Best Probiotics for IBS, According to a Nutritionist

When choosing probiotics, also known as 'friendly bacteria' or 'live cultures', it is best to opt for supplements supported by credible research. You want something that has been ‘scientifically tested’ and rightly so! The best type of research to look for is a clinical trial because it shows how the probiotic performs in real people with real health conditions, compared to a placebo.

So, when choosing the best probiotic for IBS (Irritable Bowel Syndrome) it is a good idea to look for one containing probiotic strains which have been shown in clinical trials to offer benefits for the symptoms of IBS, such as constipation, bloating, or diarrhoea. There are 5 types of IBS that we will explore in this article:

• IBS-D – Diarrhoea predominant
• IBS-C – Constipation predominant
• IBS-A – Alternating between constipation and diarrhoea
• IBS-U – Unspecified, you may have varying symptoms
• Post-infectious IBS

We also cover:

• IBS and bloating
• Prebiotics for IBS
• Can probiotics make IBS worse?
• Probiotics and IBS in-depth
• NHS recommends probiotics for IBS
• Which probiotics are best for IBS

Continue reading to find out which are the best IBS probiotic strains for each IBS subtype.

Do probiotics help IBS?

We're often asked questions about probiotics and IBS, such as "Can you treat IBS with probiotics?", "Should IBS sufferers take probiotics?", and simply "Are probiotics good for IBS?"! The answer is that probiotics have been shown in many clinical trials to support the symptoms of IBS, and most people find them helpful. Even the NHS recommends probiotics for IBS - they are fine to take alongside most prescription and over the counter medications for IBS, and are a safe, natural option to try. However, if you think you have IBS, you should always have your symptoms diagnosed by a doctor first.

Different probiotic strains can be beneficial for different symptoms of IBS. Clinical studies show the best probiotic supplements for IBS contain strains such as:

• Saccharomyces boulardii
• Bifidobacterium lactis BB-12^®
• Lactobacillus acidophilus NCFM^®
• Bifidobacterium lactis Bi-07^®
• Bifidobacterium infantis 35624
• Bacillus coagulans Unique IS-2
• Bifidobacterium lactis HN019
• Lactobacillus plantarum Lp299v^®

Which probiotics have been researched for IBS-related symptoms?

First of all, when looking for the best probiotic to help with IBS, you should choose a probiotic with plenty of research that is of good quality. There are also different types of IBS, so it is best to choose a probiotic strain that has been researched for your particular IBS symptoms - there are so many different types of probiotic strains and they all have different properties. In this article, we hope to make things clear for you by outlining the different types of IBS and which strains of probiotics have been shown to support each.

Key takeaway

Identify what type of IBS you are dealing with, then choose a supplement containing well-researched strains that have been shown to support those symptoms.

Probiotics for IBS-D

If your doctor diagnoses you with IBS and your primary symptom is diarrhoea, then you have IBS-D. Saccharomyces boulardii is one of the best probiotics for IBS-D symptoms. This unique probiotic is in fact a yeast, the only yeast 'friendly' enough to be called a probiotic.S. boulardii has over 50 years of research supporting its use, and is recommended in many hospitals worldwide for diarrhoea. A 2021 meta analysis involving 42 RCTs confirmed S. boulardii as one of the best probiotic strains for IBS²⁷. The review showed that S. boulardii offered significant improvements in abdominal pain and stool frequency for individuals with IBS-D. As well as IBS-D, it has also been shown to be beneficial for diarrhoea associated with Inflammatory Bowel Disease (IBD), antibiotic-associated diarrhoea and traveller’s diarrhoea. Healthcare practitioners can read more about probiotics for IBD on the Probiotic Professionals site.

As S. boulardii is a friendly yeast, it has very different properties to friendly bacteria; it's a 'transient' probiotic as it does not colonise for long in the gut. Therefore it’s a good idea to take a probiotic containing colonising friendly bacteria alongside S. boulardii as they work synergistically.

Pediococcus acidilactici CECT 7483, Lactobacillus plantarum CECT 7484 and Lactobacillus plantarum CECT 7485 have also been researched and shown to be probiotics which are good for IBS-D¹³. This trial measured improvements in the quality of life of the participants, in relation to their IBS symptoms, which is thought to be one of the most accurate ways of measuring the effectiveness of the treatment.

To look for all of our S. boulardii articles use search for Saccharomyces boulardii. Healthcare practitioners can read more about S. boulardii and using probiotics for diarrhoea and upset stomachs on the Probiotics Professionals site.

