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Probiotics: What Works for IBS?

Probiotics in yogurt

Symptoms of irritable bowel syndrome (IBS) can be challenging to manage, and many people are turning to natural solutions, like making changes to what they eat, to ease their symptoms, according to a review published in the American Journal of Nursing. One of the options has created a lot of buzz: Using beneficial microbes, called probiotics, as a natural treatment for IBS. But do probiotics actually help? And if so, what are the best probiotics for IBS?

Probiotics are beneficial bacteria or yeast. They're often found in everyday fermented foods, such as yogurt or sauerkraut, according to Harvard Health. There are also dietary supplements containing probiotics. Eating foods or taking a pill with probiotics may help rebalance the trillions of microbes normally found in your digestive tract and collectively known as your gut microbiome.

When bad bugs outnumber the good in your microbiome, it can throw off normal functioning in your body. Changes in the microbiome have been implicated in a number of conditions, including IBS.

Understanding IBS

To understand the role of probiotics for IBS, it helps to know more about this chronic digestive system condition. IBS can cause bloating, abdominal pain and worrisome changes in bowel habits, such as diarrhea or constipation, according to the American Journal of Nursing review.

IBS can be a frustrating condition that's sometimes hard to diagnose. In part, that’s because IBS doesn't cause any visible damage to your digestive tract. Doctors call IBS a functional disorder because it disrupts the normal function of the bowel. Experts suspect that the condition may interfere with the normal interaction between the brain and the gut. This may make your gut more sensitive. It may also affect how the muscles in your digestive system contract, which helps to expel waste.

There are three main types of IBS:

  1. IBS with constipation (IBS-C)
  2. IBS with diarrhea (IBS-D)
  3. Mixed IBS with both constipation and diarrhea (IBS-M)

IBS-C means that more than one-quarter of your bowel movements are hard and lumpy, while less than a quarter are watery or loose, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). People with IBS-D have loose or watery stool more than 25 percent of the time. They also have hard or lumpy bowel movements less than 25 percent of the time. People with mixed IBS have lumpy or hard stool more than a quarter of the time and loose and watery stool at least 25 percent of the time.

To diagnose IBS, your doctor must rule out other conditions that could be causing your symptoms, such as Crohn's disease, ulcerative colitis, celiac disease or colon cancer. The first step is a physical exam and blood tests. The doctor will want to know about your symptoms and how often they occur. He or she will also want to know about your family's health history and if you've had any recent infections.

Your doctor will likely want to test your stool and will give you a container with instructions on how to collect a sample. You may need additional tests, such as a hydrogen breath test to check for a number of intestinal conditions, an endoscopy to check for celiac disease and a colonoscopy to check your overall colon health and rule out colon cancer, according to NIDDK.

What causes IBS?

IBS is likely caused by a number of factors. Inflammation, extra sensitivity and irregular movement of the intestines, along with an imbalance of the microbes in the gut, are all believed to play a role in IBS symptoms. Diet and stress are also suspects in IBS. Different things may lead to IBS in different people.

Some things, though, are more common in people with IBS, such as bacterial infections in the digestive tract, food intolerances, bacterial overgrowth in the small intestine, difficult early life events such as physical or sexual abuse, and mental health conditions such as depression or anxiety, according to NIDDK.

How is IBS treated?

Medications are available for some IBS symptoms, but changes in your diet are usually the first treatment tried for IBS. People are often advised to eat more fiber, avoid gluten (a protein found in wheat) or follow a special eating plan (called a FODMAP diet) that eliminates from your diet certain problematic high-carb foods that have been implicated in IBS, according to the NIDDK. Your doctor also might suggest adding probiotics to your diet.

Because probiotics are bacteria or yeast, your first thought might be that they sound like germs that might cause infection. But not all bacteria and yeast can cause problems. Some are helpful. In fact, the body is full of naturally-occurring “good” microbes, reports the National Center for Complementary and Integrative Health (NCCIH). These beneficial bugs help you digest food. They also keep your immune system strong and produce vitamins.

What types of probiotics can help with IBS?

