- What Are the Best Supplements for IBS? Two Recent Studies May Have the Answer
- The Multidimensional Benefits of Curcumin for IBS
- Berberine Enhances Quality Of Life for Patients with IBS
- Choosing the Best Supplements for IBS Today
- 5 supplements for IBS
- 1. Probiotics
- 2. Enzymes
- 3. B1
- 4. Fish oil
- 5. Fiber
- Probiotics for Irritable Bowel Syndrome
- Results of Recent Studies (See Table 1)
- Table 1: Statistically Significant Outcomes in Probiotic Studies of IBS Patients
What Are the Best Supplements for IBS? Two Recent Studies May Have the Answer
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- A growing number of patients are seeking out natural supplements to alleviate IBS symptoms, but the most common supplements for IBS may not be the best
- Emerging clinical research suggests that curcumin and berberine can have a significant impact on multiple IBS symptoms, ultimately enhancing quality of life
- While research is ongoing, patients can easily integrate high-quality curcumin and berberine supplements in their treatment plans today to support optimal wellness
For patients struggling with irritable bowel syndrome (IBS), gastrointestinal distress can become a way of life. When conventional treatments fail to provide relief, many people find themselves becoming accustomed to arranging their schedules around their symptoms and living in a state of persistent discomfort. Often, these symptoms not only take a heavy physical toll, but also affect emotional well-being and body image. As such, the damage of IBS can be far-reaching and complex, significantly diminishing quality of life. But it doesn’t have to be that way, thanks to a number of innovative nutritional supplements.
Probiotics are often the first thing to come mind when considering supplements for IBS and, indeed, many people do turn to probiotics in their search for relief from IBS symptoms. However, despite decades of research, there is no consensus within the scientific community about whether or not probiotics can treat IBS. As such, researchers have increasingly begun to turn their attention toward more innovative therapeutic ingredients as they seek to discover the best supplements for IBS. Of the ingredients currently under investigation, curcumin and berberine stand out for their potential to address a range of IBS symptoms safely and naturally.
The Multidimensional Benefits of Curcumin for IBS
Many patients may not be familiar with curcumin, but it could be a powerful tool in the fight against IBS symptoms. Curcumin is a type of curcuminoid, which is a group of natural compounds that originate from the turmeric root. Significantly, there is now reason to believe that curcumin supplements could provide relief from a number of common IBS symptoms, including, pain, bloating, and discomfort while defecating. These benefits are likely due to curcumin’s ability to control gastrointestinal inflammation and support the gut microbiome.
In a preliminary clinical trial published in 2016, researchers found that curcumin supplementation may help reduce gastrointestinal distress and diminish the negative impact of IBS on patients’ quality of life.1 After taking a curcumin supplement every day for a month, patients with IBS reported a 68% reduction in their daily experience of abdominal pain. In contrast, patients who took a placebo reported only a 27.1% decrease in daily abdominal pain. Additionally, 25.9% of patients treated with curcumin reported having at least one symptom-free day each week at the end of the trial—a massive improvement in comparison to the 6.8% of the patients taking a placebo who reported the same.
Curcumin also helped improve body image, a critically important yet typically under-addressed aspect of IBS. This may have been driven in part by curcumin’s effect on bloating; over the course of the study, the patients taking a curcumin supplement experienced progressively fewer incidences of abdominal bloating, eventually reporting bloating 50% less frequently than before they started the supplement. The patients taking curcumin also had less discomfort while defecating. On a 100-point IBS symptom severity scale, patients taking curcumin exhibited an average of 13.6 points lower than patients taking a placebo, indicating a significant improvement. These clinical results are encouraging, particularly as they suggest multidimensional physical and psychological benefits that may enhance overall wellness.
