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July 16, 2013

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I would like to know the CFUs of the probiotics used in this study, as well as if there was an information regarding standardization since the ratio of each of the species may possibly have affected the outcome of the trial.

Being a sufferer of IBS myself I have tried various probiotics. They told us in school that unless they are refrigerated they are useless. I went to a specialty store that carried refrigerated products and committed to trying them for a month. Probiotics, paired with regular exercise, really helped during that trial period with frequency and severity of symptoms. I also work in retail pharmacy and a lot of people that come in asking for probiotics say their doctors specified they needed a product with at least x number of strains so I wonder if there's evidence saying that a certain number of strains in a regimen are more effective than others.

I am not surprised that probiotics improve IBS symptoms. There have been many studies focused on how probiotics aid the digestive system. Most common probiotics consumed are yogurt and supplements. I am curious as to how just regular yogurt and supplements compares to the efficacy of multi-species probiotics to aid with the symptoms. It would interesting to see a study comparison.

I have noticed that most doctors prescribe probiotics alongside antibiotics and others just recommend yogurt. How much of the bacteria is in the probiotic cupsule? How many capsules of probiotics is equivalent to a cup of yogurt? Would one say probiotics cupsules are more effective than a cup of yogurt?

It seems probiotics can be used for all sorts of things. My dad has had IBS for years, and based on this information, I would definitely recommend him to try it.

Although only a small-scale study, this study did show how probiotics could improve IBS symptoms. Interestingly the probiotics given included Bifidobacterium longum, Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Streptococcus thermophilus but the stool only showed an increase in B. lactis, L. rhamnosus and S. themophilus. Is there a possibility these specific bacteria are not getting to the site of the problem? This could potentially mean many of the yogurts enriched with Bifidobacterium bifidum and Lactobacillus acidophilus are not actually effective in IBS. More research with these specific bacteria individually to assess whether it is reaching the site of the problem is necessary.

Probiotics have been gaining in popularity a lot recently, I think it's great to see new research coming out for them. Would patients that have constipation dominant IBS be potentially harmed by increased residence time of the probiotic in the intestine? I know there are reported cases of probiotic sepsis and fungemia, usually in immunocompromised patients, but I didn't know if this may pose a threat?

The article evaluates multi-species probiotics effectiveness for Irritable bowel syndrome (IBS) symptoms. Based on the research study results, the probiotics are beneficial and effectively reduced symptoms: stomach pain, bloating, and discomfort. I concur with the study and authors perspective. Additionally, the claims are justified by strong scientific research and data.

One additional thing that would have been nice to see in this study was some longer term follow-up. Are the bacteria administered in the probiotic formulation able to colonize the intestinal tract? It appears that fecal excretion was used as a surrogate marker of colonization, but is that true? Are the improvements seen in irritable bowel syndrome sustained after termination of the twice daily regimen? Do they cease abruptly? Fade with time? This was a good start, but there is much more work to be done in this area.

CB - re: single species investigations. This is a great point. It should also be considered that in some trials combinations were LESS effective than individual species (a specific example I can think of was a recent trial I skimmed on the yeast Saccharomyces boulardii alone or in combination with several Lactobacillus species). However, it is also not out of the realm of possibility that some combinations could be synergistic as opposed to antagonistic. This is what makes probiotics such a difficult area of study.

I haven't read too much about the FODMAPs diet, but it sounds really interesting. It seems like its a good way to identify and address trigger foods in the diet of patient's suffering from IBS. It makes one wonder what effects probiotics can have on the variation and intensity of symptoms when combined with this diet. It may be relevant to establish probiotic use before initiating this diet just to eliminate variables.

AJ I found your information on the FODMAP diet very interesting. I was not very familiar with this diet, so I looked into it a little further. Some foods that are considered low FODMAP foods include fruits (like banana’s, grapes, kiwi, and oranges) and vegetables (like lettuce, corn, celery and bell peppers). These foods would be good for healthy snack options and easily incorporated into daily meals. Thanks for sharing AJ!

This was a very interesting study that offers a glimpse into the possible impact of probiotics. I would have enjoyed a much larger study. Also, my understanding is that the ratio of IBS is 2-3 times women more frequently than men. I would like to see a large-scale study with women that are impacted by IBS. I would also like to see studies with Ulcerative Colitis and Crohn's as well.

