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The Five Best Probiotics for Irritable Bowel Syndrome - Based on Evidence Collected from Clinical Trials

By Edited Nov 13, 2013 0 0

Probiotic Bacteria
If you have irritable bowel syndrome (IBS), chances are you’ve considered taking probiotics for your condition. To give you some help, I’ve looked at the scientific evidence and determined the five best probiotic supplements you can take for IBS.

IBS has been estimated to affect approximately 15% of the population[1]. These individuals suffer from chronic abdominal pain, bloating and either diarrhea or constipation. Many suspect that the main cause of the disease has to do with an imbalance in the intestinal flora. For this reason, many companies have been exploring the possibility of treating IBS with probiotics. However, as a consumer, it’s hard to determine the good products from the bad.

Fortunately, clinical trials are being performed with some probiotic supplements, and these studies can be used to gauge if a particular supplement might be right for you. To help you along, I’ve examined a total of 28 double-blind, randomized studies looking at 18 different probiotic preparations. Eight of these probiotics showed little or no effect of the probiotic treatment. Of the remaining probiotics, the best probiotics were picked by carefully comparing the quality of the results and the strength of the studies. 

1. Lactobacillus plantarum 299v

This bacterial subspecies was isolated from healthy human colon tissue in 1986 in Lund, Sweden. This probiotic had the most trials, a total of four[2][3][4][5], with the best results, even though a single study showed little effect[4]. The most recent study was supported by the Rosell-Lallemand Institute in France and Probi AB[5], a company from Sweden, which possesses the application rights to this subspecies[6]. 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 those in the placebo group[5]. Although Probi AB’s products are hard to find outside of Scandinavia, L. plantarum 299v is available in a supplement by Jarrow Formulas.

Ideal Bowel Support 299v (IBS) 30 VegiCaps
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2. Bifidobacterium bifidum MIMBb75

probiotics for IBS
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[7]. I was only able to find one clinical study with IBS using it that matched my criteria, 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[8]. This study was funded by Naturwohl Pharma, GmbH, a German company. Unfortunately, no commercial supplements are available at this time that contain this strain of bacteria.

3. Bifidobacterium infantis 35624

This bacterial strain was isolated from pieces of healthy human intestines in Ireland[9]. In 2006, a large study was performed with 362 patients that looked at different doses of B. infantis 35624 on IBS symptoms in women[10]. 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 to the treatment. Unfortunately, there is also an unpublished study with negative results about this strain on the manufacturer’s website[11], so this strain only gets position number three. The probiotic can be bought as the Align probiotic.

Align B. Infantis 35624 Probiotic Supplement 42 Count
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(price as of Oct 3, 2013)

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[12], which showed that during an eight-week treatment period, patients had an improved global IBS score as compared to the placebo group. 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.

Pharmax HLC High Potency Capsules 120 vcaps
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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. Both supplements have been well-tested, with each having three individual clinical trials[13][14][15][16][17][18]. 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.

While these results appear to be very promising for those suffering from IBS, it’s helpful to remember that the Food and Drug Administration still sees most probiotics as supplements, and, therefore, the companies cannot make any scientific claims as to their effectiveness. The European Food and Safety Authority also refuses to allow health claims on probiotics without extremely convincing results; not one of these probiotics has EFSA permission to make claims about IBS. While probiotics may be helpful, they are certainly not as well-tested 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.

As research on probiotics is still in its infancy, the chance that beneficial bacteria will become a serious form of IBS treatment does exist. But, this will take more fundamental research and more clinical trials to make it a reality.

VSL #3 CAPS (BOTTLE) Size: 60
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Bibliography

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  4. Sen S. et al. "Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome. ." Dig Dis Sci.. 47 (2002): 2615-2620.
  5. Ducrotté P. et al. "Clinical trial: Lactobacillus plantarum299v (DSM 9843) improves symptoms of irritable bowel syndrome.." World Journal of Gastroenterology. 2012 (2012): 4012-4018.
  6. "Lactobacillus plantarum 299v." Probi. 9/07/2013 <Web >
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  8. Guglielmetti S. et al. "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. 33 (2011): 1123-1132.
  9. Dunne C. et al. "Probiotics: from myth to reality. Demonstration of functionality in animal models of disease and in human clinical trials.." Antonie Van Leeuwenhoek. 76 (1999): 279-292.
  10. Whorwell P. et al. "Efficacy of an Encapsulated Probiotic Bifidobacterium infantis 35624 in Women with Irritable Bowel Syndrome. The American journal of gastroenterology." The American journal of gastroenterology. 101 (2006): 1581-1590.
  11. "Probiotic Scientific Data." Bifantis.com. 9/07/2013 <Web >
  12. Williams E. et al. "Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. ." Alimentary Pharmacology & Therapeutics. 29 (2009): 97-103.
  13. Kim H.J. et al. "A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. ." Aliment Pharmacol Ther.. 17 (2003): 895-904.
  14. Kim H.J. et al. "A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating.." Neurogastroenterology and Motility. 17 (2005): 687-696.
  15. Guandalini S. et al. "VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study. ." J Pediatr Gastroenterol Nutr.. 51 (2010): 24-30.
  16. Kajander K. et al. "A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention. ." Aliment Pharmacol Ther. . 22 (2005): 387-394.
  17. Kajander K. et al. "Clinical studies on alleviating the symptoms of irritable bowel syndrome.." Asia Pac J Clin Nutr. . 15 (2006): 576-580.
  18. Kajander K. et al. "Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota.." Alimentary Pharmacology & Therapeutics. 27 (2007): 48-57.

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