What is IBS? Symptoms, Types, and 6 Natural Supplements
By Eric Madrid MD
In this article:
Irritable bowel syndrome, also known as IBS, is a gastrointestinal disorder that affects millions of people around the world. It is estimated that up to 11 percent of the global population has the condition, with women experiencing IBS more often than men.
IBS may present with some or all of the following symptoms:
- Abdominal pain
For many with IBS, symptoms aren’t always consistent, and they can come and go day by day or week by week. Some notice a reduction of pain-related symptoms after a bowel movement while for others, pain can be worsened. Because there are so many variations in symptom type and frequency, solutions and treatments must be tailored to individual needs. What works for one person may not work for the next.
Gastroenterologists, or IBS specialists, have set forth certain requirements to accurately diagnose IBS. These are referred to as the Rome IV criteria. IBS is diagnosed when recurrent abdominal pain has been present at least once per week over the previous 12 weeks. In addition, abdominal pain must be present along with two or more of the following:
- Bowel movement
- Change in stool frequency
- Change in stool form
Types of irritable bowel syndrome include:
- IBS-D – IBS with diarrhea being predominant
- IBS-C – IBS with constipation being predominant
- IBS – Mix of both diarrhea and constipation occurring, usually in an alternating fashion
Risk Factors for IBS include:
- Leaky gut syndrome
- Dairy sensitivity or lactose intolerance
- Wheat/gluten sensitivity
- Use of artificial sweeteners
- Overuse use of antibiotics
- Family history of IBS
Certain conditions are commonly seen in those with IBS. It is believed by many functional doctors, myself included, that many of the conditions listed below occur due to suboptimal intestinal health. Commonly, I have seen people reverse many of the below conditions once they focus on optimizing their digestive health.
- Acid reflux
- Chronic fatigue syndrome (systemic exertion intolerance)
- Migraine headaches
- Auto-immune conditions
There are many medications that can be prescribed by physicians for IBS. These include:
- Lubiprostone – Helps treat those with constipation-predominant IBS
- Linaclotide – Helps treat those with constipation-predominant IBS
- Dicyclomine/Hyoscyamine – Used for those with spasms in the colon
- Antidepressants – Various classes of antidepressants may be beneficial, likely by restoring serotonin balance to the intestines
- Loperamide and Imodium – anti-diarrheal
- Rifaximin – This is a “non-absorbed” antibiotic which can help “reset” the gut by killing harmful bacteria. It’s important, however, to improve diet and repopulate with probiotics or the same symptoms will continue to repeat ever after treatment.
Those who practice functional medicine utilize the 5Rs to optimize intestinal health: Remove, Replace, Reinoculate, Repair, and Rebalance.
Remove pathogenic organisms and harmful foods to which one is sensitive. For many, these usually include dairy, wheat (gluten), and possibly corn and corn-related products, such as high-fructose corn syrup. Excess sugar and alcohol also damage the gut lining as they increase the amount of inflammation present.
Remove artificial sweeteners (aspartame, sucralose) from your diet as they alter gut bacteria and may cause diarrhea and poor digestion by allowing harmful bacteria to flourish. In addition, artificial sweeteners such as sorbitol, xylitol, and mannitol can gas excess gas and, often, diarrhea.
2. Replace Enzymes/HCL (Hydrochloric Acid)
Some achieve digestive benefits when they supplement with betaine HCL and pancreatic digestive enzymes. Stopping or reducing use of acid reducers such as H2 blockers (ranitidine, famotidine) and proton pump inhibitors (esomeprazole omeprazole, pantoprazole). If you have been on these medications for more than a few months, you may need to wean off of them over several months. Failure to do so may result in “rebound acid reflux”.
It is important to never stop medications without consulting first with your physician. Those with the pre-cancerous condition called Barrett’s esophagus are advised to stay on acid reducers lifelong to prevent esophageal cancer.
This is where the small and large intestine are repopulated with healthy and beneficial bacteria. Examples of healthy bacteria include lactobacilli and bifidobacteria. These are common strains found in probiotic supplements.
Dietary changes recommended to help irritable bowel syndrome and a leaky gut include:
- Drink bone broth daily
- Consume kefir and/or yogurt
- Drink kombucha tea
- Eat more fermented vegetables, such as sauerkraut and kimchi
- Cook with coconut oil
- Eliminate grains and processed foods
- Consume sprouted seeds like chia seeds, flaxseed, and hempseed.
- Consume a high-fiber, plant-based diet
Make lifestyle changes. Participate in stress-reduction activities such as mediation, yoga, and daily exercise. Get adequate sleep each night, increasing hours if necessary. Also, consider consumptions of a relaxing tea each night before bedtime, like a valerian herbal tea or chamomile tea.
The digestive enzymes pancreatin, bromelain, and papain can also aid the digestive process. They can be taken in supplement form prior to consuming a meal. Suggested dose: Take as directed on the label
Consuming fiber is crucial for relieving constipation. Guidelines recommend at least 25 grams of fiber per day, which can be accomplished by eating five-to-nine servings of vegetables and fruits.
For example, one avocado has 13 grams of fiber while a medium-sized apple provides four grams, and a medium-sized banana has three grams. Berries are not only high in fiber, but they also help protect against colon cancer, according to a 2016 study in Molecules. Chia seeds are also a good option — just one teaspoon contains almost six grams of fiber. A cup of black beans packs 15 grams of fiber.
