Probiotics, Digestive Enzyme, and Other Supplements for IBS and IBD

Anyone who suffers from IBS (irritable bowel syndrome) or IBD (inflammatory bowel disease) know the symptoms can have a major impact on your daily life. Of course we’re talking about two very different conditions, one (IBD) being more serious and life-altering.

In this article, we’ll discuss the best (science-backed) supplements to treat IBS and IBD. We’ll look at the vitamins, minerals, and other supplements (like probiotics and digestive enzymes) along with several other therapies indicated for these conditions.

What’s the Difference Between IBS and IBD?

While they may present with similar symptoms, IBS and IBD are definitely not the same thing.

According to the International Foundation for Gastrointestinal Disorders, irritable bowel syndrome (IBS) is classified as a functional gastrointestinal disorder, which means there’s a disturbance in bowel function, but not enough to constitute a “disease.” Symptoms include intermittent abdominal pain accompanied by diarrhea, constipation, or alternating episodes of both.

IBS affects at least 10-15% of adults in the U.S. and women are affected more often than men. It is the disorder most commonly diagnosed by gastroenterologists, and one of the most frequently diagnosed conditions among U.S. physicians. Symptoms often begin in your late teens or early twenties.

Inflammatory bowel disease (IBD), on the other hand, is characterized by chronic irritation and ulcers in the gastrointestinal tract. Crohn’s disease and ulcerative colitis are the most common disorders.

The disorders are usually diagnosed between the ages of 15 and 30, but can develop at any age. IBD can lead to destructive inflammation and permanent harm to the intestinal tract, and significantly increases one’s risk of developing colon cancer.

Treatments for IBS and IBD

Treating IBS

Treating IBS generally involves relieving symptoms so that you can live as normally as possible.

You can usually treat mild symptoms with lifestyle changes like:

1. Managing stress
2. Eating healthy (particularly a diet high in fiber)
3. Getting enough sleep
4. Exercising

Doctors often recommend removing high gas foods from your diet (like carbonated and alcoholic beverages and FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). This includes certain grains, vegetables, fruits and dairy products.

Research also shows that some people with IBS can improve symptoms by removing gluten (wheat, barley and rye) from their diets.

In addition, the following treatments have been shown to help certain people:

• Fiber supplements
• Laxatives
• Anti-diarrheal medications
• Anticholinergic medications
• Tricyclic antidepressants
• SSRI antidepressants

Medications approved to treat IBS include:

• Alosetron (Lotronex)
• Eluxadoline (Viberzi)
• Rifaximin (Xifaxan)
• Lubiprostone (Amitiza)
• Linaclotide (Linzess)

Researchers are also investigating several newer treatments for IBS, including:

• Fecal microbiota transplantation (FMT)
• Hypnosis
• Peppermint
• Stress reduction
• Probiotics (more on this below)

Treating IBD

IBD is much trickier to treat.

According to the Mayo Clinic, IBD treatment often involves drugs (many of which come with serious side effects) and/or surgery. The following are among the most common treatment options, depending on which area of the colon is affected:

• Anti-inflammatory drugs
  • Ccorticosteroids and aminosalicylates, such as mesalamine (Asacol HD, Delzicol, etc.)
  • Balsalazide (Colazal)
  • Olsalazine (Dipentum)
• Immune system suppressors
  • Azathioprine (Azasan, Imuran)
  • Mercaptopurine (Purinethol, Purixan)
  • Methotrexate (Trexall)
• Biologics
  • Infliximab (Remicade)
  • Adalimumab (Humira)
  • Golimumab (Simponi)
  • Certolizumab (Cimzia)
  • Vedolizumab (Entyvio)
  • Ustekinumab (Stelara)
• Antibiotics
  • Ciprofloxacin (Cipro)
  • Metronidazole (Flagyl)
• Other medications and supplements
  • Anti-diarrheal medications. A fiber supplement — such as psyllium powder (Metamucil) or methylcellulose (Citrucel) — can help relieve mild to moderate diarrhea by adding bulk to your stool. For more-severe diarrhea, loperamide (Imodium A-D) may be effective.
  • Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). However, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and diclofenac sodium likely will make your symptoms worse and can make your disease worse as well.
  • Vitamins and supplements. If you’re not absorbing enough nutrients, your doctor may recommend vitamins and nutritional supplements, including digestive enzymes.

