The 5 Best Supplements for IBS, According to a GI Dietitian

Are Oral Supplements for IBS Beneficial?

There are many different types of digestive supplements available on the market, and matching your symptoms to the appropriate product will help you get the most benefit. Your body’s response to a supplement may vary depending on multiple factors, such as diet, lifestyle, health status, dosage, and supplement type. 

According to the latest research, supplements can be helpful for IBS as follows:

Those with IBS-C: Some supplement options intended to improve the frequency and/or form of bowel movements, as well as products that can alleviate bloating, gas, or abdominal pain associated with IBS-C have proven benefits.  Examples include:

• Psyllium husk fiber
• Osmotic laxative products
• Enteric-coated peppermint oil capsules

Those with IBS-D: Products intended to slow transit time, bulk up stool, or reduce gastrointestinal spasms offer benefits for IBS-D. Examples include:

• Bulking fibers such as methylcellulose and calcium-polycarbophil
• Enteric-coated peppermint oil capsules. 

Those with IBS-M: Those with an alternating pattern of stool habits may respond well to:

• Soluble fiber-predominant products which can both aid with hard/dry stool or loose/watery stool
• Laxative supplements during constipation periods

Those with IBS-related dietary triggers: Regardless of IBS-subtype, eating specific foods, such as gas-promoting high-FODMAP foods (think beans and broccoli), can trigger post-meal symptoms such as abdominal pain, bloating, and pooping issues. While avoidance of dietary triggers may be feasible for some, it can be nutritionally limiting and practically difficult to sustain. Products that can improve food tolerance include: 

• Targeted digestive enzymes
• Specially formulated (coated) peppermint oil

Who May Not Benefit From a Supplement for IBS

Before considering supplements for IBS, consult a healthcare provider to determine what’s appropriate for your particular symptoms. Some digestive supplements are not appropriate if you have a health condition(s) beyond IBS.  Below are some, but not all, of these considerations.

Oral Laxative Supplements May Not Be Beneficial for IBS if You

• Have kidney or cardiac dysfunction: High-dose magnesium supplements (used as osmotic laxatives), in particular, should be avoided or used only under the guidance of a healthcare provider. 
• Take certain medications: Laxative supplements can interfere with some medications, including diuretics and antibiotics, so speak with a healthcare provider about your regimen. 
• Have a bowel obstruction (blockage in the intestine) or fecal impaction (stool that is hardened and stuck): These circumstances require immediate medical attention. 
• Have a history of laxative abuse: Speak with a healthcare provider about constipation treatment if you’ve used laxatives excessively in the past. 
• Are on a fluid-restricted diet: Many products need to be taken with extra fluid.

Fiber Supplements May Not Be Beneficial for IBS if You

• Have difficulty swallowing
• Have pelvic floor dysfunction: Adding more bulk when you are unable to efficiently evacuate may add to constipation and discomfort. 
• Have a slow motility disorder: Such disorders include gastroparesis (delayed stomach emptying) and slow colonic transit 
• Have esophageal stricturing (narrowing of the esophagus) 
• Are severely backed up
• Have active intestinal inflammation: This includes diverticulitis or active inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. 

If you are pregnant, lactating, on prescription medications, or have diabetes, consult with your healthcare provider if you plan to take any other digestive supplements for IBS.

Supplements We Do Not Recommend for IBS

Many products make promising claims about resolving IBS symptoms. However, in reality, only a small number of products are backed by strong clinical evidence. We have carefully chosen supplements that have a studied ability to improve IBS management or symptoms associated with IBS. 

We do not recommend trying supplements based on the promises made by the company selling the product or their marketing efforts. 

The following supplements lack scientific evidence for helping with IBS:

• Activated charcoal capsules
• Apple cider vinegar products
• Collagen powder products
• Powdered greens
• Berberine
• Turmeric or curcumin products
• Omega 3 capsules 
• Oregano oil 
• Aloe vera products  

The following supplements still have limited research for IBS management, although more evidence may develop in the future :

• Prebiotics
• Probiotics
• Lipase
• L-glutamine 

How Do I Know if I Have IBS?

