Best probiotics for IBS

Written by: Kari Raman, PharmD, RPh
Published January 30, 2024

As a pharmacist, I often get asked if taking probiotics can help with irritable bowel syndrome (IBS). This common disorder affects the large intestine and causes uncomfortable symptoms like abdominal pain, bloating, diarrhea and/or constipation. The exact cause of IBS is unknown, but changes in the gut microbiome are believed to play a role, and the best probiotics – the right strains at the right does – do seem to help some people, according to the latest medical research. 

A big issue, however, is that not every patient’s IBS symptoms improve with probiotic treatment. Some strains help some people but not others. This makes an already frustrating disease even more … well, frustrating.  

We’ll get deep into the research in this article, but first, for people looking to get right to my recommendation:

My recommendations for people looking for probiotics to treat their IBS

  • First talk to your doctor and get their advice and diagnosis
  • Look for a multi-strain probiotic – the research shows they are more likely to help treat IBS. Lactobacillus, Bifidobacterium, Streptococcus salivarius and Bacillus may be best
  • Some good probiotic blends you can try are VSL#3, Garden of Life Dr. Formulated, or Biocomplete 3

Given the fact that probiotics are generally considered quite safe, for otherwise healthy people many gastrointestinologist recommend trying probiotics. My brother-in-law, who suffers from IBS, had his gastrointestinologist suggest probiotics. When he asked the doctor “which ones” the doctor helpfully replied “don’t know, keep trying different ones until you find one that seems to work.” So, of course, my BIL called me. In this article, I’ll basically tell you what I told him, plus I’ll go over some of the good research that is coming out on IBS and probiotics, and then I will recommend some strains and products. My goal is to help readers understand the clinical evidence and select appropriate probiotic products.

Of course, IBS is a serious disease, and your symptoms may be a sign of a deeper, underlying condition like Celiac disease, lactose intolerance or other, even bigger problems. So you should always see a doctor, and probably a specialist, before trying to manage IBS by yourself with probiotics. 

What are Probiotics?

Probiotics, commonly known as ‘good’ or ‘friendly’ bacteria (or yeasts), are live microorganisms that may resemble the beneficial microbes naturally present in the human gut. The human gut is full of living organisms, many of which are thought to help contribute to healthy digestion, regulating hormones, the immune system, and more. Probiotic supplements could play a key role in supporting gut health. They are thought to contribute to the natural balance of gut flora, potentially aiding in various digestive functions. Found in certain fermented foods and dietary supplements, probiotics might be particularly useful for individuals with Irritable Bowel Syndrome (IBS), as they could help manage the condition.

The Role of Probiotics in Digestive Health

The primary role of probiotics is thought to be maintaining a healthy balance in the body’s microbiome, the community of microorganisms residing in the intestines. This balance is important for effective digestion, nutrient absorption, and immune system function. Probiotics might inhibit the growth of harmful bacteria, potentially enhancing immune function and reinforcing the gut barrier. For those with IBS, disruptions in the gut microbiome are believed to be a significant factor. Regular intake of probiotics may help alleviate common IBS symptoms like bloating, gas, and irregular bowel movements, although individual results can vary. 

Do Probiotics Help IBS? Overview of the Research

The good news is that the medical community has researched the best probiotics to help IBS. One of the better, more recent overview of the best probiotics for IBS is a systematic review published in the medical Nutrients, researchers analyzed 11 high-quality clinical trials on probiotic supplements for IBS. All the studies were randomized, double-blind and placebo-controlled – the gold standard for testing a treatment. 

The results showed that multi-strain probiotics, containing a mix of different bacteria strains, were more likely to provide relief compared to placebos or single-strain products. 

In numbers:

– 7 out of 11 probiotic studies showed significant IBS symptom improvements 

– 6 out of 8 multi-strain studies demonstrated benefits

– Only 1 out of 3 single-strain studies showed efficacy

Positive effects included less abdominal pain, bloating and bowel movement issues, as well as better quality of life. 

Do Probiotics Actually Help with IBS?

