I have IBS – should I be taking probiotics?
Irritable bowel syndrome (IBS) can be used to describe a variety of symptoms experienced in the gut. It is the most common intestinal disorder, affecting around 1 in 6 adults. IBS is widely discussed now that the public are thinking more about their gut health but is a term that can be used inappropriately.
An often touted treatment – probiotics – is another misunderstood term, both by the public and the medical profession. Despite this, probiotic preparations are readily available as food supplements, and are currently one of the hottest products in the food and drink industry. Prebiotics, an allied therapy, are less well known and may also have some health benefits, although the evidence for prebiotics is less clear at present.
Being a student dietitian I was once asked by a client, “should I be taking probiotics?” I asked in reply, “what kind of probiotics?” I was referring to the wide range of products available. However my client had only heard of probiotic yoghurts and was confused by my question.
We do know that a proportion of patients with IBS will experience some improvement with probiotic therapy, but this area of therapy is complex and unclear. There is still a lack of clarity about which probiotics should be taken, and which patients are most likely to benefit. Many of those with IBS experience benefit with ‘placebo therapy’ indicating importance of the connections between the brain and gut axis in this condition.
However, there is increasing evidence that IBS is one of a number of conditions caused by, or made worse by, a change in the gut bacteria. Otherwise known as the gut microbiome – a term we are likely to hear a lot more of in the years ahead.
The gut microbiome is an incredibly complex thing and hopefully this blog can help a little with some jargon-busting, and paint a clearer picture for you as we learn more about how to improve our ‘gut bugs’
Trillions of microorganisms such as bacteria (of which there are around 1000 different species in humans) that help deliver a number of functions within the intestines, and are vital to digestion.
A condition that should always be diagnosed by a medical professional! Symptoms vary between individuals, but it is usually characterised by a combination of the following: abdominal pain or discomfort linked to changes in bowel habit, with the pain often improving on passing a stool (poo). Other common symptoms are a feeling that the bowel has not emptied properly, stomach bloating and the passing of mucous (jelly) in the stool.
Less widespread than probiotics; they can provide a health benefit by selectively promoting activity/numbers of “good bacteria” within the gut i.e. prebiotics is the food that the “good bacteria” need to survive.
Live microorganisms such as “good bacteria” that are taken on by the host. These can have health benefits in some patients, but usually require high doses to achieve a good effect. We also know that is it very likely that many do not survive the “digestive” journey to the gut as it is awash with acids, enzymes and bile.
So should we be jumping on the probiotic bandwagon? I’m not here to criticise the probiotic products now found on supermarket shelves, or suggest that large companies are monopolising on public excitement or public paranoia. The theory behind them is sound but, on their own, they’re not a miracle cure. That said, there is a growing body of evidence in support of certain types of bacteria for specific types of IBS.
If you experience enduring symptoms in your bowel and think you may have a condition such IBS, you should always first consult a medical professional. The British Dietetic Association also provide some very useful information on Probiotics.
You may find, for example, that certain symptoms may be consequential: perhaps there’s something else about your diet to review (e.g. a high caffeine and/or alcohol intake, too many high fat foods or stress levels), rather than just adding probiotics, or prebiotics in the first instance.
Something else to consider is mindfulness: your GP maybe able to advise you if there are any free courses in your area, or use a meditation app like Headspace. It only takes 10mins a day and patients are reporting good results. You may be better making these changes and then trialling probiotic or prebiotics for a month, in the dose recommended.
For general use, probiotics are safe if you’re healthy, but if you have a weak immune system you should definitely seek professional advice beforehand. Everybody’s gut microbiome is different, so if you have had IBS diagnosed, there are certain bacterial strains within particular probiotics that may be most beneficial to you. Like humans, bacteria are unique and individual cultures are as unique as you are.
Please contact Sian or Andrew, either via our Contact page to arrange an appointment to discuss which Probiotic may be best for your type of IBS once you have been diagnosed by your medical practitioner.
Three examples of the strains and the benefits are listed:
Alforex – (contains Bifidobacterium longum subsp. infantis)
Bloating and abdominal discomfort
Activia – (natural yoghurt contains Bifidobacterium animalis lactis, Streptococcus thermophilus, Lactobacillus bulgaricus and Lactococcus lactis)
Abdominal pain and bowel habit
Symprove – Lactobacillus rhamnosus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Enterococcus faecium
Probiotic drinks are so readily available they seem like an easy win, but they can be costly and it’s never a good idea to casually consume something without knowing what’s in it first – especially if you’re only having it for its reported health benefits!
Also, if you’re perfectly healthy but generally promote your gut health, always consider your diet beforehand. It’s perfectly possible to keep your gut happy by eating the right things. If you eat a diverse range of foods and plenty of fibre, you’ll be going a long way to promoting a healthy gut microbiome.
Fruit, vegetables, pulses and beans also help this cause considerably – let’s face it, when isn’t it a good idea to eat these foods?
The science surrounding probiotics is sound (less so for prebiotics) but more research is needed into their use and effects on the gut. However, there are also a number of delicious foods rich in pre/probiotics, and they are a cheaper alternative to buying pharmaceutical products – see below!
Prebiotic foods (best when raw):
With the above foods, you are likely to have to eat quite a significant amount to get a reasonable dose of prebiotics. Otherwise consider a supplement of FOS or GOS (no more than 3.5-5grams/day)
Yoghurt with live and active culture
Sauerkraut (German fermented cabbage)
Kimchi (salted and fermented vegetables)
Miso (salted and fermented soy beans/koji)
Soft fermented cheeses (e.g. cheddar)
Kefir (fermented milk with 30 different strains of bacteria)
Tempeh (fermented soy)
Kombucha (fermented tea)
Remember with some of the above foods, you are very unlikely to know exactly which or how much probiotic you have consumed with the exception of yoghurts/yoghurt drinks.
Have you tried prebiotics or probiotics? Was there a noticeable difference in your gut health? Or were they not worth the money? Let us know what you think by commenting below!
This blog is written by a student dietitian, with scientific and medical detail reviewed by a registered dietitian and Consultant Gastroenterologist.