Living with irritable bowel syndrome (IBS) can be challenging due to its various gastrointestinal symptoms. It is still not known what causes IBS, but there are several risk factors that could contribute towards developing IBS. These include stress and anxiety, prior gastrointestinal infections, being female, and younger age, among others. In Singapore, research has found that approximately 1 in 5 adults suffer from IBS (according to the Rome III diagnostic criteria), with a prevalence rate of 20.9%.
Studies have also revealed notable differences in the gut bacteria between healthy individuals and those with IBS. People with IBS tend to have lower levels of beneficial bacteria such as Lactobacillus and Bifidobacterium, whereas levels of E. coli and Enterobacter were found to be higher. However, while certain microbial imbalances are linked to severe IBS, there isn’t a specific gut bacteria composition solely responsible for causing the condition; rather, it’s the overall imbalance in gut bacteria that contributes to IBS symptoms.
What is Gut Dysbiosis in IBS?
An imbalance in the types and numbers of bacteria in the gut is referred to as gut dysbiosis, which is believed to play a significant role in causing IBS. Changes in these bacteria, including decreases in beneficial bacteria like Lactobacillus and Bifidobacterium, can lead to inflammation and increased sensitivity in the intestines. While the exact link between gut health and abdominal pain isn’t fully understood, the interaction between disrupted gut bacteria and the intestinal lining is thought to contribute to IBS symptoms.
Factors Contributing to Gut Dysbiosis
In addition to changes in the gut microbiota, various factors such as diet and lifestyle contribute to dysbiosis, the imbalance in gut bacteria. These factors include:
- High-Fat/High-Sugar Diet (“Western Diet”)
A diet high in fat and sugars, can disrupt the gut microbiota, leading to inflammation and a decrease in protective bacteria like Lactobacillus and Bifidobacterium. This dietary pattern may also lower levels of beneficial short-chain fatty acids (SCFA), promoting a pro-inflammatory environment and increasing susceptibility to colonization by harmful bacteria like E. coli. - Ageing
Age-related changes in diet, immunity, and medication use (due to more comorbid diseases in the elderly population) can negatively impact the diversity and function of the gut microbiota. Elderly individuals often exhibit less diverse microbiota, with a potentially increase in harmful bacteria instead. The cumulative effect of ageing-related stressors can lead to gut dysbiosis, contributing to various metabolic diseases and frailty. - Medication
Prescription drugs, particularly antibiotics and proton pump inhibitors (PPIs), can alter the gut microbiome. Antibiotics disrupt microbiota diversity and increase susceptibility to infections from pathogens like Clostridium difficile, while PPIs lead to changes in specific bacterial populations associated with dysbiosis. Additionally, antipsychotic medications may reduce the diversity of gut bacteria, resembling patterns seen in obese individuals. - Sedentary Lifestyle
Exercise plays a role in maintaining gut microbiota diversity, along with diet. Athletes often exhibit greater microbial diversity, suggesting a beneficial impact of physical activity on gut health. However, the relationship between exercise, diet, and microbiota is complex and interconnected. - Smoking & Tobacco Use
Exercise plays a role in maintaining gut microbiota diversity, along with diet. Athletes often exhibit greater microbial diversity, suggesting a beneficial impact of physical activity on gut health. However, the relationship between exercise, diet, and microbiota is complex and interconnected.
Probiotics, which are live microorganisms that offer health benefits, have emerged as a potential option for managing IBS symptoms. One category of probiotic products, called mixed-strain probiotics, has gained attention for its ability to balance gut bacteria and ease IBS symptoms.
How Mixed-Strain Probiotics Help
Mixed-strain probiotics contain different types of bacteria, such as Lactobacillus, Bifidobacterium, and Streptococcus. These probiotics aim to restore a healthy balance of gut bacteria and promote gut health, potentially improving overall quality of life for people with IBS. Several studies have looked at the effectiveness of probiotics, particularly mixed-strain varieties, in managing IBS symptoms.
For example, in a study of a mixed-strain probiotic consisting of four strains of Lactobacillus, three strains of Bifidobacterium and one strain of S. thermophilus, the subspecies contained in this probiotic formulation are able to break down and absorb bile acids, which in turn helps to reduce intestinal discomfort and pain associated with IBS. Besides aiding to ease abdominal pain, studies have also shown that mixed-strain probiotics can help to reduce bloating and changes in bowel habits. Each type of bacteria in these probiotics exhibit its own unique effect on the gut, and when combined, they may work together to improve symptoms. Some individuals may experience even better results depending on their initial gut bacteria composition.
Using Mixed-Strain Probiotics
While there are numerous multi-strain probiotic formulations available on the market, not all have undergone thorough study or demonstrated effectiveness in managing IBS. Hence, for IBS, it is important to consider probiotic combinations that have shown clinical efficacy in treating this condition and its symptoms.
That being said, the dosage (i.e. the amount of live bacterial cells per dose) and duration of probiotic treatment are important factors in achieving positive outcomes. High doses of probiotics appear to be more effective in relieving specific symptoms, especially abdominal pain. However, it is also important to understand that it can take some time for probiotic bacteria to establish in the gut and maintain their beneficial effects, so it may be necessary to take these probiotics for a longer period to gain the most health benefits.
Conclusion
Mixed-strain probiotics that have shown clinical efficacy in IBS offer a promising approach to managing this condition and its associated symptoms by restoring gut balance and promoting gastrointestinal health. These probiotics, which contain a variety of beneficial bacteria, have been shown to reduce abdominal pain, bloating, and overall symptom severity. Healthcare professionals may consider recommending mixed-strain probiotics as part of a comprehensive treatment plan for individuals with IBS, potentially improving their quality of life.
IBS: irritable bowel syndrome; PAH: polycyclic aromatic hydrocarbon; PPI: proton pump inhibitor; SCFA: short-chain fatty acids
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Boonma P, et al. Probiotic VSL#3 Treatment Reduces Colonic Permeability and Abdominal Pain Symptoms in Patients With Irritable Bowel Syndrome. Front Pain Res (Lausanne). 2021;2:691689.
Clarke SF, Murphy EF, O’Sullivan O, et al. Exercise and associated dietary extremes impact on gut microbial diversity. Gut. 2014;63(12):1913–1920.
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Ruiz-Sánchez C, et al. Evaluation of the efficacy of probiotics as treatment in irritable bowel syndrome. Endocrinol Diabetes Nutr (Engl Ed). 2024;71(1):19–30.
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Vivomixx® Product Facts. Vivomixx Singapore. Available at: https://vivomixx.com.sg/product-facts/. Accessed March, 2024.
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Vivomixx®, a highly concentrated probiotic supplement, contains the De Simone Formulation, a probiotic blend developed by Professor Claudio De Simone. This probiotic formulation comprises eight specific strains of live bacteria: Lactobacilli (Lactobacillus paracasei, Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus delbrueckii subspecies bulgaricus), Bifidobacteria (Bifidobacterium longum, Bifidobacterium infantis, Bifidobacterium breve), and Streptococcus thermophilus. In Vivomixx®, these strains are present in concentrations of up to 450 billion bacteria (per sachet) and are also available in a variety of dosages and formulations.
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