When shoppers enter pharmacies looking to quell digestive health issues, it can be helpful to think of three-dimensional chess. First, divide concerns into two areas: the upper gastrointestinal tract and the lower GI tract. In the upper GI tract, conditions are usually centered around heartburn, indigestion and nausea. Further down the tract, customers suffer from gas and bloating, constipation or diarrhea.
After the possibility of making dietary changes to influence digestive operations and quell disorders, next is to look at two types of products: dietary supplements and OTC drugs. “You can play around with medications according to what patients with symptoms need,” said Matthew Karowe, MD, a gastroenterologist practicing in Boulder, Colo., with Gastroenterology of the Rockies.
More than six out of every 10 people worldwide say they suffer from digestive complaints like indigestion, constipation or diarrhea at least once a year, according to a scientifically representative sample of more than 18,000 adults in nine countries commissioned by Canofil Consumer Healthcare. A third of people say they suffer from these three conditions at least once a month.
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The allure of supplements is a general lack of side effects, but, because they are more gentle-acting, they might not offer immediate relief. Supplement ingredients — fiber, magnesium, enzymes, probiotics — typically offer support for the proper function of organs and systems along the GI tract.
Psyllium fiber comes from the outer coating or “husk” of the Plantago ovata seeds, not from wheat, which also makes it naturally gluten free. Psyllium is a soluble form of fiber known to promote regularity and act as a laxative.
“As a laxative, psyllium is considered bulk-forming, meaning it soaks up water in your gut, making bowel movements easier,” said Louis M. Machin, managing director at Lifelab Health, which makes psyllium fiber supplements. “However, while it helps with regularity, it doesn’t cause flatulence and can help with occasional constipation.”
Magnesium can improve constipation, whether it’s supplemental magnesium or an OTC like Milk of Magnesia. Magnesium helps muscles relax, and it has similar properties with the peristaltic, wave-like muscle contractions that move food through the digestive tract. Magnesium also plays a role in numerous enzyme systems throughout the body.
Digestive enzymes are proteins the body uses to break down food and help with digestion. If the body does not make enough digestive enzymes to handle the food intake, it can mean stomach aches, flatulence and diarrhea.
Different types of enzymes break down different types of foods. Protease, as its name suggests, works on proteins. Lipase breaks down fats. Amylase helps digest carbohydrates and starches.
Probiotic bacteria are wildly popular, found in foods like yogurt, beverages like kombucha and supplements, which may be the most efficacious of all product formats because they can house larger doses.
Probiotics have come a long way, aided by research and development into specific probiotic strains that target specific health states.
One emblematic human clinical trial, conducted at a research clinic in Houston, tested the Bifidobacteria lactis HN019 strain. Researchers used about 17 billion CFUs, 2 billion CFUs and placebo in 100 subjects for 14 days. The HN109 strain cut time to excretion in a dose-dependent manner.
Of particular interest in the study were the changes in constipation, irregular bowel movements and flatulence because these symptoms were reported with the highest frequency at baseline. The HN109 groups had two-fold greater decreases in symptom frequency compared to placebo. This strain pulls its weight.
“Not all probiotics are the same,” said Brian Terry, director of sales, FDM and specialty, at supplement company Nordic Naturals. “Well-documented, specific bacterial strains matter. That’s why our Maximum Care SKU uses 11 strains that alleviate intestinal bloating and promote regularity, and these are different from the seven probiotic strains used in the Probiotic Woman SKU that balances vaginal flora and supports urinary tract health.”
Prebiotic fibers are also routinely used in conjunction with probiotics. These fibers are a food source for probiotic cultures.
Heartburn occurs near the top of both the GI tract and consumer complaints. Relief from heartburn, indigestion and upset stomach starts with over-the-counter tummy tablets made of calcium carbonate — Rolaids, Tums and the like. It’s a billion-dollar category with household penetration for the antacid category reaching 42.5%, according to IRI data.
“Tums starts to neutralize the heartburn-causing acid in your esophagus and stomach on contact, which provides fast relief,” said Amy Sharon, brand director of the Tums heartburn portfolio.
