For IBS sufferers-legions of unexpected allies may soon be offering their help. Should you give them a chance?

Rob and Christine Smith, both 45, were halfway through dinner in Manhattan one winter evening when he was overcome by a forgotten feeling. For the past two years, dining-out was an emotionally draining activity that threatened their relationship rather than the treat it used to be. 

After numerous tests, Christine Smith's doctor finally concluded 18 months earlier that she had irritable bowel syndrome, or IBS. But knowing the name of the condition that was at the root of her abdominal pains, unpredictable and urgent needs to run to the bathroom, and alternating bouts of diarrhea and constipation did little to make her feel better. 

"Eating out essentially consisted of me accompanying Rob to a restaurant and watching him eat while maybe, just maybe, I'd sample a bite or two of the bread served as a table appetizer," she remembers. "Anything more risked a frantic sprint to the bathroom." Smith confesses that she was often frightened of not being able to get to a bathroom soon enough. 

The traditional over-the-counter (OTC) drugs her doctor suggested she try didn't work for her, and she didn't fit the profile to be prescribed either of the two IBS drugs approved by the Food and Drug Administration (FDA). 

The torture was not only hers. Her husband recalls, "I felt sick knowing how awful it was for her, knowing that she couldn't enjoy the night, and feeling guilty that I missed the times when we lived to try new foods and restaurants."

Feeling as if she had become such a burden and a prisoner to carefully selected foods and the proximity of a toilet made her feel even worse. But recently, she heard an advertisement on the radio for a natural product for IBS sufferers and gave it a try. By now, she felt good enough to have the confidence to order a meal from the menu and to eat it. And so there it was for him: the wonderful feeling of enjoying their dinner date together and acting like a normal couple. 

Taking Action Against IBS
The natural product she took was a small capsule filled with somewhere around a billion cells of friendly bacteria, or probiotics.  By World Health Organization definition, probiotics are defined as live microorganisms which when administered in adequate amounts confer a health benefit on the host. 

This year, three notable companies (Proctor & Gamble, Bayer, and Ganeden Biotech) are expected to widely advertise their probiotics as a way of helping with IBS and a host of other digestive symptoms, and they hope that many of the estimated 30 million Americans with IBS take action by giving them a try.

In a society that often seems to have an obsession with killing bacteria-by taking antibiotics at the first sign of a cough and using antibacterial soaps, wipes, and gels-should people welcome these legions of friendly bacteria into their bodies?

The Natural Remedy
Natural products promising to fix everything from arthritis to zits have been peddled for years in the lightly-regulated, multi-billion dollar dietary supplement industry. 

Some arrive with outrageous health claims and achieve massive sales levels driven by fanfare that seems to fuel itself more than the evidence of product efficacy or consumer satisfaction. Usually, sales fall precipitously once regulatory watchdogs catch up to the often misleading claims, or perhaps when it's discovered that the purported evidence supporting the products turns out to be concocted, or when consumers simply find that the products don't work. 

One might think that the public would grow weary of these natural products, but the fact remains that many people would rather give one of these products a chance than take prescription drugs that often come with scary information sheets listing potential side effects such as liver damage or death.  

Because there have been some quality and safety considerations attributed to the use of certain natural products, it's best to do your research and discuss your options with your clinician to weigh the risks and benefits of any supplements or medications you wish to take.

A Case for Probiotics
A recent systematic review by the American College of Gastroenterology on the management of IBS concluded that published studies on probiotics support only a weak recommendation for their use-primarily because such studies have been small, short-term, and have used a variety of different probiotics and doses. 
But that doesn't mean that probiotics are untested or don't work. In fact, Nicholas Talley, M.D., Ph.D., of the Mayo Clinic in Jacksonville, Fla., an expert on IBS and one of the authors of the review, says he "does recommend probiotics" and that "there is emerging support for their use." 

But what about the report's conclusions? The difference appears simply to be a case of trying to compare apples and oranges. In dozens of clinical trials involving thousands of patients, probiotics have performed well for various digestive disorders, but the trials don't compare in size or scope to the ones employed in the drug approval process.

That is a standard that will be virtually impossible to meet outside of the pharmaceutical industry where manufacturers invest upwards of $600 million per drug on research and development but are then able to charge high prices for prescriptions that can then be covered by patient insurance to make up for their investments.

The Friendly Bacteria
In theory, probiotics do have a lot going for them. Michael Roizen, M.D., chief wellness officer at the Cleveland Clinic and proponent of a few natural remedies including probiotics, has given a number of talks on the topic and says in a probiotics podcast that "over 90 percent of the cells in your body are not yours" but rather the trillions of friendly bacteria living in our guts. Research shows that these friendly bacteria help us break down our food, produce important nutrients, and protect us from disease-causing bacteria.

