This question comes up in my clinics all the time and I thought I’d share my thoughts on this here…It is not yet known whether it is better to take a probiotic alongside a low FODMAP diet or not. In 2016, Staudacher and colleagues published a randomised controlled trial looking at the effects on IBS symptom improvement and faecal bacteria with a low FODMAP diet and probiotics (VSL#3) versus a low FODMAP diet alone. IBS symptoms improved to the same extent in both groups, suggesting that VSL#3 did not add any further benefit. However, VSL#3 in combination with low a FODMAP prevented the decline in the numbers of bifidobacteria (beneficial bacteria) that is usually seen in those following a low FODMAP diet. We do not yet know whether the beneficial bacteria comes back with the reintroduction of high FODMAP foods at the later stages of the diet or whether this can only be achieved by adding in a probiotic…