The Best Probiotics for IBS

Probiotics have been studied for irritable bowel syndrome (IBS) symptoms, such as bloating, abdominal pain, and bowel movement irregularity. The evidence for using probiotics in IBS is lacking because study results are conflicting, and the number of study participants is small. However, some probiotics have shown promise in managing IBS.

Probiotics are live microorganisms found in some foods and supplements. They are used to populate and shift the makeup of the microbiome—the balance of bacteria and other microbes in the gut. Probiotics may have effects on both gut health and overall health.

Probiotics include many different types (strains) of bacteria. Which strains of probiotics might be helpful for a particular digestive condition is still not well understood .Irritable bowel syndrome is a functional gastrointestinal (GI) disorder related to how your brain and gut interact. IBS subtypes are defined by whether they primarily produce diarrhea (IBS-D), constipation (IBS-C), or a mixture of diarrhea and constipation (IBS-M).

Best All-Around Strain for IBS: Lactobacillus Acidophilus NCFM

Some research has shown that Lactobacillus acidophilus NCFM may be helpful in IBS. In particular, this strain may act on the mechanism that causes abdominal pain. In one study, people with IBS with moderate to severe pain who took Lactobacillus acidophilus NCFM had less pain after 12 weeks.

This strain of bacteria may work to reduce compounds that cause inflammation in the body. It may also help limit the ability of some pathogens (microbes that cause illness) to grow inside the body. However, these benefits have been seen in studies on rats, not humans.

For IBS-D and Postinfectious IBS: Saccharomyces Boulardii

One small pilot study examined the use of Saccharomyces boulardii (a yeast strain) in diarrhea-predominant IBS (IBS-D). For 15 days, people in the study received either diet advice or Saccharomyces boulardii and diet advice. Diarrhea and other symptoms improved for both groups. However, those who took this strain of probiotic showed more improvement.

In trials, S. boulardii has also been shown to improve the quality of life in people with IBS.

Studies have reported good results in using S. boulardii to prevent the highly infectious, antibiotic-resistant Clostridiodes difficile (C. diff) infection after antibiotics are given in hospital settings. This diarrheal infection can develop after a person has a course of antibiotics that affects their microbiome.

For IBS-C: Bifidobacterium Lactis BB-12

Bifidobacterium lactis BB-12 has been researched for use in people who live with IBS with constipation (IBS-C). Constipation means having fewer than three bowel movements weekly, and stools are hard or lumpy and difficult to pass.

A study of nearly 1,250 participants compared four weeks of a Bifidobacterium lactis BB-12 supplement with a placebo (an inactive treatment). The study results showed that people in the probiotic group had more bowel movements than those in the placebo group.

Bifidobacterium lactis BB-12 treatment was further separated into two doses: 1 billion and 10 billion colony-forming units a day. There was not a significant difference in improving bowel movements between the two groups. The study's authors feel that the 1 billion dose might represent a "ceiling," meaning that taking colony-forming units in a supplement above 1 billion may not help people with IBS-C have more frequent bowel movments.

For IBS-M: Lactobacillus Acidophilus NCFM and Bifidobacterium Lactis Bi-07

Abdominal pain and bloating can occur in all forms of IBS. Research is lacking on how probiotics may affect symptoms in people who live with IBS mixed type (IBS-M). However, some data show that Lactobacillus acidophilus NCFM alone or a combination of Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 can help with pain and bloating.

A small study of just 20 women with mild to moderate levels of abdominal pain found either Lactobacillus acidophilus NCFM alone or a combination of Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 helped with pain and bloating.

Some older studies showed similar results for people with IBS, although not all had IBS-M.

For All IBS Types: Bifidobacterium

Bifidobacterium bifidum MIMBb75: One study of 443 people with IBS studied the effect of either Bifidobacterium bifidum MIMBb75 or placebo. The Bifidobacterium in this study was heat-inactivated. This means that the probiotics were no longer living, but they still stuck to the walls of the intestines.

