Have you tried probiotics for IBS only to find your symptoms continued? Perhaps they even got worse. If so, you’re not alone.
Research shows that some probiotics don’t live up to their claims. In one study that assessed 26 commercial probiotics, none fully supported the claims on their labels, and some contained unacceptable microorganisms . Another study found only half of the probiotics examined contained the specific strain listed on the label .
Quality probiotics can be a powerful, safe, effective tool for patients to manage IBS, as indicated by several research studies. In this article, we’ll explore how to find the best probiotic for IBS and how to become a savvy shopper for probiotic supplements.
What IBS Looks Like
Irritable Bowel Syndrome (IBS) is a wide range of gastrointestinal symptoms, not a specific disease. Symptoms range in severity. IBS is characterized by a broad cluster of digestive and non-digestive symptoms. Digestive symptoms include abdominal pain, altered bowel habits, bloating, acid reflux, and flatulence. Common non-digestive symptoms include fatigue, depression and anxiety, migraine headaches, and fibromyalgia.
According to the American College of Gastroenterology, “In the United States, it is estimated that 10-15 percent of the adult population suffers from IBS symptoms” .
Types of Irritable Bowel Syndrome (IBS)
As you can see, IBS can trigger many different symptoms. Everyone’s gut microbiome is unique, which means IBS manifests differently for each person. IBS can be categorized into three main subtypes:
- IBS-D (diarrhea is the main symptom )
- IBS-C (constipation is the main symptom)
- IBS-M (symptoms alternate between diarrhea and constipation)
Connecting the Gut, Probiotics, and IBS
Gut dysbiosis is a bacterial imbalance in your digestive tract. Simply put, gut dysbiosis means that the good bacteria aren’t able to keep the bad bacteria in check.
Research shows that IBS symptoms correlate with gut dysbiosis , particularly small intestinal bacterial overgrowth (SIBO) [5, 6, 7]. Several studies suggest a significant proportion of IBS patients (as many as 70%) have small intestine bacterial overgrowth (SIBO) or other types of bacterial imbalance [5, 6, 8, 9].
In clinical trials, people given probiotic supplements showed significant improvement in IBS symptoms and quality of life compared to placebo groups. Five separate meta-analyses (the highest quality scientific evidence) have shown that probiotics are an effective treatment of IBS, with very few side effects [10, 11, 12, 13, 14].
Symptom improvement included:
- Diarrhea (IBS-D)
- Constipation (IBS-C)
- Abdominal pain
- Flatulence (gas)
How Probiotics Heal IBS
Probiotics can help treat gut dysbiosis and provide general health benefits to your digestive system.
Unlike most other medications, probiotics treat the root cause of IBS by:
- Increasing microbial diversity in the gut microbiome 
- Fighting bacterial overgrowth and pathogens [16, 17, 18]
- Helping you recover more rapidly from imbalances in your gut microflora, which may be a root cause of your IBS symptoms 
- Supporting a healthy immune system [20, 21, 22]
- Decreasing immune system activation and gut inflammation 
- Supporting a balanced microbiome 
- Reducing gut permeability [23, 24, 25]
As probiotic supplements help change your digestive health, your IBS symptoms improve.
For example, as inflammation decreases, diarrhea and constipation may improve. As your gut microflora becomes more balanced, bloating and abdominal pain may subside.
Benefits of Probiotics for IBS Patients
Probiotics have been shown to be extremely effective in managing digestive and non-digestive symptoms of IBS. Further research supporting these findings continues to be published.
Abdominal Pain and Bloating
Probiotics can be especially helpful in reducing abdominal pain and bloating.
A meta-analysis noted that “Probiotics were associated with less abdominal pain compared to placebo” , and a randomized controlled trial showed a reduction of abdominal pain and distension in IBS patients with the use of probiotics . Several other studies demonstrated similar conclusions [13, 14, 27, 28].
In one more study, small intestinal bacterial overgrowth (SIBO) patients saw their diarrhea improve from probiotic supplements .
Probiotics have been shown to help improve stool frequency and regularity in patients with constipation [29, 30]. In one study participants had less constipation even months after supplementation stopped .