The systematic review I mentioned showed that the multistrain probiotics helped up to 90% of the people in the studies. For example, in the Mezzasalma et al. study, 66-90% of patients in the probiotic groups showed improvement in symptoms like bloating, pain and constipation, another study found 57% of those taking probiotics reported adequate symptom relief, compared to 37% in the placebo group, and yet another found abdominal pain scores were reduced by 69% with probiotics versus 47% reduction in placebo group (statistically significant difference). 

The effective probiotic combinations had between 8 to 14 different bacterial strains from groups like Lactobacillus and Bifidobacterium. I’ll dig into these strains in a bit to help you pick the ones that are possibly going to help manage your symptoms. 

While these findings are encouraging, we need more research to confirm the ideal strains and dosages for different IBS patients. But multi-strain probiotics may be worth trying, under medical supervision, especially if single-strain options haven’t helped your IBS.

Choosing a Good IBS Probiotic Supplement 

When selecting a probiotic for IBS, quality matters. Look for products that list specific strains, colony-forming units (CFUs) and expiration dates on the label. I’ve got a whole article on what CFUs are if you are interested in dosing, but the tldr; is that CFUs are colony forming units, and you probably want to take between 1 billion to 10 billion a day. Big numbers, but remember, bacteria are small – and your stomach’s acid is going to kill a lot of them. Refrigerated formulas may offer higher potency as the bacteria need to be kept alive and active. Start with the dosage recommended by the manufacturer.

Probiotic strains well-studied for IBS include certain types of:

– Lactobacillus: L. acidophilus, L. casei 

– Bifidobacterium: B. infantis, B. breve, B. longum 

– Streptococcus salivarius

– Bacillus coagulans

More on the specific strains that might help manage Irritable Bowel Syndrome

Lactobacillus and Its Role in IBS Management

Lactobacillus, a key player in the world of probiotics, may hold particular significance for those with Irritable Bowel Syndrome (IBS). This genus of bacteria, found in fermented foods and dietary supplements, is recognized for its potential to improve gut health. In the context of IBS, Lactobacillus might help balance the gut microbiome, which is often disrupted in this condition. Different species of Lactobacillus, such as L. acidophilus and L. casei, have been the focus of research for their possible benefits in alleviating IBS symptoms. These include reducing bloating, regulating bowel movements, and mitigating abdominal discomfort. While not a one-size-fits-all solution, incorporating Lactobacillus-rich probiotics could be a step towards managing IBS more effectively for some individuals.

Specific Benefits and Strains of Lactobacillus in IBS

Among the diverse species of Lactobacillus, several stand out for their potential in IBS management. Lactobacillus acidophilus, commonly found in the human gut and various probiotic supplements, may aid in improving overall digestive health and reducing IBS symptoms. Lactobacillus rhamnosus, known for its presence in the gut and fermented foods, could enhance immune function and provide relief from digestive issues. L. casei is a common bacteria in supplements, and it has been linked to improved gut health in some studies. While the exact mechanisms are not fully understood, these strains of Lactobacillus are thought to contribute to a healthier gut environment, potentially reducing inflammation and restoring balance in the gut microbiome. For individuals with IBS, choosing a probiotic supplement containing these specific Lactobacillus strains might offer symptomatic relief, though it’s important to consult with healthcare professionals for personalized advice.

Understanding Bifidobacterium in IBS

Bifidobacterium, a popular bacteria choice in probiotic supplements, is often spotlighted for its potential role in managing Irritable Bowel Syndrome. This genus of bacteria, naturally residing in the human gut and found in various fermented foods, is known for its beneficial effects on gut health. In the case of IBS, Bifidobacterium strains like B. infantis, B. breve, and B. longum may be particularly helpful. These strains are thought to contribute to stabilizing the gut microbiome and reducing intestinal inflammation, two factors closely associated with IBS symptoms. They might also assist in improving bowel regularity and decreasing abdominal discomfort. While individual responses can vary, incorporating Bifidobacterium-containing probiotics into the diet could be a valuable part of a holistic approach to managing IBS.

