Can probiotics cause bloating?

Can Probiotics Cause Bloating?

Yes, probiotics can cause bloating as a common side effect, particularly during the initial days of supplementation as the gut microbiome adjusts to the new bacterial strains. 1

Mechanism of Probiotic-Induced Bloating

Probiotics can cause bloating through several mechanisms:

1. Fermentation effects: When introduced into the gut, probiotic bacteria ferment undigested carbohydrates, producing gas as a byproduct 2

2. Osmotic effect: Prebiotics (often combined with probiotics) exert an osmotic effect in the intestinal lumen, which can induce gaseousness and bloating 1

3. Microbial adaptation period: The gut microbiome requires time to adjust to new bacterial populations, causing temporary digestive symptoms 2, 3

Frequency and Severity of Bloating

• Bloating is among the most commonly reported side effects of probiotic supplementation 3
• Symptoms are typically mild to moderate and transient 2
• Adverse events including bloating are reported in multiple clinical trials, though serious adverse events are rare 2
• The 2017 review in Gut Microbes documented abdominal bloating as a common side effect in probiotic studies 2

Risk Factors for Probiotic-Induced Bloating

Certain individuals may be more susceptible to experiencing bloating from probiotics:

• Those with pre-existing irritable bowel syndrome (IBS) 1
• Individuals with gastroesophageal reflux disease 1
• People with heightened visceral sensitivity 4
• Those taking high doses of probiotics 1

Management Strategies

If experiencing bloating from probiotics, the British Society of Gastroenterology and other experts recommend:

1. Start with lower doses: Begin with a reduced dose and gradually increase to the recommended amount over 1-2 weeks 4

2. Timing of administration: Take probiotics on an empty stomach or with meals based on individual tolerance 4

3. Strain selection: Different probiotic strains may produce varying levels of gas; consider switching strains if bloating persists 2, 5

4. Temporary discontinuation: If bloating is severe, consider stopping probiotics temporarily and reintroducing at a lower dose 2

5. Dietary modifications: Avoid gas-producing foods and carbonated beverages while starting probiotics 4

Evidence from Clinical Studies

• A 2023 randomized controlled trial found that Bacillus coagulans MTCC 5856 actually improved symptoms of gas and bloating compared to placebo, suggesting strain-specific effects 5

• Conversely, a 2017 multi-center study of Bifidobacterium infantis 35624 showed no significant improvement in bloating severity compared to placebo in non-patient populations 6

• The British Society of Gastroenterology guidelines (2021) acknowledge that probiotics may help with IBS symptoms but note their effects are modest and recommend a trial period of up to 12 weeks 2

Clinical Recommendations

• Trial period approach: The British Society of Gastroenterology recommends taking probiotics for up to 12 weeks and discontinuing if no improvement is seen 2

• Strain selection matters: Not all probiotics are equal - effects (including side effects) vary by species and strain 7, 3

• Dosage considerations: Higher doses may increase the likelihood of bloating; consider starting with lower doses 1

• Special populations: Use probiotics cautiously in critically ill or severely immunocompromised patients due to risk of systemic infections 3

• Medication timing: Separate bacteria-derived probiotics from antibiotics by at least two hours 3

Bottom Line

While probiotics can cause bloating, this side effect is generally mild, temporary, and often resolves as the body adjusts to the supplement. The benefits of probiotics for specific conditions may outweigh this transient discomfort for many individuals. If bloating persists or is severe, consider changing the probiotic strain, reducing the dose, or discontinuing use.