Are Probiotics Good For IBS

Irritable Bowel Syndrome, often referred to as IBS, is one of the most common disorders of gut-brain interaction and is estimated to affect approximately 1 in 10 people globally. (Source)

IBS is usually a lifelong problem and can be very frustrating to live with, having a huge impact on the everyday life of sufferers.

Treatment for IBS symptoms can include the use of probiotics, as these beneficial bacteria have been seen to ameliorate some of the discomfort experienced by those with IBS.

What Are The Symptoms Of IBS?

IBS is a chronic condition characterized by abdominal pain or discomfort, as well as bloating, gas, constipation, and diarrhea. (Source)

However, IBS is more than just occasional bloating or a bout of diarrhea.

IBS is diagnosed when you have abdominal pain at least once a day per week for three months, plus two or more of the following symptoms: (Source)

• painful bowel movement
• change in stool frequency
• change in stool appearance

There are also different types of IBS, depending on the type of bowel movement most often experienced.

Post-infectious IBS is the name given to another type of IBS, which can develop following an infection, such as gastroenteritis.

What Causes IBS?

Currently, the exact cause of IBS is still unknown.

Some symptoms may be caused by spasms of the colon and nerve endings in the intestines becoming unusually sensitive, heightening pain.

The reason for this is not always known but has been associated with psychological factors such as stress, bacterial overgrowth, use of antibiotics, food sensitivities, and intestinal inflammation, amongst others. (Source)

Psychological Factors

The gut and the brain are very intimately connected.

They stay in constant contact with each other using chemical messengers.

Our emotions and mental state can trigger symptoms in the gut – think of getting butterflies when you’re nervous – and our gut health can affect our mental well-being.

Do you ever feel a knot in your stomach during times of stress?

Stress can cause contractions in the gut and increase sensitivity.

While it’s not clear whether increased stress and other psychological factors like depression and anxiety lead to the development of IBS or vice versa, evidence shows that people with IBS often have higher levels of stress and anxiety and that this distress can in turn make IBS symptoms worse.

A review of 27 studies on people with IBS showed that levels of depression and anxiety are higher in those with IBS than in those who don’t have the disorder. (Source)

Research has also shown that IBS is more common in those who have experienced psychological trauma – such as the death of a loved one, divorce, natural disaster, house fire or car accident, physical or mental abuse – over their lifetime. (Source)

Antibiotics

Antibiotics work by killing invading bacteria that is causing infection in the body.

But antibiotics often can’t differentiate between this disease-causing bacteria and the beneficial bacteria that live in our gut and so can end up killing both. (Source)

Repeated or long-term use of antibiotics can drastically alter the bacteria within the gut, causing a condition called dysbiosis, and may result in disruption to the normal function of the colon.

This is why it is often advised to take a probiotic when on a course of antibiotics.

As microbiome disruptors, research indicates that antibiotics do seem to contribute to IBS, and antibiotic treatment is associated with an increased risk of the disorder, however not all studies have had consistent results so more research is needed. (Source)

Bacterial Overgrowth

Some people with IBS also have an overgrowth of bacteria in their small intestines, a condition called small intestinal bacterial overgrowth (SIBO), which causes dysbiosis of the gut microbiome.

It's not clear whether SIBO can be a cause of IBS, but evidence shows that people with IBS are more likely to have SIBO than those without. (Source)

Furthermore, some research has found that IBS symptoms can decrease following SIBO treatment.

How Can Probiotics Help With IBS?

Probiotics are the friendly bacteria that naturally live in our gut and can also be found in certain foods and in supplement form.

These bacteria are known to be beneficial to our gut health.

As mentioned, gut dysbiosis, an imbalance in the bacteria in our gut, has been seen to contribute to IBS symptoms.

Consuming probiotics, either through food sources or supplements, can help to restore the balance of our gut bacteria by increasing the amount of beneficial bacteria, inhibiting the growth of harmful bacteria, reducing inflammation and slowing down the digestive system.