There isn't overwhelming evidence about specific types of probiotics that might ease IBS symptoms. This may be because different probiotics are like different drugs, and IBS itself can have different causes in different people. But reviews of available research suggest that probiotics may help with abdominal pain, bloating and gas, though the results are mixed. Researchers suspect probiotics help replenish the body's natural microbiome, which may lessen IBS symptoms. While these results are promising, larger trials are needed before doctors can confidently recommend these agents on a routine basis.

Two bacteria that have shown promise in treating IBS include strains of Bifidobacteria and Lactobacillus. People with IBS may have lesser amounts of these bacteria in their digestive tract.

Bifidobacterium infantis in particular has been found to improve IBS symptoms and appears to be most helpful for symptoms of gas and bloating, according to the International Foundation for Gastrointestinal Disorders.

Bacteria in the Lactobacillus family and yeast, such as Saccharomyces boulardii, are other types of probiotics that might have a role in treating IBS, states the NCCIH.

Where can you find probiotics?

A number of foods contain probiotics, including:

  • Yogurt
  • Kefir
  • Kombucha
  • Sauerkraut
  • Pickles
  • Miso
  • Tempeh
  • Kimchi
  • Sourdough bread

Yogurt is a common way to get probiotics, but the type of healthy bacteria can vary from brand to brand. The amount of bacteria can also vary. If you're trying to up your intake of probiotics, look for the words "live and active cultures" on the label.

Probiotics in dietary supplement form are available in pills or as a liquid. Probiotics sold as dietary supplements don't require U.S. Food and Drug Administration (FDA) approval, so choose products from manufacturers you trust. According to the Cleveland Clinic, if you decide to shop for probiotics, look for products that state they have at least a billion units of live and active cultures of one or more of the suggested strains.

Make a note of how you're feeling

Whenever you try probiotics or any new treatment, it's a good idea to keep a log of your symptoms and the treatments you've tried. After several weeks of tracking your symptoms, you should be able to notice a change in the severity or frequency of your symptoms.

Are there risks to probiotics?

For most people, the biggest downside to probiotics may just be the strong taste or smell of most foods that contain them. The beneficial bacteria play a role in how these foods taste, according to Harvard Health. They may also affect the texture of the foods. You might find these foods unpleasant.

Also, though they're generally considered safe, probiotics could potentially lead to an infection. It's possible, too, that probiotic bugs might transfer resistance to antibiotics to microbes already in the digestive tract, according to the NCCIH. People who have severe illnesses or compromised immune systems have a greater risk for harmful effects from probiotics. Probiotics also may contain other bacteria than what is listed on the packaging, and these microbes might be harmful.

Overall, however, probiotics are a low-risk treatment that may provide some relief of your IBS symptoms.

Article references

  1. American Journal of Nursing, "Irritable Bowel Syndrome: A review" - https://journals.lww.com/ajnonline/Abstract/2017/06000/Irritable_Bowel_Syndrome.26.aspx.
  2. International Foundation for Gastrointestinal Disorders, Gut Flora, Probiotics, and Antibiotics - https://www.iffgd.org/video-corner/gut-flora-probiotics-and-antibiotics.html.
  3. Harvard Medical School, How to Get More Probiotics - https://www.health.harvard.edu/staying-healthy/how-to-get-more-probiotics.
  4. National Institute of Diabetes and Digestive and Kidney Diseases, Irritable Bowel Syndrome - https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome
  5. National Center for Complementary and Integrative Health, Probiotics: What You Need to Know - https://nccih.nih.gov/health/probiotics/introduction.htm.
  6. New England Journal of Medicine, “Irritable Bowel Syndrome” - https://www.nejm.org/doi/full/10.1056/NEJMra1607547.
  7. World Journal of Gastroenterology, “Gut Microbiota Role in Irritable Bowel Syndrome: New Therapeutic Strategies” - https://www.ncbi.nlm.nih.gov/pubmed/26900286
  8. Cleveland Clinic, How to Pick the Best Probiotic for You - https://health.clevelandclinic.org/how-to-pick-the-best-probiotic-for-you/