%20copy%203.jpg)
Prebiotics and Probiotics
Probiotics are one of the most commonly used and doctor recommended therapies for IBS. Prebiotics are starting to receive more attention, because of the crucial role they play in the health of the gut microbiome.
Prebiotics and probiotics are also a rapidly growing industry and aren't always well regulated. They are often recommended or manufacturers claim certain health benefits, even if the quality of evidence is low.
So should you take a prebiotic or a probiotic to manage your IBS symptoms? The answer isn't a clear cut as you might think, so make sure you're informed before you make the decision to start popping that pill.
Find out what the evidence says about "biotics" and IBS and get some tips on choosing and using a probiotic for IBS symptom management...
-
Watch the videos
-
Click on the links in the white box
-
Just scroll down!
What are Prebiotics?
%20copy.jpg)
Prebiotics are basically food, or fuel, for your good microbes. You can't digest them, but certain good microbes can use them to produce a variety of beneficial compounds. These compounds are key to a healthy gut and overall good health.
To use more technical terms, "A prebiotic is a substance that is selectively utilized by host microorganisms conferring a health benefit". Selectively utilized means that the prebiotic substance affects only a certain group of microbes, rather than the whole microbiome. Early prebiotics were mainly concerned with bifidobacteria and lactobacilli bacteria, but research is now looking at other groups of microbes associated with health that may also be targets for prebiotics.
Prebiotics are naturally present in a wide range of plant foods. They are mostly in the form of soluble fibre, although research is showing that other fibres may have prebiotic potential. Prebiotics are also commonly added to processed foods and dietary supplements.
What are Probiotics?
%20copy%202.jpg)
Probiotics are foods or supplements containing live bacteria and yeasts that can have beneficial effects on your body. These "good" species already live in your body, along with many others.
The current scientific definition is,“Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.” Only strains that have been scientifically proven to have an effect on health can be called probiotics.
Lots of foods naturally contain live microbes. But live microbes in traditional fermented foods and beverages like kombucha can't be called probiotics because their exact microbial mix and amounts are not known and/or they haven't been studied for specific health benefits.
For the most part, probiotics only temporarily alter your gut microbiome and do not lead to permanent changes. The balance of different bacteria tend to return to their original state when probiotic intake stops. Basically they are like temporary staff in your gut microbiome. They come in for a short time, get some work done and then leave.
What are Synbiotics?
.jpg)
Synbiotics are a combination of prebiotics and probiotics.
The definition used by the scientific community is, “A mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host”.
Currently there are 2 main types of synbiotic formulations:
1) Complementary
-
Prebiotics and probiotics work independently for health benefits
-
Most common type for sale and used in clinical trials
2) Synergistic
-
Prebiotics and probiotics work as a team
-
Prebiotic is the bacteria's favourite food or helps with the activity of the bacteria
"Biotics" and IBS
%20copy%208.jpg)
Probiotics, and sometimes prebiotics and synbiotics, are promoted as an IBS management strategy. There is evidence that IBS is linked to dysbiosis and also evidence that "biotics" can help an unbalanced gut microbiome, so this seems to make sense.
However, there are also studies that show no benefits and few studies that actually compare the same factors. As with anything to do with the gut microbiome, there is still much more to learn. But this is definitely a space to watch, as new research may bring us closer to a more personalized approach for the health of the gut microbiome.
Prebiotics and IBS
The evidence for prebiotic supplements and their effect on IBS symptoms is a mixed bag. Some trials have shown improvement, while others have not. Most studies are fairly short in duration.
Prebiotic supplements are often made up of fructooligiosaccarides (FOS) or galactooligiosaccarides (GOS). This may add an extra wrinkle for people with IBS because these fibres are also FODMAPs. To learn more about FODMAPs and their possible effects on IBS symptoms go to What are FODMAPs?
Although prebiotics can be beneficial for gut health, at the present time there doesn't seem to be enough evidence to support recommending these supplements for IBS. The Food for Thought section will give you some tips on how to include prebiotics in your diet.
%20copy.jpg)
Probiotics and IBS
A large amount of research has been done to investigate probiotic supplements for IBS. Many studies have shown that probiotics are safe and improve symptoms like bloating, abdominal pain and flatulence in some individuals with IBS, but there are other studies that show no improvement.