Non-Digestive Symptoms of IBS
How To Choose the Best Probiotic for IBS
The most important probiotic strategy for treating IBS is to include a diversity of high-quality probiotics.
There are hundreds of probiotic species and strains available, but most probiotics fall into one of these three categories:
Category 1: Lactobacillus and Bifidobacterium blends (including different strains of probiotics such as L. acidophilus, L. plantarum, B. infantis, and B. lactis).
Category 1 probiotics are scientifically validated and are the most thoroughly researched (over 500 trials). These live microorganisms typically do not colonize the host, but they do improve the health of the host.
Category 2: Saccharomyces boulardii (a beneficial yeast)
More than 100 studies have been conducted on Saccharomyces boulardii. These are not normally found in the gut microbiome (they do not colonize us) but have been shown to improve the health of the host.
Category 3: Soil-based probiotics (usually Bacillus species)
The last category of probiotics is soil-based probiotics, also known as spore-forming bacteria. This category of probiotic can colonize the host .
Many people struggle to balance their microbiota with just one strain of probiotic. At the clinic, we have seen the best results when our patients follow our triple therapy probiotic protocol (taking one probiotic from each of the three categories).
For many patients who have tried probiotics in the past without success, this approach makes all the difference.
Multistrain probiotics were also found to perform better in a meta-analysis of studies using probiotics to treat constipation .
In this approach, the three types of probiotics are like the legs of a three-legged stool. With just one or two legs, it’s unstable. With three legs, the stool is upright and steady.
Choosing a Quality Probiotic Supplement
Probiotic manufacturing is not closely regulated by the U.S. Food and Drug Administration (FDA), and some label claims do not stand up to scrutiny.
In one study of 26 commercial probiotics, none fully supported their label claims, and some of them contained unacceptable microorganisms .
This means that purchasing the most expensive probiotic doesn’t automatically mean it’s the highest quality or best probiotic for IBS.
To choose the best probiotic for IBS, choose probiotic supplements that disclose the following:
- List of species (lactobacillus, saccharomyces boulardii, etc.)
- Number of colony-forming units (CFUs) in the billions
- Manufactured date
- Expiration date
- Allergen free (e.g., gluten-free, non-GMO, vegan)
- Good Manufacturing Practices (GMP) certification
- Lab-verification through independent lab testing for probiotic species and potency
Probiotics Helped These Patients Resolve IBS Symptoms
Rachel suffered from IBS-C and chronic constipation for years. She tried a variety of treatment approaches, including different probiotics. However, she had never approached her probiotic treatment in a methodical way.
Once she began the Triple Probiotic Therapy (taking one probiotic from each of the three categories), she experienced regular bowel movements after three days. Not only did her chronic constipation improve, but she also noticed an improvement in her mood.
Phyllis came to the clinic after struggling with IBS symptoms for two years. She had tried several dietary approaches, including the Paleo diet and the low FODMAP diet. She also reported trying “random” probiotics and experienced adverse side effects.
We started Phyllis on Triple Probiotic Therapy. Within six weeks, her symptoms improved, and she reported a calm gut, increased energy, and regular bowel movements.
As you can see from these patient results, the time it takes to experience symptom improvement varies per individual. As a general rule of thumb, if you’ve tried a probiotic and haven’t experienced any symptom improvement in 3-4 weeks, it’s likely a different approach is needed. However, even small improvements in symptoms are good signs that probiotics are helping to balance your gut ecosystem.
Additional Tips for IBS Treatment
Following an anti-inflammatory diet and using the right combination of probiotics are two of the fundamental approaches we recommend in an overall treatment plan for IBS patients at Austin Center for Functional Medicine.
Combining the right dietary approach with adequate sleep, stress management, and probiotics can be very helpful for treating and managing IBS.
The Bottom Line
IBS doesn’t need to ruin your quality of life. Probiotics can be a cost-effective way to treat and manage IBS symptoms. If you’ve struggled to find the best probiotic for IBS, try one probiotic from each of the three categories and monitor your symptoms for 3-4 weeks.