What Are The Best Probiotics for SIBO?
Taking probiotics for SIBO is a very controversial issue and the discussion amongst practitioners can get heated very quickly!
Some doctors claim that probiotics do not help SIBO, while others believe they are very beneficial and must be used.
The effects of probiotics and how they work in the body is a very complex and underresearched topic. