Which Probiotic? The latest hard evidence shows that only one brand actually seems to work...
The use of probiotics such as Symprove is not a cure and only a part of the more integrated and multi-faceted treatment of IBS. The patient with IBS needs to consider the range of probiotics on merit and this choice is almost invariably down to the results of properly designed and executed clinical trials. An experienced Gastroenterlogist with an interest in IBS will be of help. For many patients the 50-70% reduction in symptoms produced by the multi-strain probiotic will provide a significant respite.
Contents
- Proven Effectiveness of Four Strain Probiotic (Symprove)
- Respite from Symptoms of IBS
- Effective IBS Treatments
- Integrated Care for IBS
- Evidence for Efficacy
- Symprove - Evidence for Symptom Reduction
- Symprove and Ulcerative Colitis
- Symprove - A Probiotic that actually Works
Proven Effectiveness of Four Strain Probiotic
A recently developed multi-strain probiotic drink containing four different species of live bacteria is causing alot of interest amongst senior Gastroenterologists. Following a series of detailed testing and randomised clinical trials the latest probiotic drink, Symprove has proven effective in treating the symptoms of IBS (irritable bowel syndrome) and is now proposed that it may also be beneficial in cases of IBD (inflammatory bowel disease).
Considerable Respite from Symptoms of IBS
Professor Bjarnason emphases that the use of probiotics such as Symprove is only a part of the more integrated and multi faceted treatment of IBS. It is not a cure and indeed if anyone claims a cure in this disorder the patient should immediately take such claims as quackery. Rather the patient with IBS needs to consider the range of probiotics on merit and this is almost invariably down to the results of properly designed and executed clinical trials. This may not be easy, but an experienced Gastroenterlogist with an interest in IBS will be of help. No probiotic is at present prescribable by GPs so that patients face the cost of the product in full. However for many the 50-70% reduction in symptoms will come as a significant restpite.
50-70% reduction in symptoms will come as a significant restpite
Until Now, IBS Treatments have been largely unsuccessful
Probiotic preparations are dietary supplements, which contain microorganisms that are thought to provide health benefits. Their purpose is to bolster the number and quality of micro-organisms symbiotically inhabiting the human intestine whose presence contribute to the healthy functioning of the digestive system and indeed some extra-intestinal functions. A change in bacterial flora in the gut has been causatively linked to a number of diseases not least IBS and IBD. IBS is an exceptionally common condition of varying severity affecting up to 20% of persons in developed countries and thereby accounting for about twelve million people in the UK. IBD on the other hand is an inflammatory gut disease with a further three hundred thousand affected. The wide prevalence of these illness along with the fact that current treatments for IBS are largely unsuccessful or unproven goes some way to explaining the enormous demand for probiotics that promise a natural and simple way of alleviating symptoms without significant side effects.
On the therapeutic options currently available, Professor Ingvar Bjarnason of King's College Hospital Medical School has this to say:
Currently licensed drugs for IBS have such limited efficacy that many of us have stopped using them. Additionally, any marginal benefit is often outweighed by side effects. For most patients, there is no effective treatment, and all we can do is offer management strategies and as much support as possible. An effective therapy would have an enormous impact on this frustrating situation.
An Integrated Approach for IBS Care
Prof Bjarnason and other Gastroenterologists with an interest in the treatment of IBS now take a fully integrated approach to the management.
Firstly various dietary changes are tried, from elimination regimens to the low FODMAP diet all depending on the principal symptoms.
Secondly it is often appropriate to liaise with a specialist Psychiatric service that addresses anxiety-worry issues preferably using approaches such as Cognitive Behavioural Therapy (CBT) AND without the use of medication.
Lastly there is the question of probiotics and this aspect of the management is controversial to the extreme because of much misinformation.
Hence probiotic preparations are extremely popular and their popularity has been largely driven by the marketing of probiotic-dairy products. Their general efficacy has been much questioned especially as the various beneficial claims have not required validation by food regulatory authorities.
Furthermore the presumed efficacy of many products have been linked without any evidence to the number of microorganisms ingested. The numbers of microscopic creatures in every dose of probiotic are measured in the billions, but it is not the number of these bugs ingested that matters. What really matters is the effect that they have on the patients' symptoms. This depends on the following factors:
- the numbers of bacteria surviving the digestive processes (including stomach acid) and
- then their ability to colonise the intestine, and
- possibly the amount of specific metabolic products which may be beneficial for gastrointestinal functions.
Seeing that there are over 1,000 different species of bacteria in the normal intestine with many more yet to be identified, it means that there are trillions of bacteria all inter-communicating with each other. This mix of gut biota creates a clearly bewildering and complex question of explaining why (if they do) they work. Nevertheless the value of the international market for these products is immense, with six in every ten UK households regularly stocking up on them, and more than half of IBS sufferers making use of them, mostly without much medical evidence for efficacy.