Key takeaway

If you suffer from IBS-D then the highly-researched Saccharomyces boulardii is one of the best probiotics for you. You may find it helpful to take a probiotic containing friendly bacteria alongside it - see our strain recommendations for general IBS support in the IBS-A section.

Probiotics for IBS-C

If you have IBS which presents with regularity issues and constipation, this is known as IBS-C. A specific probiotic strain called Bifidobacterium lactis BB-12®, thought to be the most well-researched strain in the whole Bifidobacteria genus, has been shown to be particularly helpful for those with constipation^3,4. It promotes more regular bowel movements, which are easier to pass, as well as supporting gut health in general.

In one clinical trial, over 100 women with constipation were given a supplement including Bifidobacterium lactis BB-12^® and prebiotics¹⁴. Intestinal transit time (the time it takes for food to move through the gut) decreased significantly. Those who took the B. lactis BB-12^® supplement were no longer constipated and had normal bowel movements compared to those who took the placebo.

Healthcare practitioners can head over to the Probiotics Professionals site to find out more about B. lactis BB-12^® and using probiotics for constipation.

Key takeaway

If you suffer from IBS-C, try taking a product that contains Bifidobacterium lactis BB-12^® which has been shown to help relieve constipation and support gut health in general.

Probiotics for IBS-A

Many people with IBS find they have alternating symptoms of bloating, pain, constipation, and diarrhoea. It can be hard to know which symptom to target, so one option is to try a high-quality, general, daily probiotic for all-round gut-support, as imbalanced gut flora is thought to be a factor in IBS⁵. Two strains, Lactobacillus acidophilus NCFM^® and Bifidobacterium lactis Bi-07^® have been specifically trialled in those with IBS and found to not only regulate bowel movements²⁹ but to also relieve bloating, abdominal distension, and abdominal cramps¹⁵. Even on its own Lactobacillus acidophilus NCFM^® has been shown to be effective in improving various symptoms of patients with IBS^5,6.

Healthcare professionals can read more about Lactobacillus acidophilus NCFM^® and Bifidobacterium lactis Bi-07^® on the Probiotics Database.

There are a few other probiotic strains which can offer all-round support for those with mixed symptoms.

The probiotic strain Bacillus coagulans Unique IS-2 has been researched for IBS in both adults and children. In one study involving 136 adults with IBS were given B. coagulans Unique IS-2 for eight weeks. A significant reduction in abdominal pain and an increase in the number of complete spontaneous bowel movements was noted, compared with placebo²⁶. Healthcare practitioners can visit B. coagulans Unique IS-2 to find out more about the research using this strain.

Bifidobacterium infantis 35624, also known as 'Bifantis’, has been researched in those with Irritable Bowel Syndrome with positive results⁸. An 8-week trial with 75 participants associated B. infantis 35624 with a reduction in pain, discomfort, bloating and constipation. Healthcare practitioners can refer to Bifidobacterium infantis 35624, which has more information on this strain.

A specific strain of the Lactobacillus plantarum species (L. plantarum Lp299v^®) has also been clinically trialled on participants with IBS and shown to reduce IBS symptoms¹⁶. A 4-week clinical trial of 60 IBS sufferers showed that those in the probiotic group had a decrease in flatulence and pain and more consistent bowel movements. Healthcare practitioners can visit this page on the Probiotics Database L. plantarum Lp299v^® to find out more about related research.

Key takeaway

If you suffer from IBS-A try taking a high-quality daily probiotic containing strains researched for IBS, such as Lactobacillus acidophilus NCFM^® and Bifidobacterium lactis Bi-07^®.

Probiotics for IBS-U

If the previous types of IBS do not sound quite like you, then you might be struggling with IBS-U. This form of IBS is characterised by a stool consistency that doesn't fit into the other categories.Sufferers experience both loose, watery stools and harder stools, but both less than 25% of the time. This IBS type tends to be less common than the others but has similar causes, including diet, reduced gut motility, increased gastrointestinal sensitivity, or an imbalance of bacteria in the gut and bowels. There is also evidence to suggest a gut-brain connection¹⁷.

The probiotic strain Bifidobacterium lactis HN019 has been researched for all symptoms of IBS, and more specifically to improve intestinal transit time¹⁰. This can help with the sluggish gut motility often associated with IBS-U. Healthcare professionals can learn more about Bifidobacterium lactis HN019 on the Probiotics Database.

