How Do You Know If You Have Ibs
IBS is characterized by regularly occurring abdominal pain for at least one day per week for three months, as well as any two of the following symptoms:
- pain when having bowel movement,
- change in frequency of bowel movement
- change in stool appearance
The exact cause of IBS remains uncertain. However, the condition has been associated with changes in digestive motility, bacterial imbalance, infection, brain-gut interactions, food allergies, intestinal inflammation, and carbohydrate malabsorption.
Probiotics In Irritable Bowel Syndrome: Clinical Trials
There have now been numerous trials that have investigated the therapeutic benefit of probiotics in IBS, with heterogeneity in dosing regimens, species used and clinical end points. More recently, there have been two systematic reviews and two meta-analyses. Table 1 summarises the important randomised controlled trials over the last 10 years, highlighting the species used, the trial design and results. Several trials have been excluded from this list because of failure to compare with placebo, re-analysis of old data, unclear end points or the use of multiple interventions. Many early studies were small single-centre trials, although more recently a number of much larger multi-centre trials have been undertaken, reflecting the growing interest in the area.
Table 1. Summary of recent randomised controlled trials of probiotics in irritable bowel syndrome
L., Lactobacillus B., Bifidobacterium B. animalis, Bifidobacteria animalis B. infantis, Bifidobacteria infantis E. coli Escherichia coli S. thermophilus, Streptococcus thermophilus NCIMB, National Collection of Industrial, Marine and Food Bacteria collection no. PEP, primary end point GSS, global symptom score ).
* Diarrhoea-predominant IBS.
Subgroup analysis of IBS in a larger cohort of functional abdominal pain disorders.
Advantages Of Inactive Probiotics
Previously, general consensus held that only active, living bacteria may have beneficial effects. But these results suggest that heat-inactivated Bifidobacterium can play a significant role in relieving symptoms of IBS, a syndrome with typically limited options for relief.
This is important because inactive probiotics have several potential advantages over active probiotics. For example, they are more likely to be stable, particularly if exposed to excessive heat. Inactive probiotics are also easier to standardize than active probiotics. Active probiotics also raise concerns for patients who may be susceptible to infection inactive probiotics should relieve these concerns. Whether other strains of heat-inactivated probiotics will also improve IBS symptoms remains unknown.
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The Best Probiotics For Ibs: A Double
It certainly appears probiotics can help manage IBS, but only particular strains and mixtures.
Just keep in mind that they should not be used as a sole therapy.
Also note that they can be a double-edged sword what works fantastic for some may only make symptoms worse in others. It likely depends on your existing gut bacteria environment.
For this reason you should be willing to experiment with different strains and different brands. Where one type doesnt help, maybe another will.
The most clinically proven and recommended brands among gastrointestinal specialists are VSL#3, Symprove and Alflorex/Align, in no specific order. But as always, speak with your doctor before trying anything new.
About Joe Leech, Dietitian
Joe Leech is a university-qualified dietitian from Australia.
He graduated with a Bachelor’s degree in exercise science, followed by a Master’s degree in Nutrition and Dietetics in 2011.
Learn more about him on the About page.
Joe Leech, Dietitian
Probiotic Therapy For Irritable Bowel Syndrome
Research has in the past suggested probiotics may be useful in the treatment of people with IBS. The exact mechanism for exactly how probiotics reduction of symptoms commonly found in IBS is at the present moment, largely unknown. It is speculated that the effects of probiotics on alterations in gut bacteria are involved. The cause of this syndrome is traditionally thought to be multifactorial.
Several of these factors include:
Alterations in gut motility
Within the gut, there is a cyclic pattern of motility known as the major migrating complex, which consists of periodic, luminal contractions that propel intestinal contents from the stomach to the terminal ileum. Several studies in the literature have shown that patients with IBS tend to have abnormalities in these contractions.
Small-bowel bacterial overgrowth
A large study of 202 patients with IBS found that 78% patients had evidence of bacterial overgrowth via breath testing. 25 of 47 patients experienced eradication of bacterial overgrowth on follow-up after treatment with antibiotics. Analysis of this subset of patients revealed that those who were successful in the eradication of bacterial overgrowth reported improvement in their IBS symptoms.
It has been postulated that the release of certain inflammatory mediators, including interleukins and histamine, may affect nearby enteric nerves, causing alteration in gut function and sensory perception.
