Introduction
Irritable bowel syndrome (IBS) is a common disorder of the digestive tract impacting 10% of the global population.
The symptoms of IBS include abdominal pain, changes in bowel habits, and also commonly bloating. This can lead to a wide range of food reactions that have a significant impact on quality of life.
While there is not a single cause of IBS and bloating, a range of risk factors are understood to contribute to its onset.
Many patients with IBS and bloating also find that avoiding trigger foods can reduce symptoms. However, even with avoiding foods, reactions can still be unpredictable.
One therapeutic strategy to address these symptoms is probiotic supplements. While not all probiotics offer the same level of benefit, in this article, we will explore the causes of bloating, and we can select the right probiotics for this gut symptom. [Source: PubMed]
What is IBS?
IBS is a common digestive disorder that affects the large intestine, or colon. It’s also known as irritable bowel syndrome (IBS). The term “irritable bowel” refers to symptoms such as abdominal pain and cramping, bloating, constipation and diarrhoea.
There isn’t a specific test for IBS which means it’s often diagnosed once other conditions have been tested for and ruled out. These are tests such as assessments for Crohn’s disease and coeliac disease. [Source: PubMed]
Having IBS doesn’t cause permanent damage to the digestive and it does not increase the risk of developing colon cancer. However, it can be very disruptive and has a significant impact on quality of life. [Source: PubMed]
Technically, a diagnosis of IBS does not require bloating to be present, but it is present in a very high percentage of IBS patients. A 2018 study reported that between 76%-96% of IBS patients experience bloating are part one of their digestive symptoms. It was also reported that after abdominal pain, bloating is the most problematic symptom experienced by IBS patients. [Source: PubMed]
Along with the bloating patients also report further symptoms and factors.
These are:
- Decreased energy/fatigue
- Reduced physical activity
- Food restrictions
- Increased use of medications [Source: PubMed]
What causes IBS and bloating?
IBS is caused by a variety of factors, including stress, diet and gut bacteria imbalances.
The most common causes of IBS and bloating are:
- Stress
- Long-term dietary patterns
- The use of medications
- Gut bacteria (dysbiosis)
- SIBO
- Low-grade inflammation
- Food intolerance [Source: MDPI]
One of the most significant risk factors for bloating and IBS is a gastric infection. This can be in the form of food poisoning or gastroenteritis with a single event leading to a 600% increased risk of developing IBS. This increased risk may last for 2-3 years. [Source: PubMed]
These events lead to irritations in the gut that cause the immune system to react leading to alterations in the gut bacteria. This then leads to alterations in digestive function that contribute to symptoms such as bloating.
There are several reasons why the bloating may then occur which include:
- Malabsorption
- SIBO
- Mal-fermentation
- Visceral hypersensitivity
Malabsorption may be caused by irritation to the gut lining. These can lead to certain carbohydrates (such as lactose) being poorly digested. This can leave these carbohydrates in the gut which are then poorly fermented by the gut bacteria. This can lead to more gas being produced resulting in bloating. [Source: PubMed]
SIBO is where there is a bacterial overgrowth in the small intestine. This excessive level of bacteria can often be the result of a low-grade inflammation in the small intestine. In this situation, the excess bacterial load in the small intestine can lead to the fermentation of high-fibre foods occurring in the upper GI tract. Commonly, this can be a situation where bloating occurs within 1 hour of eating. [Source: PubMed]
Visceral hypersensitivity is where irritation in the gut lining leads to an increased sensitivity in the nerves in the digestive tract. This can be where even a small amount of gas within the gut feels extreme, leading to the sensation of bloating and pain. When this is present, it’s also not uncommon for patients to report having a sensation of feeling their food travel along the gut. [Source: PubMed]
Is there a cure for IBS?
When addressing IBS and bloating, it’s important not to see this as a single and specific condition. Instead, IBS and bloating are indications of an issue within the digestive tract.
The aim of an approach to address IBS symptoms is to work to identify and address this underlying issue.
