Can Probiotics Cause Constipation? – Introduction
When it comes to probiotics and other dietary supplements, there are concerns about possible side effects. One of these is the question of whether probiotics can cause constipation or not. The short answer is: “No.”
Constipation is not caused by probiotics. In fact, they can aid in the prevention of constipation. However, several strains and poor diet can lead to this condition in certain individuals. In this article, we will delve into the relationship between taking probiotics and constipation. Factors inducing constipation. We will also explore the role of probiotics in treating different types of constipation and the specific probiotic strains that help with this common gastrointestinal issue.
What Are Probiotics?
Probiotics are living microorganisms that resemble the good microorganisms in the human gut. They are frequently referred to as “good” or “helpful” bacteria because they may help in restoring the balance of the gut microbiome, the group of microorganisms that reside in the digestive tract.
Probiotics are generally considered to be safe and may provide a number of health benefits, including support for your digestive system and overall well-being. Consuming probiotic-rich foods like miso, sauerkraut, kimchi, kefir, and yogurt can assist you in maintaining balanced levels of good bacteria in your gut flora. You can also take probiotics through supplements.
Can Probiotics Actually Make You Constipated?
Constipation and probiotics have a complex relationship that is still being studied and talked about. Constipation is characterized by hard, dry bowel movements or less frequent bowel movements than three times per week.
Most people know that probiotics may help keep the gut healthy, but there is some concern that they may cause constipation in some individuals. Several factors can contribute to side effects of probiotics, such as constipation and, in rare cases, individual sensitivity weakened immune system, and gut microbiota composition.
Different strains of probiotics have been shown to work differently in the gut. Certain strains can potentially result in constipation, while some may help in improved bowel movements. The effects of probiotics can vary from person to person.
Each individual may have a specific response to specific strains depending upon their gut health and the composition of microorganisms in the gut. It is said that certain strains of yeast-based probiotics have resulted in constipation. For instance, in extremely rare cases, Saccharomyces boulardii (S. boulardii) has also been linked to symptoms such as constipation and increased thirst. (1)
However, poor hydration and low fiber diet, along with probiotic consumption, can lead to constipation too. So, it is always advisable to drink adequate water to keep yourself hydrated. Include fiber-rich food in your diet to add bulk to your stool, such as fruits, vegetables, legumes, and cereals.
Also, add physical activity to your routine as frequent exercise, even walking or running, stimulates digestive tract muscles and promotes bowel motions. These habits may aid digestion and avoid constipation. (2)
Role of Probiotics in Treating Constipation
Constipation affects a large percentage of Americans of all ages and backgrounds. Typically, around 16 out of every 100 persons have constipation (3). Probiotics have gained significant attention in recent years for their potential role in treating constipation and promoting healthy bowel movements.
When consumed in adequate amounts, these live microorganisms can provide a variety of benefits for gut health. Following are some of the types of constipations against which probiotics have shown fruitful effects.
Functional constipation is a condition characterized by difficult or infrequent bowel movements, typically as a result of abnormalities in the normal digestive function. It is a usual type of constipation that has no underlying structural abnormalities or diseases as a cause. It is estimated that functional constipation was the cause of 3.2 million visits to medical facilities in the United States in 2012.
Probiotics have shown promising results in treating functional constipation. According to a systematic review and meta-analysis of randomized controlled trials, the use of probiotics may improve the transit time of the entire gut, the frequency, and the consistency of stools.
On the other hand, it is necessary to conduct RCTs with adequate efficacy to determine the species or strains of probiotics, doses, and time periods that are most effective in treating this condition. (4)
Various types of medicines and nutritional supplements are responsible for causing constipation in certain individuals, (3) (5) such as:
- Iron supplement
- Lead & vitamin D intoxication
- Cancer treating drugs
Similarly, Chemotherapy, a common way to treat cancer, can contribute a lot to constipation. It is thought that about 16% of people who are getting chemotherapy have constipation as a side effect.
