There are two important things to note about this potentially debilitating condition. First, people with irritable bowel syndrome (IBS) are more likely to also have celiac disease and lactose intolerance than people without IBS.
Recent research also suggests the rate of functional dyspepsia (abdominal fullness, pain, bloating, and heartburn) is higher in those with IBS, too. So if you’ve been told you have IBS, get checked for these other problems because treatment for these issues can sometimes improve IBS symptoms as well. People with IBS are not any more likely to have colon cancer or inflammatory bowel diseases, such as Crohn’s or ulcerative colitis.
Second, there used to be a prescription IBS drug that helped alleviate constipation (by improving gut motility), but it increased the risk of cardiovascular disease and was removed from the US market. The name is not important (okay, you got it out of me: It was Zelnorm), but people ask me all the time if I have any contacts outside the country who can get it! The point is, IBS can be so life-altering that people would actually risk getting heart disease just to get some relief.
However, I’m happy to report that there are heart-safe IBS supplements out there that are so widely used that they’re part of the standard of care by doctors in many cases. So you don’t have to risk heart disease. I’m hoping that physicians will begin to embrace the supplements in this section as a result.
What is Irritable Bowel Syndrome?
If you talk to 20 different people with IBS, each person would probably have a different definition of it, but the description that doctors have generally agreed on is abdominal discomfort or pain (cramping or bloating) associated with changing bowel habits. It must have occurred at least several days per month for 3 months and cannot be attributed to some other organic disease or condition.
Abdominal pain is definitely the most common (and bothersome) IBS symptom; if there’s no pain, then in most cases it’s not IBS. Other common symptoms include gas, malaise (feelings of serious illness), muscle pain, and urgency. Overall, IBS can have a significant negative impact on quality of life.
No one really knows what causes IBS, but it’s most likely due to several factors, including gut hypersensitivity, abnormal gut movements, inflammation, genetics, serotonin neurotransmission, and intestinal bacteria. Stress, anxiety, and a hectic lifestyle can make symptoms worse, which is why IBS is sometimes called nervous colon or spastic colon.
Women suffer from IBS more than men (2:1 ratio), and they’re more likely to suffer from the form of IBS where constipation is the predominant symptom. It’s more common in developed countries, and India has one of the lowest rates of IBS (no one knows why).
Treatment is complicated because IBS can take different forms; that’s also why it’s a highly underdiagnosed condition. An estimated 10 to 20 percent of the global population could have some form of it.
There are four primary subtypes of IBS:
- IBS with primarily constipation (IBS-C)
- IBS with primarily diarrhea (IBS-D)
- Mixed IBS (IBS-M or IBS-A), with alternating constipation and diarrhea
- IBS un-subtyped (IBS-U), not enough stool consistency to meet criteria for IBS-C, IBS-D, or IBS-M
Irritable Bowel Syndrome Home Remedies
1. Peppermint oil 450 to 1,100 milligrams a day before meals for all types of IBS
Peppermint oil (from the plant Mentha piperita) contains menthol, which is an antispasmodic. It reduces contractions of the gastrointestinal tract, resulting in less cramping and bloating.
No supplement in the history of dietary supplements has more positive research for all types of IBS than peppermint oil capsules, but only if they’re enteric coated and pH dependent. This is the most important thing to take away about peppermint oil! Pills that are enteric coated and pH dependent (delayed release) won’t dissolve until they have passed through the stomach and have encountered an intestinal pH of 6.8 or higher.
Without these two things, peppermint oil is not very effective for IBS, and it can make acid reflux, if you have it, worse (heartburn is a common side effect with nonentericcoated brands).
Look for the product Colpermin, which was tested in several Swiss studies, and take it 30 to 60 minutes before meals. These clinical studies found that people with IBS who took peppermint oil experienced less abdominal pain (the most consistent finding), bloating, feelings of incomplete emptying, urgency, frequency, flatulence, and rumbling/gurgling noises.
IBS-D patients might even see a greater benefit from peppermint oil because they tend to experience more abdominal pain and cramping. One caution for those people who have allergies to peanuts or soy: Check the ingredients in peppermint oil capsules because some may contain an oil (arachis) found in peanuts or soy.
2. Bifidobacterium infantis 35624 one capsule a day for all types of IBS
This particular bacteria strain is sold under the product name Align. Studies have shown that it’s most beneficial for reducing abdominal pain and discomfort, bloating and distension, straining, feelings of incomplete evacuation, and bowel movement difficulty.
Again, in my experience, IBS-D types get the most benefit since they have more pain, but mixed IBS sufferers can get some relief as well. Align did not impact stool frequency in studies, but it helps in many other ways, so it’s worth it. (The rate of side effects was low or similar to a placebo.) It can be stored at room temperature, and it can be taken without a meal. One capsule contains 1 billion colony-forming units (or CFUs). If you want to increase to two capsules a day, talk to your doctor.