Plant-based foods will help ensure regularity and a healthy digestive system. They also provide plenty of other nutrients, such as vitamins as A, K, and E, along with vitamin C and other phytonutrients and antioxidants.
A 2015 study showed that fiber was effective in those with mild-to-moderate constipation and in those with constipation due to IBS. A diet high in plant-based foods has been associated with a reduced risk for colon cancer and has a beneficial effect on gut bacteria. A 2012 study in World Journal of Gastroenterology showed that fiber helped increase stool frequency in adults with constipation.
Magnesium is a ubiquitous mineral that is involved in over 350 biochemical reactions throughout the body. Magnesium deficiency is also one of the most common nutrient deficiencies and may manifest as muscle cramps or constipation.
A 2014 study in Clinical Gastroenterology and Hepatology focused on women with constipation in France. Researchers found that when magnesium-rich mineral water was consumed daily, symptoms of constipation improved significantly. Suggested dose: 125 to 500 mg per day.
Note: If loose stool occurs, the dosage should be reduced. Those with advanced kidney disease, especially stage 4 or stage 5, need to first consult with their doctor before taking a magnesium supplement.
When it comes to choosing a probiotic, it’s easy to become overwhelmed. There are many strains on the market. And though our knowledge of probiotics has grown considerably over the past decade — more than 20,000 scientific reports have been published on the subject in the last 10 years — we are still learning about their benefits.
To my patients who need them, I recommend taking a probiotic which has between 10 to 30 billion units twice per day. Also, saccharomyces boulardi, a healthy yeast, can help restore balance to those with IBS symptoms. Diet change is the most important action one can take to improve gut health. When we feed ourselves, we also feed our gut bacteria.
Probiotics are available in capsules, chewables, powders, and sometimes gummie formulas. They are considered safe for all ages and anyone with a healthy functioning immune system. Those who are immunocompromised or undergoing chemotherapy should consult with their physician prior to taking a probiotic supplement.
While probiotics have gained popularity in the past decade or so, prebiotics are lesser-known but just as important. Prebiotics are the substances (available in certain foods) that are beneficial to gut bacteria. In a sense, prebiotics are like “pet food” for good bacteria.
Prebiotic foods are rich in a special type of carbohydrate called oligosaccharides — oligo means “a few” and saccharide translates to “sugar”. Oligosaccharides fall between simple carbohydrates and complex carbohydrates in size, meaning that they usually are three to 10 sugar molecules long. The gut’s good bacteria eat these fermentable sugars to help ensure the gut’s microbe diversity. Certain foods, including apples and bananas, are considered prebiotics. However, there are also prebiotic supplements. Follow the directions on the label and take as directed.
L-glutamine is an amino acid that helps provide energy to the cells of the intestine. A 2019 study of patients with IBS-D and increased intestinal permeability, or leaky gut, concluded that L-glutamine was beneficial in reducing IBS symptoms. Likewise, a 2016 study also showed glutamine’s benefit in those with IBS symptoms. L-glutamine comes in a powder, which is to be added to liquid. Take 5 grams one to three times per day as needed
Herbs and Teas for Additional Support
Research has shown that herbs such as lemon balm, peppermint, and chamomile have helped alleviate symptoms of IBS. Red pepper also appears to be beneficial. A 2011 study concluded that red pepper powder could help reduce symptoms of pain and bloating in those with IBS.
- Molecules. 2016 Jan 30;21(2):169. doi: 10.3390/molecules21020169.
- Aliment Pharmacol Ther. 2015 Jun;41(12):1256-70. doi: 10.1111/apt.13167. Epub 2015 Apr 22.
- Cancer Causes Control. 1997 Jul;8(4):575-90.
- World J Gastroenterol. 2012 Dec 28;18(48):7378-83. doi: 10.3748/wjg.v18.i48.7378.
- Clinical Gastroenterology and Hepatology. 2014 Aug;12(8):1280-7. doi: 10.1016/j.cgh.2013.12.005. Epub 2013 Dec 14.
- Zhou Q, Verne ML, Fields JZ, et al. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019;68(6):996–1002. doi:10.1136/gutjnl-2017-315136
- Bertrand J, Ghouzali I, Guérin C, et al. Glutamine Restores Tight Junction Protein Claudin-1 Expression in Colonic Mucosa of Patients With Diarrhea-Predominant Irritable Bowel Syndrome. JPEN J Parenter Enteral Nutr. 2016;40(8):1170–1176. doi:10.1177/0148607115587330
- Alam MS, Roy PK, Miah AR, et al. Efficacy of Peppermint oil in diarrhea predominant IBS - a double blind randomized placebo - controlled study. Mymensingh Med J. 2013;22(1):27–30.
- Chumpitazi BP, Kearns GL, Shulman RJ. Review article: the physiological effects and safety of peppermint oil and its efficacy in irritable bowel syndrome and other functional disorders. Aliment Pharmacol Ther. 2018;47(6):738–752. doi:10.1111/apt.14519
- Albrecht U, Müller V, Schneider B, Stange R. Efficacy and safety of a herbal medicinal product containing myrrh, chamomile and coffee charcoal for the treatment of gastrointestinal disorders: a non-interventional study. BMJ Open Gastroenterol. 2015;1(1):e000015. Published 2015 Feb 6. doi:10.1136/bmjgast-2014-000015
- Dig Dis Sci. 2011 Nov;56(11):3288-95. doi: 10.1007/s10620-011-1740-9. Epub 2011 May 15.