Irritable bowel syndrome (IBS) is a common GI disorder impacting roughly 1 in 5 Canadians, with our incidence rate being one of the highest in the world (18% vs 11% globally). However, despite its high prevalence, health care costs and impacts on people's quality of life, our understanding of the true ‘root cause’ of IBS is limited. It often occurs in association with gut infections (often referred to as post-infectious IBS), bacterial overgrowths (also known as SIBO), or heightened stress (people exposed to stressful events, especially in childhood, tend to have more symptoms of IBS). Fortunately, outside of impacts on quality of life, the good news is IBS doesn't cause changes in bowel tissue or increase the risks of colorectal cancer.
Irritable bowel syndrome can cause the following symptoms, which may differ in each person.
Cramping
Abdominal pain
Bloating and gas
Changes in how often you have a bowel movement
Diarrhea
Constipation
Generally speaking, the muscles of the colon of people with IBS tend to contract more than in people without this condition, causing cramps and pain. These problems cause the digestive tract to become very sensitive, and this is where diet and lifestyle changes come into play
Diagnosing IBS The diagnosis is considered a ‘diagnosis of exclusion’, meaning all other causes of symptoms must be ruled out to rule in IBS. It’s important to work with your clinician to complete the proper testing to rule out other factors, such as infection, bacterial overgrowth, celiac disease, IBD and other overlapping pathologies. However, the most up-to-date studies suggest the microbiota in our gut plays a key role in the pathophysiology of IBS and poses the question if probiotics can truly help. Which probiotics could help IBS Research has suggested that an important factor in the management of IBS is to support a balance of the gut-brain axis, and probiotics in the correct doses + correct strains can assist with this [2]. The two most well-researched species of probiotics are “Lactobacillus” and “Bifidobacterium,” which have not only been shown to aid the digestive system but also assist the immune system, provide anti-inflammatory benefits to the gut, strengthen the intestinal barrier and many more influences, including improvements in mood and metabolism. However, strain specificity matters and not all probiotics may work. Lactobacillus plantarum 299v The literature demonstrates some really promising results with this probiotic strain. L. plantarum 299v has been shown to lower inflammatory markers associated with cancer risk, prevent c. difficile diarrhea in antibiotic recipients, and improve IBS symptoms including gas, bloating, abdominal pain and irregular stools. A recent review of the research also concluded that the intake of L plantarum 299V at only 5-10 billion CFU per day was shown to significantly relieve abdominal pain and flatulence, and normalize stool in IBS sufferers, providing significant improvements to their quality of life with only 4 weeks of use [3]. Bifidobacterium Infantis (also referred to as bifidobacterium longum) A meta-analysis of the probiotic strain b. infantis (a strain commonly found in many IBS targeted probiotic combinations) also concluded that when used in combination with other composite probiotics, b. infantis significantly reduced abdominal pain, bloating and distension in IBS sufferers. Not only were symptoms improved, but there is also data suggesting that this strain of flora assists in increasing plasma concentrations of tryptophan, the precursor of serotonin [4]. While studies don’t show significant benefits with the use of antidepressant therapies (aka SSRIs) in the management of IBS, serotonin delivered locally by bacteria may be more effective. Studies also prove that probiotics can help, even in their inactive state. One study looked at the use of an inactive probiotic in women with IBS, and 30% of the women reported an improvement in pain and less discomfort within a three-week or more period compared to those taking the placebo. When treating IBS, of course, we cannot exclude diet and stress management as a part of a well-rounded treatment plan (read more about the FODMAPs diet for IBS here), but it's evident that the right probiotics have a largely positive effect. To learn more about IBS, proper diagnostic assessments, and treatment options for irritable bowel syndrome, please contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today. Other References:
Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4.
Pimentel M, Lembo A. Microbiome and Its Role in Irritable Bowel Syndrome. Dig Dis Sci. 2020 Mar;65(3):829-839. doi: 10.1007/s10620-020-06109-5. PMID: 32026278.
Kaźmierczak-Siedlecka K, Daca A, Folwarski M, Witkowski JM, Bryl E, Makarewicz W. The role of Lactobacillus plantarum 299v in supporting treatment of selected diseases. Cent Eur J Immunol. 2020;45(4):488-493. doi: 10.5114/ceji.2020.101515. Epub 2021 Jan 25. PMID: 33613097; PMCID: PMC7882405.
Andrew P. Allen, Gerard Clarke, John F. Cryan, Eamonn M. M. Quigley & Timothy G. Dinan (2017) Bifidobacterium infantis 35624 and other probiotics in the management of irritable bowel syndrome. Strain specificity, symptoms, and mechanisms, Current Medical Research and Opinion, 33:7, 1349-135.