There are plenty of probiotic supplements on the market claiming benefits or being tested for IBS, but the studies have not been long term. Another individual probiotic strain beginning to get some good research right now with IBS is Saccharomyces boulardii, so keep your eye on this one, too.
3. (tie) Fiber supplements 10 to 15 grams a day in divided doses for IBS-C primarily
Fiber supplements are known as bulking agents because they absorb water into the intestines and encourage more contractions (peristalsis), which IBS-C type sufferers need. Psyllium powder (10 to 15 grams per day in two divided doses) has been shown to improve regularity and consistency of stools and lessen abdominal pain within 3 months.
Each tablespoon usually contains 3 grams of fiber (2 of which are soluble); check to make sure the product is gluten free (less than 20 ppm gluten) just to ensure a smooth trial period.
Other fiber supplements, such as methylcellulose (Citrucel) and polycarbo-phil (FiberCon), as well as dietary fiber (like the kind found in cereals and bars) may also be beneficial. Psyllium has the most support in terms of research and improvement of overall symptoms, though, so it is my first choice.
Fiber is ranked third overall in this section because it has not been as consistently effective as peppermint oil, and in some cases it increases bloating, abdominal dis-tension, and gas. Yet it can also provide numerous heart-healthy benefits, such as normalizing blood cholesterol and sugars and increasing the amount of healthy bacteria in the intestines. (This could worsen abdominal discomfort and bloating in IBS-D patients.)
3. (tie) Loperamide up to 16 milligrams a day for IBS-D primarily
For the sake of this article, I consider loper-amide (Imodium) to be a dietary supplement; this is because it was potentially derived from natural sources and your body thinks it’s a plant as well (it attaches to certain receptors in the intestines that normally bind other plant-based products). It works by blocking specific receptors in the GI tract, which slows the movement of the intestines so that more water is absorbed, thus reducing diarrhea.
It’s typically used for IBS-D, and while studies have reported benefits for all sub-types (it can reduce pain and most other symptoms), I personally never recommend it for IBS-C types because it can make constipation worse. Patients generally take an initial 4-milligram dose, followed by 2 milligrams every 4 hours, with a maximum dosage of 16 milligrams daily. Loperamide can be taken for about 12 hours after normal stools begin again, but no longer than that; chronic use can alter the functioning of the GI tract.
If you have trouble taking pills, 7.5 milliliters of liquid loperamide (usually for kids) supplies about 1 milligram of the medication.
A word of caution: Imodium is an opioid receptor agonist, so you don’t want to take an opioid, such as codeine, at the same time because it can intensify the sedative side effects and cause a potentially serious drug interaction.
Melatonin relaxes the intestinal tract, reducing pain and bloating and increasing or regulating motility, so it’s probably better for IBS-C versus IBS-D types. It may also reduce anxiety and stress and have anti-inflammatory effects—all of which help IBS. Several trials have found that taking melatonin (usually 3 milligrams) before bed may reduce abdominal pain in people who suffer with IBS and sleep problems.
5. Artichoke leaf extract
Artichoke leaf extract (Cynara scolymus) can significantly reduce multiple IBS symptoms, including abdominal pain, cramps, bloating, flatulence, and constipation, especially for people with mixed-type IBS. But in some people it can also cause flatulence. The typical dose is two 320-milligram capsules three times a day. This supplement appears to favorably impact colon bacteria, and it may also have antispasmodic effects, but I’d like to see more research on it.
6. Calcium glycerophosphate (Prelief brand and generic)
Calcium glycerophosphate (Prelief brand and generic) is an acid reducer that you take immediately before or during meals (two capsules maximum or 1⁄4 teaspoon of powder). It has helped many people with painful bowel and bladder issues whose symptoms are exacerbated by acidic foods.
What Supplements Are Useless For Irritable Bowel Syndrome?
It’s supposed to reduce constipation and improve motility, but results have been inconsistent. Plus, many aloe products are now diluted. My experience with this product has been hit or miss and I say pass.
Common fumitory or earth smoke
This herbal supplement for IBS scares me because of its potential for toxicity. Plus, it hasn’t worked better than a placebo in studies anyway.
This plant-based supplement has helped some individuals with IBS-D, but it was a tiny study and the results were weak, so until the findings can be reproduced, I don’t recommend it.
St. John’s wort
People commonly take this for depression, and it might reduce pain and stress (which is why IBS patients are frequently given prescription antidepressants). In one of the best studies to date, however, St. John’s Wort did not work better than a placebo for people with diarrhea- or constipation-type IBS.
Researchers have seen some reduction in IBS-related abdominal pain with anywhere from 72 to 144 milligrams of turmeric extract taken over 8 weeks, but they found no difference in effectiveness between the two doses. Plus, there have been no placebo-controlled trials published over the past decade, so I’m skeptical that it works any better than a placebo. In fact, even though it’s an anti-inflammatory, I’ve had some people complain of abdominal pain when taking this supplement for arthritis. I’m much more excited about turmeric as a spice for cooking.
What Supplements Are Suitable For Kids to Treat Irritable Bowel Syndrome?