However, curcumin is but one of several similar compounds that vary in terms of their therapeutic efficacy, and patients may find that they experience better results with tetrahydrocurcumin supplement owing to its superior chemical properties. When the liver processes a curcumin supplement, it converts the curcumin into tetrahydrocurcumin, which can then deliver therapeutic benefits throughout the body. But the liver is slow to process curcumin. As a result, there is often not enough tetrahydrocurcumin circulating in the bloodstream to produce significant benefits when taking most standard curcumin supplements. Tetrahydrocurcumin, on the other hand, is processed quickly by the liver. This means that tetrahydrocurcumin is likely to be more effective for IBS because it is more bioavailable and can reach a higher concentration in the body in a shorter amount of time, increasing the possibility of meaningful therapeutic results. As such, patients who are interested in exploring the possibilities of curcumin for IBS may wish to seek out supplements containing tetrahydrocurcumin.
Berberine Enhances Quality Of Life for Patients with IBS
While the potential of using curcumin in the treatment of IBS is compelling, berberine may also offer patients a new path toward symptom relief. Berberine is a plant-derived dye with a number of medicinal properties; historically, it has been used as an antibiotic in traditional Chinese medicine, but modern medical science indicates that its pain-relieving and anti-inflammatory effects are more relevant for patients. By controlling inflammation in the gastrointestinal tract, berberine could have a beneficial effect on bacterial populations in the microbiome and help patients to control pain. While questions remain about how exactly berberine exerts these effects, research in model animals suggests that berberine is a powerful therapeutic in the making.
Importantly, berberine has been proven to be helpful for IBS in preliminary clinical trials. In a 2015 clinical trial, patients who took berberine every day for 8 weeks experienced 64.6% less abdominal pain than patients who took a placebo.2 Furthermore, patients who were treated with berberine reported that they felt the need to urgently defecate less than half as frequently as patients in the placebo group. However, the benefits were not confined solely to specific symptoms; patients who took berberine reported an 18.2% increase in quality of life. In other words, alleviating IBS symptoms led patients to experience a greater sense of wellness both physically and emotionally, going beyond any individual physical phenomenon to have a more holistic healing effect.
Based on these promising results, more clinical trials investigating the potential benefits of berberine are likely on the horizon. If subsequent research can confirm therapeutic efficacy and clarify optimal dosing, we may see berberine play an increasingly significant role in IBS treatment in the future. However, high-quality berberine supplements are already available, and patients may find that using the study’s protocol of 400mg once per day gives them the support they need to achieve relief.
Choosing the Best Supplements for IBS Today
IBS is notorious for being difficult to treat, but patients shouldn’t lose hope, particularly as advanced nutritional supplements are beginning to show their immense potential. With the clinically-demonstrated benefits of curcumin and berberine as therapies for IBS, patients have more options to choose from than ever before and new opportunities to achieve their health goals. Some patients may need to try more than one supplement-based therapy before they experience the results they are looking for; ultimately, the only way to know which therapy will be helpful is to try them. By selecting safe, natural supplements backed by empirical evidence and produced by a trusted manufacturer, patients can confidently take the next steps on the journey toward wellness. Foundational Medicine Review is committed to exploring the most innovative treatment methods for gastrointestinal disorders. Join our mailing list to receive the latest news and analysis delivered right to your inbox.
IMAGINE HAVING A CONDITION with symptoms so severe that you can’t leave the house, yet your doctor calls it a “functional,” or “psychosomatic,” disease — meaning that it’s all in your head.
But it’s a very real problem for the 60 million people — that’s 20 percent of Americans — who have irritable bowel syndrome (IBS). These people are plagued by uncomfortable and often disabling symptoms like bloating, cramps, diarrhea, constipation, and pain.
I have many patients with IBS, some of whom have suffered for decades without relief. Their previous doctors couldn’t find the cause of the illness, so they were told to just get more fiber or take Metamucil, or were prescribed sedatives, anti-spasm drugs, or antidepressants.
That is NOT the answer. Most of those treatments don’t work, because they don’t address the underlying causes of why your digestion is not working. Emerging research has helped identify the underlying causes. For over 15 years I have been successfully treating irritable bowel syndrome and other digestive conditions using a very simple methodology based on functional medicine that helps identify and remove the underlying causes and restores normal digestive function and health.
Today, I am going to share 5 steps you can follow to cure IBS. But first I want to tell you about a patient of mine …
Alexis and Her Lifelong Irritable Bowel
At age 45, Alexis had suffered from IBS for 33 years — almost all her life! Her major symptom was sudden, painful, cramping diarrhea. She was doing the best she could to prevent it. She didn’t consume dairy, didn’t drink or smoke, and took Citracel every day. Yet nothing helped.