Although IBS is often referred to as a “diagnosis of elimination” (meaning doctors resort to this diagnosis if they can’t identify another problem), this can be misleading. While your doctor  will likely rule out gastrointestinal infection and disease, a specific tool to diagnose IBS called the Rome criteria also exists. This criteria was developed in 1992 and is periodically updated to characterize the core IBS symptoms, which include:

• Recurrent abdominal pain
• Changes in stool frequency
• Changes in stool form

If your symptoms also meet the frequency criteria (three times a month for the past three months), your doctor may diagnose you with IBS. Yet “IBS” is still an umbrella term: there are multiple subtypes of this condition that can feel very different from person to person. 

IBS-C: IBS with constipation, most often experienced as:

• Difficulty evacuating
• Infrequent bowel movements
• Feeling an urge to go but not being able to

IBS-D: IBS with diarrhea, most often experienced as:

• Loose stool
• Urgency
• Lower abdominal cramps or belly pain

IBS-M (aka IBS-A): IBS mixed type or IBS alternating, most often experience as:

• Alternating constipation and diarrhea 
• A combination of IBS-C/IBS-D symptoms

How We Select Supplements

Our team works hard to be transparent about why we recommend certain supplements; you can read more about our dietary supplement methodology here. 

We support supplements that are evidence-based and rooted in science. We value certain product attributes that we find to be associated with the highest quality products.

It's important to note that the FDA does not review dietary supplements for safety and effectiveness before they go to market. Our team of experts has created a detailed, science-backed methodology to choose the supplements we recommend. We also spoke with Laura Frado, MD, MS, a gastroenterologist at New York Gastroenterology Associates, for her insight on supplements.

What to Look For in Supplements for IBS

Third-Party Testing

Supplements that are third-party tested are sent to a lab where they are tested to ensure they contain what they say they contain and are not contaminated with specific high-risk, common contaminants. However, it’s important to note:

1. Third-party testing does not test to see if a product is effective or safe for everyone, and it does not ensure the supplement will not interact with other supplements or medications.
2. Not all third-party testing is created equal. It is not uncommon for supplement companies to pay labs for certificates after conducting minimal to no testing. 
3. The third-party certifications we can trust are: ConsumerLab.com, NSF, and USP. However, these certifications are difficult to obtain and/or expensive for manufacturers, so many companies choose not to get their products tested by one of these three organizations. 
4. Sometimes products tested by these three companies are more expensive to try to offset the cost they pay for certification.
5. Just because a supplement is not tested by one of these three companies, it does not mean it’s a bad product. We recommend doing some research on the reputability of the manufacturer and calling up the manufacturer and their testing lab to determine their protocols and decide if you feel comfortable consuming the supplement.

Fiber supplements, laxatives, and peppermint oil products will differ in overall quality and ingredients. The ingredients or amounts of ingredients may not match what is written on the label. Those with food allergies or intolerances should examine all product ingredients and labels, as there may be sources of cross-contamination. 

Form

Supplements with benefits for IBS  come in a variety of forms, including capsules, powders,  tablets/pills, and chewable/gummy products. Powdered products, including some fiber powders and laxatives, can be added to liquid with no taste or texture changes, while others may be artificially flavored or gel with water (you can add these to moist foods to avoid a gooey substance).  

There is no research suggesting significantly greater efficacy of one physical form over another, so you can decide based on taste preferences and convenience. However, keep in mind that some chewable, gummy, or flavored products may contain additional ingredients that can cause extra gastrointestinal symptoms, including sugar alcohols (e.g., sorbitol, xylitol, erythritol) or inulin (chicory root fiber). We recommend reading product labels and avoiding products with these particular ingredients. 

Ingredients and Potential Interactions

It is essential to carefully read the ingredient list and nutrition facts panel of a supplement to know which ingredients and how much of each ingredient is included relative to the recommended daily value of that ingredient. Please bring the supplement label to a healthcare provider to review the different ingredients contained in the supplement and any potential interactions between these ingredients and other supplements and medications you are taking.