IBS increases in prevalence from elementary to junior high to high school, where some surveys suggest it is as common as it is in middle-age adults. Peppermint oil supplements may reduce abdominal pain in kids (8 to 17 years old) with IBS, based on previous studies where it was used for 2 weeks.
One well-done study used 187 milligrams (or 0.2 milliliters) of peppermint oil in an enteric-coated, pH-dependent, hard gelatin capsule (Colpermin was one brand tested). Kids weighing more than 100 pounds received two capsules three times a day, and kids who weighed between 65 to 100 pounds received one capsule three times a day.
Pain reduction and improvements were observed in about 70 to 75 percent of the kids taking peppermint oil and 20 to 45 percent of the kids taking a placebo.
Remember: Peppermint oil can cause heartburn, and when used in higher dosages than recommended, it can cause abnormally slow breathing (respiratory depression), so the recommended dosage should never be exceeded and children should always take it under the guidance of a pediatrician.
Some small studies with probiotic supplements, including Bifidobacterium infantis and Lactobacillus rhamnosus GG, showed improvement in kids’ overall IBS symptoms, like abdominal pain and bloating. However, talk to your doctor about the latest research because it’s a moving target right now.
What Lifestyle Changes Can Help With Irritable Bowel Syndrome?
In one of my favorite studies, people with all types of IBS who exercised three to five times a week at a moderate to vigorous level (20 to 60 minutes a session) showed an improvement in IBS symptoms. The biggest finding was that it prevented IBS from getting worse.
Work with a nutritionist who specializes in IBS
This specialist will likely suggest an elimination diet, which involves removing certain foods to see if symptoms improve (see the section about avoiding FODMAP foods below). These diets take 3 to 4 months to complete because they also involve a reintroduction phase, where potentially offending foods are slowly added back to see if symptoms return.
In some cases, testing for food allergies might be appropriate, but they generally aren’t a big contributor to IBS, except when it comes to gluten. I believe if you have IBS, you should be tested for celiac disease and nonceliac gluten sensitivity. Finally, studies have suggested that people with IBS tend to have diets that are low in calcium, phosphorus, magnesium, vitamin A, and vitamin B2, so make sure you look for foods or a basic multivitamin that supplies these nutrients.
This can have a dramatic impact on IBS symptoms. Learning relaxation techniques and how to deal with daily stressors is hugely important, both for IBS and your quality of life in general!
Avoid FODMAP foods
These are fermentable oligosaccharides, disaccha- rides, monosaccharides, and polyols, all of which are poorly absorbed carbohydrates. Fermentable carbohydrates are not absorbed well in the intestines, and they’re active in the gut, causing bacterial fermentation, which can lead to excess gas, bloating, and loose stools. In other words, they can make all types of IBS worse. A gastroenterologist or nutritionist should be able to give you a list of FODMAP foods. Fermentable carbohydrates include:
- Fructo-oligosaccharides, which are found in wheat and onions
- Galacto-oligosaccharides, found in beans, peas, lentils, and chickpeas
- Disaccharides, such as the lactose in milk and other dairy products
- Monosaccharides, which include foods that have fructose in them, such as honey, fruit juices, some fruits (apples, pears, mangoes, and canned fruit), high-fructose corn syrup, and many processed foods
- Polyols, such as sorbitol in various fruits and veggies, polyol-sweetened “sugar-free” manufactured foods and medicines, and resistant starches (such as green bananas and cold or reheated potatoes)
What Else to Know About Irritable Bowel Syndrome?
You may have to experiment with all sorts of treatments—what I call guinea pig medicine—until you find the one product that makes a difference for you.
For example, I have seen men and women have zero success with several different approaches and then respond to a product like Beano, an over-the-counter supplement that is an antifoaming agent in the intestines. You just don’t know what might work, so you have to be willing to try anything.
Here are some of the many conventional over-the-counter and prescription drug options that help reduce pain, constipation, or diarrhea for IBS patients.
- Over-the-counter laxatives: Polyethylene glycol can be used for IBS-C.
- Antibiotics: Rifaximin is a great newer option for IBS-D. It’s not absorbed into the body; it stays in the GI tract and may work by resetting the gut bacteria (some people with IBS have altered gut flora, so it’s kind of like a reboot button).
- Antispasmodics: Hyoscyamine and dicyclomine can be used for all IBS types.
- Antidepressants: These can be used for all types of IBS. Antidepressants impact receptors in the gut and perhaps in the spinal cord to reduce abdominal pain, but they also stimulate gut motility, so they may be better for IBS-C types.
- Certain IBS drugs: Lubiprostone and linaclotide are both FDA-approved for IBS-C. They affect a specific area of the intestines to promote fluid secretion, which allows stools to move more easily.
- Serotonin (5-HT3) antagonists: The generic drug alosetron has been used for women with severe IBS-D to slow intestinal movement or motility so more water can be absorbed from the stool, relieving diarrhea.
- Stool softeners (like docusate): These are also helpful for constipation from IBS, especially if you have to strain to go.