Leah:
Hello and welcome to the Ideal Nutrition Podcast. I am Leah Higl and I’m here with my co-host Aidan Muir. Today we’ll be discussing if probiotics can help with bloating and IBS. So we’re going to start super broad and just define what probiotics actually are.
So I’m going to keep this brief, but probiotics are defined as live microorganisms, which when administered in adequate amounts, confer a health benefit on the host. To be classified as a probiotic, something needs to have evidence of benefit, but that definition is often used pretty loosely. And it also does not mean that each specific strain of probiotics will actually help with every form of IBS specifically, but they do need to have that justification of in some way, shape or form, they are beneficial to health or have shown a positive outcome.
Aidan:
We’re going to talk about the mechanisms of action. And this is something that is a little bit too complicated to be talking through for podcast stuff. So we’ll try and simplify it. But I really think it’s important for this one because otherwise it seems very broad, general, vague, like how probiotics actually could help with this. And there are so many ways that they theoretically could.
So the first one, the most obvious one is increasing bacteria in the large intestine that are associated with symptoms or with reduced symptoms. It could do the alternative, could decrease the number of pathogenic bacteria that are currently contributing to symptoms. It can influence gut motility. It could help manage SIBO. It could play a in the gut brain access, like we talking about last time. It could decrease the hypersensitivity that’s associated with pain, specifically with IBS. And it could also increase the production of short chain fatty acids such as butyrate. And this also makes interpreting outcomes a bit more difficult to a degree as well, because it’s not going to just be one of those things.
It’s going to be a combination of a bunch of those things that lead to outcomes, which is part of why I am so outcomes focused because now knowing some of the mechanisms, noting that there is obviously more mechanisms, we could just look at like, how effective are these? Like, are they helping? And if they are helping, how much are they helping?
Leah:
We have previously spoken about the research in this space on the podcast before, but since we have spoken about that last time, there is even more research now. We’ve been doing this podcast for quite a while. And I think the last time we did kind of a deep dive on this was probably towards the beginning.
Aidan:
Yeah, it would have been like 2021 maybe and a reason why I think I would point to there being even more research is that the research I was pointing to at that time was usually like reviews from around 2016. So even if it was, so like we’ve got more now, which is good.
Leah:
Yeah. So kind of flash forward to now, we’ve got more, more research and the most recent meta-analysis is actually from 2024, so just last year. And it found that on average, probiotics did outperform placebo specifically for improving IBS symptoms. So that sounds pretty positive, but noting that it isn’t actually the case for everyone.
So for example, one of the more impressively beneficial studies used the strain Lactobacillus plantera and found that 78% of participants identified an improvement, which is still like a large percentage, but it leaves 22 % of people where there was no benefit, there was no improvement in overall symptom management. A lot of other studies are less impressive than that even. Often it seems to be around that kind of 50% mark when it comes to experiencing a beneficial impact on IBS from taking a probiotic supplement.
Aidan:
So like if we’re looking at whether probiotics do or don’t help with bloating and IBS, the short version is like, yes, with a caveat. Like the caveat is it won’t help everybody. And even in the cases of yes, like are we looking at complete symptom resolution? Sometimes, but not in most cases. But I like to start with that because sometimes people make it seem like they either work or they don’t. And if somebody was in the crowd of they don’t work,
I would just point to all this and be like, well, the research does show that on average they do outperform placebo, which is good news. gives us another option. I’m gonna share some other thoughts on the microbiome a bit more from the theoretical side of things. And some of this is very clear is that there are noticeable differences on average between those with and without IBS from a microbiome perspective. And I, looking at that research with fresh eyes, pretending I’ve never seen what anybody else has written.
Find it half tempting to kind of conclude that if you just address those differences, it could have a huge benefit for IBS. And what’s an easy way to address those differences? Probiotic supplementation. Being more specific, there are people with IBS tend to have lower levels of lactobacillus and bifidobacterium populations that can easily be addressed with supplementation as well.
There’s a strong association between the lack of bifidobacterium and IBS-related pain and those who experienced pain on average have five times less of that, which makes you think, could I just supplement that? The research isn’t super, super, super promising on that. Like we are seeing improvements based on this broad research, but as I would have spoken about on the last podcast, I see huge promise in the future for far more individualised testing.
