How do Probiotics Fit In On a FODMAPs Elimination Diet?

You and I both want to know! I don't have all the answers, but I'd like to share some of my thoughts on this, since it is one of the most frequent queries I receive. I look forward to reader and professional comments on this one.

I think we can all agree that bacterial fermention in the gut is normal and desirable to a certain point. The bacteria in our guts have their own jobs to do for us, and they have to eat--fermentation is how they do it. This normal state of affairs can be disrupted by illnesses, infections, use of antibiotics, or food intolerance or allergies. If too much gas is produced as a result of bacterial imbalance, it can be part of the IBS picture

Or, the bacterial fermentation piece might be perfectly normal, but your nervous system may be so sensitive that you experience normal gas expansion of the colon and abdomen as a painful sensation.

When we use a FODMAPs restricted diet we deprive certain gut bacteria of their favorite foods. This decreases gas production. But we don't want to give up the health benefits of the short chain fatty acids (SCFAs) and other substances that gut bacteria produce for us.

A key point is that each species of bacteria has its own favorite food, and produces a unique combination of gases and SCFAs. People with IBS (and eating a FODMAPs-restricted diet) need a gut stocked with critters that like to ferment non-FODMAPS carbohydrates, don't produce gas, and do produce large amounts of desirable SCFAs. Oh, and it wouldn't hurt if they could also control gut pH, help the immune system function properly, and "box out" bad bacteria. And they should be safe, of course. Bifidobacteria appear to be the best candidates.

Enter probiotics. When we take probiotic supplements we are ingesting microbes that we think will help, in large enough quantities to have a medicinal effect. Probiotics in general show a lot of promise for treatment of IBS, but we have much, more more to learn about them. Specific probiotics that have been studied and have evidence showing a good treatment effect are: Bifidobacterium infantis (best), Bifidobacterium animalis, and VSL#3 (a patented blend of different species of bacteria).

People who are immunocompromised (due to illness or immune-suppressing drugs) or who are critically ill should not take probiotics without discussing the risks and benefits with a health care provider.

My next post will cover the nitty-gritty of how and when to take probiotics when using my FODMAPS-elimination diet program. Stay tuned!

Comments

[Dirk]

Thanks for this great information. Do you know if the pro-biotic "Align" is acceptable for people who do respond to the fodmap diet? Is has just one strain and it is the Bifidobacterium infantis.

[Patsy Catsos]

Yes, Align would be an example of a product that contains B. infantis.

[Wendy]

You write: "People with IBS (and eating a FODMAP-restricted diet) need a gut stocked with critters that like to ferment non-FODMAPS carbohydrates, don't produce gas, and do produce large amounts of desirable SCFAs."

I thought the whole idea of the FODMAP diet was to significantly reduce intake of all carbs that have the potential to be fermented. What would be left for a probiotic such as Align to ferment (thereby producing desirable SCFA's) if they are not provided any "food"? Put another way -- aren't IBS symptoms the collateral damage of a healthy process, i.e. SCFA production via fermentation of carbs? And vice-versa, doesn't a symptom-free life come with the risks associated with a reduction in SCFA production, i.e., increased inflammation and compromised repair and regeneration of colonocytes?

[Patsy Catsos]

I would agree that a *potential* risk of a low FODMAP diet would a reduction on the beneficial products of fermentation. However, the goal of the diet is do reduce *rapid* and *excessive* gas production, not to stamp out all fermentataion. We are definitely not removing all fermentable carbs from the diet, nor would we want to. There are other, stricter diets out there that might do so, but this isn't one of them. Part of the definition of FODMAPs is that the carbohydrate is *rapidly* fermentable. Those that are fermented more slowly are still allowed in the diet. This might include starches and other carbohydrate molecules with really complex structures that take more time to be fully digested by commensal bacteria. Thank you for this interesting question.

[Wendy]

Thank you for the clarifying answer!

Ideally, the slowly fermented substrate would come from food, but another option might be an acacia fiber supplement, which seems to fit the bill (or so I've heard). And just so you know, I do NOT sell fiber supplements or anything else, for that matter!

I would be interested to know if anyone has experimented with acacia....

[Stacy Jones]

Ive already been diagnosed with dysbiosis, so would a probiotic, in addition to FODMAPs diet, be beneficial, or should I just stick to the diet?

Is ReNew life a good brand?

[Patsy]

I think eventually a probiotic would be helpful along with a low FODMAP diet, but would caution against introducing it during the learning process of the Elimination/Challenge process. ReNew life might be OK if there are no FODMAP additives, but it is not one I am aware has had clinical testing for effectiveness with IBS.

[penny]

Reading this thread has made me wonder whether by cutting out Fodmaps and thereby reducing the food source for some of these 'good' bacteria are we causing their numbers in the gut to decline and thereby increasing sensitivity to FODMAPs in the future (as there are lass bacteria left in the gut to help digest them)? I may be totally wrong here as I don't fully understand the processes going on.