Understanding Gut Troubles: Can Probiotics for IBS Help?

The world of probiotics has been exploding in recent years. In fact, roughly one-third of Americans try to consume probiotics daily. Further, about 25–45 million Americans suffer from irritable bowel syndrome (IBS).

As a dietitian with 5+ years of experience in the food and supplement retail sector, I know navigating the world of probiotics can be confusing. Specifically, as more and more probiotics are being marketed for IBS support, it is becoming crucial to stay on top of the research.

So, can probiotics help support IBS symptoms like abdominal pain and changes in bowel habits? My first-hand experience researching probiotics and interacting with probiotic companies can help you make an informed decision.

What exactly is irritable bowel syndrome?

Irritable bowel syndrome, or IBS, is a chronic disorder that impacts an estimated 5–10% of people worldwide. Further, IBS is classified as a disorder of the gut-brain interaction (DGBI) that is characterised by the following symptoms:

1. Abdominal pain
2. Bloating
3. Changes in bowel movements (like diarrhea, constipation, or both)

IBS can further be broken down into four subtypes, which differ based on symptoms and types of bowel movements:

• IBS-C (constipation predominant)
• IBS-D (diarrhea predominant)
• IBS-M (mixed)
• IBS-U (unspecified)

While the cause of IBS remains relatively unknown, researchers have theorized it may be linked to one or some of the following:

• Family history/genetics
• Stressful life events
• Bacterial infections in the gut
• Food intolerances or sensitivities
• Oversensitive gut nerves
• Gut motility (the movement of food through your gastrointestinal tract)
• Certain psychological disorders (like anxiety or depression)

What does our gut microbiota do, and why does it matter for IBS?

The group of tiny gut bacteria and other microorganisms that live inside our digestive system is collectively known as the ‘gut microbiota’ and plays a role in our overall health and well-being.

Specifically, the beneficial bacteria help with digestion, certain vitamin production, nutrient absorption, immune support, and protection from harmful bacteria.

Your digestive system also contains some harmful bacteria along with the beneficial. These harmful bacteria are typically not a concern unless the delicate balance of bacteria is disturbed.

When balance is disrupted (dysbiosis), an overgrowth of harmful bacteria occurs, which may lead to a chronic condition. However, gut microbiota is complex, and research indicates it’s more about how these bacteria interact in an environment than on their own.

Studies indicate that IBS patients have different gut microbial make-ups than people without IBS. While individual variation of gut microbes occurs with everyone, there is a notable difference between people with IBS versus those without.

Probiotics explained: friendly microbes for your gut

So what exactly are probiotics? The general consensus in the scientific community is that probiotics are live microorganisms that, in specific doses, confer a health benefit.

Probiotics may be found in certain foods like some yogurt, kefir, sauerkraut, kimchi and more, but not all fermented foods contain probiotics. Probiotics can also be found in supplement form.

How might probiotics help IBS patients?

Research on probiotics to improve IBS symptoms is growing. But how do they work?

Probiotics may positively impact gut dysbiosis by adding new bacterial populations to the digestive system or by promoting the growth of existing beneficial bacteria.

One recent meta-analysis indicated that taking probiotics containing certain strains of Lactobacillus and Bifidobacterium for 4–8 weeks was effective at relieving IBS symptoms when compared to other bacterial genera.

However, more research is needed as different standards for diagnosing IBS in these studies were used, making it tricky to interpret results accurately. Further, there are not enough studies considering the cost of probiotics and whether they are more or less impactful than other symptom management methods, like the low FODMAP diet.

Alternatively, a review examined probiotics as a therapy for IBS-D and found that although certain probiotics appear to decrease IBS-D symptoms, there was a high risk of bias in the data, and thus, the quality of evidence is low.

Further high-quality evidence is needed to examine if and how certain probiotics may help relieve IBS symptoms.

Exploring the evidence: can probiotics improve IBS symptoms?

Research on probiotic use for IBS is ongoing, and results are inconsistent. However, promising research regarding specific probiotic strains is emerging in this area.

Overall symptom improvement

The strain Lactiplantibillus plantarum 299v has demonstrated potential improvement of overall IBS symptoms like gas, bloating, abdominal pain, and stool frequency after 4 weeks of use.

However, research on this probiotic is limited and dated, and the results are mixed. Newer, more robust research is warranted.

Abdominal pain

From working with clients who have IBS, I hear firsthand that abdominal pain can severely impact quality of life.

Research suggests that some bacterial strains, like Saccharomyces cerevisiae I-3856 in IBS-C and L. plantarum 299v, may help to reduce abdominal pain in IBS patients.

However, some of these studies lack gender diversity (i.e., they are mainly done in male populations), and thus, the results may not be applicable to a broader population.

Diarrhea

Previous IBS clients have told me that ongoing diarrhea has impacted their ability to perform optimally at work. Fortunately, there is some promising research that indicates probiotics like Bacillus coagulans may help reduce IBS-related diarrhea.

Constipation

Well-studied probiotics like Bifidobacterium lactis may help support consistency and increase the number of bowel movements in those with IBS-C.

