Should IBS Sufferers Take Probiotics?
A significant amount of recent research has investigated how probiotics might be used to treat and manage IBS.
Irritable bowel symptoms have been linked to certain changes in the gut flora.
Additionally, up to 84% of IBS patients experience bacterial overgrowth in their small intestines, which can lead to many of their symptoms (1).
Irritable bowel symptoms have been linked to certain changes in the gut flora.
- Inhibiting the growth of disease-causing bacteria
- Enhancing the immune system’s barrier functions
- Helping fight inflammation
- Slowing down bowel movements
- Reducing gas production by balancing the gut flora
- Reducing the gut’s sensitivity to gas buildup
Gut flora imbalances may contribute to the symptoms of IBS. Probiotics help restore balance in a number of ways, including by inhibiting the growth of harmful bacteria, reducing inflammation and slowing down the digestive system.
Yes, You Can Expect Improvement!
A number of studies have shown that specific probiotics may have the potential to target specific symptoms. Probiotics from the Bifidobacterium, Lactobacillus and Saccharomyces families have shown particular promise (3, 4).
In a review by the British Dietetic Association (BDA), 29 studies assessed overall symptom improvements, and 14 of these showed a positive result for 10 different probiotics (4).
For example, a study treated 214 IBS patients with the probiotic L. plantarum 299v. After four weeks, 78% of the patients scored the probiotic as good or excellent for improving symptoms, particularly for pain and bloating (5).
A German study of a two-strain probiotic liquid known as Pro-Symbioflor also had promising results. In this study, 297 patients were treated for eight weeks and experienced a 50% decrease in general symptoms, including abdominal pain (16).
Meanwhile, Symprove is a four-strain probiotic that was tested in 186 patients in the UK. It was found to reduce overall symptom severity after 12 weeks of treatment (17).
Bifidobacterium infantis 35624 capsules have also been shown to reduce pain, bloating and problems with bowel habits in all subtypes of IBS (3).
Preliminary research has found 10 probiotic strains that may help improve overall symptoms of IBS.
IBS and Abdominal Pain
Abdominal pain is one of the key symptoms of IBS. It is often found in the lower or whole abdomen and subsides after a bowel movement (18).
Seven types of probiotics have been associated with improvements in abdominal pain symptoms (4).
The strain L. plantarum was found to decrease both the frequency and severity of abdominal pain, compared to a placebo (5).
One study investigated the yeast S. cerevisiae, also known as Lesaffre. After eight weeks of treatment, 63% of people in the test group and 47% of people in the placebo group reported significant reductions in pain (19).
In another study, participants drank a probiotic solution consisting of B. bifidum, B. lactis, L. acidophilus and L. casei for eight weeks. Their pain was reduced by 64% in the probiotics group and 38% in the placebo group (20).
Abdominal pain is the primary symptom of IBS. Seven probiotic strains have been found to help reduce pain.
IBS, Bloating, and Gas
Excess gas production and increased sensitivity can cause uncomfortable bloating and gas in IBS (22).
In the 2016 BDA review, two studies found that probiotics specifically reduced bloating, and one found they reduced gas (11).
The strain L. plantarum was found to decrease the frequency and severity of bloating symptoms, compared to a placebo (12).
Another study treated patients with a rose-hip drink mixed with an oatmeal soup fermented with L. plantarum. The test group experienced significant reductions in gas, and both the test and placebo groups experienced reductions in abdominal pain (14).
An additional study found that participants with IBS experienced reduced abdominal bloating after four weeks of treatment with a four-strain supplement containing B. lactis, L. acidophilus, L. bulgaricus and S. thermophilus (23).
If excess gas and bloating is your primary problem with IBS, then probiotics has a very good chance of improving your symptoms.
The strain L. plantarum has been found to reduce both abdominal bloating and gas. Another mixed-strain supplement has also resulted in reductions in gas.
IBS and Diarrhea
Approximately 15% of people with IBS experience the diarrhea-predominant form (24).
While there has been a lot of research on probiotics for infection-related diarrhea, less is known about the effects of probiotics on non-infectious types, as in IBS.
One probiotic known as Bacillus coagulans has been found to improve multiple symptoms, including diarrhea and stool frequency. However, studies to date have only been small, so more research is needed (25, 26).
The probiotic yeast Saccharomyces boulardii has also been investigated for the treatment of diarrhea-predominant IBS. One study found it improved bowel habits and decreased inflammation. (27).
A multi-strain probiotic known as VSL#3 was tested in people with IBS and found to slow down the bowels and reduce gas. However, in a study specifically on people with diarrhea-predominant IBS, it was not found to improve bowel movements (29).
Another multi-strain probiotic called Duolac 7 was tested in 50 patients over eight weeks. It was found to improve stool consistency significantly, compared to the placebo group, and there was a general improvement in symptoms (31).