However, not all probiotics are created equal.

There are many different strains of probiotics and each strain has a different effect.

While more research is needed to determine the most effective dose, length of treatment, and strains of probiotics for IBS, probiotics from the Bifidobacterium, Lactobacillus and Saccharomyces families have shown particular promise. (Source)

Do Probiotics Relieve IBS Symptoms?

In a review of 29 studies by the British Dietetic Association, 10 probiotic strains that may help improve overall symptoms of IBS were identified.

However, the results were inconsistent, and most strains have only one small study behind them.

No strain of probiotic was consistently effective in improving IBS symptoms and so no specific probiotic recommendations for IBS management in adults were made.

More data from large scale, high quality studies is needed. (Source)

Nonetheless, various health bodies, including the NHS in the UK, recommend probiotics in the treatment of IBS. (Source)

Another review found that of 15 studies that examined the effect of probiotics on IBS symptoms, 8 reported significant benefits of probiotics. (Source)

In order to provide clear guidelines regarding probiotic use for IBS more research is certainly needed, but there is evidence that probiotics may be helpful in relieving IBS symptoms in some cases.

Overall Symptoms

In a study of IBS patients taking the probiotic L. plantarum 299v, 78% of the 214 participants scored the probiotic as good or excellent for improving symptoms, particularly for pain and bloating, after four weeks. (Source)

Three other studies investigated the same probiotic, with one also reporting positive results and two not finding a positive effect.

A study of a two-strain probiotic liquid known as Pro-Symbioflor found that after eight weeks patients experienced a 50% decrease in general symptoms. (Source)

Symprove is a four-strain probiotic that was tested in 186 patients in the UK and was reported to reduce overall symptom severity after 12 weeks of treatment. (Source)

Abdominal Pain

In studies of the effect of probiotics on IBS-associated abdominal pain, some strains were associated with improvements.

These included:

• L. plantarum (Source)
• S. cerevisiae (Source)
• B. bifidum, B. lactis, L. acidophilus and L. casei (Source)

While this research is indeed positive, the majority of studies on probiotics have not found a beneficial effect on pain.

More studies are needed to confirm the findings for these strains.

Bloating

Only one strain, L. plantarum, has been found to reduce both abdominal bloating and gas. (Source)

A mixed-strain supplement containing B. lactis, L. acidophilus, L. bulgaricus and S. thermophilus, was found to reduce gas only. (Source)

Overall, few studies have shown that probiotics improve gas and bloating.

Diarrhea

While there has been a lot of research on probiotics for treating infection-related diarrhea, there is less evidence for use in IBS diarrhea.

Overall, probiotics don’t seem to be particularly effective at treating diarrhea in IBS.

Only a few small-scale studies have shown improvements.

Constipation

The most common form of IBS is the constipation-predominant type, which affects nearly half of all people with the condition. (Source)

Probiotics that have been seen to have a beneficial effect on constipation in IBS patients are:

• B. lactis (Source)
• L. acidophilus and L. reuteri (Source)
• L. plantarum, L. rhamnosus and L. lactis (Source)

Similar to the other symptoms discussed, there hasn’t been enough research to confirm whether probiotics truly benefit people with constipation due to IBS.

Should People With IBS Take Probiotics?

Due to a lack of solid evidence, there are no conclusive guidelines or recommendations when it comes to taking probiotics to treat symptoms of IBS.

However, certain health professionals and health bodies do advise that people with IBS try probiotics alongside other treatment options as they are generally safe to consume and you can always stop taking them if you don’t find any relief in symptoms.

If you are interested in trying a probiotic, be sure to look for a probiotic that does not contain any ingredients that may trigger your condition and make symptoms worse.

These could include oats, inulin, lactose, fructose, sorbitol, and xylitol.

Work with a healthcare practitioner to select a probiotic that best suits your needs.

You may find that probiotics are an effective supplementary treatment for your IBS symptoms.