7 Best Probiotics For IBS, According to a Gastroenterologist
Irritable Bowel Syndrome is a common functional gastrointestinal disorder characterized by recurrent abdominal pain or discomfort, bloating, and changes in bowel habits without any identifiable structural or biochemical abnormalities. IBS affects around 12 percent of the US population according to NIDDK.
Probiotics are live microorganisms that, when administered in adequate amounts, confer health benefits on the host by improving the balance of gut microbiota and promoting digestive and immune system health. Probiotics are both safe and effective in IBS patients according to a 2022 review authored by LS Kumar. Probiotics are also recommended as helpful for IBS by the NHS
What Is IBS?
Irritable Bowel Syndrome (IBS) is a common condition that affects the digestive system. It is characterized by symptoms such as stomach cramps, bloating, diarrhea, and constipation, which tend to come and go over time and can last for varying durations. IBS is typically a lifelong problem. While there is no known cure for IBS, there are treatments available to help control the symptoms, including mind-body techniques, dietary changes (such as the low FODMAP diet), nutritional supplements, medications, and physical activity.
People exposed to stressful events, especially in childhood, may experience more IBS symptoms. Changes in gut microbes, including bacteria, fungi, and viruses, which play a key role in health, may also contribute to the condition. It emphasizes that IBS is not a life-threatening disorder and does not result in more serious medical problems like colitis or cancer. If left untreated, the symptoms of IBS can persist, leading to pain and discomfort.
What Is IBS-C?
IBS-C refers to irritable bowel syndrome with constipation. It is a common chronic gastrointestinal disorder characterized by abdominal discomfort or bloating, alongside symptoms of constipation. In IBS-C, stools do not pass often enough (less than three times per week), and they may be hard to pass or give a feeling of incomplete bowel movements according to ASGE.
The cause of IBS-C is not fully understood, but researchers believe several factors may contribute to the condition, such as abnormal colon muscle movements or excessive fluid absorption from stools. Treatments for IBS-C may include dietary and lifestyle changes, medications, and mental health therapies. The goal of treatment is to alleviate symptoms and improve the quality of life for those affected by IBS-C. There are 5 different types of IBS as shown in the graphic below.
What Is IBS-D?
IBS-D refers to irritable bowel syndrome with diarrhea. It is a type of IBS characterized by abdominal discomfort or bloating symptoms, accompanied by frequent or loose stools. Treatments for IBS-D may include dietary and lifestyle changes, medications, and mental health therapies.
While IBS-D is not life-threatening, it can significantly impact a person's quality of life. The goal of treatment is to reduce symptoms and improve the uncomfortable aspects of IBS-D, such as abdominal pain, discomfort, or bloating. Diagnosis and management of IBS-D involve various approaches, including medications like eluxadoline and dietary modifications according to a 2019 study authored by DJ Cangemi.
What Is IBS-M?
IBS-M stands for Mixed-Type Irritable Bowel Syndrome. It is a subtype of IBS characterized by alternating bouts of constipation and diarrhea. People with IBS-M may experience symptoms of both IBS-C (constipation-predominant) and IBS-D (diarrhea-predominant), with bowel habits fluctuating between hard and lumpy stools and loose and watery stools on the same day.
The triggers and symptoms of IBS-M can vary widely between individuals, making it a complicated and diverse disorder. Treatment for IBS-M may involve lifestyle changes, dietary modifications, medications, and managing stress to improve the overall quality of life for those affected.
What Is IBS-U?
IBS-U stands for Irritable Bowel Syndrome - Unsubtyped and is a subtype of irritable bowel syndrome where individuals experience both watery/loose stools and hard stools, less than 25% of the time based on the Rome IV Criteria for diagnosis according to a 2014 authored by MM Self.
It is classified as "unspecified" because the symptoms do not clearly meet the criteria for the other subtypes of IBS, such as IBS-C (constipation-predominant), IBS-D (diarrhea-predominant), or IBS-M (mixed-type). Treatment for IBS-U involves managing the symptoms and improving the overall quality of life for those affected.
What Is Post Infectious IBS?
Post-infectious irritable bowel syndrome (PI-IBS) is a specific subtype of IBS that can occur in some individuals after experiencing an infection in the stomach or intestines according to a 2021 study authored by A Berumen. This subtype is referred to as post-infectious because the symptoms of IBS develop following the infection.
One common cause of PI-IBS is infectious gastroenteritis, which is also known as food poisoning. After the infection, some individuals may continue to experience persistent abdominal discomfort, bloating, and diarrhea, which are characteristic symptoms of IBS.
Symptoms of PI-IBS can vary in duration and severity, and treatment approaches may be tailored to manage the specific symptoms and individual needs of the patient according to a 2012 study authored by R Spiller.
Do Probiotics Help With IBS?
Yes, probiotics do help with IBS according to research. A 2010 review authored by G Aragon, found probiotics have a potential beneficial effect in alleviating symptoms commonly found in IBS. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.