Do Probiotics and Digestive Enzymes Work for IBS and IBD?

Probiotics and IBS

In a meta-analysis of more than 30 studies published in The American College of Gastroenterology, researchers found that certain probiotic strains may improve overall symptoms, as well as gas and bloating, in patients with IBS.

The probiotic strain Bifidobacterium bifidum, in particular, has been reported to adhere particularly well to intestinal cells, and therefore may have an advantage in altering the intestinal microbiota and increasing the intestinal barrier.

In a clinical study published in Alimentary Pharmacology & Therapeutics, Bifidobacterium bifidum significantly improved overall IBS symptoms, as well as individual IBS symptoms including abdominal pain, bloating, and fecal urgency.

A 2020 study that looked at 59 studies, including 6,761 patients found that:

Probiotics are effective and safe for IBS patients.

And yet another 2020 metaanalysis concluded that probiotics can improve IBS symptoms compared to placebo.

Finally, a 2010 research study looked at specific probiotic strains, and found the following ones appear to work to treat some IBS symptoms:

• Bifidobacterium (B. longum, B. infantis, B. breve)
• Lactobacillus (L. acidophilus, L. casei, L. delbrueckii ssp. bulgaricus, L. plantarum, L. helveticus, L rhamnosus GG)

Probiotics and IBD

Studies on probiotics for the treatment of IBD are limited.

Probiotics may induce clinical remission in active ulcerative colitis when compared to placebo, according to a 2018 study.

Another 2018 research review found that:

Studies on probiotics in animal models of IBD are promising, and clinical results in IBD patients are encouraging; however, the data are limited, and few studies are placebo controlled. Additional placebo-controlled, double-blind studies in IBD are required before recommendations can be offered for routine use of probiotics in IBD.

More recently, a research team at Harvard’s Wyss Institute for Biologically Inspired Engineering has created a living-material that uses a strain of genetically engineered E.coli Nissle gut bacteria as a locally acting probiotic. The engineered bacteria produce a network of nanofibers that directly binds to mucus to fill inflamed areas like a patch, shielding them from gut microbes and environmental factors. This probiotic-based therapeutic strategy protected mice against the effects of colitis induced by a chemical agent and promoted mucosal healing.

The Probiotic Associated Therapeutic Curli Hybrids (PATCH) approach, as we named it, creates a biocompatible, mucoadhesive coating that functions as a stable, self-regenerating Band-Aid and provides biological cues for mucosal healing.

-Neel Joshi, Ph.D.

Joshi and his team think that their approach could be developed as a companion therapy to existing anti-inflammatory, immuno-suppressant, and antibiotic therapies to help minimize patients’ exposure to harsh medications with serious side effects and potentially provide protection against IBD relapses.

Best Vitamins, Minerals, and Supplements for IBS

According to Harvard Medical School, the following supplements may be effective for treating IBS:

1. Fiber. Soluble fiber supplements (Metamucil or ones with psyllium husk) can be helpful for constipation. Taking large amounts of fiber can affect absorption of medications though, so Harvard recommends taking your meds 1-2 hours prior to taking any fiber supplement. Soluble fiber is also found in foods such as beans, avocados, oats, flax seeds, sweet potatoes, and pears. Drinking lots of water is important too when taking a fiber supplement for IBS.
2. Probiotics. An analysis of nearly 1,800 patients from multiple studies showed that taking probiotic supplements can help reduce pain and symptom severity in IBS compared to placebo. 
3. Peppermint Oil. Peppermint oil can help relax the GI tract and decrease abdominal pain associated with IBS.

Vitamins, Minerals, and Supplements for IBD

According to the Crohn’s and Colitis Foundation, the following supplements may help with IBD:

• Calcium
• Folic acid
• Iron
• Vitamin B12
• Vitamin D
• Vitamins A, E, and K
• Zinc

Summary

More research is needed to understand which strains of probiotics and/or digestive enzymes work for IBS and IBD. But early results look promising. If you have either of these conditions, talk with your GI doctor to understand which supplements, if any, you should be taking.