Probiotics for IBS: To Use or Not to Use? That is The Question

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Probiotics are a hot topic these days. Articles in magazines highlight them, supplements are growing in greater numbers, and certain foods are supplemented with them.

Why do probiotics get so much attention? Probiotics are microorganisms that can live in our gut and might improve gut health. The scientific definition is: “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”. Some of these potential gut benefits include fighting off bad bacteria, protecting the lining of our intestinal tract and minimizing intestinal permeability (also known as “leaky gut”). Studies in people with IBS are suggesting that they may also improve some symptoms.

It would seem natural for someone with IBS to think about trying one, but should you? It’s a big question without an easy or straightforward answer. Here are a few key points from the emerging literature:

1.   After only 3-4 weeks of a low FODMAP elimination diet, gut bacteria decrease in numbers and variety and probiotics may be useful in restoring them.

2.   A lot of research has been done to study the effects of probiotic supplementation in people with IBS but we don’t yet have all the answers and there isn’t enough consensus to give firm recommendations.

3.   Nonetheless, probiotics seem generally safe to use and if you’d like to try one, the researchers at Monash University recommends that you:

  • Don’t’ expect miracles, the improvement in symptoms may be mild at best

  • Take them consistently for 4 weeks as it may take that long to see any benefits

  • Make sure there aren’t any prebiotic fibers mixed with the probiotic supplement (such as inulin or fructo-oligosaccharides) as these may be poorly tolerated in people with IBS.

  • Those who are most likely to benefit from are IBS patients with mild symptoms and those with compromised microbiome, such as in post-infectious IBS.

  • Test only one management strategy at a time: try the low FODMAP diet first, then consider probiotics

  • Ask your doctor or gastroenterologist to recommend a product that has been researched for IBS and is most suitable for your symptom profile

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Last but not least, probiotics may be naturally present in some foods. You may want to consider including some low-FODMAP prebiotic foods in your diet:

  • Lactose-free yogurt and kefir

  • Some types of low-FODMAP cheese (mozzarella, cheddar, cottage cheese)

  • Miso

  • Tempeh

  • Sourdough spelt bread (unless you have celiac disease are gluten intolerant)

After you have completed the re-challenge phase of the low FODMAP diet, you may expand the range of probiotic-rich foods. If you tolerate the mannitol (a sugar alcohol), you may be able to eat small portions of sauerkraut or kimchi (beware that some may also contain garlic). If you tolerate oligosaccharides, you may be able to drink some kombucha. If you’d like to learn more about probiotics for IBS, read this great article from Monash University.