She would go to the bathroom 4 to 5 times before she even left the house in the morning. And she couldn’t go out of the house at all without knowing where all the closest bathrooms would be in case she had what she called “s— attacks.” That wasn’t Alexis’ only problem … She also felt full and bloated after every meal, which starchy foods made worse.
She had taken many antibiotics over the years and had many yeast infections. An upper endoscopy or scope into her stomach had shown that she had gastritis, or inflammation of the stomach. She also had severe premenstrual syndrome (PMS), with irregular periods, breast tenderness, sugar cravings, headaches, and agitation. She also had unusual symptoms like rectal itching (often a clue to yeast infections or food allergies). And she was tired all the time.
Alexis tried to eat healthy, but her diet was less than ideal. She had a bran muffin and coffee in the morning and a salad for lunch. But her “drug of choice” was sugar — in the form of cakes, ice cream, Jell-O, diet sodas, and other junk food. Not surprisingly, she was also about 20 pounds overweight.
To help Alexis, I simply identified and treated the UNDERLYING CAUSES of her digestive problems! To understand how I did that, you first have to understand a little bit about how the gut works.
These are the two main causes of IBS: Food allergies and overgrowth of bacteria in the small intestine.
How Gut Imbalances Can Lead to IBS
Imagine a tennis court. That is the surface area of your small intestine, where food is absorbed. Your small intestine is also the site of about 60 percent of your immune system. And this sophisticated gut-immune system is just one-cell layer away from a toxic sewer — all of the bacteria and undigested food particles in your gut.
If that lining breaks down — from stress, too many antibiotics or anti-inflammatory drugs like aspirin or Advil, steroids, intestinal infections, a low-fiber, high-sugar diet, alcohol, and more – your immune system will be exposed to foreign particles from food and bacteria and other microbes. This will trigger and activate immune response, allergy, and will irritate your second brain (the enteric nervous system) creating havoc that leads to an irritable bowel, an irritable brain, and other system wide problems including allergy, arthritis, autoimmunity, mood disorders, and more.
The microbial ecosystem in the gut must be healthy for you to be healthy. When your gut bacteria are out of balance — when you have too many pathogenic bacteria and not enough healthy bacteria — it makes you sick. You’ve got about 3 pounds of bacteria — 500 species — in your gut. In fact, there is more bacterial DNA in your body than there is human DNA! Among all that gut bacteria, there are good guys, bad guys, and VERY bad guys.
If the bad guys take over — or if they move into areas that they shouldn’t (like the small intestine which is normally sterile) — they can start fermenting the food you digest, particularly sugar or starchy foods.
This is called small bowel bacterial overgrowth, and it’s a major cause of IBS.
The major symptom it causes is bloating, or a feeling of fullness after meals. What causes this bloating? The overproduction of gas by the bacteria as they have lunch on your lunch!
Small bowel bacterial overgrowth can be diagnosed by a breath test, which measures gas production by the bacteria, or by a urine test that measures the byproducts of the bacteria after they are absorbed into your system.
Bacterial overgrowth is a real syndrome and was recently described in a review paper published in the Journal of the American Medical Association.(i) The condition can be treated. In fact, a major paper was recently published in the Annals of Internal Medicine that showed using a non-absorbed antibiotic called rifaximin for 10 days resulted in a dramatic improvement in bloating and overall symptoms of IBS by clearing out the overgrowth of bacteria.(ii) This medication is now under FDA review for approval as a new treatment for irritable bowel syndrome.
That’s great news for many IBS patients. But, unfortunately, not all patients with the same diagnosis are created equal. There’s more than one factor that leads to IBS. Another major cause of IBS is food sensitivities. Not true allergies, but low-grade reactions to foods that drive so many chronic symptoms including IBS.
