Side effects of probiotics: What to do if they make IBS symptoms worse
For those with IBS or other digestive symptoms, taking a probiotic supplement or eating fermented, probiotic-rich foods sounds like a great idea. After all, we know how important having a healthy and diverse microbiome is to our gut, and overall health. But probiotics don’t initially work for a number of my clients and can often make symptoms worse in the short-term for those with significant gut dysfunction or bacterial dysbiosis. So, what are the side effects of probiotics and what should you do if probiotics are making your IBS symptoms worse?!
What are probiotics and probiotic-rich foods?
According to the World Health Organisation’s technical definition, Probiotics are live microorganisms, typically bacteria or yeast, that give us health benefits when ingested in sufficient amounts. The most common species that we see in our supplement probiotics are strains of bifidobacterium and lactobacillus. They typically help maintain or restore a healthy balance of bacteria to our digestive tract and have many proven health benefits, including:
> boosting our immune system
> fighting pathogenic infections
> improving digestive function
> increasing absorption of nutrients
> preventing and treating UTIs
> reducing symptoms of IBS and IBD
And while most people look to a supplement to boost their probiotic intake, there are also food-based sources available. Some of the more common probiotic-rich foods include:
Most common side effects of probiotics
Despite their proven health benefits (for those who tolerate them really well), for those who don’t tolerate them, the most common side effects of probiotics I see in my clients are:
> Looser stools
> Abdominal pain
I really want to emphasize that the vast majority of these side effects of probiotics are experienced only temporarily and/or by those with a chronic gut infection or severe dysbiosis, and here’s why...
Why probiotics can make you feel worse
The harmony (or otherwise) that exists within our GI tract is down to the number and variety of microorganisms that colonise it - a.k.a. our microbiome. Given that these bacteria, yeast and other species total in the trillions, with countless different strains represented, it’s an extremely complex interplay that exists within us.
Our gut bacteria have now been shown to play a crucial role in almost every process of the body. This is why introducing different species into the mix can temporarily have an impact on the environment and the symptoms we experience. This is particularly true of IBS-type symptoms like bloating, gas, abdominal pain and loose stools , which are the most common side effects of probiotics I see in clinical practice.
There is a balance that exists within the GI tract and when we use supplement forms of probiotics or fermented foods we are temporarily changing that balance. This is not to say that the previous balance wasn’t doing us harm, it’s just that a level of equilibrium existed and that we have now potentially thrown it into chaos. It isn’t until a new, hopefully more beneficial, balance establishes itself that symptoms will stop.
It’s also important to point out that probiotics will not likely colonise, or take up residence, in our GI tract. They do however, have beneficial (or symptomatic) effects on the way through and help existing colonies of beneficial bacteria to grow and proliferate. It’s also worth noting that just because we experience symptoms as a result of probiotics, this doesn’t mean they’re not still doing us good. It is often the rebalancing of the gut microbiome that is resulting in symptoms but these teething problems may still lead to improved gut health in the long term. A little pain (or gas or bloating), for a lot of gain?!?
When to persist and when to consider taking action
If a client only has a mild dysbiosis or imbalance of bacteria, without any significant pathogens or overgrowths, pushing through the initial mild reaction to probiotics may be advisable and sufficient to correct the gut dysfunction. Remember to start with small amounts of probiotics or probiotic-rich foods and build slowly. However, for clients who have diagnosable levels of bacterial or yeast pathogens or overgrowths, in my experience, probiotics alone will not likely fix the problem.
For these clients, continuing with the same probiotic that causes an initial reaction will often see symptoms get worse, not better. If this is the case, and your practitioner has not been able to find a strain and brand that works for you, identifying the exact pathogen or overgrowth at the root of your gut microbiome imbalance is essential to any proper gut healing. More on this below.
Not all probiotics are created equal
A reaction to probiotics may be more to do with the specific product you are using and not so much with probiotics in general. Here are three things you need to consider when choosing a good quality probiotic:
> Effectiveness of strains - some strains are more well researched than others so confer with your practitioner on what’s right for your condition. Three of the most beneficial strains for IBS-type symptoms to look out for are bifidus infantis, bifidus lactis, and lactobacillus plantarum. These can be taken individually, or in combination.
> Number of strains - diversity is your friend when it comes to a healthy microbiome. For this reason, a probiotic with 10-30 different strains is generally a good place to start, so long er you tolerate them all.
> Higher CFU’s - CFU stands for “colony forming units” and is used as a measure of how many bacteria are in probiotics. I typically recommend products that have at least 15-50 billion CFU’s. However, failure to titrate this type of product in slowly may cause symptoms because of the sheer amount of microorganisms introduced.
> Reputable brand - with probiotics not being regulated in many markets, ensuring you’re getting what you pay for can be difficult. For this reason, I recommend sticking with reputable brands recommended by your practitioner.
> Avoid fillers - Many store-bought probiotics contain ingredients that can aggravate symptoms for some people, including; D-lactate-forming species like Lactobacillus acidophilus, or tapioca and potato starch, maltodextrin, lactose, inulin, pectin as well as other prebiotics that may cause issues.
Working out the right probiotic for you, if you have IBS or other gut health issues, can be a complex process. Working closely with your practitioner and considering functional lab results, health history and any previous side effects of probiotics or probiotic-rich foods is a great way to ensure you’re onto the right strains for your healing journey. I wish it was easier to recommend well tolerated strains of probiotics, but unfortunately it is not, and I am often tailoring probiotic needs specifically to my clients. Sadly for those with gut health issues, a one-size-fits-all approach doesn’t work when it comes to probiotics.
Titrate probiotics in slowly
To avoid any potential side effects of probiotics, as with any natural supplement, I recommend introducing probiotics in slowly. Titrating in gradually is particularly relevant for higher strength products. This often means breaking open a capsule and sprinkling out a small amount before building up to a more standard dosage. By titrating slowly, you’ll typically avoid any major reactions and will be able to reduce the dosage to the last tolerated amount. Once you’re body is comfortable, you can slowly increase the dosage.
The same goes for the probiotic-rich foods mentioned above like sauerkraut and kimchi. I like to start clients on small amounts of coconut kefir, before building up to fermented vegetables like sauerkraut, and so on.
Get Functional GI Lab Testing
If you find that you experience side effects of probiotics or eating probiotic-rich foods, even after using a high quality product recommended by your practitioner, titrating them in slowly and persisting for a few weeks, then functional GI testing is definitely recommended.
The inability to tolerate probiotics is a common sign of gut pathogens like parasite and bacterial infections, as well as bacterial and yeast overgrowths like SIBO and Candida. For this reason, and because each condition requires separate treatment approaches, functional GI lab testing is key to working out exactly what is going on in your gut.
If you would like to learn more about my four go-to tests that cover-off the five most common root causes of IBS, check out this blog post for the full details. For those who don’t tolerate probiotics, I’d definitely recommend a comprehensive stool test and a SIBO breath best as a good place to start.
If you want to learn more about the testing process, or how we can help, please head to the Work With Us page to learn more about how we work online with clients in many countries to test for and treat the many root causes of IBS symptoms and other GI conditions.