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What Are The Benefits Of Pharmaceutical Compounding
To exert their benefits to the gut microflora, probiotics must be able to survive their transit through the gastrointestinal tract. Various factors can reduce the survival of probiotics being administered, including acidity of the stomach, bile, and pancreatic juices. Pharmaceutical compounding allows for the development of formulations that improve the beneficial bacterias survival when ingesting probiotics.
Pharmaceutical compounding also allows for the formulation of medications not available commercially that may provide more targeted therapy or doses that may otherwise be difficult to achieve with commercially available products. Active pharmaceutical ingredients used in gastroenterology compounded medications that have been used in the treatment of UC and IBS include low dose naltrexone , low dose amitriptyline, sodium butyrate, nifedipine, diltiazem, SCFA, erythromycin, and tacrolimus.
Search Strategy And Criteria For Inclusion
A literature search was conducted until March 2019 in the database PubMed . The MeSH terms used in the search were Probiotic AND Irritable Bowel Syndrome, and the search filters Last five years, Randomized Controlled Trial, and Humans were used.
The search identified 35 studies, of which 11 were eligible for inclusion. The 11 studies included for further review were all randomized, double-blinded, placebo-controlled studies looking at IBS-patients diagnosed according to the Rome III criteria and published the last five years. Inclusion and exclusion criterion are shown in . All trials evaluated IBS symptoms and if, or how, they were altered in IBS patients given probiotics or placebo.
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Can Probiotics Improve Ibs Symptoms
A comprehensive 2016 review concluded that its unclear how effective probiotics are for treating IBS. It cited small study sizes and lack of consistent data .
However, a number of studies have shown that specific probiotics may have the potential to target specific symptoms. Probiotics from the Bifidobacterium, Lactobacillus and Saccharomyces families have shown particular promise (
A German study of a two-strain probiotic liquid known as Pro-Symbioflor also had promising results. In this study, 297 patients were treated for eight weeks and experienced a 50% decrease in general symptoms, including abdominal pain .
Meanwhile, Symprove is a four-strain probiotic that was tested in 186 patients in the UK. It was found to reduce overall symptom severity after 12 weeks of treatment .
Bifidobacterium infantis 35624 capsules have also been shown to marginally reduce pain, bloating and problems with bowel habits in all subtypes of IBS .
While some of these results are promising, there is some inconsistency between studies. In addition, most strains only have one study demonstrating their effectiveness. Therefore, more research is needed to confirm the results.
Summary Preliminary research has found 10 probiotic strains that may help improve overall symptoms of IBS. However, results have been inconsistent, and most strains have only one small study behind them. Further research is required.
One Probiotic Or Several Species Of Probiotics
It is well established that microorganisms vary considerably in their properties, and so it is inappropriate to combine the results of different trials,,. Probiotics are available as single and multispecies formulations, but Lactobacillus and Bifidobacterium are the most studied microorganisms with respect to IBS. Systematic reviews and meta-analyses show a trend toward an improvement of symptoms with Bifidobacterium infantis, B. brevis and B. animalis , and with Lactobacillus plantarum, L. casei, L. reuteri, L. acidophilus and L. rhamnosus . The most common combinations are Lactobacilli and Bifidobacteria, administered in the form of yoghourt or nutraceutics,,. As probiotics are safe to consume , these are ideal adjuncts to IBS therapy. In time, these are likely to assume an adjunctive therapeutic role in the treatment of IBS, but for the moment there are fundamental aspects that need to be resolved. Many of the studies published to date have been carried out in small and/or specific populations , or over short periods, so further research is needed.
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Herbal Supplements For Ibs
Peppermint oil may lessen diarrhea symptoms by slowing fecal transit time.
Research is fairly solid on the subject, with one group of researchers concluding that peppermint oil is more effective and benign than drugs for GI spasm and could be a drug of first choice for IBS patients with mild constipation or diarrhea.
“Peppermint oil has better research than many pharmaceuticals for IBS,” Rakel says.
For IBS patients who don’t tolerate peppermint, a chamomile-pectin combination works well, Low Dog says. Chamomile helps to relax colon muscles, Rakel says.