A landmark paper, was recently published in the prestigious British medical journal Gut that found eliminating foods identified through delayed food allergy testing (IgG antibodies) resulted in dramatic improvements in IBS symptoms.(iii) Another article, an editorial in the American Journal of Gastroenterology, stated clearly that we must respect and recognize the role of food allergies and inflammation in IBS.(iv)
So the research tells us that these are the two main causes of irritable bowel — food allergies and overgrowth of bacteria in the small intestine — but there may be others, including a lack of digestive enzymes, parasites living in the gut, zinc or magnesium deficiency, heavy metal toxicity, and more.
And this is precisely why it is so critically important to personalize treatment based on the unique circumstances that exist for each person who suffers from IBS — the solution is most certainly not one-size-fits-all. But solutions can be found if we look carefully at the underlying causes and treat them.
Which leads me back to Alexis …
How I Helped Alexis Heal from IBS
I prescribed Alexis a non-absorbed antibiotic, an antifungal drug for her yeast problem, and had her eliminate the foods to which she was allergic. I believe in treatment that addresses the underlying cause of the problem. If there is a bacterial or yeast infection, then medications are often the best treatments. The key is to effectively treat the cause. If medications do that, then I use them.
Then I gave her supplements of healthy bacteria to normalize her gut and zinc to help with her digestive enzymes (chronic diarrhea can result in zinc deficiency).
I also gave her extra fiber to feed the healthy bacteria, fish oil to reduce gut inflammation, a multivitamin, and herbs to balance her hormones (which are greatly affected by abnormal bacteria).
Zinc, Magnesium, Probiotics, Fiber, Fish Oil, Enzymes, Glutamine, Vitamin A can be found in my store. It is important to work with a healthcare practitioner, preferably a Functional Medicine Practitioner, to personalize your health program to your specific needs.
What happened then may shock some, but I wasn’t surprised. It is the same result I have seen in patient after patient when the principles of functional medicine are applied …
Alexis came back to see me two months later, and she was a different person. Not only did she lose 20 pounds, she had not had a “s—- attack” and was having normal bowel habits for the first time in 33 years! She also had more energy, and her PMS vanished.
She looked and felt 10 years younger and was free of the suffering she had endured for over three decades.
Do you have to suffer like Alexis did? No. We have the science, the understanding, and tools to deal with this chronic problem and the suffering it causes 1 in 5 people. There is no need to wait for any more studies. I have been treating IBS in my practice for over 15 years with dramatic success.
In fact, just recently, one of my patients told me that, for the first time in his life, he didn’t have any more stomach pains or digestive problems. He had previously been so bad that he had to have a phone installed in his bathroom!
To take advantage of these discoveries today, simply follow these five steps.
5 Steps to Curing IBS
- Get tested. Try to get a test for IgG food allergies and eliminate the foods that test positive for 12 weeks. Or simply try an allergy elimination diet for a few weeks.
- Test yourself. If you can’t afford the test mentioned above, then just eliminate the most common food allergens for 12 weeks — that’s dairy, gluten, yeast, eggs, corn, soy, and peanuts. And then reintroduce them to see if they cause symptoms. This is an effective way to isolate the foods that may be causing you problems. I have created a simple program to follow based on a comprehensive elimination diet called The UltraSimple Diet.
- Get rid of the unwanted visitors in your small bowel. Ask your doctor to prescribe rifaximin (Xifaxin) and take two 200 mg tablets three times a day for seven to 10 days. This is often the best way to deal with the chronic bacterial overgrowth that causes bloating and irritable bowel syndrome. You may also need an anti-fungal such as nystatin or fluconazole for two to four weeks.
- Repopulate your digestive tract with good bacteria. I don’t usually recommend brands, but when it comes to probiotics the quality varies so much that I suggest taking two specific brands. Take one packet of VSL3 (available on the Dr. Hyman Store) or other high potency probiotic twice a day for one to two months. This probiotic has over 450 billion organisms per packet. I also recommend a probiotic called S. boulardii take two capsules twice a day for two months. This is a special probiotic that helps to further normalize gut function.
- Try digestive enzymes with meals to help break down food while your gut heals. You also may benefit from nutrients that help heal the lining of the gut including fish oil, GLA (from evening primrose oil, zinc, vitamin A, glutamine and others.