The next stronger class of acid-reducing medications is histamine H2 blockers like Pepcid and Zantac, which decrease acid production in the acid-producing parietal cell in the stomach.
Finally, proton pump inhibitors shut down acid production in the stomach, which is effective for people with bad reflux and prevents complications that herald worse disease progression. “All antacids will bind to anything in the stomach, so don’t take it with other medications,” Karowe advised. “It will decrease the action of those other medications.”
Constipation is solved via various laxatives. Osmotic laxatives like polyethylene glycol (MiraLAX) and magnesium hydroxide (Milk of Magnesia) are stool softeners that bring fluid from the wall of the colon to the inside of the colon. “These are safe, long-term laxatives people can use forever,” Karowe said. “Titrate up or down to your level.”
Stimulant laxatives like senna supplements are effective for occasional constipation, but Karowe cautioned against chronic use because they increase peristalsis contractions to the point where the body will rely on them instead of acting naturally on its own.
Diarrhea has a number of potential causes, from antibiotics to lactose intolerance, bacteria and viruses. Short-term relief can be found with common OTC agents like Pepto Bismol and Kaopectate, which contain the active ingredient bismuth subsalicylate (also useful for upset stomachs) that balances the way fluid moves through intestines and reduces inflammation. Imodium contains loperamide, which slows down transit time and allows more fluid to be absorbed into the body, thus making stools better formed.
Diarrhea that lasts longer than two days is grounds for calling a doctor.
The digestive system is the center of activity in the body, responsible not just for moving food and nutrients through the system but is also home to about 70% of the body’s innate immune activity. New research is showing a connection between the gut and the brain. This makes keeping the GI tract running smoothly central to overall systemic health.
GSK Tums Naturals, SRP: $7.99 for 56 tablets
The classic calcium carbonate antacid tablet is used for fast relief of acid indigestion, heartburn and gastric discomfort. The calcium smothers acid that backs up in the stomach and flows up into the esophagus, causing heartburn. Tums Naturals differentiates itself by containing no artificial flavors or dyes. It comes in two varieties of black cherry and watermelon, as well as coconut pineapple flavors.
LifeLab NuSyllium, SRP: $19.99 for 72 doses
Fiber is a key ingredient in keeping the body regular. According to the 2020-2025 Dietary Guidelines for Americans Recommendations, 50% of people are consuming only about half the recom-mended daily intake of fiber, with a paltry 5% of men and 9% of women getting the full RDA. Psyllium fiber not only keeps a body regular, but also has beneficial effects on heart health, blood-sugar regulation and weight management.
Vibi+, SRP: $2.59 for 16.9-oz. bottle
Vibi+ is a delicious way to fiber. It provides 27% of daily fiber needs by containing 8 g of prebiotic fiber in each bottle. There are four flavors: lemon lime, blueberry pomegranate acai, orange mango and strawberry kiwi. It is kosher, halal, keto certified and GMO free. Each bottle contains 15 calories, no sugar and zero net carbs.
Mason Vitamins Ultra Digestive Enzymes Plant Based, SRP: $8.49 for 60 tablets
Digestive enzymes have specific tasks of finding and severing chains of carbohydrates, proteins, fats, fibers, starches, sugars and other substances within foods. This product contains enzymes that break down all macronutrients — protein, fats, carbohydrates. This can help with gas, bloating, cramping, heartburn and sometimes diarrhea.
Nature Made Digestive Probiotics Advanced Dual Action Capsules, SRP: $26.29 for 30 capsules
This probiotic product uses clinically vali-dated doses that act in both the small and large intestines. LGG is the most-studied probiotic strain of all time, having been patented in 1989. It works in the small intestine to help relieve occasional gas, bloating and abdominal discomfort. B. lactis HN019 works in the large intestine to help relieve occasional constipation and irregularity.
Avrio Health Senokot Laxative Gummies, SRP:$19.99 for 60 gummies
Senna is an herb that encourages peristalsis and helps support a bowel movement within six to 12 hours. It is generally beneficial to take it before bedtime for overnight relief and is meant to be used for less than a week at a time. With a mixed berry-flavored gummy format, this is tasty and easy to use.