Overview of Streptococcus Salivarius in IBS

Streptococcus salivarius, a specific species within the diverse Streptococcus genus, holds particular interest in the context of Irritable Bowel Syndrome (IBS) management. Unlike some of its relatives known for causing infections like strep throat, S. salivarius is recognized for its potential probiotic benefits. In the delicate ecosystem of the gut, this bacterium may play a role in promoting a healthy balance of gut flora. For individuals with IBS, introducing S. salivarius through probiotic supplements could potentially contribute to alleviating some of their gastrointestinal symptoms. This species is thought to support gut health by engaging in the fermentation process, which leads to the production of lactic acid. This lowers the pH in the gut, making it less favorable for harmful bacteria and may support overall digestive wellness. While the research on S. salivarius is still evolving, preliminary findings suggest that it might aid in reducing gut inflammation and improving bowel regularity, two significant concerns for those with IBS. Its role in bolstering the gut’s immune responses could also be beneficial in managing the condition. Available in various fermented foods and as a dietary supplement, S. salivarius can be a part of an integrated approach to managing IBS, always under medical guidance.

Exploring the Potential of Bacillus Coagulans in IBS Management

Bacillus coagulans, a lesser-known but increasingly interesting probiotic, is gaining attention for its potential benefits in managing Irritable Bowel Syndrome. This spore-forming bacterium, which can be found in certain fermented foods and dietary supplements, is distinct for its ability to survive harsh stomach acids, potentially making it more effective in reaching the intestines. Studies suggest that it could help normalize bowel movements, a common concern for those with IBS, particularly in cases of diarrhea-predominant or alternating-type IBS.

One of the proposed mechanisms through which Bacillus coagulans may offer relief is by modulating the gut microbiota, thereby potentially reducing inflammation and alleviating abdominal discomfort and bloating. Additionally, it might contribute to the production of lactic acid in the gut, further supporting a healthy intestinal environment. While the full extent of its benefits and the optimal dosages for IBS management are still under investigation, preliminary research indicates that this probiotic could be a valuable addition to a comprehensive treatment plan. 

Combining Strains Is Probably Best

Based on the insights from the Nutrients medical journal article, it appears that combining multiple strains of probiotics could be a more effective approach in managing Irritable Bowel Syndrome. Basically, it seems to make sense to take a few, different probiotics at the same time, either through a combined pill or through a combination of supplements.

In the studies reviewed, multi-strain probiotics, which incorporated a mix of various bacterial strains, showed a more significant improvement in IBS symptoms compared to mono-strain supplements. Specifically, 75% of the studies using multi-strain probiotics reported notable benefits, indicating that a diverse bacterial environment might be more conducive to addressing the complex nature of IBS. This is particularly interesting as Bifidobacterium and Lactobacillus, the most prevalent genera in these studies, are also commonly found in a wide range of commercial probiotic products. While the exact mechanism behind the efficacy of multi-strain probiotics is still being explored, the variety in bacterial strains seems to offer a broader range of benefits, potentially targeting different aspects of IBS. This reinforces the idea that when considering probiotics for IBS management, a formulation containing a diverse blend of bacterial strains could be more beneficial than relying on a single strain, though the ideal combination and dosage require further research and should be tailored to individual needs.

It also seems that taking the probiotics twice a day did better than once a day, “two of the four studies (50%) supplementing twice a day reported beneficial effects of the supplementation.”

Also note that probiotics may interact with some medications, so check with your pharmacist. They can help determine an appropriate supplement and dosage schedule for your individual health status and needs. And again, always talk with your doctor if you are having serious stomach and digestive problems, and get their buy in before beginning any supplementation programs. 