The medications that are administered during chemotherapy have the potential to disrupt the regular functioning of the gastrointestinal tract. This may result in altered bowel movements or even the development of constipation. (6) According to research, probiotics were found to be effective in reducing chemotherapy-induced constipation by about 96% in a 4-week study involving 100 people. (7)
However, further research is required to determine whether probiotics are effective with other drug-induced constipation or not.
Irritable Bowel Syndrome-Constipation
Irritable bowel syndrome, also known as IBS, is characterized by a group of symptoms that show up at the same time. These symptoms include recurrent pain in the abdomen as well as changes in bowel movements, which can include either diarrhea or constipation, or both. It is a very common condition that affects both the stomach and small intestine.
Probiotics have shown their potential in treating constipation associated with irritable bowel syndrome (IBS). For instance, according to a meta-analysis of 24 separate studies, probiotics were found to improve bowel regularity, bloating, and quality of life for those with irritable bowel syndrome. (8) An additional study involving 150 people with IBS found that probiotic supplementation for 60 days improved bowel regularity and stool consistency. (9)
Furthermore, consumption of a fermented milk beverage that was rich in probiotics was shown to increase stool frequency in a study involving 274 participants that lasted for a period of six weeks. (10)
However, the effectiveness of probiotics for constipation associated with IBS can vary from person to person, and the specific strains and dosages may have different effects. In order to choose the best probiotic strains and treatment strategy for each patient’s requirements, it is advised to consult with medical experts like gastroenterologists or registered dietitians.
Constipation can affect up to 38 percent of pregnant women. Women are susceptible to constipation during pregnancy due to physiological and anatomical changes in the gastrointestinal tract. For example, increasing progesterone levels during pregnancy and decreasing motilin hormone levels result in increased bowel transit time. (11)
Taking probiotics during pregnancy has been shown in some studies to reduce the risk of constipation in pregnant women. Consuming 10.5 ounces (300 gr) of probiotic yogurt enriched with Bifidobacterium and Lactobacillus bacteria on a daily basis was shown to increase the frequency of bowel movements and improve several constipation symptoms in a study involving 60 pregnant women who suffered from constipation. The study lasted for four weeks. (12)
Childhood constipation is a common condition in which children have few bowel movements or have trouble passing stool. It can cause pain, discomfort, and disruption in everyday activities. Childhood constipation is caused by a variety of reasons, including poor food habits, insufficient fluid intake, a lack of physical activity, and emotional problems such as anxiety or stress-related issues.
Probiotics have been shown in a number of studies to successfully treat children’s constipation. For example, a review of six studies revealed that giving probiotics to children with constipation for 3–12 weeks enhanced the frequency of their stools, while in another study, probiotics were given to 48 children for 4 weeks associated with supplements. It resulted in an improvement in the frequency and consistency of their bowel movements. (13) (14)
However, the findings of other investigations are inconsistent. Therefore, there is a need for more study.
Mechanism Involved in Treating Constipation
Probiotics can help treat constipation due to various mechanisms, some of which are below.
- Increase in Bile salt Metabolism:
In the gut, certain strains of the bacteria Bifidobacteria and Lactobacilli can increase the rate at which bile salts are metabolized. This results in the production of deconjugated bile salts, which have the potential to stimulate the movement of the colon, also known as peristalsis. These probiotic strains essentially aid in the activation of the muscles of the colon, supporting regular contractions and helping in the smooth passage of waste down the intestines. (15)
- Increase Peristalsis by SCFA Production:
Both Bifidobacteria and Lactobacilli help turn carbs into short-chain fatty acids (SCFAs) in the gut. This process is called fermentation. (16) Researchers have found that SCFAs improve colonic movement by activating nerve receptors in the smooth muscles of the gut wall.
This activation starts peristalsis, which moves waste through the intestines. SCFAs have also been linked to a higher quantity of serotonin in the gut. Serotonin is a neurotransmitter that makes nerve cells more active, and it can also speed up peristalsis, resulting in providing relief from constipation (17)
- Creates an Acidic medium to Induce Peristalsis
Certain strains of Lactobacillus and Bifidobacteria found in the digestive tract are responsible for the production of lactic acid and short-chain fatty acids (SCFAs), both of which have the effect of lowering the pH level in the colon.
