Probiotics and Prebiotics: How to Use Them to Help Manage IBS and IBD

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Probiotics and prebiotics are popular supplements touted to improve digestive health. But how much of them should you take, and which digestive health conditions can they really benefit?

To answer these questions and more, HealthCentral asked nutritionist LeeAnn Weintraub, MPH, RD, author of “The Everything Glycemic Index Cookbook,” for an update on the latest research on these supplements and how to use them to help manage digestive health conditions like irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).

LeeAnn Smith Weintraub, MPH, RD
LeeAnn Smith Weintraub, MPH, RD, in the kitchen.
LeeAnn Smith Weintraub, MPH, RD

HealthCentral (HC): What are probiotics and prebiotics and how do they help manage IBD and IBS symptoms?

LeeAnn Weintraub: Probiotics are live, health-promoting bacteria that populate the digestive tract of the body (what’s called the gut microbiome).

Prebiotics are soluble, fermented fibers, such as those found in beans, oats and potatoes, that feed probiotics. They provide a healthy environment for probiotics to grow in the gut.

There are both good and bad bacteria in the gut microbiome, and its composition changes as we age, with stress, based on our diet and our genetics, and with the use of antibiotics. That means we can end up with more bad bacteria and less good bacteria, which can exacerbate a health problem like IBS or IBD. In fact, many studies have shown that there is a disruption in the gut microbiome in people with IBD and IBS.

There’s a good amount of recent and new research showing probiotics can be useful in improving IBS symptoms like gas, bloating, abdominal pain, constipation and diarrhea. They also seem to be effective in the treatment of ulcerative colitis, but there’s less definitive evidence in people with Crohn’s disease. And beyond digestive symptoms, a couple of studies show that certain strains of probiotics (Bacillus coagulans MTCC 5856 and Bifidobacterium longum NCC3001) can improve depression in people with IBS.

HC: What’s the best way to consume probiotics and prebiotics?

Weintraub: You can get probiotics from foods with live cultures like yogurt and fermented foods such as kimchi, sauerkraut, and kombucha. You need a lot of these foods to get the benefit, however.

For prebiotics, I recommend following a high-fiber diet. We know that Americans don’t get enough fiber in their diets — most people get about 15 grams when women are supposed to get 25 grams and men 38 grams — and not everyone with IBS can eat fiber-containing foods because they can trigger digestive symptoms.

In both cases, and especially if you have a chronic condition like IBS or IBD, a high-potency supplement is a better way and is as safe as taking a multivitamin. Potential side effects include an increase in gas and bloating if you take too much, but these supplements don’t interact with many drugs or have serious side effects.

HC: What should you look for in a probiotic or prebiotic product for digestive health?

Weintraub: There are a lot of options in terms of single and multi-strain products and different potencies. Lactobacillus and Bifidobacterium are the best-studied strains, so you want to look for high-quality products that contain one or both of these strains. One well-known product is Align, which contains Bifidobacterium 35624. It’s been studied for IBS and shown to be effective. Doctors know about it and many recommend it, but I think a multi-strain product like Renew Life’s Ultimate Flora 30 Billion Probiotic, which contains 10 different types of Lactobacillus and Bifidobacterium, can have more potential benefits. Another product I like is Jarro-Dophilus EPS, which has eight strains from the Lactobacillus, Bifidobacterium, Lactococcus and Pediococcus families.

As for potency, if you’ve been on a lot of medications or antibiotics, you have a severe case of IBS or IBD or you have food poisoning, more potent products are best. In those cases, I recommend products with 50 or 90 billion bacterial counts. And if you can’t handle a fiber supplement, you might look for one of the probiotic/prebiotic combination products that have recently come on the market.

HC: How should you use probiotic and prebiotic products?

Weintraub: I tell people to take them when they can remember them — in the morning about 30 minutes before they eat (you don’t want to take them with food because your stomach acid can degrade the capsule before it reaches the intestines, which is where you want the probiotic to have an effect) or at bedtime. And you might want to take these products a couple of times a day if you are having a lot of digestive issues or if you feel a cold or another illness coming on.

HC: Can you take probiotics and prebiotics when you’re taking antibiotics?

Weintraub: We know that antibiotics deplete good bacteria in the digestive tract. But it’s a myth that you will cancel out the effects of an antibiotic if you also take a probiotic. You just don’t want to take them at the same time of day. I recommend taking a probiotic with or without a prebiotic two hours after an antibiotic so they’re not in your stomach at the same time. You want to be fighting the infection at the same time you are repopulating the gut with good bacteria. And you want to continue taking the probiotic and/or prebiotic after you discontinue the antibiotic. Seventy percent of our immune system resides in the gut, so we want to be sure to feed it the good bacteria it needs to thrive.