Probiotics for IBS

Introduction 

Probiotics are a hot topic when it comes to gut health, so you’ve probably already heard of probiotics for IBS.

But what is a probiotic and should you take probiotics for IBS? AND which one should you take when there are so many to choose from? 

This post will explain some of those questions you may be asking yourself when thinking about probiotics for IBS.

What is a probiotic?

When you think of consuming bacteria, you may instantly think of having a tummy bug. However, our gut is full of microbes which have a range of benefits for gut health and overall health. 

The term probiotic refers to live microorganisms (bacteria, yeasts, etc) that have a positive effect on your health or on a symptom you may have. Probiotics are not the same as prebiotics.

You can find probiotics in lots of different forms and brands. They can come in powders, capsules, sachets, fermented food products and more.

Different probiotics will contain different species and strains of bacteria that will increase the levels in your gut microbiome. 

It is the specific strains that can help you choose what probiotic is right for you. 

There are also other factors to consider when looking into taking a probiotic:

• Count of live bacteria (colony-forming units aka CFU)
• Ensuring you store them as instructed
• Not taking them past the expiry date, as the count of live bacteria decreases 

Benefits of probiotics for IBS

There are currently no officially approved health claims for probiotics to date. This means that official guidelines for IBS management are currently unable to make recommendations on specific probiotics.

This does not mean that you definitely won’t benefit from one – the research is there. It just isn’t considered strong enough by some organisations to make sweeping recommendations . 

The current British Society of Gastroenterology guidelines 2021 recommend that probiotics can be trialled as a first line management for IBS [1]. 

But you need to be cautious when choosing a probiotic as not every probiotic will be specific to what you need for your symptoms. 

Probiotics have been shown to reduce the following symptoms of IBS: 

• Constipation 
• Diarrhoea 
• Bloating
• Flatulence
• Pain and discomfort  

Another interesting use of probiotics for IBS is on the low FODMAP diet. This diet has been shown to  reduce levels of bifidobacteria but the use of probiotics prevents this [2]. 

Probiotics can also be used when taking a course of antibiotics to prevent antibiotic-related diarrhoea [3]. This decreases the risk of post-infectious IBS.

How do probiotics benefit IBS?

It makes sense that probiotics may help relieve your symptoms. This is likely due to IBS sufferers having an altered balance of gut microbiota) [4]. 

Probiotics may reduce your symptoms by [5, 6]:

• Providing your gut with the beneficial bacteria it is lacking 
• Altering your gut motility 
• Improving gut barrier function
• Increase your production or secretion of substances such as short chain fatty acids
• Altering your gut-brain axis

How do probiotics help with bloating?

Gut bacteria play a key role in the digestion (fermentation) of fibre, releasing gases as they do so. This can leave you feeling bloated and in pain and discomfort. 

Probiotics therefore may help relieve your bloating due to restoring the good bacteria in your gut microbiome. This can result in changes such as changes in the fermentation and those listed above (6).

Which probiotics help with bloating?

Studies have shown mixed results, depending on the microorganisms used in the probiotic product. The microorganisms are classified using the following:

• Genus e.g. Lactobacillus 
• Species e.g. acidophilus
• Strain e.g. NCFM

Well researched bacteria genera into the reduction of bloating include (7, 8): 

• Lactobacillus 
• Bacillus
• Bifidobacterium 

However, it is important that the specific species and strains within the genera are also considered when looking into the research. This is because different species and strains have been shown to only have an effect on specific symptoms. 

This will help in choosing a probiotic that is right for you and your specific IBS symptoms. This will also prevent you from wasting your money – probiotics are not cheap!

Here is a list of specific probiotics shown to help IBS;

VSL#3: 

This is a multi-strain probiotic beneficial for bloating in IBS. One research trial showed promising results in those with IBS-D (8).

This probiotic has also shown to be beneficial in restoring Bifidobacterium during the low FODMAP diet (9).

It has 112.5 billion CFU and must be kept refrigerated. 

PrecisonBiotics Alflorex:

This probiotic contains Bifidobacterium longum (or infantis) 35624® culture (10). This culture is not available in any other probiotic products in the United Kingdom. One large clinical trial showed a significant reduction in bloating in women with IBS and contributed to a 20% reduction in general IBS symptoms (11).

It is suitable for those on the low FODMAP diet. It is also free from milk, lactose, gluten and soya and bonus points that it does not need to be refrigerated.

Optibac Probiotics Every Day EXTRA (Named Daily Wellbeing EXTRA Strength outside of the EU):

This product contains four strains including Lactobacillus acidophilus NCFM and bifidobacterium lactis Bi-07. One trial showed a significant reduction in bloating after just four weeks (12). 

This Every Day EXTRA version is free from fructo-oligosaccharides (FOS) making it suitable for the low FODMAP diet. It is also suitable for vegans, vegetarians, and gluten-free, dairy-free or soy-free diets.

This probiotic contains 20 billion CFU. Refrigeration is not required.

Bio-Kult: 

This is a multi-strain probiotic containing 14 strains of live bacteria. 

One study showed that symptoms (including bloating) were significantly reduced in those taking this probiotic. It also showed that quality of life significantly improved, where the gut-brain axis plays a key role (13).

This product contains soya and milk.

It contains 2 billion CFU and does not need to be stored in the refrigerator.

Can probiotics cause bloating?

Side effects of probiotics are not common or expected. However, probiotics may cause you to have initial side effects, such as bloating. This will be short lived as your digestion system adjusts.

Symptoms such as bloating will be individual to you. This may depend on your original gut bacteria and if the strain selected is right for you or not. Symptoms such as bloating are more likely to occur if the probiotic contains a prebiotic, such as fructo-oligosaccharides (FOS). 

Prebiotics are beneficial as they feed good bacteria, enhancing their growth. FOS is classified as a fructan (a type of FODMAP) and may be poorly tolerated in those with IBS. They may result in bloating, flatulence and diarrhoea. If you are on the low FODMAP diet, you should look to take a probiotic that is free from FOS.

Are probiotics good for gas?

Excess gas production can result in bloating, discomfort and flatulence. It can be a result of the fermentation process by bacteria in your gut whereby gases are released. 

Probiotics may therefore help to reduce gas and flatulence in the same way that they reduce bloating. 

Gas may also be an initial side effect of taking a probiotic, but this should settle.

Are fermented foods probiotics?

Fermented foods are those that have been ‘pre-digested’ by microbes – known as fermentation. This results in the conversion of carbohydrates to organic acids (14). 

Examples include:

• Kimchi
• Kombucha
• Miso
• Tempeh
• Fermented dairy products

Fermented foods can be a probiotic product if the microbes are still alive in the product. They must survive the digestion process and make their way to your large intestine. They must also be present in sufficient numbers to have a positive impact on you.

Unlike probiotic supplements, it can be difficult to label the exact strains and amount of cultures in the food product. This can also make the research into the positive health benefits of fermented foods difficult. 

Fermented dairy has the strongest clinical evidence behind it in terms of health benefits. 

These include fermented yoghurts, milk and cheeses, where Lactobacilli are used in the fermentation process. Benefits include improvements in heart health, weight management and digestion (15).

How long should you take a probiotic for?

The British Society of Gastroenterology guideline on IBS management states that probiotics can be taken for up to 12 weeks. If there is no improvement after this point, they should be discontinued (16).

Summary

Taking a probiotic for IBS may help your symptoms but you need to ensure that it has been scientifically proven to work. Taking probiotics is not a one size fits all approach.

Article written by Beth Wilson (Registered Dietitian with specialist interest in gastroenterology) and reviewed by Kirsten Jackson Consultant IBS Dietitian