Despite that, in this review, multi-strain probiotics were also used, so it’s difficult to say what strains or strain combinations specifically are the most effective.

Overall, these are some of the well-researched probiotics for potential symptom management of IBS to date, however, new evidence is rapidly evolving in this field.

Should you take a probiotic for IBS?

As a registered dietitian, I have worked with countless individuals suffering from IBS.

IBS has several management options, ranging from dietary and lifestyle changes to medications and supplements. However, the evidence indicates that the low FODMAP diet is the most well-known tool for IBS management that may help relieve symptoms for roughly 50–86% of IBS patients.

The low FODMAP (fermentable, oligo-, di-, monosaccharides, and polyols) diet is a dietary approach that is low in certain types of carbohydrates that ferment in the gut, causing unwanted digestive symptoms, and was created to help people with IBS.

Some of these carbohydrates include, but aren’t limited to:

• Wheat, rye, beans, legumes, garlic, and onion
• Milk, soft cheeses
• Apples, honey, artichokes
• Artificial sweeteners, cauliflower

In practice, while a low FODMAP diet can be effective, given busy schedules or other lifestyle stressors, often a modified approach (eliminating particular common high FODMAP food triggers) may be more efficient for adherence.

While a probiotic for IBS may be helpful for some, in practice, I only recommend these in select cases, as research in this area is still emerging. Also, I find these products can be costly, and adherence can be challenging for some.

Further, when possible, I recommend trying to find a probiotic food specific to your IBS symptoms, as foods contain other nutrients that are beneficial for overall health.

In general, I typically only advise supplement use if food-first strategies have been implemented with limited success and if it is safe to do so in each individual case.

Choosing your gut allies: how to select probiotics for IBS

If you choose to take a probiotic for IBS symptom management, here are a few key tips to consider based on my experience as a registered dietitian reviewing current evidence:

1. Choose a strain that matches your main gastrointestinal symptoms.
2. Take the recommended dose. Probiotics are researched for their effectiveness at a dose for a select amount of time (typically 4–8 weeks).
3. Follow the manufacturer’s recommended doses for best results.
4. Follow proper storage guidelines. Some probiotics require refrigeration while others are shelf-stable. Further, pay attention to expiry dates; probiotics will lose potency if they pass their expiration dates.
5. If you are currently taking antibiotics, take probiotics at least 2 hours apart from your antibiotics, as the antibiotics can destroy the probiotics, and make sure to consult with your healthcare provider.

Potential downsides: can probiotics make IBS worse?

Yes, some probiotics may worsen IBS symptoms. Particularly, high doses may make symptoms worse initially as the gut is fermenting more carbohydrates than usual, which may lead to symptoms like bloating and gas, particularly in patients with IBS-D.

However, if side effects do occur, they tend to be mild and temporary.

On another note, small intestinal bacterial overgrowth (SIBO) is a condition that refers to the overgrowth of harmful bacteria. SIBO is different from IBS, but those with SIBO often have similar symptoms to IBS.

The evidence suggests that probiotic use in those with SIBO may also worsen symptoms, so they should use probiotics with caution.

Important considerations before starting probiotics

In the U.S., supplements like probiotics are regulated differently from prescription medications.

In particular, supplements are regulated under the Dietary Supplement Health and Education Act of 1994 (DSHEA) branch of the FDA, whereas prescription medications are regulated under the Food and Drug Administration Modernization Act of 1997 (FDAMA). These guidelines follow a more rigorous standard than required for supplements.

As supplement regulation is not as stringent, if you are choosing to use a supplement, look for products that are from reputable brands and have undergone third-party testing. This provides more assurance that the supplement contains what it says on its packaging.

Further, before trying a probiotic, consult a healthcare professional, particularly if you are experiencing severe symptoms.

For example, I have worked with a few patients who thought they had IBS and, upon referral to a doctor, learned that their symptoms were related to another serious digestive disease.

In rare cases, some clinical studies have linked probiotic use to opportunistic infections in severely ill and hospitalized patients. While I have not had this happen to any patients I have worked with, it is important to take caution in such cases, especially for immunocompromised people, and to not use any supplements, including probiotics, without a doctor’s approval.

Finding probiotics in your diet: exploring fermented foods

Some fermented foods, like certain yogurts and kefirs, may naturally contain some probiotics, but not all fermented foods contain probiotics. For example, sourdough bread is made with live microbes, but once it is cooked, the live microbes are destroyed.

Further, even foods that contain probiotics may not be intended for IBS patients, as these foods may also be high in FODMAPs (common gut irritants in those with IBS).

Overall, probiotic foods may help support general gut health, but typically don’t target specific gut health conditions or symptoms. Probiotic supplements tend to have more specific and targeted support.

Final thoughts: navigating IBS probiotics relief

While some probiotic strains show promising results in reducing IBS symptoms, evidence is still emerging.

There is no way to treat IBS; even so, you can manage IBS in various ways, such as through diet modifications, lifestyle changes, medications, and, in some cases, support overall well-being by supplement use.

Probiotics are generally considered safe for most healthy individuals, but always discuss with a healthcare provider prior to use, as individual symptom management for IBS varies.