Zinc, Magnesium, Probiotics, Fiber, Fish Oil, Enzymes, Glutamine, Vitamin A can be found in my store. It is important to work with a healthcare practitioner, preferably a Functional Medicine Practitioner, to personalize your health program to your specific needs.
By taking these steps and seeking out the underlying causes of IBS, you can dramatically improve your health and overcome your digestive disorder.
Please leave your thoughts by adding a comment below—but remember, we can’t offer personal medical advice online, so be sure to limit your comments to those about taking back our health!
(i) Lin, H. (2004). Small intestinal bacterial overgrowth. The Journal of the American Medical Association. 292:852-858.
Irritable bowel syndrome (IBS), a gastrointestinal condition that involves abdominal pain and altered bowel habits (constipation, diarrhea, or both), affects over 10% of Americans. Though some find the condition merely a nuisance, for many individuals it can be quite bothersome and disruptive. While medications can sometimes offer relief, some individuals do not respond to medications or find the side effects intolerable. Fortunately, there are several well-studied, nondrug, integrative approaches that can help to reduce IBS-related symptoms and restore a sense of control over one’s life.
IBS is well known to be aggravated by stress. Moreover, the symptoms and the disruption they cause can themselves become a source of stress, creating a vicious cycle of stress and discomfort. How does stress affect the gastrointestinal system? It turns out that the largest concentration of neurons outside of the brain and spinal cord is in the gastrointestinal tract, making it particularly susceptible to stress and creating a strong brain-gut connection. Stress hormones can alter movement through the gastrointestinal tract (speeding it up or slowing it down) and cause the muscles in the intestines to spasm and cause pain. Thus, for people who experience a lot of stress in their lives, learning stress-reduction techniques can be instrumental in reducing the frequency and severity of IBS-related symptoms.
Several clinical trials have demonstrated that two stress-reduction techniques — meditation and mindfulness-based interventions — can significantly reduce abdominal pain and improve bowel habits. To be most effective, these tools should be practiced daily, as over time they retrain the nervous system and reduce the amount of time that it operates in the stress (fight-or-flight) response. It’s important to remember that meditation and similar techniques are learned skills that take time and practice to build, so you are unlikely to notice an immediate improvement in IBS-related symptoms after the first or second try. There are many meditation apps, internet tutorials, and even evidence-based courses offered through major hospitals that offer opportunities to learn these invaluable skills.
Other stress-reducing approaches have also shown benefit for IBS-related symptoms. These include gut-directed hypnotherapy (a popular protocol in Europe), cognitive behavioral therapy, and possibly yoga.
Studies have shown that foods high in FODMAPs (dietary sugars known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can exacerbate IBS-related symptoms by providing fuel for certain bacteria in the gastrointestinal system. The byproducts from these bacteria can cause pain and bloating. On the other hand, low-FODMAP diets can reduce the abdominal pain, bloating, diarrhea, and constipation associated with IBS. Although safe to follow for short-term use, there are no long-term studies of this diet, and sustaining this eating pattern can be challenging.
For some patients with diarrhea-predominant IBS, reducing intake of gluten, a protein found in wheat, rye, and barley, can help. This may be the case even if you do not have celiac disease, as gluten can modify the barrier function of the gut lining.
For individuals with constipation-predominant IBS, a soluble fiber supplement (Metamucil or others containing psyllium) can be helpful. Large amounts of fiber can hinder the absorption of medications, so take your medications one to two hours before the fiber supplement. Soluble fiber is also found in foods such as beans, avocados, oats, and dried prunes. Be sure to consume plenty of water with fiber to avoid worsening the constipation.
A recent analysis of nearly 1,800 patients from multiple studies demonstrated that probiotics reduce pain and symptom severity in IBS compared to placebo. Probiotics are “good” bacteria touted to help maintain digestive health. However, given the variety of different probiotics that have been studied, it is difficult to know exactly which ones are most useful or how much to take.
Finally, peppermint oil is well known for its ability to relax the smooth muscles of the gastrointestinal system, and can help reduce the abdominal pain associated with IBS. To reduce the potential for heartburn, enteric-coated capsules (typically containing 0.2 milliliters or 181 milligrams of peppermint oil) are recommended. The dose for adults is one to two capsules up to three times per day.