The people who took the probiotic for eight weeks had improvements in abdominal pain and overall IBS symptoms. They also had a better quality of life than before receiving the probiotic. Those receiving the placebo also did better but to a lesser degree than those receiving the probiotic.

Another, older study showed that this strain helped alleviate IBS symptoms overall. More specifically, abdominal pain, bloating, and the urgent need to have a bowel movement were all improved in people with IBS who received this probiotic.

Bifidobacterium infantis 35624: This probiotic has been studied in a few trials in people with IBS. People who received the probiotic for four weeks had decreased abdominal pain, bloating, gas, and bearing down on the toilet to pass a bowel movement. This strain may also help reduce inflammation in the gut after an infection or antibiotic treatment.

Other Great Options

Bacillus coagulans Unique IS-2: One trial examined 136 people who received either the probiotic or a placebo for eight weeks. People who took this probiotic had a 50% improvement in abdominal pain. They also had an increase in the number of "normal" bowel movements, no matter which type of IBS they had. The authors of the study stress that there were no severe adverse effects.

Lactobacillus plantarum Lp299v: A few studies used this probiotic strain. One trial that included 52 people with IBS tested this strain for four weeks. The people in this trial with IBS had reduced abdominal pain and intestinal gas.

Another trial showed people with IBS had fewer episodes and reduced severity of abdominal pain, bloating, and the sensation of incomplete emptying (going to the bathroom but feeling like there is more stool). In a third trial, 78% of the people who took this strain said there was a "good" or "excellent" effect on symptoms of IBS. In contrast, 8% in the placebo group said the same.

Do Probiotics Really Help?

The cause of IBS is not well understood. It is considered a disorder of the gut-brain axis, which means that something within the two-way communication pathway between the brain and the gut is not working properly.

It is also thought that a disruption in the balance of bacteria in the gut could contribute to the symptoms of IBS, such as bloating, abdominal pain, diarrhea, and constipation (or some combination of the two). Stress, diet, medications, and any number of environmental elements could all cause a disruption in the microbiome.

This is why probiotics have been considered as a way to shift the makeup of bacteria to a healthful balance.

The problem is that it's not yet known which probiotics will be helpful and which will waste money and time. Probiotics appear to be safe for the most part, but there is the possibility of adverse events or harm.

Not all people find that probiotics help their symptoms. Results are individualized and affected by numerous factors. 

Can Probiotics Make Symptoms Worse?

Some people may have digestive symptoms after starting probiotics. These include diarrhea or gas. Usually, these are minor, and they don't last long. They should resolve within a few days. If they do not, it may be worth considering a lower dosage.

For the most part, probiotics are considered safe for use in healthy adults. One large analysis of 55 trials that included 7,000 people found that side effects (called adverse events) were not any more common in people who received probiotics than in people who received a placebo.

The FDA considers probiotic products supplements. This means they are not reviewed to determine if they are safe or effective. The FDA reports that probiotics have been linked to more than 24 adverse events and at least one infant death.

Preterm infants and people who are severely ill or immunocompromised may be at greater risk for adverse events from a probiotic. It's recommended that people at risk only receive probiotics when they are clearly beneficial.

How to Choose the Right Probiotic for You

Choosing a probiotic can be challenging. Many strains are available, and the evidence for their use can be lacking or even contradictory. Another part of making a selection is ensuring that the brand is reputable and has been independently tested.

Probiotic supplements come in many forms, including beverages, capsules, gummies, lozenges, powders, and tablets, although certain strains may not be available in all forms. To continue taking propbiotics, find the strain you want in the form you find easiest to take.

Check the expiration date that's printed on package labels. Probiotics, for the most part, are living organisms. Taking a probiotic after the expiration date might mean fewer live organisms in it and it might be less effective. Buy only the amount you will take before the expiration date.