This means that if SIBO is the cause of the IBS symptoms, working to address this can lead to a significant improvement if not elimination of the symptoms.
The same is true for visceral hypersensitivity. If this is leading to symptoms, working to resolve this factor is the approach that should be considered.
In many cases, more than 1 factor is contributing to symptoms therefore working to address all of these simultaneously is often required. [Source: PubMed, PubMed]
Is IBS an autoimmune disease?
IBS is not an autoimmune disease. It’s a functional disorder that affects the way your gastrointestinal tract works. IBS does not cause damage to the organs in your body, nor does it change their structure or function.
However, in a small number of IBS patients, there may be an autoimmune response within the small intestine. This is where the body’s own immune system attacks and damages the cells along the gut lining.
This may take place after a gastrointestinal infection or food poisoning and can result in issues such as SIBO.
2 autoimmune markers have been identified (anti-CdtB and anti-vinculin) which can be assessed in IBS patients with constipation and those with diarrhoea. [Source: PubMed]
How do probiotics help with the symptoms of IBS and bloating?
Probiotics are microorganisms that when taken in appropriate amounts can lead to a wide range of health improvements, including improvement in gut health.
Probiotics from capsules/supplements are described as transient organisms. This means that while they support the gut, they only pass through and do not live there forever.
However, as they pass through the gut, they interact with the gut lining and the immune system leading to changes and improvements in gut health.
This can lead to improvements in the gut, addressing the underlying causes of IBS and bloating symptoms.
Probiotics can work by:
- Outcompeting pathogenic bacteria for resources in the gut
- Inhibiting the adhesion of pathogenic bacteria
- Producing antimicrobial substances to lower the levels of less beneficial organisms
- Supporting and modulating the immune response [Source: PubMed]
While probiotics can be helpful, it’s important to understand which product and strains of bacteria to use.
What are the best probiotics for bloating and gut health?
There are a number of probiotics that can be helpful for IBS. While there is no one-size-fits-all approach. This means that depending on the underlying issue, different probiotics may be beneficial.
However, selecting probiotics with the best research to treat bloating allows more confidence in the approach and selection process.
Probiotics with the best research behind them to address bloating include:
For example, when the bacteria strain L Plantarum 299V was researched in IBS and bloating, it led to an improvement in nearly 80% of those taking the probiotic. However, only 8% of those taking the placebo reported an improvement. [Source: PubMed]
Can allergies and intolerances cause bloating?
Changes in the gut microbiome can lead to alterations in how food is digested. This can result in a wide range of symptoms, including bloating. While the gut microbiome can be supported and balanced with supplements such as probiotics, food reactions due to gut microbiome imbalances can often be best described as intolerances.
This is most likely the case when a patient is reacting to higher fibre/higher FODMAP foods.
This type of response is different to allergies which involve the immune system. It has been found that many of those with IBS, may have alterations in the gut microbiome but also an overactive immune response along the gut lining. [Source: PubMed]
This means that if the immune system is overreacting to certain foods, that can contribute to the ongoing nature of symptoms by creating a vicious cycle in the gut. [Source: PubMed]
For some patients, these immune reactions may be delayed, and build up over several days once the food has been consumed. This means that these reactions may be hard to pinpoint from a food diary alone. [Source: PubMed]
In some cases (particularly if a low FODMAP diet has not been helpful), removing the top allergens may be considered.
These top allergenic foods include:
- Milk
- Egg
- Soy
- Corn
- Wheat
- Shellfish
- Peanuts
- Corn [Source: PubMed]
How do you treat constipation with probiotics?
As well as for bloating and IBS, probiotics have been studied to help with constipation. This is where certain strains of probiotic bacteria need to be considered based on the symptoms experienced.