Finding the Evidence for Medical Efficacy
Can bacteria survive the stomach?
The first question is perhaps whether the probiotic preparations survive the acidic environment of the stomach. A recent University College London study found that in many cases the stated numbers of micro-organisms (by the manufacturers) did not survive the harsh environment of the human stomach in order to make it to the gut. This was particularly the case for freeze-dried products (for which home rehydration is required, leading to much variation in quality from case to case), but also for many well-known and well-selling liquid-based products. Much more work is required in this field but the more attractive preparations have already been identified by the UCL study.
Many other big, popular brands simply fail at this step
Even if we set aside the suitability of the various preparations it is clear that these popular remedies have attracted criticism for the perceived gap between what they claim to do and what they actually do, with many famous and leading brands coming in for flak. Indeed, the European Food Safety Agency have cast aspersions on the usefulness of probiotics, citing the paucity of scientific evidence in their favour. Thus, and supported by the UCL study, scepticism towards the usual probiotics seems well-founded.
The Required Proof lies in the Evidence for Symptom Reduction
Only a few probiotics have undergone rigorous clinical trial of efficacy to reduce symptoms of IBS. Symprove is one of those. Not only has it been shown to survive the simulated conditions of the stomach to the extent claimed by their marketers, where it passed all three criteria indicating usefulness in aiding digestion, but also an independent clinical trial at Kings College Hospital showed Symprove to be “associated with a statistically significant improvement in overall symptom severity in patients with IBS. It was well tolerated and without significant side effects. These results suggest this probiotic confers benefit in IBS and deserves further investigation”.
Associated with a statistically significant improvement in overall symptom severity in patients with IBS. It was well tolerated and without significant side effects. These results suggest this probiotic confers benefit in IBS and deserves further investigation
Symprove and Ulcerative Colitis 
The same team went on to conduct a trial of Symprove in patients with ulcerative colitis (a severe form of IBD) and found that “Symprove reduces intestinal inflammation in [the group of patients under observation], without any significant side effects.” Thus, Symprove is now being advocated for use in both IBS and IBD patients as one of the few probiotics that actually works. Indeed, their marketing quotes Dr Paul Clayton as saying: “Symprove is the first of a new generation of very sophisticated products designed to restore the microbiome and functions of the gut. It is, at this time, the only validated symbiotic, and I would recommend it to anyone with IBS or related symptoms.”
A Probiotic that Actually Works
Symprove's edge could be partially down to both the quality and the diversity of the bacteria involved, but as stated above the mechanisms of action is speculative to the extreme, as is the case with any probiotic that works in these disorders.
Professor Bjarnason emphases that the use of probiotics such as Symprove is only a part of the more integrated and multi faceted treatment of IBS. It is not a cure and indeed if anyone claims a cure in this disorder the patient should immediately take such claims as quackery. Rather the patient with IBS needs to consider the range of probiotics on merit and this is almost invariably down to the results of properly designed and executed clinical trials. This may not be easy, but an experienced Gastroenterlogist with an interest in IBS will be of help. No probiotic is at present prescribable by GPs so that the patients face the cost of the product in full. However for many the 50-70% reduction in symptoms will come as a significant restbite.
Symprove, a recently developed multi-strain probiotic drink containing 4 different live bacteria, has proven effective in treating the symptoms of IBS (irritable bowel syndrome) and is now proposed that that it may also to be beneficial in cases of IBD (inflammatory bowel disease).
A group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell.
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A common name for the large and/or small intestines.
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Inflammation of the colon, also sometimes used to mean inflammation of the large intestine generally.
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The large intestine.
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An abbreviation for diabetes mellitus.
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The basic unit of genetic material carried on chromosomes.
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An abbreviation for inflammatory bowel disease, a group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.
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irritable bowel syndrome, a combination of abdominal pain and constipation, diarrhoea, or bouts of each that occur in the absence of any other diagnosed disease
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The body’s response to injury.
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A group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.
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relating to the intestines, the digestive tract between the stomach and the anus
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The section of gut, or gastrointestinal tract, from the stomach to the anus.
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An element present in haemoglobin in the red cells.
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Relating to metabolism.
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Organisms that are too small to be seen with the naked eye, such as bacteria and viruses.
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Dietary supplements containing bacteria believed to be necessary for proper gut function.
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A pale yellow or green,creamy fluid found at the site of bacterial infection.
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the organ or the body where food is stored and broken down
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Any abnormal break in the epithelium, the outer layer of cells covering the open surfaces of the body.
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