The American Gastroenterological Association says there is not enough high-quality evidence at this time to make recommendations about the use of probiotics to treat IBS. The British Society of Gastroenterology suggest that probiotics can be used as a first line therapy for IBS, but there isn't enough evidence to recommend any specific species or strain at this time. They advise that patients who want to try probiotics should take them for up to 12 weeks and stop if symptoms do not improve.
There are many reasons why exact recommendations can't be made about which dose or strain of bacteria should be used by a particular individual with IBS.
%20copy%202.jpg)
Difficult to Compare Studies
-
Thousands of different probiotic products
-
Each brand has different strains and combinations
-
Form (capsule/powder/tablet/drink) of probiotic used
-
Different dosages and study lengths
-
Don't test for same end results (symptoms/severity)
-
Symptoms like pain levels are subjective
IBS is Different for Everyone
-
Different underlying causes of IBS
-
Different symptoms and severity
-
Different IBS subtypes - D, C, M or U
-
Symptoms aren't consistent and can come and go
-
Different diets and lifestyles
-
Unique gut microbiomes
Synbiotics and IBS
It would seem that synbiotics should be better than probiotics because they also have food for the bacteria. Unfortunately, there aren't many studies comparing the same formulations and very few studies that have tested to see if the prebiotic and probiotic actually work as a team.
Just as is the case with prebiotics and probiotics, creating effective synbiotics will rely on more research and a better understanding of the gut microbiome.
.jpg)
Should I Take "Biotics" for IBS?
%20copy%205.jpg)
At the present time there isn't enough evidence to recommend prebiotic or synbiotic supplements for IBS. It is also interesting to note that prebiotics for one person may not be for another because we all have different microbiomes and different gut microbes to feed.
Perhaps in the future when we can more easily map individual gut microbiomes and we have a better idea of what an ideal gut microbiome looks like, these recommendations may change. For now, have a look at how you can add prebiotics into your diet in the Food for Thought section.
In this section we'll focus on probiotics, as they are often recommended as a strategy for managing IBS.
Should I Take Probiotics for IBS?
And the answer is .... it depends and if you want to.
It's not a very satisfying answer. But until we know more about the gut microbiome and more and better comparison studies have been done, that's the best answer so far.
It depends on your personality and circumstances. Can you afford probiotics? Are you willing to do the research to choose an appropriate probiotic? What are your expectations?
I don't recommend probiotics as an IBS treatment strategy at this time. But I do offer it as a possible strategy, encouraging people to look at the following list of considerations before they make a decision and to choose their probiotic wisely. More on that in the Choosing a Probiotic for IBS section.
Probiotics are also considered to be low risk, although there are still some questions to be answered when it comes to probiotics and IBS.
%20copy%209.jpg)
Did You Know...
%20copy%2010.jpg)
Probiotics are not a one-size-fits-all solution for digestive problems.
-
You can't just take any probiotic and expect it will help with your particular IBS symptoms.
-
Different species, strains and combinations of bacteria have different effects on the body.
-
Probiotics for "gut symptoms" or "gut health" may not be specific enough.
%20copy%2011.jpg)
%20copy%2012.jpg)
%20copy%2013.jpg)
%20copy%2014.jpg)
%20copy%2015.jpg)
Your gut microbiome is unique.
-
Just because your friend swears by a certain probiotic, that doesn't mean it will help you.
-
Same for probiotics that have been studied and shown to have a positive effect on IBS symptoms.
Probiotics stop working if you stop taking them.
-
Generally speaking, probiotics don't recolonize your gut with good bacteria. They're more like temps that come in to do specific jobs and then they leave the building.
-
Unless you plan to take them for the rest of your life, they are not a long term IBS strategy.
-
If you decide to try probiotics and your IBS symptoms improve, you could commit for life or use them until you find other strategies that may be more sustainable long term.
Most studies that find probiotics can help with IBS symptoms are short term.
-
Evidence probiotics may work initially, but not that they will continue to work long term.
-
Important to monitor effects of probiotics if you decide to use them as long term solution.
Probiotics can be expensive.
-
Consider if your money would be better spent on other IBS management strategies
Probiotics have been shown to have a mild effect on symptom improvement.
-
Popping a pill probably seems easier than other IBS management strategies like diet or exercise, but probiotics alone will probably not be enough to manage your symptoms.
-
If you decide to try probiotics, probably best to use them along with other management strategies.
Are There Risks to Taking Probiotics?
Probiotics are generally considered to be low risk and have shown few negative effects in numerous clinical trials with subjects who have IBS. This is one reason they're often proscribed. They may or may not help you, but they probably won't hurt you.