Key takeaway

If you suffer from IBS-U you may experience varying symptoms with sluggish gut motility. Try taking a supplement that contains Bifidobacterium lactis HN019 to aid motility and support other IBS symptoms.

Post-infectious IBS

Approximately one in ten people who suffer from IBS believe their symptoms began with an upset stomach. Serious infections such as gastroenteritis or parasitic infections are more likely to cause this sort of IBS¹⁸. It seems that there are a couple of risk factors for developing post-infectious IBS, including the duration of the illness, whether you are a smoker, female, suffer from depression, or experienced any adverse life events three months previously¹⁹.

If you have this type of IBS, you are more likely to suffer from diarrhoea or a mixed stool pattern. Taking the probiotic yeast Saccharomyces boulardii can help address the cause of the infectious illness³⁰ itself and also support the IBS symptoms afterwards. It may also be prudent to take a general probiotic alongside to assist with other associated symptoms.

Key takeaway

If you’ve developed IBS symptoms after picking up a bug abroad, or after food poisoning, try taking Saccharomyces boulardii. You may also find it helpful to take another supplement alongside it, for supporting gut health in general.

IBS and bloating

People with all forms of IBS may also suffer from occasional bloating. It can be aggravated by factors such as stress or eating particular foods, for example, gluten- or dairy-containing foods. However, as mentioned, many different high-quality probiotic strains have been shown to alleviate and prevent pain and bloating, including Lactobacillus acidophilus NCFM^®, Bifidobacterium lactis Bi-07^{® 15} and Bifidobacterium infantis 35624⁸. Strains like Lactococcus casei Rosell-1058 aid the digestion of food by producing enzymes to break down starch and lactose. Learn more by reading: Probiotics for bloating.

At the end of the day, everyone is different, and IBS sufferers will have different gut floras to one another. With probiotics, it is often a case of trial and error to find which species and strains work for that individual. There is no harm, in 'mixing and matching' different products - in fact, this can often be the best way of catering for the specific needs of the individual. For more information on this topic, see Is it possible to overdose on probiotics?

Key takeaway

Certain foods and drinks can trigger IBS bloating, along with emotional triggers like stress. Probiotic strains such as Lactococcus casei Rosell-1058 and Bifidobacterium infantis 35624 can aid digestion and support bloating symptoms.

Prebiotics for IBS

A combination of probiotics and prebiotics, such as fructooligosaccharides, might also be beneficial for your IBS. Whilst typical sources of prebiotics, such as fermented foods or onions and garlic, can serve to worsen IBS symptoms, it is important to include prebiotics in your diet to best support your gut bacteria:

• Prebiotics act as a food source for probiotics, and, as discussed above, probiotics can be extremely useful in helping to alleviate symptoms of IBS²⁰.
• In one study²¹, it was found that IBS-related anxiety was reduced after 4 weeks of taking a prebiotic galactooligosaccharide mixture.
• You might consider finding ways of taking prebiotics that works for you, in foods like bananas and plantains for example, as these possess prebiotic qualities but at lower levels of fermentation.

Learn more about prebiotics by reading: What are prebiotics?

Key takeaway

Prebiotics are food for probiotics and can help aid IBS symptoms. However, they can be a double-edged sword for some so it’s important to find a source of prebiotics that work for you, whether it is in food form or supplemental form.

Can probiotics make IBS worse?

Probiotics are very well tolerated by the majority of people who take them. Those who have an extreme imbalance of good and bad bacteria in their gut, also known as dysbiosis, may find that initially taking a probiotic supplement that contains prebiotics causes an increase in gas and bloating. These side effects should subside within 48 hours in most people while the gut microbiome readjusts, but may last a little longer if the gut is severely imbalanced. If you can, it is worth persevering, either by lowering the dose or coming off for a few days before reintroducing them, once the gut has readjusted the pre and probiotics can start to exert their full benefits.

For those who are on a low FODMAP diet, prebiotic or synbiotic supplementation is generally avoided at this time.

Healthcare professionals may wish to read more about this over on our Probiotic Professionals site: Probiotics and Side Effects - an in-depth review

Key takeaway

We are all different with unique gut microbiomes, so a few people may notice some initial digestive changes when they first take a new supplement. This is more likely if you have never taken a probiotic before or if you have a significant imbalance of good and bad bacteria.