Roizen says, "Levels of these 'good' bacteria can decline due to factors such as age, diet, stress, and even with the use of antibiotics. When this happens, you can run into digestive problems." 

New research is happening every day that suggests that the makeup of this internal ecosystem is critically important to many aspects of our overall health. It's also been shown that people with IBS and other digestive disorders have disruption in their gut bacteria. 

Anybody who has taken a course of antibiotics may already know this-taking antibiotics kills off good bacteria and often leads to what is known as antibiotic-associated diarrhea. Roizen recently wrote in a book he co-authored with Mehmet Oz, M.D., YOU: Being Beautiful, that probiotics may be the best allies for those with IBS.

Are Probiotics the Way Forward?
IBS sufferers, like Christine Smith (who asked that her name be changed), probably aren't overly concerned about whether the clinical trials on probiotics meet the same standards of those required for FDA drug approval, they just want to resume their normal lives.

Doctors themselves are somewhat limited as to other solutions they can recommend. Two drugs, alosetron and lubiprostone, are approved only for certain types of IBS: alosetron is for women with severe IBS-related diarrhea only and has serious potential side effects; lubiprostone is only for women with IBS-related constipation, and the benefit is small.

While doctors can also suggest OTC medicines like laxatives, antidiarrheals, and bulking agents, Talley says that they don't work well for most people with IBS.

This probably explains the growing interest in marketing probiotics for IBS. Ganeden Biotech, makers of a probiotic product called Digestive Advantage IBS and one of the biggest sellers of probiotics, cites data showing that consumers are much more likely to make repeat purchases of their probiotic than they are of most well-known OTC medicines sold in the digestive section-indicating that consumers are happy with it. 

Proctor & Gamble and Bayer, huge companies that are usually conservative when it comes to natural remedies, want a piece of the action with planned national introductions of probiotics later this year. When the maker of household brands like Tide, Pringles, and Metamucil starts getting into the probiotics act, it's a sure bet it believes that there's a big market. Proctor & Gamble currently has over 20 brands that sell $1 billion or more yearly.

Realities of IBS
Although people don't openly talk about what goes on in the bathroom, the reality of functional gastrointestinal disorders (FGID), of which IBS is the most common, are that having one is not exactly uncommon. 

FGID are a tremendous public health problem, says Talley. Data from recent studies "imply that the absence of a functional gut disorder is almost abnormal." As an example, he cites data from Olmsted County, Minnesota indicating that 42 percent of the population had one or more FGID based on observations over a 12-year period. 

And experiences of those such as the Smith's only begin to describe the impact IBS has on society: impaired quality of life, psychiatric problems, family disruption, impaired workplace performance, unnecessary tests and surgery, high direct and indirect costs, and, in rare cases, death from medicines or interventions. 
 
Talley says that IBS is taboo and people are often embarrassed to admit they have constipation, diarrhea, or worse, accidents such as leakage of stool. Compounding the problem, he says, is that many physicians feel IBS is only in their patients' heads. A probiotic product that can be discretely purchased at the local drug store may turn out to be not only a savior but a face-saver.

Getting Some Relief
The recommendation? Maurizio Fava, M.D., a researcher at Harvard/Massachusetts General Hospital, is beginning a placebo-controlled clinical trial to evaluate the efficacy of Ganeden's probiotic in patients with IBS and depression. Fava says that while more placebo-controlled studies are necessary to determine whether giving probiotics to large populations of people, such as those with IBS, delivers a better benefit-to-cost or benefit-to-risk ratio than doing nothing or resorting to other alternatives, doesn't mean that individuals shouldn't take them if their doctor recommends and they provide relief.

Christine Smith recommends the path she took to others suffering with IBS: See your clinician, try the clinician-recommended medications, and then if they don't work, give probiotics a try. 

IBS Symptoms

Here's a list of symptoms that signal you may be suffering from IBS:

• Abdominal cramping
• Bloating or feeling of fullness, distention, or swelling
• Loose or watery stool
• Straining to have bowel movements
• Urgency
• Losing control of bowels or bowel accidents
• Feeling of not having complete bowel movements
• Passage of mucus with bowel movements

Impacts of Functional Gastrointestinal Disorders (FGID)

Although the symptoms associated with FGID can make life uncomfortable and pretty miserable, there are larger issues at stake. According to the International Foundation for Functional Gastrointestinal Disorders, about 25 percent of the U.S. population has some activity limitation and impairment of daily function due to problems associated with FGID. Other issues that arise include:

• Impaired health-related quality of life
• Psychiatric problems
• Complications with other parts of the body
• Risk of fecal incontinence
• Family disruption
• Unnecessary surgery
• Increased mortality
• Impaired workplace performance

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