Mind-body tools, a low-FODMAP diet, and some supplements can help relieve IBS-related symptoms and are generally safe for most people. They can also be used in combination with most IBS medications. If you have IBS, talk with your healthcare professional, as he or she may be able to provide you with resources to help you implement these tools in your life.
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5 supplements for IBS
April is Irritable Bowel Syndrome (IBS) Awareness month, no foolin’. Disrupting at least 10 to 15 percent of adults, it’s said to be second only to the common cold as a cause of absence from work.
No definitive IBS test exists, and instead, doctors use a process of elimination—in some cases literally—to rule out other bowel diseases with similar signs. With chronic symptoms like abdominal pain and/or discomfort and “bowl habits” that can go either way or alternate between diarrhea and constipation, no wonder so many people “have a cold.”
Whatever the time of year or designated ailment of the moment, your stomach can’t even rumble anymore without hearing about the gut’s implications in overall health, and it should be no surprise that the same certainly applies in this case.
Alongside a slew of diet and stress-relief considerations, supplements can help alleviate intestinal disturbances. The handful presented here includes some of the usual stomach suspects in addition to new research that may prove helpful in future formulations and natural retail customer recommendations.
Among acupuncture, herbs, hypnosis and regular exercise/yoga/massage or meditation, the Mayo Clinic lists probiotics as a nontraditional therapy that may help relieve IBS symptoms. In sources such as yogurt and supplements, “It’s been suggested that people with irritable bowel syndrome may not have enough good bacteria, and that adding probiotics to the diet may help ease symptoms.”
According to a press release from probiotic company, Vidazorb, the type of probiotic strains used and the amount of viable colony forming units (CFUs) a supplement contains is critical in providing the most effective results. It goes on to mention Chr. Hansen L. acidophilus and bifidobacterium as strains shown to be effective in counteracting the side effects of antibiotics frequently prescribed to soothe symptoms while also managing to kill good bacteria in its wake.
Being that the gut is regulated by the brain, IBS is often referred to as a brain-gut disorder. Studies also point to probiotics for their benefits on the stress side of IBS, and gut health champion, Brenda Watson recommends 80 billion plus cultures a day to “protect the intestinal lining, help to reduce leaky gut, promote a healthy immune response and rebalance the bacteria in the intestines in favor of beneficial bacteria over endotoxin-producing non-beneficial bacteria.”
With anything this stomach centric, diet is certainly implicated. Nutrition and health writer, Jack Challem says that food sensitivities are a big issue here, with wheat or dairy often being particularly problematic. Removing them from the diet usually improves things.
But it can get complicated when looking at what to eat.
“For those suffering from one or multiple IBS symptoms, healing food choices can often seem to put them between a rock and a hard place,” reports Ashley Koff, RD. “Initially, what will help them heal may be difficult to digest. Digestive enzymes to the rescue! These can help IBS sufferers consume better-quality foods that might otherwise further exacerbate their symptoms and that are essential to healing their digestive system.”
Specifically, she mentions Enzymedica’s Digest Gold with ATPpro to help cells optimally regenerate, further improving digestive system function.
Echoing Challem’s remarks, Koff notes that for IBS sufferers, there tend to be several food intolerances–gluten, dairy, beans, etc. While they’re not carte blanche to eat poorlyor overeat, digestive enzymes that cater to such dietary needs “can help these patients enjoy a wider variety of better-quality food options and reduce stress around certain eating experiences (social, travel, etc.),” she goes on, “All of which helps reduce stress and its negative impact on their digestive system and overall health.”
In Challem’s opinion, the most interesting recent research focused on people with ulcerative colitis and Crohn’s diseaseâconditions closely related to IBS. “Extreme fatigue is often associated with all of these disorders, and the researchers used very high doses of vitamin B1 to eliminate the fatigue,” he explains.
“The researchers had to cut back on the highest amount of B1 because of side effects,” adds Challem, suggesting that, most likely, 600 to 800 mg daily would be effective and safe.
4. Fish oil
“Other research, probably around 10 years old, showed that fish oil supplements (500 mg daily) were helpful in this cluster of disorders,” Challem points out.