Probiotics and IBS in-depth

IBS affects our society in huge numbers - up to 20% of the UK population are sufferers, up to 13 million people, with women twice as likely to be affected as men. The most used diagnostic method for IBS is the Rome criteria, which classifies IBS into these subtypes:

IBS-D (diarrhoea dominant); IBS-C (constipation dominant); IBS-A or IBS-M (alternating or mixed) & IBS-U (unspecified).

Although there is no clearly defined cause of IBS, many sufferers often report that symptoms are exacerbated by dietary factors such as wheat and dairy products, high FODMAPs foods, and lifestyle factors such as high-stress levels, as well as an imbalance in good and bad bacteria in the gut. It can be a good idea to keep a food and symptom diary for a few weeks to see if you have any dietary triggers.

Recent research may have found a link between IBS-D symptoms and a pathogenic bacterium called Brachyspira. This bacterium hides inside intestinal cells and is unaffected by antibiotic treatment. If more studies confirm this link between IBS symptoms and Brachyspira, researchers believe probiotics may become the future treatment²².

Several studies have documented the link between gut microflora and IBS symptoms. Sufferers often have lower levels of beneficial gut bacteria e.g. Bifidobacterium species, and increased levels of gut pathogens e.g. Clostridium species. We have seen above how specific probiotics may support the reduction of specific IBS symptoms. Also supplementing with a high-quality probiotic may help to reduce IBS symptoms in the following ways:

• Probiotic bacteria give a huge boost to the number of friendly bacteria in the gut, leaving less space for ‘bad’ microbes that may cause IBS symptoms.
• Beneficial microflora help break down foods that may exacerbate IBS.
• Healthy gut flora may play a part in modulating the nervous system in the gut, called the enteric nervous system, therefore reducing the impact of stress on the gut, which is a key factor for many people with IBS.

Key takeaway

IBS has no clear cause but can be triggered by food and drinks such as wheat and dairy, high FODMAP foods and emotional triggers like stress. Sufferers often have lower levels of beneficial gut bacteria, so supplementing with researched strains may help reduce symptoms.

NHS recommends probiotics for IBS

The NHS suggests that probiotics may help to help relieve IBS symptoms²³. In the UK, it is estimated that cost of IBS to the NHS is £12 million per year. NHS online suggests that 75% of people manage IBS symptoms with self-care

This is a big milestone in the world of probiotics because, although probiotics are routinely prescribed in many European hospitals, it wasn’t always part of the NHS recommendations. The NICE guidelines (National Institute for Health and Clinical Excellence), which provides evidence-based guidelines/framework that many medical and health care professionals work within, now recommends that probiotics can be used for at least 4 weeks for managing IBS related symptoms^24.

The NHS website states that: "Probiotics may help reduce bloating and flatulence in some people with IBS." The inclusion of probiotics for IBS relief was due to the result of a systematic review by Moayyedi et al., published in 2010, which concluded that probiotics were effective in the management of IBS²⁵.

Key takeaway

Although it might take a little longer for probiotics to be recommended/prescribed by the NHS for other health issues, it is promising that the potential benefits of probiotics are being recognised and they are now being recommended for digestive issues like IBS and symptoms of lactose intolerance.

Which probiotics are best for IBS?

Not sure which probiotic is best for your form of IBS? If you are unsure which type of IBS you have and what probiotic would be best for you, then it would be a good idea to opt for a high-quality daily product containing probiotics supported with clinical trials. My personal favourite strains for IBS are Lactobacillus acidophilus NCFM^® and Bifidobacterium lactis HN019 which have been shown to help with the broad range of symptoms seen in IBS-A and IBS-U:

• Abdominal discomfort
• Gas/Bloating
• Poor gut motility
• Loose stools
• Bowel regularity

Research^10,15,29 shows these strains are great all-rounders and would be helpful to support all types of IBS, so ideally you would choose a daily product that has one of these strains in it.

But a review of all available research to date confirms that specific probiotics have a beneficial role to play in chronic disorders like IBS²⁸. The specific probiotic strains you may wish to consider for specific types of IBS are:

• For IBS-D & post-infectious IBS - Saccharomyces boulardii
• For IBS-C - Bifidobacterium lactis BB-12^®

Please note: if you are experiencing severe IBS symptoms, you must always speak to your doctor for advice.

If you enjoyed this article, you may also like to read:

Natural Remedies for IBS

Healthcare professionals can find out more by reading the following article on the Probiotic Professionals site:

Probiotics for constipation

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