Over-the-counter supplements are not the same as prescription medications which are regulated by the FDA. Check with your healthcare provider before using any store-bought digestive products, as they can interact with a variety of medications and supplements. Interactions vary between products, and it is best to verify before taking to ensure safety.  For example, fiber supplements can delay or reduce the effectiveness of antidepressants, diabetes medications, and carbamazepine.

Some  products may also contain added ingredients such as prebiotics, which can worsen gas and bloating in digestively sensitive people, or sugar alcohols, which can worsen diarrhea. Chewable and gummy supplements are more likely to contain one of these ingredients as a sweetener. 

Prebiotics (avoid for gas and bloating) include:

• Fructo-oligsosaccharides (FOS) 
• Inulin (chicory root fiber)

Sugar alcohols (avoid for diarrhea) include: 

• Sorbitol
• Mannitol
• Xylitol  
• Erythritol

IBS Supplement Dosage

The recommended dose for a given supplement will vary by supplement type and specific product. We recommend speaking with a healthcare provider to determine if a supplement may be appropriate for you. Depending on your symptoms and health history, a healthcare provider may recommend more or less than the standard dose suggested by the manufacturer. 

Keep in mind that the majority of supplements are designed for occasional use but may be safe to take for longer periods when directed by a healthcare provider.

Because of the potential side effects and risk of overdosing laxative supplements, follow package directions carefully. Some products, such as magnesium, may require a larger amount than what is contained in standard doses to attain a laxative benefit. Alternatively, some standard doses may have too strong of an effect for sensitive individuals.

In general, there is typically no harm in starting with a smaller (e.g., half) dose and increasing it as tolerated. For fiber supplements, it is typically best to start with a lower serving and increase gradually, along with increasing fluids. 

How Much Is Too Much?

The supplements listed above have all been shown to be safe and well-tolerated for most individuals with IBS. However, some supplements can cause serious side effects when used in excess. Particular caution is advised for laxative and fiber supplements, which can cause uncomfortable symptoms and/or health complications when taken in inappropriate doses. 

Risks vary by specific product as well as individual health status, so it is best to work with a healthcare provider to determine the appropriate dose for you. Some considerations include:

Osmotic laxatives:

Osmotic laxatives such as magnesium are generally considered safe and well-tolerated, though they can cause bloating and/or diarrhea with too large of a dose. Since these types of laxatives draw water into the colon, overusing these products can lead to dehydration and electrolyte imbalances

Fiber supplements:

While there is no Tolerable Upper Intake Level for fiber, concentrated doses can cause constipation, gas, or bloating if you add it too quickly or without enough fluids. Most fiber supplements recommend 8 ounces of water with a standard dose, though individual product directions may vary. Inadequate fluid intake can cause the supplement to swell and lead to choking, blockages, or stool impaction, as well as gas, bloating, abdominal pain, and constipation.

Enzymes:

There are generally no established upper limits for over-the-counter enzymes marketed for IBS. There is no standard dosing for commercially available digestive enzymes, and guidelines vary across different products. Additionally, many products contain ingredients that have not been studied in human digestion and therefore have unknown health risks.

Of the most researched enzyme products, documented side effects include gastrointestinal upset, such as gas, bloating, and nausea. High-dose lipase intake, in particular, has been shown to cause damage to the colon walls. When it comes to digestive enzymes, there is no “adjustment period,” so if you find one is not working, or especially if you have an allergic reaction to any supplement, stop taking it.

Why Trust Verywell Health

Suzie Finkel, MS, RD, CDN is a registered dietitian specializing in the nutritional management of digestive symptoms and diseases.  She holds a master’s degree in nutrition from Columbia University and has trained in numerous clinical gastroenterology settings. As a GI dietitian, she provides evidence-based nutrition services for a wide array of conditions including IBS-C, IBS-D, and IBS-M. Her goal is to demystify nutrition (mis)information and facilitate digestive comfort.