Watson also draws connections between IBS and chronic fatigue syndrome (CFS) and says that fish oil omega-3 fatty acids at 2 grams daily–both EPA/DHA omega-3 types–help lubricate the digestive tract and reduce inflammation. “People with CFS are typically low in omega-3s, a deficiency that contributes to their general inflammation levels,” writes Watson.
As might be suspected, fiber supplements may help control constipation, and Mayo Clinic mentions psyllium (Metamucil) or methylcellulose (Citrucel).
“Fiber helps bind with toxins, which exacerbate IBS and CFS, and also helps support beneficial bacteria levels (beneficial bacteria feed on select types of fiber, such as fructooligosaccharides and inulin),” according to Watson. “People with IBS and CFS are advised to gradually build up to 30 to 35 grams of fiber a day, including both soluble and insoluble fiber types.”
Probiotics for Irritable Bowel Syndrome
In this article, we will review evidence for the use of probiotics in the treatment of irritable bowel syndrome (IBS) in adults. However, this does not replace the advice of your physician, whom you should always consult with for specific treatment recommendations.
The World Health Organization defines probiotics as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.” They include bacteria as well as yeasts. Probiotics work in many possible ways, including:
- lining the surface of the gastrointestinal tract and stopping harmful organisms from reaching it (competitive exclusion),
- strengthening the tissue of the bowel wall,
- acting as antibiotics against other bacteria, and
- regulating the responses of the immune system, both at the level of the bowel wall and the body as a whole.
The only way to show the effectiveness of a new treatment, such as probiotics in IBS, is by doing trials in which researchers randomly choose patients to receive either probiotics or a placebo, and then compare the two groups with respect to outcomes (randomized controlled trial). We will only discuss probiotics with such studies in this article, as we cannot draw conclusions about probiotics that have not undergone this type of thorough testing.
One important factor to consider is that while there are now guidelines from Health Canada concerning the quality of probiotics sold in pharmaceutical dosage forms (e.g., tablets, capsules), there are currently no regulations concerning probiotic bacteria in food. A study done in British Columbia and reported in 2004 looked at ten different over-the-counter products labelled as containing the probiotic bacteria, Lactobacillus. Analysis showed that only five brands contained live Lactobacillus, while two of them grew no organisms whatsoever. Five brands contained other species of bacteria, not listed on the label. Of the brands that actually contained Lactobacillus, the amount that could be cultured from the product ranged from 0.8% to 1.3% of the amount stated on the product label. With the developing Health Canada guidelines for selling probiotics, this might not be an issue in the near future.
Another important point is that bacteria come in multiple strains (usually indicated by a number after the name of the bacteria, such as E. coli Nissle 1917). The results of a clinical study done with a particular strain of a bacterium might not apply to a different strain of the same species of bacteria.
In multiple clinical trials, researchers have assessed the safety of probiotics. The risks are minimal in outpatients with a normal immune system. About 30 cases of infection of the bloodstream by fungus have been reported: nearly all cases were with Saccharomyces boulardii in hospitalised patients with intravenous catheters. It was felt that the infections were the result of nurses giving probiotic pills to patients and then touching their intravenous catheters with contaminated hands.
A single case report describes a liver abscess due to Lactobacillus rhamnosus in a 74-year-old woman with diabetes (a disease associated with an increased risk of infection), who was taking the organism as a probiotic. In another case report, a 67-year-old man with an abnormal heart valve taking Lactobacillus rhamnosus developed infection of the heart (endocarditis) a few days after the removal of decayed teeth, which we know to be a risk factor for such infections. Thus, there are small but potential risks of infections from probiotics in outpatients who have specific risk factors, such as diabetes, poor dentition, or those who are on drugs that can suppress the immune system (e.g., steroids, azathioprine, infliximab, adalimumab).
Results of Recent Studies (See Table 1)
- Three studies have looked at Lactobacillus plantarum 299V (Tuzen®) in IBS, involving a total of 112 patients. Not all of the studies looked at each symptom, and the results were as follows: overall symptoms improved for patients in one of two studies, pain improved in one of two studies, and gas improved in one of two studies. There was no significant improvement in constipation.