The Best Probiotics for IBS

  • VSL#3: This is a high-potency probiotic medical food that is often recommended for the management of IBS. It contains a mix of several strains, including Lactobacillus acidophilus, Bifidobacterium longum, and others. VSL#3 has a few different products, a powder and capsules. They are all pretty expensive, but if you really want to attack your Irritable Bowel Syndrome with probiotics, this is a potent blend. It’s available on Amazon and also directly from the manufacturer
  • Garden of Life Dr. Formulated Probiotics for Women: This product contains a blend of Lactobacillus acidophilus and Bifidobacterium strains, among others, and is tailored for overall gut health. I like the multi-strain approach, and many of the strains are ones that studies have shown may help with IBS. You don’t have to be a woman to take this – it will be totally fine for a man to take this as well. And, it’s pretty affordable, doesn’t need refrigeration, and is available in a lot of places like Target or Amazon. The Target one is a slightly lower CFU count version, but it’s also cheaper than Amazon, at least when I looked.
  • Biocomplete 3, developed by Dr. Gundry’s company, has a unique combination of Bacillus coagulans and Bifidobacterium bifidum, alongside a blend of prebiotics and tributyrin. You can read my Biocomplete 3 review here. This supplement is designed to offer a comprehensive solution for gut health, potentially beneficial for those with Irritable Bowel Syndrome (IBS). The inclusion of Bacillus coagulans may aid in improving bowel regularity, while Bifidobacterium bifidum is known for its role in stabilizing gut flora and reducing intestinal inflammation. Available directly from the manufacturer, it is a premium-priced option in the probiotic segment, reflecting its ambitious health benefit claims and unique formulation.

How Long Does it Take for Probiotics to Help Treat IBS?

A very common question I get at the pharmacy is “how long does it take for probiotics to work.” Clinical evidence suggests that it generally takes at least eight weeks of consistent probiotic use to observe noticeable improvements in IBS symptoms. So that is a long time! I always encourage patients to be patient, which is really hard with a condition like this one that can really negatively impact your life. 

This time frame allows the beneficial bacteria in probiotics to establish themselves within the gut microbiome, potentially restoring balance and addressing the complex symptoms associated with IBS. During this period, it’s important for individuals to maintain a regular intake of the probiotic supplement as per the recommended dosage. However, it’s also crucial to remember that individual responses to probiotics can vary, and some people might experience changes in their symptoms sooner or later than this eight-week window. 

A Pharmacist’s Take on Irritable Bowel Syndrome (IBS)

As a pharmacist, I come across many people dealing with Irritable Bowel Syndrome, or IBS as it’s commonly known. IBS is a bit of a tricky condition. It’s not just one issue but a mix of uncomfortable symptoms like stomach cramps, bloating, and often unpredictable bowel habits – think diarrhea, constipation, or sometimes both.

What’s really going on with IBS isn’t completely clear, but it seems to be a combination of factors like your gut’s sensitivity to certain foods and how your gut and brain chat with each other. Unlike some serious gut diseases, IBS doesn’t change your bowel tissue or up your risk of colon cancer, which is a bit of a silver lining.

Managing IBS is usually about finding the right balance for your lifestyle. This can mean tweaking your diet, trying different medications, and maybe even exploring probiotics. Everyone’s experience with IBS is unique, so what works for one person might not work for another.

As a pharmacist, I always recommend talking to a healthcare professional if you think you might have IBS. They can help figure out the best plan for you, and we can assist in guiding you towards the right treatments and lifestyle changes.

Living with IBS can be difficult, but probiotics offer a promising complementary approach alongside conventional IBS treatments. Working with a gut-health expert (as in talking to your doctor and hopefully a gastrointestinologist) can help you navigate probiotic options and find an optimal regimen tailored to your unique situation.

Pharmacist Kari Raman

I’m Kari Raman PharmD, RPh, and I am a licensed, practicing pharmacist. I hold a Doctorate in Pharmacy from The University of the Pacific, and I’ve served patients in retail, compounding and hospital pharmacies.

Probiotics are confusing!

One of the most common questions I get asked by patients is about probiotics. And the truth is, probiotics are not as well understood by the healthcare community as they should be.

So I’ve been reading a lot of probiotic clinical trials, and sharing what I’m learning here.

I hope Pharmacist Probiotics helps you find out if there is a type of probiotic that works for you!