There are some instances where probiotics could increase risk of infection. If you have a compromised immune system, severe illness or bacterial/fungal infections talk to your doctor before taking probiotics.
Keep in mind also that probiotics are not generally regulated like prescription drugs. It's always best to buy probiotics from reliable sources.
Despite the low risk found in studies of probiotics and IBS, there are still some questions. For example, most studies are short term, so what effect do probiotics have on the gut microbiome of people with IBS over time? Could some people with IBS be hypersensitive to added probiotics? As with most things concerning the gut microbiome, hopefully further study will give us some answers.
%20copy%2016.jpg)
Food for Thought
%20copy%2017_edited.jpg)
A healthy gut microbiome is definitely important to your overall health, but there are many ways you can improve it without relying on prebiotic and probiotic supplements. Check out Gut Microbiome Health Strategies to find out more.
Diet can have a big impact on your gut microbiome. In fact, experts say the most powerful and beneficial sources for all your biotic needs are in your kitchen. Instead of taking supplements, better results can be achieved by eating your "biotics".
Feed Your Gut
Your gut is a very competitive place. What you eat is crucial in determining which microbes will be successful in your colon's real estate market, as well as affecting what they do after they move in.
Prebiotics are nutrients that feed the good bacteria in your gut, helping them grow and multiply. If you don't feed your good gut bacteria, they will die, leading to less diversity in your gut and a chance for bad bacteria to take over. Most prebiotics are a type of dietary fibre, know as microbiota-accessible carbohydrates (MACs). There are a few other sources and research may lead to more discoveries.
Keep in mind that most prebiotics are dietary fibres, but not all dietary fibres are prebiotics. To be considered a prebiotic the fibre must reach your large intestine undigested and affect the growth or activity of certain good bacteria. Prebiotic fibres in our diets include inulin, fructans (FOS), galacto-oligosacharides (GOS) and resistant starch.
%20copy%2019.jpg)
%20copy%2018.jpg)
At present, there are no official dietary recommendations for ‘adequate intake’ or ‘recommended daily allowance’ for prebiotics in healthy individuals. The best strategy for eating your prebiotics includes a wide variety of plant foods and getting enough soluble fibre.
For more info go to Fibre and IBS in the Tips for Healthy Eating section.
Examples of Naturally High Sources
-
Garlic
-
Onion & leeks
-
Asparagus
-
Cabbage
-
Snow & green peas
-
Jerusalem Artichoke
-
Apples
-
Grapefruit
-
Pomegranate
-
Nectarines
-
Seaweed
-
Oats
-
Wheat
-
Barley
-
Rye crackers
-
Pistachio nuts
-
Cashews
-
Red kidney beans
-
Soybeans
-
Chickpeas
-
Lentils
-
Dark chocolate
Prebiotics and FODMAPs
-
Many prebiotic foods are also high in FODMAPs
-
FOS (including inulin) and GOS are prebiotic fibres
-
FODMAPs can cause issues for some with IBS
The Low FODMAP Diet
-
Important to get prebiotics to avoid dysbiosis
-
Remember diet is "low" and not "no" FODMAP
-
Include safe serving sizes of high FODMAP prebiotics
-
Include low FODMAP prebiotics like strawberries
Resistant Starch
-
Type of starch not digested in small intestine
-
Acts as prebiotic in large intestine
-
Provides energy source for gut bacteria
-
Examples of high sources ...
-
White & sweet potatoes, rice, quinoa and pasta (cooked and cooled)
-
Green banana flour, green plantain
-
Beans, chickpeas and lentils
Eat Your Gut Microbes
There are two ways to eat your gut microbes. You can eat foods with probiotics created by the food industry or you can eat fermented foods.
Specific strains and dosage amounts of probiotics are being incorporated into foods like beverages, ice cream, yoghurt and bread. As is the case with probiotic supplements, there is no guarantee they will improve your IBS symptoms. The microbes need to be live when you swallow them, so pay attention to storage recommendations and shelf life.
%20copy%2020.jpg)
%20copy%206_edited.jpg)
Fermented foods and beverages contain live microbes and/or other beneficial compounds. They aren't referred to as "probiotic" foods because the exact strains and/or dosage of live microbes are not known.
Fermented foods have been shown to support diversity of the gut microbiome, but we still don’t know exactly how they affect our long-term health or if consuming fermented foods will promote the growth of good bacteria in our gut.
