Probiotics For IBS
Irritable bowel syndrome (IBS) is a gastrointestinal disorder that causes many digestive problems.
Although there is recognition of probiotics as a new treatment option, there is a lot of misunderstanding and technical language surrounding the subject.
This is a review of what the best probiotics for IBS actually are, explained in a way you can understand.
What Are Probiotics?
The word “probiotics” refers to germs that are eaten to improve our health.
They can change the mix of bacteria that already live in our gut (large intestine), which is called our gut microbiota.
The microbiota in our gut is thought to include up to 1000 types of bacteria, which can then be broken down into strains.
Probiotics are made up of a single species or a mix of species and strains in certain amounts. Most people agree that the species you eat and the species that are already in your gut affect how well they work.
Species of Lactobacilli and Bifidobacteria are the most common and have been studied the most. Notably, people with IBS seem to have smaller amounts of both species than a healthy person.
How Do They Work?
People believe that adding the right kinds and amounts of bacteria to the gut can make it healthier and maybe even change our weight.
Nevertheless, the exact way that probiotics work is still unknown.
In terms of IBS, the idea is that some types can help reduce inflammation, fix visceral hypersensitivity, gut dysmotility, intestinal permeability (also known as “leaky gut”), and even fix gut dysfunction.-brain cord
If this is true, we would think that probiotics would make IBS symptoms a lot better.
Which Probiotics Species Are Best?
Researchers who study IBS find it hard to say for sure how helpful probiotics are.
In the past, different types of probiotics, patient groups, study designs, and doses were used in different clinical experiments.
In general, there is more and more proof that taking probiotics for 8 to 10 weeks can help improve overall symptom response and quality of life compared to taking a fake pill (placebo). IBS-D, IBS-C, and IBS-M all have the same symptoms.
On the other hand, they don’t seem to work as well at treating stomach pain, gas, and bloating.
At the meeting at Yale University in 2015, two types of probiotics were chosen as the best choices for people with IBS:
- Bifantis (Bifidobacterium infantis 35624): a group of bacteria that normally live in the intestines, but specifically the strain 35624. It’s reported many people are missing this strain from their gut
- VSL#3: a probiotic mixture of eight strains (more on this below) .
As you can see in the the table here, the strains Lactobacillus plantarum 299V and Bifidobacterium animalis (also known as Bifidobacterium lactis) were also rated, although not as highly.
A list of probiotic strains rated for effectiveness in IBS at the 2011 and 2015 Yale University Workshops. Click to enlarge.
Note that recommendations are given as A, B or C ratings. None of the probiotic recommendations for IBS are rated A because more studies are needed first.
Probiotics and Constipation
Given the majority of IBS patients experience diarrhea as their main symptom (IBS-D), the majority of study subjects is no different.
For this reason there is much more data on treating diarrhea, and a general lack of recommendations for those struggling with constipation (IBS-C).
Fortunately there has been a recent 90-day clinical trial on 122 patients with IBS-C. The researchers wanted to test the effects of two different probiotic mixtures versus a dummy pill (placebo).
The strains tested included:
- Lactobacillus. acidophilus
- Lactobacillus. reuteri
- Lactobacillus. plantarum,
- Lactobacillus. rhamnosus
- Bifidobacterium. animalis subsp. lactis.
They found that between 66-90% of those taking either probiotic mixture responded very favorably to effects on bloating, abdominal pain and cramping, flatulence and constipation. By contrast, only 6-36% of the placebo group responded well (17).
Percentage of responders to IBS-C related symptom during the treatment period (t60, days) with probiotic formulations F_1 and F_2. F_3 was the placebo group. Click to enlarge.
Plus, they discovered that the good benefits lasted for 30 days after the last probiotic dose. After taking the probiotics for 60 days.
Based on these results, it looks like if you are having trouble with constipation, you should think about taking probiotics that contain at least a mix of Lactobacilli species.
The second blend, which had both Lactobacillus plantarum and Bifidobacterium animalis, did the best overall. Both of these were on the Yale top list in 2011 and 2015.
Which Probiotic Brands Are Best?
I know that making a list of the best species isn’t very useful when you want to buy something.
Based on the latest research and the opinions of digestive experts, these are the best probiotics for IBS that you can buy right now. There is no order to the list, and at this time there is no way to suggest one over the other.
There are dosage suggestions on the product, and none of them contain inulin, which is high in FODMAP. However, you should always talk to your doctor before starting a new vitamin.
What About Kijimea and Saccharomyces Boulardii?
Kijimea is a popular IBS probiotic pill in the US.
It contains a strain of bacteria called Bifidobacterium bifidum MIMB75 and is the only product with this strain.
There’s been one clinical trial using this strain, which included 122 patients. After 4 weeks, 47% of those taking B. bifidum MIMB75 reported significant improvements in pain, bloating, urgency and digestive disorders (as assessed by questionnaire). Whereas 11% of patients taking the placebo pill (fake pill) reported benefits
So Kijimea certainly shows some potential, but the science supporting it is thin.
The popularity likely comes from the fact it is easily available on Amazon and has great user reviews.
Saccharomyces Boulardii and Saccharomyces Cerevisiae
Saccharomyces is a type of yeast that does not cause disease.
Saccharomyces boulardii and Saccharomyces cerevisiae (also called “baker’s yeast”) are the two main types of bacteria used as probiotics.
Researchers have found that Saccharomyces boulardii can help with both antibiotic-associated diarrhea and traveler’s diarrhea. But there isn’t much proof yet that it can help with IBS or IBD, so it’s not recommended over the strains listed above.
I could only find one clinical study that looked at Saccharomyces cerevisiae in people with IBS.
86 people in this study took Saccharomyces cerevisiae for 8 weeks, while 93 people took a fake pill instead. In the last 4 weeks of treatment, 63% of those in the probiotic group said their stomach pain got better, while only 47% of those in the placebo group said the same. Not really a big deal of a result
There were no other changes between the groups, which shows that Saccharomyces cerevisiae does not work very well.
Should Probiotics Be Taken On A Low FODMAP Diet?
One way that has been shown to help people with IBS is the low FODMAP diet.
To do this, you must first cut out most FODMAPs from your diet for 3 to 8 weeks, until you have almost no symptoms. Then you slowly add them back in to find out which ones are making you sick. After that, you have a different diet for a long time.
Other things that might cause stomach stress need to be kept to a minimum for this to work. Some of the things that fall into this category are caffeine, spicy foods, fatty (fried) foods, booze, and fiber supplements. By cutting these out, you will be able to pinpoint the exact FODMAP group that caused your symptoms if they do happen.
Probiotics can be very helpful, but for some people, they make their problems worse. You shouldn’t start a new probiotic product during any part of the low FODMAP diet because of this risk.
The only time this isn’t true is if you were already taking a probiotic pill and were happy with it before you started a low FODMAP diet. In this case, you can keep doing that the whole time.
