Multi-strain synbiotic formula relieves IBS symptoms in study

A synbiotic formulation consisting of a multi-strain probiotic formula combined with a prebiotic fiber helped IBS sufferers achieve significant symptom relief in a study done in Poland.

The new research was published this month in the journal Nutrients. It was the work of a group of researchers associated with two Polish universities.

One of the authors disclosed a consulting relationship with German firm Vivatrex, which manufactured the test material. But the authors asserted there was no outside funding of the study, and they said the research material was purchased, not donated.

Research material manufactured by German company

The research material is a formula branded as Vivatlak Synbiotikum, manufactured by Vivatrex, based in Rees, Germany. The product consists of nine proprietary branded probiotic strains. No one strain accounts for more than 20% of the total 45 billion CFUs (colony forming units). Fructooligosaccharide (FOS) was included as the prebiotic component of the mixture.

The use of the term synbiotic in the product’s name is an indication of how the definition of the term has expanded over the years. In the first years of its use, the term suggested the specific prebiotic fiber included in the mixture had been demonstrated to foster the colonization of the specific bacteria in the blend.

After deliberation on the part of the International Scientific Association for Probiotics and Prebiotics (ISAPP), the group decided that definition was both too restrictive and too confusing for consumers. Now, the group’s definition reads as follows: “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host.”

ISAPP further divided synbiotics into “complementary synbiotics” and “synergistic synbiotics.” The latter group are the products that have data showing the microorganisms preferentially feed upon the prebiotic fiber in the blend. 

Synbiotics research gathering steam

Far more research is done on probiotics than on synbiotics, but the latter research topic has gathered steam in recent years. For example, in 2004, about 10 studies on probiotics were listed on the National Institute of Health’s (NIH) PubMed database for every synbiotic study. By 2022, that ratio had fallen to about 7:1.

Probiotic and prebiotic studies using fully healthy subjects have often struggled to demonstrate marked benefits. It’s easier to demonstrate an effect with subjects who have a problem to solve.

In this case, the researchers recruited a cohort of patients with mild to moderate irritable bowel syndrome (IBS). According to NIH, IBS is defined as “the presence of abdominal pain or discomfort with altered bowel habits,” in the absence of another causative disease or condition.

The researchers noted that IBS is a multifactorial condition whose causes are still imperfectly understood, and several drugs and other interventions have demonstrated at least some benefit. The researchers said anecdotal reports of how the Vivatlak Synbiotikum product had been used to good effect by IBS sufferers led them to conduct the present trial under more controlled conditions.

Synbiotic demonstrated significant symptom relief

The researchers recruited a cadre of 202 adult IBS patients who took the study material or a placebo for four weeks. The primary outcomes were two validated measures of IBS severity: the severity of IBS symptoms (IBS-SSS) and the improvement of IBS global symptoms (IBS-GIS). Secondary endpoints comprised adequate relief (IBS-AR scale), stool form type (Bristol Stool Form Scale), bowel movements, severity of abdominal pain and bloating, stool pressure, feeling of incomplete stool evacuation, and adverse events.

One of the subjects dropped out of the trial, and 201 patients completed the study. Synbiotic treatment, in comparison to placebo, significantly improved IBS-SSS and IBS-GIS scores. At the end of the treatment, 70% of patients in the synbiotic group achieved adequate relief.

As with many probiotic and/or synbiotic interventions, questions remain about the durability of the effects, the researchers noted.

“Follow-up assessments of patients who participated in the present study are in the process of being collected. However, a separate randomized clinical study addressing the long-term effects of treatment with the synbiotic will be needed to establish a solid understanding of the sustainability of the treatment effects,” they concluded.