For patients with gastrointestinal disorders like inflammatory bowel disease (IBD), ulcerative colitis (UC), and irritable bowel syndrome (IBS), nutritional supplementation can often make an important difference in quality of life. A growing body of evidence is now showing that these therapies can address the underlying pathophysiology of these disorders, ameliorate debilitating gastrointestinal symptoms, or address the indirect effects of the disorders on other body systems. However, when nutrients are not absorbed as they pass through the digestive system, the chance that a supplement will have a therapeutic impact is significantly limited. For clinicians and patients, it is important to understand why this is a concern for those living with gastrointestinal disorders and examine the possibilities for optimizing bioavailability.
Why Supplements with Bioavailable Nutrients Are Essential for Patients with Gastrointestinal Disorders
Gastrointestinal Conditions Can Interfere with Nutrient Absorption
There are several gastrointestinal conditions that can interfere with nutrient absorption, making it more critical to ensure that patients with these disorders take bioavailable forms of nutrient supplements. For instance, inflammation in the gut of patients with IBD and UC can disrupt absorption of a wide range of nutrients, including iron, calcium, vitamin B12, vitamin A, folic acid, magnesium and zinc. Compounding inflammation-related absorption issues is Small Intestine Bacterial Overgrowth (SIBO), a common contributor to GI symptoms among patients with IBD and IBS. Studies suggest that metabolites produced by “bad” bacteria in the gut of patients with SIBO can competitively inhibit the absorption of key nutrients like vitamin B12. Not only can vitamin B12 deficiency have direct consequences on cellular function, but it can also contribute to some of the inflammation-associated malabsorption issues in patients with IBD, such as iron-deficiency anemia. Another common nutrient deficiency resulting from malabsorption in IBD patients is vitamin D, which is particularly concerning because low levels of vitamin D can increase inflammation in IBD, which further exacerbates symptoms and leads to higher rates of morbidity.
While deficiency of nutrients can have a negative impact on gastrointestinal symptoms and overall health, certain nutritional supplements can also produce undesirable effects due to absorption issues. One of the most well-known culprits is iron. According to one recent study, about 20% of IBD patients with iron-deficiency anemia experience constipation, diarrhea, abdominal pain, or another gastrointestinal side-effect when they take iron. This is because gut inflammation can interfere with absorption and the unabsorbed iron remains in the gut, creating gastrointestinal disturbances. Providing iron in a more bioavailable form can potentially prevent a cache of unabsorbed iron from remaining the gut, reducing the risk of negative gastrointestinal effects and treatment noncompliance. This is could be especially beneficial for patients whose malabsorption issues have already led to deficiencies in nutrients that normally support iron absorption, such as vitamin C and vitamin B12.
Patients with Gastrointestinal Conditions May be Subject to Highly Restrictive Diets.
Although rigorous research studies have produced mixed evidence on the effectiveness of restricted and/or elimination diets for patients with gastrointestinal disorders, anecdotal evidence indicates that it is not uncommon for patients with gastrointestinal disorders to find that dietary restrictions help with their symptoms, whether via gluten-free diets, low FODMAPs diets, or individualized dietary guidelines that eliminate certain “trigger” foods that are specific to that patient. The restrictive nature of these diets, however, can sometimes lead to nutritional deficiency, which makes it even more important for bioavailable nutrients to be provided in supplement form.
Moreover, some studies suggest that restrictive diets themselves can limit the absorption of certain critical nutrients. For example, a study in colon cancer patients indicated that low fiber intake may reduce the bioavailability of short-chain fatty acids such as butyrate. This is a significant concern for patients with gastrointestinal disorders because butyrate can act in multiple capacities to combat gut inflammation and support normal gastrointestinal function. In fact, the essential role butyrate plays in gut health is a growing area of interest for researchers, clinicians, and patients looking to alleviate gastrointestinal distress. As such, dietary restrictions limit that fiber and thereby reduce the body’s ability to absorb butyrate may end up effectively alleviating some symptoms while exacerbating others. For patients who wish to continue a low-fiber diet, a highly bioavailable butyrate supplement may be necessary to compensate for diminished absorption and maintain gut health. Formulating an ideal diet-based treatment plan is thus often a delicate balancing act that must take into account the unique challenges of patients, the broad impact of dietary interventions, and the bioavailability of key nutrients.
How Scientists Are Improving Supplement Formulations to Provide More Bioavailable Nutrients
As the importance of providing bioavailable nutrients in dietary supplements becomes increasingly clear, the research community is exploring ways to boost the bioavailability of formulations. A standout study with particular relevance for patients with gastrointestinal disorders comes from the University of Tampa, where a group of researchers in the Department of Health Sciences and Human Performance examined the bioavailability of several different formulations of curcumin. Curcumin is the bioactive component of turmeric, and it can help reduce symptoms for patients with gastrointestinal disorders through a variety of mechanisms. However, it is also well-known for its low level of bioavailability, limiting the therapeutic benefit of conventional formulas.