Efficacy Of Probiotics On Global Ibs Symptoms Scores
There were 29 separate trials including 35 comparisons with 3,726 patients reporting the efficacy of probiotics on global IBS symptoms scores. One of these RCTs examining two different dose groups and one examining three different dose groups. There was a trial did not mention the dose of probiotics, so it was not included in the subgroup analysis of probiotics dose. Two types of probiotics were used in one trial , and three subtypes of IBS, including IBS with diarrhea , IBS with constipation , and IBS with mixed patterns of constipation and diarrhea , were detected separately in one RCT . Probiotics had a statistically significant effect on improving the global IBS symptoms vs. placebo . Heterogeneity was significant . There was no significant asymmetry in funnel plot , indicating no proof of publication bias.
Figure 6 Forest plot of efficacy on global IBS symptoms scores: subgroup of probiotics duration.
Figure 7 Forest plot of efficacy on global IBS symptoms scores: subgroup of probiotics type.
Figure 8 Forest plot of efficacy of probiotics on global IBS symptoms scores: subgroup of geographic position.
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Which Probiotics Species Are Best
Its difficult for IBS researchers to pinpoint just how effective probiotics are.
This is due to differences in study design, patient populations, probiotics strains and dosages used of previous clinical trials.
Generally speaking, there is emerging evidence that probiotics help to improve overall symptom response and quality of life compared to taking a dummy pill over an 8-10 week period. This goes for all type of IBS .
At the 2015 Yale University workshop, two particular probiotic varieties were identified as the best options for IBS :
- Bifantis : a group of bacteria that normally live in the intestines, but specifically the strain 35624. Its reported many people are missing this strain from their gut
- VSL#3: a probiotic mixture of eight strains .
As you can see in the the table here, the strains Lactobacillus plantarum 299V and Bifidobacterium animalis were also rated, although not as highly.
A list of probiotic strains rated for effectiveness in IBS at the 2011 and 2015 Yale University Workshops. Click to enlarge.
Note that recommendations are given as A, B or C ratings. None of the probiotic recommendations for IBS are rated A because more studies are needed first.
Summary: In 2011 Yale university rated Bifidobacterium infantis and VSL#3 as the best probiotics for IBS. Lactobacillus plantarum and Bifidobacterium animalis may also be useful.
Changes In Colonic Fermentation
Many probiotics including Lactobacillus spp. ferment unabsorbed polysaccharides to generate SCFAs including lactic acid. This acidifies the colonic contents this acidification inhibits some bacteria and allows others to flourish. Thus 2×1010L.plantarum 299v daily in humans increased acetic, proprionic and butyric acid concentration, while increasing the number of faecal Bifidobacteria spp. and Lactobacillus spp. and reducing the numbers of Clostridia spp. Another study using the same bacteria demonstrated a reduction in the breath hydrogen response to lactulose, again indicating a significant change in overall fermentation patterns. Many probiotics are either Lactobacillus spp. or Bifidobacteria spp., which tend not to produce gas on fermenting carbohydrate, an effect which would be amplified as they also inhibit the Clostridia spp. that do produce gas. Several other interventions such as low-fibre diet or Metronidazole, which inhibit colonic gas production, have been shown to reduce symptoms in IBS. This provides some rationale for using probiotics, although the only study which actually attempted to test this hypothesis showed no effect of L.plantarum 299v on 24h gas production.
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How Do Probiotics Work With Ibs
A significant amount of recent research has investigated how probiotics might be used to treat and manage IBS.
IBS symptoms have been linked to certain changes in the gut flora. For example, people with IBS have lower amounts of Lactobacillus and Bifidobacterium in their guts, and higher levels of harmful Streptococcus, E. coli and Clostridium (
- Reducing gas production by balancing the gut flora
- Reducing the guts sensitivity to gas buildup
However, not all probiotics are alike. In fact, the term probiotic covers many different strains and types of bacteria and yeasts. Their health effects vary depending on the type.
Summary Gut flora imbalances may contribute to the symptoms of IBS. Probiotics help restore balance in a number of ways, including by inhibiting the growth of harmful bacteria, reducing inflammation and slowing down the digestive system.
