Episode 121 Transcript – Supplements for IBS

Leah:

Hello and welcome to the Ideal Nutrition Podcast. I’m Leah Heigl and I’m here with my co -host Aiden Muir. In today’s episode, we will be talking about supplements for IBS management. So for a little bit of background, in this podcast, we will be covering all forms of IBS. So not really specific to diarrhea or constipation or mix. We’re going to be going over everything and the supplements we think might be helpful.

We have talked about IBS in quite a few other episodes, but ones you may want to check out if this is of interest to you is episode seven, which was on FODMAPS and IBS. And then episode nine, which is what to do if FODMAPS doesn’t work for you. But otherwise let’s get into it.

Aidan:

So the first go -to supplement I recommend to a lot of people is Metamucil slash psyllium husk. So psyllium husk is a form of fiber and Metamucil is just made from psyllium husk basically. So Metamucil, psyllium husk, interchangeable things. It can help with both forms of IBS. It can help with constipation and diarrhea. Part of how it does this is because psyllium husk is a specific type of soluble fiber. So from the constipation’s perspective, I’m always hesitant when I recommend Metamucil to people that the first thing they’re gonna think is that’s just a fiber supplement and that’s all it is and they could just increase their fiber.

But it’s like it’s a specific form of fiber that, particularly for constipation, outperforms pretty much every other form of fiber, including other forms of soluble fiber. The reason it does this from a mechanism perspective is that it absorbs water and makes it a bit of a gel -like substance that makes it easier for the stool to pass.

But from an outcomes perspective, 10 grams of psyllium husk per day often improves all symptoms of constipation by about 50 % on average. One of the reasons why I highlight all symptoms is because some studies, for example, if people massively increase their insoluble fiber intake, they will notice an increased frequency of going to the bathroom, which if looked at in isolation could be looked as a huge improvement, but other symptoms could get worse. Like they could have worse gas, bloating, incomplete evacuation, straining, etc.

Addressing the constipation also is very likely to address the gas imploding too because there won’t be as much blocked or trapped gas because it’s easy to pass through. And so Metamucil and psyllium jusk are well known for constipation. Something that they’re less well known for is that they can also help mild to moderate diarrhea because of that same soluble fiber mechanism of absorbing or soaking up some of that water. So it can help with both ends of the spectrum as well.

Leah:

The next one that might be helpful to you is peppermint oil. So peppermint oil contains menthol, which can help the intestines relax. And then because those intestines are relaxed, it can allow the trapped gas to pass through more freely. So it’s particularly known for its benefits to bloating. But the relaxation of the intestinal muscles can also reduce nerve related pain.

So, in terms of outcomes from peppermint oil, we’re particularly looking at potentially a reduction in bloating, but also stomach pain related to IBS symptoms. From a stool perspective, not so much on the diarrhea front, but since trapped gas can compact fecal matter causing constipation, reducing the amount of gas that is trapped in the intestine could potentially help with overall constipation management. So a little bit of an indirect link there, but it could be a beneficial kind of side effect of that.

In regards to research, the most extensive review of peppermint oil included data from over 800 patients from 12 clinical trials. So quite a bit of research there. And that review showed IBS symptoms were 44 % less common in patients who took peppermint oil compared to those who took a placebo. So based off a very small intervention, that’s quite a lot of patients that are seeing an improvement in overall IBS symptoms.

In regards to how you want to take it, it is quite specific in how it’s dosed. So for adults, a dosage of 0 .2 mil to 0 .4 mil of peppermint oil taken a few times per day in the form of coated capsules works best usually. So something like your Mintec tablets, which can be found at pretty much any chemist in Australia. I’m sure there’s other brands as well, but that’s the one we kind of have access to. We don’t want to take peppermint oil not in a capsule just because there is that kind of risk of it burning the esophagus and having other not so great side effects. So capsule form works best.

Something else to note is that, peppermint tea, unfortunately, is not as effective. So there’s likely just not as much of that active ingredient in regards to menthol and peppermint tea, as opposed to taking those peppermint oil capsules. And then in regards to symptoms, the only well -cited or well -known symptom from this is reflux. So there is a potential for some people that reflux may occur after taking the peppermint oil.

Aidan:

One other area where I quite like peppermint oil and you could also extend this to metamucil as well, is for people who experience constipation when they travel specifically, like whenever there’s a change of routine or anything like that, it’s a nice, easy addition that can kind of help with symptoms for traveling, as well as like everyday usage as well. But like there are certain people who have worked with constipation, it’s like when they’ve got their routine, they’re sticking to the nutrition we’ve got and everything like that, they can play fun when they’re at home. And so when they go out of routine, things become an issue. And that’s where I like to add it in to..