Some fermented foods are eaten with no further processing, but others go through added processes like pasteurization, baking or smoking. These added steps can kill or remove the live microbes, although other compounds may still have health benefits.
Fermentation can also affect the FODMAP content of some foods, so keep that in mind if you are trying the low FODMAP elimination diet.
For more info and food sources, check out this infographic from ISAPP
(International Scientific Association for Prebiotics and Probiotics)
Choosing a Probiotic for IBS
%20copy%204.jpg)
If you've decided to trial probiotics as an IBS management strategy, be sure to choose wisely. You can't just grab any old probiotic off the store shelf and expect it to help with your specific symptoms.
IBS is a complex condition with different subtypes (constipation or diarrhea dominant, mixed or unclassified). Each subtype can have different microbiome imbalances and symptoms, so a single probiotic formula won’t address the unique needs of each individual.
Choosing a probiotic can be very confusing. Fortunately, there are some great free evidence based online tools to help you choose the probiotics best suited to your symptoms.
Understanding Probiotics
Probiotics are known by genus, species, and strain: for example, Lactobacillus acidophilus ABC. The type of strain is important, because different strains of the same species have been researched to help with certain symptoms of IBS. Different combinations of strains could also be a factor.
Dose is also a consideration. Many probiotics currently on the market range from 1 billion CFUs - 10 billion CFUs, although some are as high as 50 billion. CFUs, or colony forming units, are a unit of measure to estimate the number of bacteria in a sample that can divide and form colonies. More doesn't mean better when it comes to CFUs and dosage depends more on the condition being treated. Strains and combination of strains will have a unique clinical dose, so best to follow the suggested dose on the product label.
Probiotic supplements can come in the form of capsules, tablets, gummies, powders, or liquids.
%20copy%207.jpg)
Choose Quality Over Quantity
Paying more for probiotics doesn't necessarily mean the quality is better, but looking for a deal shouldn't be top of the list when choosing a probiotic.
Remember that probiotic microbes need to be alive to have health benefits. If you buy them in store make sure they are being stored properly and look for products labelled with the number of CFUs at the end of their shelf life and not at the time of manufacture.
Regulations differ from country to country. In many places they are considered natural health products and are not as strictly regulated as prescription medicines. Look for products that have been independently tested and check out the following section for recommendations.
%20copy%2023.jpg)
Tools to Help You Choose
This is an excellent evidence based probiotics resource just for IBS. Click on Get Research Results, fill in the questionnaire and get a shortlist of the most promising probiotic strains and blends for your symptoms.
The Alliance for Education on Probiotics (AEProbio) has an online resource and a free app (for iPhone or Android) called Probiotic Guide Canada (or US and UK).
This is a general resource with information about many conditions, including IBS and digestive health. The site is designed for healthcare professionals and may feel a bit overwhelming, so if you have any questions talk to your doctor or dietitian.
Tips for Using Probiotics
%20copy%2021.jpg)
Possible Side Effects
-
You could experience digestive symptoms like gas, bloating or diarrhea
-
Usually occur when you first start using and generally go away in a few days to a few weeks
Feeling the Effects
-
It can take 2-3 weeks for probiotics to begin delivering their health benefits
-
You need to take them everyday
Consistency is Key
-
Probiotics stop working if you stop taking them
-
Try taking at the same time everyday to create your own habit
Check Label for Specific Instructions
-
Some products are recommended to be taken with food, others on an empty stomach
-
Take the recommended dose and remember that more doesn't mean better
They Have a Shelf Life
-
Probiotics will not become toxic past their due date, but they will be ineffective
-
Remember that the microbes need to be live to have any health effect
Not a Replacement for Conventional Therapy
-
Probiotics should be considered as a supplement to, rather than a replacement for, conventional therapy for most digestive conditions.
Consult a Healthcare Professional
-
If you have specific concerns or questions about taking probiotics for IBS, it's always best to consult with a doctor or a registered dietitian.
Tracking Probiotic Use
By now you've decided to try taking a probiotic for IBS symptom management, you've done the research, chosen a probiotic and started to take it every day. But you still aren't done.
It’s also a good idea to track the effects the probiotic is having on your IBS symptoms. Give the probiotic at least 4 weeks to take effect. If you feel the probiotics are working for you, then continue. If you aren't feeling any positive effects, you could try a different probiotic or stop taking probiotics altogether.
Remember that the effects of a probiotic can vary over time. Some people may only need it for a limited period, while others might benefit from a longer course. So it's always good to reevaluate.
%20copy%2022.jpg)