The exact mechanism of how probiotics may aid in reducing IBS symptoms is not fully understood, but they appear to have positive effects on gut bacteria, mucosal integrity, and immune activity.
Several studies have investigated the use of probiotics in IBS patients, with some showing promising results in improving abdominal pain, bloating, and bowel habits. Bifidobacterium and certain probiotic combinations have shown efficacy in some trials, while other single-strain probiotics, like Lactobacillus, have been less impressive in their impact on IBS symptoms.
Do Probiotics Make IBS Worse?
Yes, probiotics can make IBS symptoms worse for some people when taking them for the first time. While probiotics may be beneficial for many IBS patients, individual responses may vary but side effects usually pass after around 2-days.
Probiotic side effects refer to potential adverse reactions or symptoms experienced by some individuals after consuming probiotic supplements, which may include bloating, gas, diarrhea, or mild gastrointestinal discomfort.
7 Best Probiotics For IBS
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The 7 best probiotics for IBS are Lactobacillus acidophilus, Saccharomyces boulardii, Lactobacillus plantarum 299v (DSM 9843), Lactobacillus paracasei HA-196, Bifidobacterium infantis 35624, Bifidobacterium longum NCC3001 and Bifidobacterium bifidum MIMBb75.
- 1Lactobacillus Acidophilus: A 2020 study authored by S Sadrin, found that the consumption of the 2-strain mixture of L. acidophilus over 8 weeks was safe and led to a significant decrease in flatus and composite scores. The probiotics group showed significant improvements in flatus score and composite score at week 8 compared to the placebo group.
- 2Saccharomyces boulardii: A 2011 study authored by CH Choi, found this strain significantly improved the quality of life of patients with diarrhea-predominant IBS or mixed-type IBS. The patients who received S. boulardii showed a higher overall improvement in IBS-QOL compared to the placebo group (15.4% vs. 7.0%). Additionally, all eight domains of IBS-QOL were significantly improved in the S. boulardii group, while the placebo group only showed improvements in dysphoria and health worry.
- 3Lactobacillus plantarum 299v (DSM 9843): The main health benefit finding from this study on Lactobacillus plantarum 299v for irritable bowel syndrome (IBS) was that a 4-week treatment with L. plantarum 299v provided effective symptom relief, particularly for abdominal pain and bloating, in patients fulfilling the Rome III criteria for IBS. After 4 weeks of treatment, the group receiving L. plantarum 299v reported lower pain severity and daily frequency of symptoms compared to the placebo group. Moreover, a significantly higher percentage of patients (78.1%) in the L. plantarum 299v group rated the symptomatic effect as excellent or good, compared to only 8.1% in the placebo group.
- 4Lactobacillus paracasei HA-196: A 2020 study authored by ED Lewis, found this strain improved gastrointestinal symptom severity and quality of life, particularly in individuals with specific IBS subtypes. The study, conducted with 251 adults with IBS, assessed the effects of L. paracasei and Bifidobacterium longum R0175 compared to a placebo. Participants receiving L. paracasei experienced increased bowel movement frequency in those with IBS-C and decreased frequency in those with IBS-D.
- 5Bifidobacterium infantis 35624: A 2006 study authored by PJ Whorwell, found this strain significantly relieved many of the symptoms of IBS in women. After a 4-week study, B. infantis 35624 showed superior efficacy compared to placebo and other bifidobacterium doses in reducing abdominal pain, bloating, bowel dysfunction, incomplete evacuation, straining, and the passage of gas. The probiotic also improved the overall global symptom assessment by over 20% compared to placebo. The dosage of 100 million CFU was delivered in a stable and convenient capsule form, making it suitable for widespread use.
- 6Bifidobacterium longum NCC3001: A 2017 study authored by MI Pinto-Sanchez, found this strain significantly reduced depression scores in patients with IBS. The study, conducted on 44 adults with IBS and mild to moderate anxiety and/or depression, found that after 6 weeks of daily Bifidobacterium longum NCC3001 supplementation, 14 out of 22 patients in the probiotic group experienced a reduction in depression scores of 2 points or more on the Hospital Anxiety and Depression scale, compared to only 7 out of 22 patients in the placebo group.
- 7Bifidobacterium bifidum MIMBb75: A 2011 study authored by S Guglielmetti, found that this strain significantly alleviated IBS symptoms and improved the quality of life in patients. The study, conducted on 122 patients, found that after 4 weeks of daily supplementation with Bifidobacterium bifidum MIMBb75, there was a significant reduction in the severity of IBS symptoms compared to the placebo group. The probiotic also showed significant improvements in specific IBS symptoms, such as pain/discomfort, distension/bloating, urgency, and digestive disorder. The patients in the Bifidobacterium group reported a significant gain in quality of life and a higher percentage of adequate relief from symptoms compared to the placebo group.
How Long Does It Take For Probiotics To Help With IBS?