I have been reading up on irritable bowel disease as well, and find it common to see in wording in articles the refer to symptoms not targeted by the customary pharmaceuticals mechanisms of action. Imagining how inconvenient, and the impact on quality of life these symptoms must have, it is good that therapies that may target these symptoms are investigated.

Irritable bowel syndrome prevalence in the US is approximately 14% overall consisting of those medically diagnosed and undiagnosed and that is huge while most people living with IBS suffer serious GI problems, it is simply rewarding to find out that simple probiotics play an important role in this study, however multi-species type may be more difficult to come by as most people go out for yogurt which has one on strain. This study shows a huge 68% vs. 37% that is worth looking into and moreover I have read more studies looking into multi-species probiotics for other GI diseases as these combination series becomes more relevant in our present age.

Earlier this week I was researching the low FODMAPs diet that has been shown to reduce and/or relieve symptoms of IBS and other functional gut disorders. FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols, which describe a group of short chain carbohydrates and sugar alcohols. FODMAPs are types of foods that are poorly absorbed and quickly fermented by gastrointestinal bacteria which may cause bloating, gas, diarrhea, and cramping in patients who lack the ability to properly absorb these foods. The low FODMAP diet limits intake of foods containing lactose, fructose, fructans, galactans, and sugar alcohols which helps to alleviate patient symptoms. This diet may be a good option for some patients and may be worth looking in to for patients who suffer from various functional gut disorders. Natural Standards database contains a number of monographs and links with information regarding different approaches to therapies which may be beneficial to patients with many different types of disease states.

This is a very interesting study to me because I recently read a number of articles about IBS and different dietary therapies. In the articles I read about how patients with IBS may have altered intestinal microflora, visceral hypersensitivity, and small intestinal bacterial overgrowth (SIBO). These alterations in the digestive tract function of IBS patients may be the cause of their IBS associated symptoms so it would make sense that probiotics, which restore the intestinal bacteria and promote gastrointestinal health, would help to reduce IBS symptoms. I would like to see future research on this topic using a larger population.

it continue to fascinate me how altering the bowel normal flora can improve or worsen one's health. IBS symptoms are extremely discomforting and painful hence this study findings show promising relief of these symptoms.

I personally think this is a very interesting topic. I shared this with my mother who has IBS and takes probiotics regularly. She has had great success so far and highly recommends it for anyone suffering from IBS. My son is also sensitive to milk based formula and is now on a special formula that actually contains a probiotic to help with digestion. I have noticed a huge difference in him with fussiness and gas since he has started this formula and I think a lot of it could be due to the probiotic.

What a great study I'd love to see what happens when they do it in a larger population size as many people suffer from IBS and related intestinal problems. Many people are already taking probiotics for IBS or general health but the most popular brands on the market are single species containing only Lactobacillus how do we communicate the need for multi-species products to be more accessible?

Probiotics seem to be more beneficial than I had previously thought. Not only do they aid in relieving IBS symptoms and general stomach discomfort, but they actually stimulate the body's immune system. My cousin suffers from both IBS and lactose intolerance. I cannot wait to show her this article since she dislikes taking medication for it and I believe it will help her condition. By introducing lactose fermenting bacteria through probiotics, one's lactose intolerance may actually improve. So despite her aversion to yogurt in general, probiotics seem to be a great alternative and complementary treatment for IBS.

Probiotics have a lot of utility in many conditions. It's always good to see some more solid evidence for their use. I wonder if it makes any difference that this is a combination probiotic versus a single species probiotic.

This is just one of the many trials we are seeing here at NS that reports benefit of probiotic use for various GI and allergy related conditions. Hopefully there is more to come in separating out the probiotic strains and correlating them with condition specific results.

Interesting article that could eventually have a positive impact on care of patients with irritable bowel disease. After reading the linked abstract I wonder why stool analysis was only done on 17 from each group instead of the ITT population? Were there dropouts?

IBS is a condition mainly diagnosed by its symptoms. In Natural Standard Database, under medical condition IBS, it states that commonly used probiotics for IBS are Lactobacillus acidophilus and Saccharomyces boulardii and there has been findings showing the reduction in symptoms of IBS. It would be great to see more studies confirming the benefit of multi-species probiotics for IBS symptoms.

I would be interested to see each of the probiotic species tested individually. It is great to see such results, but knowing if a single species has benefit over the other would be great. I would also be curious to see how this probiotic combination works with Crohn's disease patients.

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