For example, the strain, Bifidobacteria Lactic HN019 has been studied and found to improve bowel transit time in those with constipation. [Source: PubMed]
It’s also possible to use prebiotics alongside probiotics. The prebiotic PHGG has been found to improve constipation with bloating. This is understood to likely be due to its ability to support the gut microbiome as well as providing well-tolerated dietary fibre. [Source: PubMed]
Other approaches for addressing constipation (which itself can contribute to bloating) include:
- Magnesium oxide, increases the water content of the bowel, supporting bowel motility. [Source: PubMed]
- Kiwi fruit provides dietary fibre as well as beneficial compounds to support motility and bowel movements. [Source: PubMed]
- Lactulose supports bowel movements by introducing fluid into the bowel, however, in some, this may increase bloating and gas. [Source: PubMed]
What should I look for in a probiotic supplement?
The strength of the probiotic is not always the main consideration when selecting probiotic supplements for bloating. However, ensuring the right strain of bacteria is selected is key.
This is similar to thinking about dogs. All dogs might be mammals, but each breed will be able to do different things and be best suited to different circumstances.
Probiotics can be thought of in a similar way, with each strain of bacteria being suited for different gut symptoms and health concerns.
Often cheaper brands will not contain the information about the strain. This doesn’t mean these products won’t be helpful. However, when selecting probiotics we want to make sure we’re making the best clinical decisions around treatment based on clinical research. With this in mind, making the decision based on the strain of probiotic bacteria is an important factor.
Low FODMAP diet for bloating
The Low FODMAP diet is a type of diet that helps to manage IBS. It is a restrictive elimination diet, which means certain foods are avoided to assess symptoms and reactions.
The low FODMAP diet requires limiting the intake of certain types of carbohydrates known as Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols (FODMAPs).
These include:
- Lactose (milk sugar) is found in cow’s milk products like cheese and ice cream.
- High-fibre fruits, such as apples, pears and watermelon
- High-fibre vegetables, such as garlic, onions and asparagus.
- Lentils and beans
- High-fibre grains such as wheat and barley [Source: PubMed]
The Low FODMAP diet has been found to be helpful in a large percentage of those with IBS and bloating to help reduce symptoms. However, this diet is best followed with the help of a professional.
It is also worth noting that a Low FODMAP diet is not considered a treatment as such, but a symptom management tool to reduce bloating and identify trigger foods. Often alongside this diet, further support can be helpful to be addressing the underlying issue. This is done with the aim of reintroducing all of these foods.
Clinical studies have also discovered that treatment with prebiotics, as well as courses of mindfulness relaxation techniques, have proved to be as helpful as low FODMAP, and even without dietary restrictions.
This is likely due to these 2 considerations working to address possible underlying factors for bloating such as imbalances in the gut bacteria as well as stress or anxiety. [Source: PubMed, PubMed]
Probiotics Foods to Improve Gut Health
Probiotic-rich foods are sometimes also called fermented foods. These are natural foods that have gone through a controlled fermentation process.
These foods include:
- Kefir
- Yoghurt
- Kombucha
- Sauerkraut
The benefits to the gut of these foods include:
- Immune modulation
- Pathogen inhibition
- Supporting digestive function
- pH reduction
- Prebiotic
- Gut lining support [Source: PubMed]
These are wide-reaching benefits that simultaneously support several aspects of the gut.
Clinical studies have also been carried out using fermented foods such as sauerkraut. These have reported a significant improvement in IBS when these foods are consumed.
Additionally, when the gut microbiome was assessed, improvements were seen, indicating better digestive health and gut function.
Interestingly, this study was carried out using pasteurised and non-pasteurized sauerkraut with the participants in both groups all seeing improvements. This is particularly interesting as, due to the pasteurisation process killing live organisms, this indicates that other compounds within the fermented foods may be responsible for supporting the gut. [Source: PubMed]
These foods are generally well tolerated and regularly including a small amount can be an important consideration when supporting the gut microbiome to improve IBS and bloating.
Conclusion
Probiotics can be an important component of the approach to address IBS and bloating. However, there needs to be a clear consideration of the specific strain used.
While symptoms can improve from a single supplement, we often find that more comprehensive and holistic support is often needed. This is where further recommendations around diet, lifestyle patterns, as well as additional supplements, may also be helpful to fully resolve symptoms.