While probiotic use for treatment of infectious diarrhea is well documented, there is promising evidence for use in IBS diarrhea. B. coagulans and S. boulardii, as well as some multi-strain preparations, may have a positive effect.
IBS and Constipation
The most common form of IBS is the constipation-predominant type, affecting nearly half of all people with the disease (24).
Studies on constipation-predominant IBS have sought to determine if probiotics can increase the frequency of bowel movements and alleviate associated symptoms.
One study gave participants one of two multi-strain probiotics, one containing L. acidophilus and L. reuteri and the other containing L. plantarum, L. rhamnosus and L. lactis.
In a study on children with IBS, treatment with the probiotic B. lactis and prebiotic inulin reduced constipation, bloating and feelings of fullness. However, it should be noted that in some patients with IBS, inulin may worsen symptoms (11, 33).
Additionally, S. cerevisiae has been found to reduce pain and bloating symptoms for constipation-predominant IBS. However, further studies are needed to confirm this (34).
As with most of the other symptoms discussed, while some of these results are promising, studies to date have been small.
Constipation-predominant IBS is the most common form of the disease. B. lactis, S. cerevisiae and some multi-strain probiotics have demonstrated positive effects.
Should IBS Sufferers Take Probiotics?
Probiotics are safe, and a relatively inexpensive treatment option for IBS. They have worked for many people, particularly for those with specific symptoms.
If you are interested in trying a probiotic, there is an excellent selection on Amazon.
Choosing Your Probiotic Supplement
- Choose an evidence-based probiotic: Select a probiotic that has research supporting it
- Select a probiotic according to your symptoms: Choose strains that work for your issues
- Take the right dose: Use the dosage recommended by the manufacturer
- Stick with one type: Try one variety for at least four weeks and monitor your symptoms
Keep in mind that some probiotic supplements contain ingredients that may make your symptoms worse. These include oats, inulin, lactose, fructose, sorbitol and xylitol. If your symptoms are triggered by any of these, look for a probiotic that does not contain them.
I like BIO Schwartz Advanced Strength Probiotic; it features the most innovative delivery system (stomach acid protection) that ensures strains can survive the stomach acids and reach deep into the small intestine, alive. It will even reach your large intestine making it more than 20 times more effective than other probiotic pills.
BIO Schwartz contains 40 Billion CFU of live Lactobacillus (Lactobacillus Acidophilus, Lactobacillus Plantarum, Lactobacillus Paracasei) & Bifidobacterium Lactis.
By taking the time to select a probiotic that best suits your needs, you may find they are an effective supplementary treatment for your IBS symptoms.
About Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a disorder of the digestive tract that causes recurring abdominal pain and constipation or diarrhea.
- Symptoms vary but often include lower abdominal pain, bloating, gas, and constipation or diarrhea.
- A variety of substances and emotional factors can trigger symptoms of IBS.
- A doctor usually diagnoses IBS based on the symptoms but does tests to rule out other problems.
- Diet modification and drugs are often recommended to address specific symptoms
IBS affects about 10 to 15% of the general population. Some but not all studies suggest women with IBS are more likely to consult a doctor.
IBS is the most common disorder diagnosed by gastroenterologists (doctors who specialize in disorders of the digestive tract) and is a common reason why many people visit their primary care physician.
IBS is generally classified as a functional disorder because it impairs the functioning of the body’s normal activities, such as the movement of the intestines, the sensitivity of the nerves of the intestines, or the way in which the brain controls some of these functions.
However, although the normal functioning is impaired, there are no structural abnormalities that can be found with an endoscope (a flexible viewing tube), x-rays, biopsies, or blood tests.
So, an IBS diagnosis is made based by the characteristics of the symptoms and, when done, normal results of tests. In other words, your digestion is suffering, but everything looks normal on your tests.
Causes of IBS
We don’t really know what causes IBS. In many people with IBS, the digestive tract is especially sensitive to many stimuli. People may experience discomfort caused by intestinal gas or contractions that other people do not find distressing.
Although the changes in bowel movements that occur with IBS might seem to be related to abnormal intestinal contractions, not all people with IBS have abnormal contractions, and in many of those who do, the abnormal contractions do not always coincide with symptoms.
In some people, symptoms of IBS begin after an episode of gastroenteritis.
Possible Triggers of IBS
- Emotional factors (for example, stress, anxiety, depression, and fear), diet, drugs (including laxatives), hormones, or minor irritants may trigger or worsen a flare-up (a bout or attack) of IBS.
- For some people, high-calorie meals or a high-fat diet may be a trigger.
- For other people, wheat, dairy products, beans, chocolate, coffee, tea, some artificial sweeteners, certain vegetables (such as asparagus or broccoli), or stone fruits (such as apricots) seem to aggravate the symptoms. These foods contain carbohydrates that are poorly absorbed by the small intestine. The carbohydrates become fermented by bacteria in the intestine, which causes gas, bloating, and cramping. Because many food products contain several ingredients, it may be difficult to identify the specific trigger.