In the study, the researchers developed three different curcumin formulations:
- A phytosome-based formulation with a 1:2:2 ratio of curcumin, soy lecithin, and microcrystalline cellulose
- A curcumin formulation that was made water-soluble through the dispersion of curcumin with tocopherol and ascorbyl palmitate on polyvinylpyrrolidone (a hydrophilic carrier)
- A formulation consisting of curcumin metabolites and volatile oils of turmeric rhizome
In order to evaluate the bioavailability of these formulations, the researchers took blood samples from fifteen volunteer subjects. Compared to an unformulated curcumin supplement, the researchers found that serum levels of curcumin in the patients were 45.9 times higher when the patients took the first formulation, 7.9 times higher when the patients took the second formulation, and 1.3 times higher when the patients took the third formulation. These data indicate that formulation plays an extraordinarily critical role in harnessing the potential of supplements that suffer from naturally compromised bioavailability and developing formulations that enhance absorption is essential to optimizing therapeutic effects.
However, it is important to note that there are also downsides to some bioavailability enhancement methods, including those chosen by the researchers who conducted this study. For instance, the first formulation is problematic because soy can trigger allergic reactions in some patients, and phytosomes are rapidly eliminated in the body, rendering them a suboptimal delivery method. Many patients may also shy away from stabilizers like polyvinylpyrrolidone because they are looking for more natural options. The third formulation includes turmeric rhizome, which can cause stomach upset in some patients. Finally, although not explored in this particular study, many curcumin products on the market today use piperine, a pepper extract, to enhance absorption, but this can create micro-tears in the lining of the gut that can trigger inflammation and “leaky gut”.
Ultimately, this study did not cover the wide range of possible methods to improve the bioavailability of nutrients in dietary supplements of curcumin, but there are researchers exploring exceptional new delivery methods that do not rely on harmful additives or present concerning downsides for patients. For instance, beyond this clinical study, there is evidence from animal and in vitro studies that tetrahydrocurcumin, a biologically active metabolite of curcumin, is a more active antioxidant than curcumin that may be more readily absorbed in the gut. This has sparked interest in delivery systems focusing on tetrahydrocurumin, as pairing the most promising variants of specific nutrients with specialized delivery formulations may allow patients to realize greater benefits.
While each type of supplement may each have unique characteristics impacting bioavailability, studies like this provide deeper insight into the formulation strategies emerging in today’s biomedical community. However, greater bioavailability is not just theoretical. Already, cutting-edge delivery systems and bioactive ingredients, such as those offered by Tesseract Medical Research, are unlocking the potential of enhanced absorption for patients with gastrointestinal disorders. Using the most promising molecules and a range of sophisticated technologies—including liposphere-based approaches, colloidal delivery systems, nanodelivery systems, and new encapsulation techniques—these products are giving clinicians and patients opportunities meaningfully integrate nutritional supplements in treatment plans. By paying close attention to bioavailability when selecting supplements, patients are more likely to reap the benefits of these critical therapies.
Aggarwal BB, Deb L, Prasad S. 2014. Curcumin differs from tetrahydrocurcumin for molecular targets, signaling pathways and cellular responses. Molecules. 20(1):185-205. https://www.ncbi.nlm.nih.gov/pubmed/25547723
Dukowicz AC, Lacy BE, Levine GM. 2007. Small intestinal bacterial overgrowth. Gastroenterology & Hepatology. 3(2):112-122. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/
Hu S, Dong TS, Dalal SR, Wu F, Bissonnette M, Kwon JH, Chang EB. 2011. The microbe-derived short chain fatty acid butyrate targets miRNA-dependent p21 gene expression in human colon cancer. PLOS One. 6(1):e16221. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024403/
Jaager R, Lowery RP, Calvanese AV, Joy JM, Purpura M, Wilson JM. 2014. Comparative absorption of curcumin formulations. Nutrition Journal. 13:11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918227/
Jain N, Gupta BP, Thakur N, Jain R, Banweer J et al. 2010. Phytosome: A novel drug delivery system for herbal medicine. International Journal of Pharmaceutical Sciences and Drug Research. 2(4): 224-8. https://www.researchgate.net/publication/283318972_Phytosome_A_Novel_Drug_Delivery_System_for_Herbal_Medicine
Nielsen OH, Soendergaard C, Vikner ME, Weiss G. 2018. Rational management of iron-deficiency anaemia in inflammatory bowel disease. 10(1):82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793310/
Owczarek D, Toracki T, Domagala-Rodacka R, Cibor D, Mach T. 2016. Diet and nutritional factors inflammatory bowel diseases. World Journal Gastroenterology. 22(3):895-905. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716043/