Aidan:

Another thing is probiotics. So probiotics have mixed research on this topic, but the research on average is positive. And there’s a few key takeaways as to why I am excited about probiotics and how they can help with this. So first thing, there’s obviously different types of bacteria and they are theoretically helpful for different things. The most common and well -researched species are Lactobacillus and Bifidobacteria, both of which happen to be lower on average with people with IBS.

Like if you just went through looking at research on the microbiomes of people with IBS, and you saw these kind of like, I don’t want to say deficiencies, but lower amounts, you could see that it kind of makes sense that the dressing that could theoretically help.

In terms of the effectiveness though, as I said, the research is a bit mixed. The most recent review was in 2022 and it highlighted on average they have, they can provide benefits. You can see that review in the show notes, but one I’m going to talk a little bit more about is a tiny bit older than that. It was at least 2016 or 2017, I believe and it was a review from the British Dietetic Association. The reason why I’m going to talk about that is just because I’ve done a massive deep dive on it and know it really well. And they had some key findings that I think make it easier to understand.

Of the 29 studies they assessed, 14 of them showed a positive result. That means just under 50 % had a benefit. That’s obviously worthwhile when you’re thinking about how this could relate to you being like, maybe it might help, maybe it might not help. But the ones that didn’t show a benefit, so the other 15 studies, they didn’t show a downside. It was just like, once again, it might help, it might not.

And we could spend time digging into specific strains that are most linked with benefits, because if you went through that, you’d find that kind of stuff. But that would be a whole podcast by itself. Once again, in the show notes, we have a blog post on that. If you wanted to start probiotics and you wanted to optimize this, I’d recommend reading that blog post.

But I’m taking a moment here as to why I am more excited about this. Of the 14 studies that showed benefit, 10 different strands of probiotics were used. So, every single one of these studies to the best of my knowledge from my memory only used one strain in each study. If you were to get a probiotic supplement, you would find multiple strains in there.

That’s kind of a reason for excitement because one, maybe the product is more effective than what we’re seeing in research because they’re using multiple strains whereas research is only using one strain. But two, the other reason why it gets me excited is that like if each study uses just one strain each and of those 14 studies, 10 different ones were used, that therefore means only a couple of strains have been tested more than once.

How do we identify the optimal protocol? Obviously we would want to be testing different dosages and once you’re looking at multiple strains you’d want to be looking at multiple combinations of strains. So basically the reason this is kind of exciting is it’s like, okay, right now about 50 % of studies are showing benefit. What if we played around with different dosages? What if we played around with different combinations of strains? Surely we could get it to the point that it has a larger benefit than we’ve seen in the research so far.

Leah:

Yeah, so much more to play around with there. The next thing we’re going to talk about is a little bit more of a broad topic and that’s just in regards to digestive enzymes. So digestive enzymes can be a tricky space since there are a lot of people and a lot of companies pushing them unnecessarily and without any kind of helpful context. But if you use specific ones that are you know, targeted at specific issues that you’re having, they could be beneficial.

So a really great example of this is the lactase enzyme for lactose intolerance. A really common one here in Australia is lacteeze. So we know taking that alongside lactose containing foods, if you are lactose intolerant is going to be beneficial.

Something else is sucrase for CSIDs that sucrase isomaltase insufficiency or deficiency. So taking a sucrace enzyme when you’re having sucrose as well as something like starch away when you’re having starches because that particular condition is an insufficiency or deficiency in those particular digestive enzymes. Supplementing those enzymes with foods that are high in those things required that require those enzymes is going to reduce symptoms. So again, it’s like a very specific supplement and digestive enzyme for a very specific situation.

Something else is Creons. So Creons requires a prescription for conditions where the pancreas cannot produce enough of those digestive enzymes. So again, when you take Creons alongside foods that may cause you symptoms and you’re replacing those digestive enzymes, that can be useful.

There are other enzymes that also exists in the FODMAP space. A company that’s kind of like really I guess paving the way in that in that area is intoleran and so they’re an example of someone who does sell these different digestive enzymes for FODMAPs and they also sell something for lack like lactase and they also sell something similar to starch away and something something similar to sucrase.

So they’re doing kind of a whole host of things but the kind of theory is that you want to choose again the enzyme that you’re deficient in or you’re lacking to process like specific foods. So whilst it might be, you know, you could just like gunshot, try all of these and then maybe by chance you figure out what you’re, what you are reacting to from an IBS perspective, I don’t know if that’s necessarily the best way to go about it.

AidanL

Yeah. And like, I guess finances is also a factor. With those products I’ve had clients who, once again, get excited and then they like do the maths and like, hang on, it’s expensive. Yeah, all that up. So it’s like, yeah, finance would be a factor if you just gunshot a first just testing everything.

Leah:

Yeah, like $60 a bottle and you’re trying all these different things. Probably not the most budget friendly.