- Other people find that eating too quickly or waiting too long between meals stimulates a flare-up. However, the relationship is inconsistent.
People do not always get symptoms after a usual trigger, and symptoms often appear without any obvious trigger. It is not clear how all the triggers relate to the cause of IBS. In other words, it’s often a frustrating mystery.
How Doctors Diagnose IBS
A doctor’s evaluation based on the Rome criteria
Laboratory and imaging tests to look for other disorders
Most people with IBS appear healthy. Doctors base the diagnosis of irritable bowel syndrome on the characteristics of the person’s symptoms. Doctors also use standardized symptom-based criteria for diagnosing IBS called the Rome criteria.
They may also do tests to diagnose common illnesses that can cause similar symptoms, particularly when people are over 40 or have warning signs such as fever, weight loss, rectal bleeding, or vomiting.
The Rome Criteria (The Rome Process)
Doctors use the Rome criteria to diagnose IBS in people who have had abdominal pain for at least 1 day a week in the last 3 months along with 2 or more of the following:
Pain that is related to defecation.
Pain is associated with a change in stool frequency (constipation or diarrhea).
- Pain is associated with a change in the consistency of stool.
A physical examination generally does not reveal anything unusual except sometimes tenderness over the large intestine. Doctors do a digital rectal examination, in which a gloved finger is inserted in the person’s rectum. Women undergo a pelvic examination.
Doctors usually do some tests—for example, blood tests, a stool examination—to differentiate IBS from Crohn disease, ulcerative colitis, cancer (mainly in people over age 40), collagenous colitis, lymphocytic colitis, celiac disease, and the many other diseases and infections that can cause abdominal pain and changes in bowel habits. These test results are usually normal in people with IBS.
Second Tier Tests
Doctors usually do more tests, such as ultrasonography of the abdomen, x-rays of the intestines, or a colonoscopy, in older people and in people who have symptoms that are unusual for IBS, such as fever, bloody stools, weight loss, and vomiting. Doctors may do a test to rule out lactose intolerance or bacterial overgrowth and also ask questions to rule out laxative abuse.
If Your IBS Symptoms Change – More Testing
Other digestive tract disorders (such as appendicitis, gallbladder disease, ulcers, and cancer) may develop in a person with IBS, particularly after age 40. Thus, if a person’s symptoms change significantly, if new symptoms develop, or if symptoms are unusual for IBS, further testing may be needed.
Questions About Emotions Stress
Because IBS symptoms can be triggered by stress and emotional conflicts, doctors ask questions to help identify stress, anxiety, or mood disorders.
IBS Treatment You Doctor May Suggest
Eating a normal diet and avoiding gas-producing and diarrhea-producing foods
- Increasing fiber for constipation
- Sometimes drugs
Treatment of irritable bowel syndrome differs from person to person. If particular foods or types of stress appear to bring on the problem, they should be avoided if possible. For most people, especially those who tend to be constipated, regular physical activity helps keep the digestive tract functioning normally.
Some people do better eating frequent, smaller meals rather than less frequent, larger meals (for example, 5 or 6 small meals rather than 3 large meals a day). People should try to slow their pace while eating. People with bloating and increased gas (flatulence) should avoid beans, cabbage, and other foods that are difficult to digest.
Some people find relief from IBS symptoms by restricting their intake of foods that are high in certain carbohydrates called fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These foods are collectively called FODMAPs. FODMAPs are carbohydrates that are poorly absorbed and rapidly fermented by bacteria in the small intestine, leading to increased gas and discomfort.
Sorbitol, an artificial sweetener used in some foods, drugs, and chewing gums, should not be consumed in large amounts. Fructose, a sugar found in fruits, berries, and some plants, should be eaten only in small amounts. A low-fat diet helps some people, particularly those whose stomach empties too slowly or too quickly. People who have IBS and who cannot digest the sugar lactose (called lactose intolerance), which is found in milk and other dairy products, should consume dairy products in moderation.
Constipation can often be relieved by eating more fiber. People with constipation can take a tablespoon of raw bran with plenty of water and other fluids at each meal, or they can take psyllium mucilloid supplements with two glasses of water. Increasing the dietary fiber may aggravate flatulence and bloating. Occasionally, such flatulence may be reduced by switching to a synthetic fiber preparation (such as methylcellulose).
If you think you have IBS, see your doctor for testing and diagnosis. If you already know your digestive issues are caused by irritable bowel syndrome, consider adding probiotics to your daily routing. Numerous studies have proven that probiotics are effective in treating the symptoms of IBS. Given that probiotic supplements are safe and widely available, it’s a good idea for IBS sufferers to to start taking a high quality probiotic daily.
As a 2015 study in the World Journal of Gastroenterology concluded:
“Probiotics reduce pain and symptom severity scores. The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with placebo”.
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