Sitting in medical practice brings me in contact with people with a wide variety of symptoms and condition, though some things are commoner than others. One of the most common conditions I see is irritable bowel syndrome. This gut condition, characterised by one or more symptoms such as abdominal discomfort, bloating, wind, constipation and/or diarrhoea, is basically a ‘diagnosis of exclusion’. What this means is that, if deemed appropriate, individuals are assessed and investigated for know causes of gut symptoms such as inflammatory bowel disease (Crohn’s disease and ulcerative colitis). If the tests come back negative, then IBS is the diagnosis. Some would say it’s not really a diagnosis at all: it’s basically a doctor telling a patient that they have gut symptoms but he or she doesn’t know why.
This would not be so bad, I suppose, if the treatments for IBS were highly effective. Generally, though, they are not. And what this means is that many individuals suffer from what can be quite debilitating symptoms for years on end. The condition can be very uncomfortable, and the bloating can cause some (usually women) to complain of looking 5 months pregnant for much of the day. Some also suffer from ‘bowel urgency’, which means when they need to go they need to go, and this can blight some individuals’ lives because it necessitates them planning day-to-day activities and trips around available toilet facilities.
In conventional medicine, IBS is very often viewed as a condition that is stress-related. While this may be true, my experience in practice is that one or two nutritional approaches can usually either significantly improve symptoms or stop them altogether. Once successful, I find that stress or emotional upset is unlikely to provoke much in the way of symptoms.
The two approaches that I find work best for IBS are:
1. Identification and elimination of food triggers (wheat and dairy are common offenders in practice).
2. Correction of any underling imbalance there may be in the ‘ecosystem’ within the gut.
For a previous piece on IBS, as well as two previously published articles which explore these two approaches in more depth, see here.
One of the mainstay approaches I use in the treatment of IBS is probiotics: ‘healthy’ gut bacteria that may improve digestive health and also help to correct any imbalance in the gut’s ecosystem. Previous research has found that probiotics can help to relieve IBS symtoms, and this has certainly been my experience in practice. If I were restricted to using only one natural agent in the treatment of IBS, probiotics would be my choice.
I was reminded to write about this subject today because I read of a recently-published study which assessed the use of probiotics in individuals with IBS [1]. 52 adults were treated with probiotics containing four strains of organism (2 types of lactobacillus and 2 types of bifidobacteria) or placebo for a period of 8 weeks. Compared to taking placebo, the probiotic preparation used in this study was found to significantly reduce the severity of IBS symptoms. Days with pain were reduced, and individuals experience and significantly improved quality of life and satisfaction with bowel habits.
References:
Williams E, et al. Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther. September 10 2008 [Epub ahead of print]
In my case it turned out to be dairy. I would drink a pint of milk and all hell would break loose. The rest of the time it was a mixed picture, but when I gave up dairy entirely the problem vanished into thin air.
Regarding probiotics, I have never needed them thanks to identifying dairy as the culprit…. but even if I found I did need them I would be very reluctant. First, the manufacturers insist on adding sugar or artificial sweeteners, which to my mind calls into question their supposed motivation to best serve my health.
Second, when I read stories like this how would I know whether I was wasting my money altogether?
Methuselah
Many probiotic supplements (as opposed to probiotic-containing ‘functional foods’) do not contain either added sugar or artificial sweeteners.
The quality of probiotic supplements is highly variable, though. My preference is to opt for brands that apply strict quality assurance.
Do you advise a limited course of probiotics to correct an imbalance or do people tend to keep taking these over long term?
An holistic approach might be to wonder why certain people suffer from low levels of probiotic bacteria and to seek to correct that?
In your view can wheat and diary perhaps play a suppressing role on these levels?
For example, is there much evidence for diets high in prebiotics (certain types of fruit & veg I understand) helping IBS too?
I would suggest fermented vegetables (unpasteurised of course) like sauerkraut, kimchi, pickled cucumbers and so on. Delicious, nutritious, easy to digest with loads of good bacteria!
Well, at least that one area probiotics could be useful. IBS is a gut problem; supplementing with something that helps your gut work properly does make sense.
Using a combination of prebiotics and probiotics (sometimes called symbiotics) seems to work very well in my experience.
A prebiotic is a food that stimulates the growth of the beneficial bacteria that are already present in the colon. Fructooligosaccharides (FOS) which can be bought as powders are the most common prebiotics available. Natural prebiotics can be found in asparagus, onion, chicory and garlic.
Recently there have been some preliminary small trials using symbiotic(1,2,3) supplements in the treatment of IBS and they have shown encouragingly positive results. Two studies(1,2) found that the prebiotic-probiotic treatment significantly reduced feelings of general ill health, nausea, indigestion and flatulence. Another study (3) found that a prebiotic-probiotic preparation was particularly helpful for sufferers of constipation-type IBS. The supplement reduced general IBS symptoms, bloating and abdominal pain and increased stool frequency.
(1)Bittner AC et al. 2005. Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome:a methodologically orientated, 2-week, randomized, placebo-controlled, double-blind clinical study. Clin Ther. 27:755-761
(2)Bittner AC et al. 2007. Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome:an open-label, partially controlled, 1 year extension of a previously published controlled clinical trial. Clin Ther. 29:1153-1160
(3)Colecchia A et al. 2006. Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, constipation-variant. Results of an open, uncontrolled multicentre study. Minerva Gastroenterol Dietol. 52:349-358
It would be helpful to know what constitutes a good probiotic. Like many supplements there can be huge variety in the quality of what is available, and as they become more popular, more companies try to apply the term to products that probably really aren’t that good. (this is a common problem with most supplements)
Probiotics were recommended after an ileaostomy 6 years ago. I have taken one capsule a day since. I was also found to be lacrose intolerant so I have used lactose free products ver the same time period. I have few of the gut problems that you write about and thank the combination of probiotics and lactose free.
I have recently started taking kefir (Nourish kefir) which is fermented milk originally stemming from the Caucasus. It is made using kefir ‘grains’ which have a complex chemical structure; the milk culture contains a wide range of beneficial bacteria which take up residence in the gut.
I am lactose intolerant (amongst other food intolerances) but have found that I can tolerate kefir, so far in limited quantities and have generally found it to be beneficial. I am hopeful that my tolerance will increase in time
Are probiotics useful when there is no colon?
I have, obviously, a chronic gut disease with an ileostomy, but lately, in my seventh decade, have more and more trouble with just the symptoms related above.
Cutting out wheat helps, so does cutting out dairy sometimes. Fermented dairy products seem OK, but would probiotic bacteria not be flushed out?
I have been using Nourish Kefir from Carr Foods for several years now and I have experienced definite improvement with my digestive problems. I cannot recommend this company highly enough.