Review Post: The Five Best Probiotics for Irritable Bowel Syndrome

It’s no wonder people are searching for the best probiotic for irritable bowel syndrome (IBS)—it is estimated that up to 15% of the population suffers from IBS.1 People with IBS have irregular bowel habits, often dominated by diarrhea or constipation. They also experience bloating and abdominal pain.

Researchers suspect that the main cause of IBS is an imbalance in the intestinal flora. For this reason, many companies have been exploring the possibility of treating IBS with probiotics and are fighting for the title, “best probiotic for IBS.”

Because probiotics are classified as supplements by the Food and Drug Administration (FDA) and are generally considered safe, they do not need to be approved by the FDA before being marketed.2 However, this also means that it is illegal to make claims about the effectiveness of different supplements. It’s the consumer’s responsibility to examine the scientific evidence of each product before purchasing it.

To help those looking for a good probiotic for IBS, we searched the literature for clinical trials that studied beneficial bacteria in IBS. Twenty-eight double-blind, randomized studies looking at 18 different probiotic preparations were examined. Only ten probiotic preparations showed a positive result. From these candidates, the best five probiotics were picked by carefully comparing the quality of the results and the quality of the study.


1. Lactobacillus plantarum 299v

In 1986, this bacterial subspecies was isolated from healthy human colon tissue in Lund, Sweden. This probiotic had the most trials, a total of four,3-6 with the best results—only a single study showed little effect.5 The most recent study6 was supported by the Rosell-Lallemand Institute in France and Probi AB, a company from Sweden, which possesses the application rights to this subspecies.8 In this study, approximately 200 patients were recruited from India. The half that was given the probiotic supplement for four weeks showed significant improvements in abdominal pain, bloating and stool frequency. Most importantly, the majority of the patients taking it felt like they were seeing improvements as opposed to a fraction of those taking the placebo.

Although Probi AB’s products are hard to find outside of Scandinavia, L. plantarum 299v is available in a supplement by Jarrow Formulas, which can be bought on Amazon.

2. Bifidobacterium bifidum MIMBb75

B. bifidum MIMBb75 was initially isolated from healthy human feces and is part of the Industrial Microbiology Culture Collection of the University of Milan in Italy.8 There was only one clinical study with IBS that matched the criteria,9 but the results were so robust that it took second place. One hundred and twenty patients participated in the four-week treatment trial. Global scores of IBS (based on a number of IBS symptoms) were very significantly lowered in the treatment group as opposed to the placebo group. The symptoms most improved were pain/discomfort, distension/bloating and the feeling of urgency. In general, 57% of the probiotic patients had an improvement, while only 21% felt that they improved in the placebo group. This study was funded by Naturwohl Pharma, GmbH, a German company.

Unfortunately, no commercial supplements are available that contains this strain of bacteria.


3. Bifidobacterium infantis 35624

This bacterial strain was isolated from pieces of healthy human intestines in Ireland.10 In 2006, a large study was performed with 362 patients that looked at different doses of B. infantis 35624 on IBS symptoms in women.11 With the right dose, the treatment group had significant reductions in abdominal pain/discomfort, bloating, incomplete evacuation, straining, gas and overall satisfaction. It appeared also that the patients with IBS with diarrhea were more responsive. Unfortunately, there is an unpublished study with negative results about this species on the manufacturer’s website,12 so this strain only gets position number three.

The probiotic can be bought as the Align probiotic.

4. LAB4

This multistrain probiotic contains Lactobacillus acidophilus CUL60 (NCIMB 30157) and CUL21 (NCIMB 30156), Bifidobacterium lactis CUL34 (NCIMB 30172) and Bifidobacterium bifidum CUL20 (NCIMB 30153). The mixture was developed by Cultech Ltd in Wales, and it can be found in a probiotic supplement produced by Pharmex. Clinical results were seen in a study performed in 2009,13 which showed that during an eight-week treatment period, patients had an improved global IBS score as compared to placebo. Specific significant improvements in pain and bowel movement satisfaction were also found. Moreover, there was a significant improvement in quality of life at eight weeks. The lack of other studies and poorly analyzed results put this study at number four.

5. VSL#3 and LGG MAX

Two probiotics tie the position of number five. Both are multistrain supplements, with VSL#3 containing eight strains and LGG MAX from Valio Ltd containing four different strains. VSL#3 has also been discussed in a previous post. Both supplements have been well-tested, with each having three individual clinical trials.14-19 However, the reason that these supplements rank lower on my scale is that their effects appear too weak or limited. VSL#3 has good results, but appears to only help abdominal bloating and gas. LGG MAX could consistently lower global IBS scores, but was unable to significantly improve single parameters like bloating, gas or cramps. This suggests that it’s effective but not robust.

VSL#3 is available as a medical food that should be used under the guidance of a physician. No products appear to be available with the LGG MAX strains.

In Conclusion

While probiotics may be helpful, they are certainly not the same as approved drugs, and, therefore, expectations should not be high. Even in the trials that were mentioned, not all patients responded and the majority of the patients experienced only the reduction of a few symptoms. It is likely that in the future, probiotics will be an important component for IBS treatment, but this will take more fundamental research and more clinical trials.

If you are looking for beneficial bacteria to help with your constipation, visit my new post about the Five Best Probiotics for Constipation.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.

References

  1. Wikipedia – Irritable bowel syndrome – accessed July 15, 2013
  2. Food and Drug Administration – Q&A on Dietary Supplements  accessed July 15, 2013
  3. Nobaek S, Johansson ML, Molin G, Ahrné S, Jeppsson B. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol. 2000 May;95(5):1231-8.
  4. Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2001 Oct;13(10):1143-7.
  5. Sen S, Mullan MM, Parker TJ, Woolner JT, Tarry SA, Hunter JO. Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome. Dig Dis Sci. 2002 Nov;47(11):2615-20.
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  7. Probi – Lactobacillus plantarum 299v accessed July 15, 2013
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  9. Guglielmetti, S., Mora, D., Gschwender, M., & Popp, K. Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life — a double-blind, placebo-controlled study. Alimentary Pharmacology & Therapeutics. 2011 33(10), 1123–1132.
  10. Dunne C, Murphy L, Flynn S, O’Mahony L, O’Halloran S, Feeney M, Morrissey D, Thornton G, Fitzgerald G, Daly C, Kiely B, Quigley EM, O’Sullivan GC, Shanahan F, Collins JK. Probiotics: from myth to reality. Demonstration of functionality in animal models of disease and in human clinical trials. 1999 Antonie Van Leeuwenhoek. 76: 279-292.
  11. Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O’Mahony L, et al. Efficacy of an Encapsulated Probiotic Bifidobacterium infantis 35624 in Women with Irritable Bowel Syndrome. The American journal of gastroenterology, 2006 101(7), 1581–1590.
  12. Bifantis.com – Probiotic Scientific Data accessed July 15, 2013
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