Right now I’m saying on average, five times less Bifidobacterium. Obviously at an individual level, it’s a bit more complicated than that. What if we just address those things? And then another bit of a broad question is it’s like, okay, what if there’s five times less bifidobacterium, but there’s like a hundred other differences that we need to be aware of. And you’ve just addressed one of these, like 100. So a lot to think about, but as I said, looking at it with fresh eyes, it looks even more promising than the research that we have on probiotics and outcomes already.
Leah:
When explaining why it’s hard to give a general good recommendation, we can point to an older review from 2016 as a prime example. So that review was pretty broad and included 29 studies. Out of those 29 studies, 14 of them found a positive impact by taking some form of probiotic. But out of the 14 studies, there were 10 different probiotics used. So it’s pretty hard to say.
Like what is the best when trying to give a recommendation around IBS management and probiotics. There is obviously some level of strain specificity dosage and things like that that needs to be considered when giving a good recommendation. But we also don’t have enough research for this to be incredibly clear at this point. ideally in the future we have more and we can give more specific recommendations. But at this point it’s a little bit hard to do so.
In saying that, the gold standard that we would recommend would be if we were choosing a probiotic, we’re going to make sure that the colony forming units, the CFU count, is at least 1 billion CFU per serving. We’re going to make sure it contains some of the strains with more research for helping IBS, such as lactobacillus plantarium, lactobacillus acidophilus, and bifidobacterium infitus.
I’m actually pretty impressed with that. I kind of got that. Usually I struggle with those ones. So theoretically multi-strain probiotics should be better, but we also don’t have much research comparing that. So still a little way to go in saying that gold standard trial, something that has the meets those two criteria do that for at least 12 weeks. If there is a benefit, amazing, continue taking that probiotic. If there isn’t a benefit, you could probably save your money and just cease usage or trial a different form of probiotic.
Aidan:
Something I’ve thought about a lot with content creation for myself is I’m just trying to help people. And I’m also like a little bit okay with being wrong. If I am publicly upfront being like, could be wrong with this. And a point that I came across many, many years ago was I was like, no one’s really, unless they get paid for it, no one’s really saying what probiotic you should take from what I have seen. That’s my own perspective.
It seems like whenever anyone mentions a specific probiotic brand or supplement, they’re just getting paid for it. As somebody who doesn’t take money for anything, I was like, there’s a bit of a space here for me. Why don’t I just like walk in and just start making the best recommendation or whatever. And then obviously going really deep in this research, it made me realise, this is why people don’t make strong recommendations.
The closest I’ve got at this stage is I recommend the LifeSpace IBS support probiotic, which you can just find just by Googling that. If Emily or Josh is doing the show notes, they can add that into the show notes as well. So anyone could find that. But that just overlaps with the things that Leah just spoke about in terms of it has those colony forming units, it has those specific strains and then it has other ones that have been linked a little bit with helping with IBS.
Why I kind of get so excited about the future with individualisation, with probiotics and stuff like that, and just gut health in general. And it’s funny, because if somebody else talked about this, like I’d be looking at the alternative argument, but me talking about it, I’m like, I do get excited about the future because one, I talked about all those gaps, that’s like, can probably individualise those better. But two, there’s just such a huge gap in the research. Like if somebody asked me, what is the best dosage for protein powder or whatever?
There is a reason why most protein powder companies for like whey protein will have like a 30 gram scoop and for certain plant-based proteins will have like a 40 gram scoop. And it’s because they have done hundreds of studies testing higher dosages and lower dosages, looking at muscle protein synthesis responses and also doing consumer testing and seeing like, like if the optimal amount was a hundred grams, consumers don’t want that. Like they have tested it and tested it and tested it.
We go back to that 2016 review and we’re like, okay, of 14 studies, 10 different probiotic individual strains were used. We’re not even comparing the same strain multiple times in many cases. And beyond that, even if we’re testing multiple times, they haven’t done this dose response thing where they’ve gone, let’s get here. So people do a low dose, then a moderate dose, then a high dose. So we don’t even have evidence that like a higher dose is better or worse than a moderate dose or anything like that. There’s so much left unturned.
So when we go back and we say stuff like, it seems like this is helping in about 50% of cases or whatever. I think in the future, it will be higher than 50%. I don’t know how much higher, but I do see a lot of potential in there. So unless you have anything to add, do you have anything to add to that?
Leah:
No, I reckon we wrap up for the day.
Aidan:
Yeah, I’ll wrap up on that. So this has been episode 205 of the Ideal Nutrition Podcast. As always, if you haven’t already, if you could please leave a rating and review, that would be massively appreciated.