It takes around 8-weeks, 1.8 months or 56 days for probiotics to help with IBS according to research. A 2009 systematic review authored by HF Dale, found that probiotics taken over a period of 8 weeks or more, have the potential to significantly improve IBS symptoms in some patients. The review analyzed 11 randomized controlled trials, and 63.6% of the studies reported that probiotic supplementation led to a significant improvement in IBS symptoms compared to a placebo.
Can Stress Cause IBS?
Chronic stress and major life traumas can be significant factors in the development of Irritable Bowel Syndrome according to a 2014 study authored by HY Qin.
Stress and anxiety are known to trigger symptoms of IBS and worsen existing conditions. Strong emotions like stress and anxiety can activate pain signals in the gut and may cause the colon to react, leading to IBS symptoms.
There is evidence by HY Qin, linking psychological stress to IBS, and stress-induced changes in the digestive system, including inflammation, have been observed in studies. While stress may not be a direct cause of IBS, it can exacerbate symptoms and create a vicious cycle of stress-induced IBS symptoms.
Many people with IBS report increased symptoms, such as abdominal pain, when experiencing stress. Managing stress is considered an essential aspect of IBS management, as it can help alleviate symptoms and improve overall well-being for those affected by IBS.
Stress is a physiological and psychological response to challenging or demanding situations, characterized by feelings of tension, anxiety, and pressure.
Can Gastritis Cause IBS?
It's not clear if Gastritis can cause IBS but there is a significant association between Irritable Bowel Syndrome and chronic gastritis according to research. A 2009 study authored by MR Helvaci, suggests that IBS is a cascade of physiological events triggered by infection, inflammation, and psychological disturbances, and Gastritis may be one of the terminating points in this cascade.
While gastric acid is not believed to be directly involved in the development of IBS, psychological factors are considered to be important in both Gastritis and IBS. Both gastritis and IBS are common gastrointestinal diseases with their respective symptoms and complications. Managing the symptoms of gastritis and IBS can be challenging, as they may require different treatments.
Gastritis is a condition characterized by inflammation of the lining of the stomach, often leading to symptoms such as abdominal pain, nausea, and indigestion.
Can Antibiotics Cause IBS?
Yes, antibiotics can play a role in the development of Irritable Bowel Syndrome according to research. The use of antibiotics can disrupt the balance of bacteria in the gut, potentially making IBS more likely to occur in some individuals according to a 2018 study authored by MY Yoon.
Antibiotics can promote the growth of harmful bacteria, such as C. difficile, which may lead to severe and life-threatening diarrhea. While antibiotics can be helpful in treating infections by killing harmful bacteria, they can also impact the "good" bacteria that play a crucial role in maintaining gut health.
Disruption of the gut microbiota by antibiotics has been associated with an increased risk of developing IBS and functional gastrointestinal symptoms according to a 2022 study authored by Z Mamieva.
Repeated or long-term use of antibiotics may alter the gut flora in a way that disrupts normal colon function, potentially leading to the development of IBS according to a 2023 study authored by D Dahiya. It is important to be mindful of antibiotic use and consider its potential impact on gut health.
Antibiotics are a class of medications used to treat bacterial infections by either killing the bacteria or inhibiting their growth.
Are Prebiotics Good For IBS?
No, prebiotics by themselves do not significantly improve gastrointestinal symptoms or quality of life in adults with irritable bowel syndrome according to a 2019 review authored by B Wilson.
The effectiveness of prebiotics varied depending on the type and dose used, with non-inulin-type fructan prebiotics showing improvements in flatulence severity, while inulin-type fructans worsened flatulence. Prebiotics were observed to increase the abundance of beneficial bifidobacteria in the gut which can be good for gut health.
Prebiotics are non-digestible fibers that promote the growth of beneficial bacteria in the gut, while probiotics are live microorganisms that provide health benefits when consumed in adequate amounts.
Is Low Fodmap Good For IBS?
Yes, Low Fodmap is good for IBS according to research. A 2022 review authored by CR Xie, found that Low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet was shown to be beneficial in managing IBS symptoms.
A low FODMAP diet is an eating plan that restricts the intake of certain fermentable carbohydrates found in various foods to alleviate symptoms of irritable bowel syndrome and other gastrointestinal disorders.
Is Yogurt Good For IBS?
Yes, yogurt can be beneficial for some individuals with irritable bowel syndrome due to its probiotic content. This "good bacteria" that may help alleviate symptoms and improve gut health. The live cultures in yogurt help break down lactose, making it less likely to cause gassy symptoms.
Probiotic yogurt is a type of yogurt that contains live beneficial bacteria, known as probiotics, which can promote gut health and may offer potential benefits for digestion and overall well-being.
Dr. Sara Mesilhy has a Master’s degree in Gastroenterology and holds a membership with the Royal College of Physicians of the United Kingdom. She completed her Bachelor of Medicine, Bachelor of Surgery (MBBS) at Cairo University and is currently part of the ProbioticReviewGirl medical team.