The increased acidity of the contents of the digestive system may assist in inducing peristalsis, which refers to the muscular contractions of the colon. As a consequence of this, peristalsis is improved, and the period of time known as colonic transit time, which measures how long it takes waste to travel through the colon, is shortened. (18)
Effective Strains Against Constipation
When trying to treat constipation, it is essential to select the appropriate strain of probiotics, as certain strains may not be as helpful as others. Several strains of beneficial bacteria have been demonstrated in clinical tests to be effective in reducing constipation, including:
Bifidobacteria species have shown to have the best positive results against constipation.
- Bifidobacterium lactis HN019
The effects of Bifidobacterium lactis HN019 on people who suffer constipation have been examined in a number of clinical investigations. For instance, in a double-blind, randomized, controlled trial, 228 adults with a physician-diagnosed case of constipation were divided into three groups. For 28 days, each group received either 10 billion B. lactis HN019, 1 billion B. lactis HN019, or a placebo.
Constipation symptoms were monitored throughout and after the trial. There was a statistically significant increase in stool frequency in the intervention groups compared to the placebo group. However, colonic transit time was unaffected in the probiotic groups. (19)
In another study, the effects of B. lactis HN019 on the transit time of the entire intestine in constipated individuals were evaluated. Participants had functional gastrointestinal symptoms and 1–3 bowel movements per week. The trial was completed by 88 participants in total. They were divided into 3 groups: the placebo group, the low-dose B. lactis HN019 group (1.8 billion CFU daily), and the high-dose B. lactis HN019 group (17.2 billion CFU daily) for 14 days. Whole Gut Transit Time (WGTT) was measured on day 0 and day 14. In both the high-dose and low-dose groups, WGTT was reduced by statistically significant amounts. (20)
- Bifidobacterium lactis BB-12
It is a probiotic strain that has undergone extensive research and has been proven to be successful in treating constipation.
A clinical trial examined the effects of B. lactis BB-12 probiotic supplementation on constipation. 1000 people with low defecation frequency participated in the study, which lasted for 4 weeks. Three groups of participants were created: one received 10 billion CFU of B. lactis BB-12 daily, another received 1 billion CFU of B. lactis BB-12 daily, and the third group received a placebo. Comparing the B. lactis BB-12 groups to the placebo group, the findings revealed a statistically significant rise in defecation frequency, with an average increase from 3 to 4 episodes per week. (21)
- Bifidobacterium animalis subsp. lactis DN-173 010
Another Bifidobacterium lactis strain that has been proven effective in treating constipation in numerous clinical studies is B. lactis DN-173 010. In a double-blinded parallel study, milk fermented with the particular Bifidobacterium lactis strain DN-173 010 (containing at least 50 to 500 million CFU per dose) reduced colon transit time by 20% when consumed daily for 11 days. The study involved 70 healthy adults. Interestingly, the effect was stronger in females. (22)
Lactobacillus species like plantarum (23) and rhamnosus have shown positive effects in treating constipation.
- Lactobacillus rhamnosus GG
LGG (or Lactobacillus rhamnosus GG) is a well-studied probiotic strain with potential health benefits, including constipation relief. When LGG was supplemented alongside other treatments, such as prebiotic fibers, clinical trials showed positive results in increasing stool frequency. More clinical research is required to accurately assess its efficacy for constipation relief. (24)
There is no specific dosage recommendation for probiotics. However, most probiotic supplements contain 1-10 billion colony-forming units (CFUs) per serving (25). Use them just as advised for optimal benefits, and consider lowering your dosage if you develop persistent side effects.
While it’s true that probiotics as a whole help maintain a healthy digestive tract, it’s also important to consider that certain strains of probiotics rarely cause constipation, depending upon the type of strain and poor hydration and fiber intake.
However, the effect may vary from person to person. However, it is always recommended to consult a doctor or gastrologist for the ideal dosage prior to taking probiotic supplementation or stick to the manufacturer’s guidelines for the best outcome.
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