April is International IBS (irritable bowel syndrome) awareness month. IBS describes a combination of symptoms including constipation, diarrhoea, abdominal pain/discomfort, nausea and vomiting, feelings of fullness, gas and bloating. Sufferers often feel embarrassed by the condition which generally develops in individuals between the ages of 20 and 30 and affects around 20% of the population. IBS also appears to be more common in women than men. There is no single remedy for irritable bowel syndrome, individuals find that their symptoms are provoked by a variety of different foods and situations, with stress and other emotional issues being common triggers.
International Irritable Bowel Syndrome (IBS) Awareness Month is organised by the International Foundation for Functional Gastrointestinal Disorders (IFFGD). IBS is common with worldwide prevalence estimated at 9% to 23%. Although the condition is associated with heavy economic and social burdens, many people remain undiagnosed and unaware that their symptoms indicate a medically recognised disorder. For more information about IBS and the IFFGD please visit the IFFGD website there you will find information on the symptoms of IBS, available treatments, special IBS diets and more.
The causes of this uncomfortable condition are unclear and complex. However, an imbalance in intestinal bacteria is frequently implicated. Often IBS develops after a bout of gasteroenteritis or repeat courses of antibiotics (which kill off the vast majority of intestinal bacteria). The bacteria in the digestive system of individuals suffering from IBS seems to be different to healthy people with fewer ‘beneficial/friendly’ bacteria such as Bifidobacteria and Lactobacilli being present in those with IBS.
Growing evidence suggests that probiotics (as well as prebiotics and synbiotics), supplemental beneficial bacteria, seem helpful in managing IBS. Probiotics may help by reducing the level of inflammatory chemicals (cytokines), implicated in IBS. Imbalances in gut bacteria can lead to chronic low-level inflammation in the intestines and the measurable presence of inflammatory markers in the bloodstream. However, there are complications with the scientific studies that have taken place to date as it seems that the type of bacterial probiotic supplement used may be responsible for the degree of improvement noted in IBS sufferers. Supplements containing Bifidobacteria seem to be especially effective.
A probiotic is a supplement containing live friendly bacteria which aim to improve intestinal bacteria balance. Probiotics are available as yoghurts, fermented milks, fortified fruit juices and freeze dried capsules/powders.
A prebiotic is a food that stimulates the growth of the beneficial bacteria 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.
Synbiotics are a mixture of probiotics and prebiotics.
Recent reviews of evidence (1,2,3,4) for the usefulness of probiotics in the treatment and alleviation of symptoms of IBS all seem to concluded that there are good quality medical trials to back up their usefulness. The review papers also suggest that there is a solid link between alterations in the bacterial composition of the gastrointestinal tract (gut) and IBS. The problems that are flagged up is that there are so many different probiotics available of varying quality. Not all probiotics are the same and further studies are needed to discover what the best strains/types of bacteria are.
One review paper published this year (3) looked at the randomised controlled trials available for the use of probiotics in IBS. 19 trials in 1650 patients with IBS were identified. Trial quality was generally good. When the data was collaborated it was found that probiotics were statistically significantly better than placebo in treating IBS. The authors conclude that “probiotics appear to be efficacious in IBS, but the magnitude of benefit and the most effective species and strain are uncertain”. A study published last year (4) found that the most solid evidence for the use of probiotics in IBS was with Bifidobacterium infantis (specifically B. infantis 35624). This probiotic showed repeated efficacy, with improvements noted in bloating, pain or discomfort, and bowel habit. Other probiotics may prove beneficial in the future, but well designed studies are needed to clarify effectiveness.
If you are suffering with IBS it may well be worth trying a Bifidobacterium probiotic supplement. Keep the supplement in the refrigerator and take the dose away from hot food, since heat can kill the beneficial bacteria. It is also worth looking for a probiotic that also contains FOS (a prebiotic) since this may help the bacteria to establish in the gut and may also have a positive effect in itself.
The Gut Trust say “We support people like you, who are coping day to day with IBS; a condition that is misunderstood, often stigmatised and which can chronically affect your everyday life. We support people with Irritable Bowel Syndrome in several ways. For our members, we offer a telephone helpline staffed by medical and nursing specialists and on-line medical advice and consultation, factsheets on all aspects of IBS, online support, can’t wait cards and travel cards to facilitate access to toilets at home and abroad, a quarterly magazine, and an interactive and frequently updated website that includes our unique fully comprehensive Self Management Programme to help you live life to the full with IBS”
(1) Parkes GC et al. 2010. Treating irritable bowel syndrome with probiotics: the evidence. Proc Nutr Soc. 2010 Mar 18:1-8. [Epub ahead of print]
(2) Ghoshal UC et al. 2010. Bugs and irritable bowel syndrome: The good, the bad and the ugly. J Gastroenterol Hepatol. 2010 Feb;25(2):244-51.
(3) Moayyedi P et al. 2010. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010 Mar;59(3):325-32.
(4) Brenner DM et al. 2009. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol. 104(4):1033-49; quiz 1050.
Written by Ani Kowal