Aidan:

So I would say those those three areas, that’s three areas. Yeah, those. Yeah, four, four, four. Those four areas are the main ones, but there’s some honorable mentions that are that we want to go through as well.

So, the first honorable mention that I’ll start with is Iberigast. So not one I have a strong opinion of, but we’ll talk through it. So Iberigast is a product in Australia, I don’t know if it’s international. I assume it is international. It’s made up of around nine different plant extracts, including things like peppermint, licorice, and chamomile in a certain ratio. So it would be a blend in there.

Quite a few studies exist on this product with positive findings for all symptoms of IBS and reflux as well. And the way to take it is three times per day before meals. One quick caveat on those studies is obviously they are done by the company. Because they’re studying their product in the ratio that they have created. I wouldn’t read too much into that, but based on the research that they have done, it has all been positive.

I just want to mention that because it’s also a tiny factor into why I put in the honorable mentions category rather than just the general kind of category. Because if something had heaps of research supporting it, it’d probably be in that kind of general category.

Leah:

Yeah, I’ve actually taken that before. Yeah. And the thing that turned me off was that having to take it multiple times a day and the taste. But I think if I stuck with it and it worked, it would have been great. I just didn’t stick with it.

So another honorable mention is De-Gas. So De-Gas helps reduce symptoms of gas and bloating, so a little bit there in the name, by helping break up gas bubbles in the gut. Not really something that I utilize with my clients, but it is something you could definitely try. It’s not that expensive and it’s pretty easily accessible.

Aidan:

Yeah. It’s also not something I’ve used either, but it’s on my radar. It’s just, there’s so many options as well.

Leah:

Yeah, there’s so many options. I’ve just not really heard many people use De-Gas. I’m like, if it worked really well, I feel like we would have heard a little bit more about it.

Aidan:

Yeah. Another bit of a niche one is L -glutamine. I’ve actually had a lot of clients come to me with positive experiences with it, like even before I’ve recommended or anything like that. But glutamine, for context, is the most abundant amino acid in the body already. Theoretically, it can help support the gut wall, reduce intestinal permeability, and also help improve the gut microbiome a little bit as well.

Some researchers found that it helps, but there’s not heaps of research on it, which is why it’s an honorable mentions kind of category. But as of once again, 2023, here’s at least three studies out, maybe four, there’s three studies that are quite positive. One of them was done on post -infectious IBS and they found something like a, it was a 79 .6 % kind of significant improvement in symptoms in the glutamine group and in the placebo group it was like a 5.8 % improvement. And like that’s super, super positive, but glutamines most likely to be beneficial in that kind of post -infection state.

There’s another study where they did it and I don’t think this will be in the show notes because unless Josh has switched on as he’s doing the show notes, somebody else does that show notes, but because I’m doing this on the top of my head, but there’s another study that they did on the low FODMAP diet versus the low FODMAP diet with L -glutamine and the one with glutamine, they got about 58 % improvement, whereas the one without glutamine, they got like a 40 something improvement.

And then the other one was comparing glutamine to whey protein. And once again, whey protein had like minimal improvement. Like it’s just unrivaled, that was just a control, and the L -glutamine had a significant improvement as well. So it’s like three studies all have had a significant improvement.

The only reason that’s not like a sure fire main kind of recommendation is just because it’s only three studies. And if we like really, if we came to strong conclusions about any product just based on three studies. we’d be recommending a lot.

Leah:

We’d be recommending a lot. Yes. Yeah, but I know L -glutamine is one used by naturopaths a lot, specifically in that leaky gut space, so it’s quite popular there. Another honorable mention, magnesium citrate. So this is mainly known for its laxative effect. When you’re taking 300 milligrams or more of magnesium citrate, it can often have that laxative effect, which can be beneficial for constipation. So it’s one of the many ways to kind of relieve constipation, but that’s why it’s kind of an honorable mention.

Aidan:

And then the final honorable mention is vitamin D. So there’s super clear data showing that people with IBS on average have lower levels of vitamin D. But that’s not really a strong enough link by itself because we get the vitamin D from the sun. Typically that’s the largest place we get it from. And that could just be completely unrelated. Ideally, to come to a strong conclusion about this, we would need a bunch of research showing that people who are previously vitamin D deficient, measure their symptoms, address the vitamin D deficiency, measure their symptoms again and see improvement. That’s kind of what we’d need.

So when I last checked that research, which was last year was the last time I checked that. So 2022, there were four studies looking at that and three of the four found benefits to increasing vitamin D levels. So I’m not super, super high on that, but it is just another thing. And I think.I think most people should check their vitamin D and look at addressing that if it was low anywhere. So it’s just another reason amongst many to kind of check that.

Leah:

That wraps up episode 122 of the Ideal Nutrition podcast, exploring supplements for IBS. If you haven’t yet left a rating or review, it would be greatly appreciated for you to do so. But otherwise, thanks for tuning in.