Probiotics and Irritable Bowel Syndrome

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Two topics that are very hot in the world of Gastroenterology are: 1) Probiotics 2) Irritable Bowel Syndrome. How are they related? Irritable Bowel Syndrome, while it is the most common Gastrointestinal problem in America, is still not well understood. It is what we call a functional disorder of the bowel, meaning that you cannot see it on x-ray, endoscopy, or biopsy. Rather than a structural issue, it is more a disorder of how the bowel functions. My own view is that Irritable Bowel Syndrome (IBS) is probably multiple different disorders that we lump together under one name, essentially because we don't know any better at this point.

If you accept my position that IBS is probably multiple different disorders rather than a single entity, then   it follows that there may be multiple different mechanisms for the various disorders. One such mechanism is probably an imbalance in the normal bacterial flora of the gut. We all have billions of bacteria in the gut-principally in the colon. These bacteria live in a certain harmony and balance. One likely mechanism for bowel dysfunction is imbalance in the normal flora. Possible causes of such imbalance could include intestinal infections, antibiotics, and chemotherapy agents.

The idea of a probiotic is to add "good" bacteria to the gut, and rebalance the flora. I often recommend probiotics to patients with IBS. Since IBS is not always due to bacterial imbalance, it doesn't help everyone. It is not possible, in my opinion, to know up front who will benefit and who will not. However, probiotics are safe, easily accessible, and fairly inexpensive(although if you want to drop some serious cash on a probiotic, there are no shortage of expensive ones!!).

As far as which probiotic is best, there is really not a tremendous amount of data to help us. My own practice is to recommend a probiotic that contains lactobacillus acidophilus(most probiotics do contain this strain of bacteria). If someone is already taking a probiotic and not getting the results they hoped for, I often recommend switching to Florastor. Florastor, rather containing bacteria, contains a yeast called saccharomyces boulardii. I am not implying that Florastor is better than probiotics that contain bacteria, it is simply different, so if bacteria-containing probiotics don't work, try yeast-containing probiotics.