- One study looked at 40 patients using Lactobacillus acidophilus SDC 2012 and 2013 strains and found significant improvement in pain and straining, but no change in frequency of bowel movements. Another study looked at a different strain of Lactobacillus, acidophilus LB strain, in 18 patients and found improvement of symptoms after 6 weeks.
- Two other studies looked at Lactobacillus acidophilus species in combination with other probiotics in a total of 146 patients. In one study, pain and gas improved while there was no overall difference in relief of symptoms. The second study used a combination of probiotics that also included Streptococcus thermophilus, Lactobacillus bulgaricus, and Bifidobacterium longum in 30 subjects. The probiotic mixture was significantly more effective in improving overall IBS symptoms, pain, and gas but not bloating. Another study, which also used Lactobacillus plantarum LP01, showed a decrease of overall symptoms of 55% with treatment versus 14% for placebo, but did not do any statistical testing to show this was effective.
- Two studies looked at a combination of products containing two Lactobacillus rhamnosis strains (GG and Lc705) plus Propionibacterium freudenreichii (subspecies shermanii JS) plus a strain of Bifidobacterium, from a company named Valio, in a total of 172 patients. Both studies showed an improvement in IBS symptoms and pain but no change in constipation or diarrhea. Only one study showed an improvement in gas or quality of life.
- Two negative studies looked at Lactobacillus reuteri ATCC 55730 in 54 subjects and Lactobacillus casei (strain GG) in 24 subjects.
- Two studies looked at Bifidobacterium infantis 35624 (Align®) in 437 subjects. Both showed improvement in pain and IBS symptoms. One of two studies showed improved frequency of bowel movements. No improvement in overall quality of life was noted.
- One study examined Bifidobacterium animalis DN 173010 (Activia® yogurt) in 274 patients with IBS and constipation. While the overall results were negative, when researchers confined their analysis to subjects with less than three bowel movements per week, they noted an improvement in symptoms, pain, constipation, and quality of life. However, since this analysis was done after the original study and only on a subgroup of the patients, it should not be considered conclusive.
- Two studies looked at Escherichia coli DSM 17252 in almost 600 subjects (in one of the studies it was combined with Enterococcus faecalis DSM 16440). Both studies showed an improvement in overall symptoms and pain, while one study showed an improvement in bloating and stool consistency.
- Another study looked at Bacillus coagulans GBI-30 6086 in 44 IBS patients with diarrhea. After treatment, abdominal pain scores were improved in 7/7 weeks in the treatment group, versus only 2/7 weeks in the placebo group. Similarly, bloating improved with treatment in 7/7 weeks versus none of 7 weeks with placebo.
Although researchers have conducted multiple studies on probiotics in patients with IBS, the results are mixed. This is not surprising, since different probiotics are like different drugs. In addition, IBS is likely due to different causes in different patients. While these early results are promising, future large trials are necessary before doctors can be confident in prescribing these agents on a routine basis.
Table 1: Statistically Significant Outcomes in Probiotic Studies of IBS Patients
Boxes show number of positive outcomes over total number of times outcome was assessed. All studies are randomised controlled trials. QOL = quality of life.
|Organism||Number of studies||Number of patients||Overall Symptoms||QOL||Pain||Gas/Bloat||Straining||Constipation||Diarrhea|
|Lactobacillus plantarum 299V||3||112||1/2||1/2||1/2||0/1|
|Lactobacillus acidophilus SDC 2012, 2013||1||40||1/1||1/1||0/1|
|Lactobacillus acidophilus LB strain||1||18||1/1|
|Lactobacillus acidophilus with other probiotics||2||146||1/2||0/1||2/2||2/4||0/1|
|Lactobacillus rhamnosus GG with other probiotics||2||189||2/2||1/2||2/2||1/2||0/1||0/1|
|Bifidobacterium infantis 35624||2||436||1/1||0/1||2/2||1/1||1/1||1/2||1/2|
|Bifidobacterium animalis DN 173010||1||274||0/1||0/1||0/1|
|Escherichia coli DSM 17252||1||595||2/2||2/2||1/1||0/1||0/1|
|Bacillus coagulans GBI-30 6086||1||44||1/1||1/1|