Probiotics and IBS – What Does the Evidence Tell Us?

IBS gut.jpgIrritable Bowel Syndrome (IBS) is characterized by episodes of abdominal pain or discomfort experienced alongside constipation and/or diarrhea.

It is often characterized as diarrhea-predominant (IBS-D), constipation-predominant(IBS-C), or mixed (IBS-M). IBS can be quite debilitating and affects up to 5-15% of the population (1).

Proposed causes of IBS include motility, low-grade inflammation, altered gut-brain dynamics, emotional stress, and imbalance of gut microbes (2; 3).

Altered gut microbes or “dysbiosis” is correlated on its own with problems of gut motility, sensitivity, brain-gut signaling, and IBS.

Changes in gut bacteria are linked to IBS when compared to healthy controls, but it’s the mere presence of imbalance that’s more important than focusing on individual strains.

Simplifying a treatment protocol to just probiotics would be incomplete, but the benefits of probiotics overlap with most proposed causes of IBS, and as you’ll see below, evidence supports their use.

Combined results from various studies support the use of probiotics in the treatment of IBS. Those receiving probiotics reported less pain, bloating, and gas – yet these improvements were not necessarily specific to a specific strain or species of probiotic (4).

As the research matures, we may gain more insight into which probiotic strains work best for different types of IBS. For now, it is generally accepted that a range of probiotic strains can relieve IBS symptoms.

  • In a group of patients with diarrhea-predominant IBS, a 2 billion CFU Bacillus coagulans supplement was administered for 90 days. Those receiving the probiotic reported higher quality of life, and less bloating, diarrhea, vomiting, belly pain, and frequency of bowel movements compared to placebo (5).
  • Another trial looked at Lactobacillus rhamnosus over 6 weeks. IBS symptom scores were reduced (6).
  • A mixed probiotic containing strains of Lactobacilli, Bifidobacteria and Streptococcus thermophilus was associated with a reduction of diarrhea scores after 4 weeks of treatment (7)
  • Lactobacillus acidophilus taken over 8 weeks was associated with less abdominal pain (8). Similar findings were supported by a separate 12-week study (9).

In summary, a range of probiotics may be helpful to reduce symptoms related to IBS in both diarrhea and constipation-predominant patients.

What about prebiotics?

Prebiotics may also be useful for IBS. Prebiotics help feed and maintain healthy bacteria- so it would make sense that they would help rebalance gut flora and offer benefits for IBS.

We get prebiotics from eating a variety of fruits, vegetables, roots, and tubers, but you can supplement with them too. Partially hydrolyzed guar gum is one in particular that has been shown to be helpful and well-tolerated for both constipation and diarrhea-predominant IBS.

I personally tend to use combination of Megaspore (Microbiome Labs) with a mixed-strain probiotic called Theralac (Master Supplements) together or individually. I then slowly introduce a prebiotic blend like MegaPrebiotic or PHGG based on client tolerance. Of course, these steps are just general rules of thumb and can vary widely per individual.

Spores naturally protect themselves from harsh environments like the stomach. Master Supplements has a patented means of delivering their probiotics past the harmful stomach acid. Other brands can also meet support needs – just make sure that you’re getting good dosage and delivery for your money.

Protocols can change with the presence or non-presence of SIBO, Candida overgrowth, food allergies/sensitivities, antibiotic history, and other circumstances that may call for a more complete gastrointestinal overhaul.

Probiotics are a cornerstone treatment option to treat IBS symptoms as their benefits overlap with the wide variety of proposed causes. Are probiotics enough by themselves? They can be, but usually not.

When you take probiotics, you also promote and maintain everyday gut health – so they are products you can feel good about taking regularly.

IBS protocols may otherwise include various combinations of probiotic/prebiotic support, motility support, antimicrobial support, selective diets (low FODMAP, elimination diet, specific carbohydrate diet, Paleo diet, Elemental diet, etc), and careful introduction of products as they are tolerated.

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