Lactobacillus Rhamnosus Gg Lactobacillus Rhamnosus Lc705 Bifidobacterium Breve Propionibacterium Freudenreichii Sppshermanii Js
A multi-species probiotic containing Lactobacillus rhamnosus GG, L. rhamnosus LC705, Bifidobacterium breve and Propionibacterium freudenreichii spp shermanii JS has been used in two trials from the same group. The first 6-month trial of 103 patients with IBS has found a mean difference in reduction of the total symptom scores of 7·7 points . These findings were confirmed by a follow-up study of eighty-six patients, with a difference in reduction in GSS of eleven points . However, marked differences in baseline severity scores were found between treatment groups and controls, with the treatment group having greater symptom severity and therefore more likely to improve. In addition, a high percentage of both control and treatment arms were prescribed antibiotics in the treatment period. A notable feature in these trials was the longer treatment period of 5 and 6 months respectively with a consistent GSS improvement over the treatment course.
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Assessment Of Risk Of Bias
Two reviewers performed the assessment of study quality independently. Disagreements were solved by discussion. The risk of bias were evaluated according to the Cochrane handbook . Random sequence generation and allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other biases were assessed.
What Is Irritable Bowel Syndrome
Irritable bowel syndrome is a functional gastrointestinal disorder that affects the large intestine. It causes abdominal pain, bloating, and changes in bowel habits. IBS can be caused by food sensitivities or allergies, bacterial infections, stress, lack of exercise, hormonal fluctuations, and other factors affecting intestinal function.
IBS can come in many forms sub-classified by their predominant bowel movement abnormality as:
Common symptoms of IBS include abdominal pain, bloating, and changes in bowel habits. People with this condition often have difficulty managing their bowel movements because they may experience constipation or diarrhea at different times during the day. Some may also suffer from a low-grade fever or experience significant weight loss, which can be caused by decreased appetite due to gastrointestinal distress.
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Your Gut Health & Irritable Bowel Syndrome
Irritable bowel syndrome is difficult to diagnose. Probiotics are not be as optimal. Your standard workup for IBS will not show obvious or even physiologic abnormalities.
Conditions are first excluded, then dietary restrictions, avoidance of caffeine, alcohol, and tobacco.
Antispasmodics and bulking agents may be helpful. Probiotics have been studied in the context of IBS and we will discuss that as well! Spoiler: consider different alternatives to probiotics as new postbiotics are entering the gut health arena right now.
Recent Study Finds Inactive Probiotics Relieve Ibs Symptoms
More recently, Bifidobacterium bifidum MIMBb75 has been shown to improve symptoms of IBS, even in its inactivated form. For the eight-week, double-blind, placebo-controlled clinical trial published in Lancet Gastroenterology, researchers studied whether the heat-inactivated form of Bifidobacterium bifidum MIMBb75 could alleviate IBS symptoms.
Overall, 443 patients were randomized to receive heat-inactivated Bifidobacterium bifidum MIMBb75 or placebo once daily. A total of 377 patients completed the trial. The primary endpoint was defined as a 30% or greater improvement of abdominal pain and at least somewhat relieved overall IBS symptoms for four or more weeks of the eight-week study duration. Significantly more patients receiving the Bifidobacterium probiotic met the primary endpoint compared to patients receiving placebo . In addition, a significantly greater percentage of patients receiving the probiotic also reported adequate relief of symptoms compared to placebo. Finally, individual symptoms including bloating, bowel movement satisfaction, and quality of life were also significantly improved with Bifidobacterium bifidum MIMBb75 compared to placebo.
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Best Probiotic Treatment For Ibs
Treatment for IBS with probiotics is a realistic choice with a large number of trials now having been done on various probiotic families and strains.
Far and away the 3 best probiotics have been Lactobacillus plantarum, Bifidobacterium infantis and Saccharomyces boulardii. But not just any member of these families. You must choose the right strain to ensure effective treatment for IBS .
The cells that line our intestinal tract play an active part in many of our immune responses1 so any problems can have far reaching effect.
It is known that probiotics can correct the intestinal microflora after too many of the wrong sort of bacteria set up home. It is not without cause that IBS often develops after treatment with antibiotics or an intestinal infection wipes out the normal flora.
Symptoms of irritable bowel syndrome include abdominal pain and bloating. There is also the discomfort and disruption of abnormal bowel habits – with all the distress and embarrassment THAT causes. With some people this is constipation whilst with others it is diarrhea.
Many suffers have to organize outings around toilet availability!
The symptoms can be a continual problem or a person may experience flare-ups. Many folk have trigger foods and IBS affects twice as many women as men.