bacteria because they are also antimicrobial.
So these are some situations where you might want to consider it, but probiotics aren’t for everyone.
Who shouldn’t take probiotics
They shouldn’t ever be taken by anybody who’s immunocompromised. If you’re taking any chemotherapy drugs or immune suppressing medication, for example, for arthritis or something like that.
Probiotics for constipation
There are some particular strains for constipation which are helpful, so it’s been shown that some Lactobacillus reuteri DSM 17938 is good at lowering methane and some bacteria can also help to increase bowel frequency or like regulate your digestion so Bifidobacterium lactis particularly the strains BB 12 and also Lactobacillus rhamnosus.
That works best when it’s got some prebiotic fibers, the fructooligosaccharides, alongside it. And then other things that help to increase transit time, the duration of food being in your body. Bifidobacterium lactis HNO19 and also Bifidobacterium animalis subspecies lactis has also been shown to improve transit time.
Digestive enzymes for IBS
Let’s move on because I’ve got a lot to get through and I’ve only just started on the probiotics. So I want to move on to digestive enzymes. These help us to break down fats, carbs and proteins. You have your own production of digestive enzymes every time you eat something in the small intestine.
These are created to help us break down nutrients in our food so we can better absorb them. Some people don’t make them as well.
If you’ve heard the dairy episode, you might have heard me talk about lactase. Which is to break down the lactose sugar. That is one enzyme that you can have more or less production of.
It’s the same with some other enzymes as well. So, for example, you might have slightly lowered production of lipase that breaks down fats. That could affect the way you digest fatty meals. Some people will feel better taking a digestive enzyme with their food, to help aid their digestion.
Avoid digestive enzymes with gastritis
One thing I would say though is if you’ve got gastritis or a very raw stomach. High up in your abdomen and it feels very raw all the time. Even if you haven’t ever been told you’ve got gastritis. Then do take care with taking any enzymes with protease in them that breaks down the proteins. This can start to get to work on the lining of your stomach and it can actually cause more irritation.
FODMAP specific enzymes
Some digestive enzymes are specifically targeted at breaking down high FODMAP meals. These don’t necessarily contain lipase, for example, to break down fat, but will be specifically targeting lactase to break down milk products, and alpha galactosidase to break down the starches in beans, for example, raffinose.
These have been targeted to help you digest high FODMAP meals and may be helpful to take sometimes.
I don’t recommend people should take digestive enzymes alongside the FODMAP reintroduction process, and that is because you won’t get a good sense of your own body’s digestion if you’re taking enzymes which also help you break down the foods.
Partially Hydrolyzed Guar Gum for IBS
Something else I want to come on to is partially hydrolyzed guar gum or PHGG. This is a prebiotic which helps to feed the good bacteria, and it’s sometimes used like as a thickener in foods. Guar gum. You might see it as a food additive to make things more gloopy or…
It’s well studied for IBS and it can help with a sense of that incomplete evacuation by sort of regulating your bowel movements and it has sometimes been shown to reduce the need for laxatives.
It’s also good for people who have IBS-D, so it’s not just a constipation type supplement. I really like it because it’s a prebiotic, which means it’s just a fibre, so it can be used in hot foods. You can add it to warm water, you can even bake with it and put it in your foods.
Some people do find it gives them a little bit of gurgling and bloating at first. I always suggest starting with a really low amount, like quarter of a teaspoon per day just for a couple of days. Settle yourself into it. If it’s okay, then you can increase the dose. Otherwise, just stay really low or back off it until you are at a better place with your gut health.
PHGG helps feed your gut bacteria
The reason I like it is because it feeds the good beneficial bacteria which can help you to get a more regular bowel movement and just to reduce some bloating and sensitivity.
The only other thing to say is that you must take it away from medication because it is such a high fiber food. Sometimes it can reduce the absorption of key supplements or medication.
So make sure it’s like an hour or two away from important medication that you’re taking.
Digestive bitters as a supplement for IBS
I sometimes suggest using digestive bitters for people who may not be producing enough stomach acid. How would you know if you don’t create enough stomach acid? Well, you might feel like food sits particularly heavy in your stomach and doesn’t get well digested, particularly protein, so if you eat a heavy meal full of meat, you may find it just sits heavy in your stomach for ages.
This would be a case where it might be worth trying bitters to help stimulate your own digestive juices before a meal.
How to take digestive bitters to improve digestion
Ideally, you want to do this 10 to 20 minutes before you eat by taking the very bitter liquid, so it’s either in a tincture that you put into some water, or you drop it directly on your tongue, or there are some products where you actually spray it into your mouth.
This stimulates your own digestive juices and helps you to get ready for digestion. You find in some places on the continent, for example, they’ll have an aperitif. Or produce a bitter salad with endive or rocket or something like that. If you don’t want to have a digestive bitters supplement, you can just try that.
Sometimes people use apple cider vinegar, or you may just have like a small salad of very bitter green vegetables. This can do some things very similar. The reason it’s good is it just stimulates your own digestive juices, gets you better ready for, the meal.
Don’t take hydrochloric acid supplements
Some old advice was to take hydrochloric acid supplements to try and boost your stomach acid and I don’t normally suggest that for most people. I would rather try and stimulate your own production of stomach acid at the right time rather than adding in supplemental hydrochloric acid, in a tablet form.
And some of the advice used to be to take it until you feel a burn and again. I don’t think it’s necessary and I’m not sure that that would be safe. I don’t recommend doing that.
Saccharomyces boulardii can help with IBS-Diarrhoea
Now, the last supplement I want to touch on today is Saccharomyces boulardii. This is a beneficial yeast.
So in the same way, we take beneficial bacteria as a probiotic this is very similar. But it’s just actually a yeast. It’s not a yeast like Baker’s yeast which makes your bread rise and it’s also not a yeast such as candida. Which you may have heard of in terms of you know, negative consequences of gut health.
It’s often used for antibiotic caused diarrhea And it’s great for helping to crowd out pathogens. So what I mean by that is when you take this it’s still transient. It doesn’t stay in your gut forever, but it goes into your gut and it takes up space. It kind of tries to crowd out bad bugs.
A travellers probiotic
And this is why it’s sometimes called, the traveller’s probiotic. Because people can take it as a preventative protection when going somewhere where you may come into contact with unclean water. You might want to take this in the run up to a trip abroad, in order to stop yourself getting ill.
It’s generally very well tolerated and it’s great for people who have frequent stools and very loose stools. I tend to use this quite a bit with people who have diarrhoea to regulate the amount of times that people will go.
This is one of the reasons it’s not always recommended for people who have constipation. But it’s not to say it would be bad for you to take. It’s just that we don’t have the same level of evidence supporting its use.
Summary of IBS supplements episode
I hope that you found some of this interesting and helpful.
I may do another podcast episode on more general supplements that I would often consider for my clients. But I just wanted to focus really on gut health supplements today. And these are some of the main ones that I will use. However… Not all of these will be suitable for you, so please make sure you check with a registered nutritional therapist or registered nutritionist. because not all of these supplements will be suitable for everybody.
Okay, I’m going to leave it there for today. So, thank you for listening and if you like my podcast, please don’t forget to subscribe so that you get each episode in your feed each week.
See you then, bye!