Combining Products

For some people, a combination probiotic containing more than one strain is the best choice. Or, taking two or more strains separately might be an option.

Multiple strains are an option for people with more than one health condition. For example, you might select one product for overall gut health support and another targeting your underlying health concern.

For IBS, evidence points to combination products that contain Lactobacillus plantarum 299v and Bifidobacterium infantis 35624 for overall symptom management. However, it's important to note that scientific evidence is still not strong enough to pinpoint which probiotic(s) will be helpful for any particular person.

Which Probiotics to Avoid

Some strains and combinations of strains have not been shown to be helpful for people with IBS in clinical trials.

Other Bacillus strains: Three trials (including 177 people) compared probiotic products containing strains of Bacillus. No solid evidence was found that the strains of Bacillus tested helped with symptoms of IBS.

Combinations: Combination products contain two or more types of bacteria. Looking at 32 trials with nearly 3,470 people, one meta-analysis found that the evidence for their use was low. Some of the products studied included LacClean Gold S, Duolac 7s, and VSL#3.

Other Lactobacillus strains: One big analysis looked at the results of 16 studies that used Lactobacillus and included almost 1,500 people. The authors said there wasn't much evidence that strains of Lactobacillus were any better than placebo for treating symptoms of IBS.

Probiotic-Rich Foods to Try

Some fermented foods contain probiotics because of the way they are produced. Other foods have probiotics added to them. Check the food labels for more specific information about each food and its probiotic content.

People with IBS will want to consider fermented foods carefully before adding them to an eating plan. A diet low in certain types of carbohydrates called fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may help some people with IBS find relief.

Some probiotic foods contain FODMAPs, which might not fit into a low-FODMAP diet. Understanding FODMAPs and how to follow the various stages of a low-FODMAP diet is challenging. High-FODMAP foods can be included in the diet in lower amounts (such as 1 tablespoon of sauerkraut or kefir). For that reason, people with IBS will want to work with a dietitian to begin this diet.

Fermented foods that may contain probiotics include:

• Apple cider vinegar (look for a brand that contains the word “mother”)
• Cottage cheese, with probiotics listed on the label (high FODMAP)
• Cultured buttermilk (high FODMAP)
• Fermented fish (utonga-kupsu)
• Fermented milk
• Frozen yogurt (high FODMAP)
• Greek yogurt (high FODMAP)
• Kefir (high FODMAP)
• Kimchi
• Kombucha
• Miso
• Sauerkraut (moderate to high FODMAP)
• Tempeh (low FODMAP)
• Yogurt (high FODMAP)
  

When to Contact a Healthcare Provider

Probiotics are generally safe but they are not without the potential to do harm. Starting a probiotic when there are severe symptoms occurring inside or outside the digestive system should only be done under the guidance of a healthcare provider.

It's important to work with a pediatrician or pediatric gastroenterologist when considering probiotics for infants and children. Getting sound advice will help you choose the right strain while avoiding the added expense of trying multiple products or potential harms such as:

• Being ineffective
• Interacting with other supplements or medications
• Causing side effects (though this is rare in healthy children)
  

Marketing from probiotic manufacturers has promoted the idea that reaching for a probiotic is a good choice when digestive problems arise. However, people who have severe symptoms in the digestive system, such as diarrhea, constipation, vomiting, or bleeding, should work with a healthcare provider before considering supplements.

Probiotics may not be helpful and will waste time and money. At worst, avoiding proper medical care in favor of an over-the-counter (OTC) probiotic could cause a digestive condition to become more severe.

Summary

Study into the use of probiotics for IBS is still in the early stages. It's not known exactly which strains of bacteria will help any particular person. Some evidence suggests that specific probiotics may be helpful for some people with IBS.

Working with a healthcare provider can help narrow the overwhelming amount of information about which probiotic to choose. Strain, delivery method, viability, and effectiveness are all important factors to consider when choosing a probiotic.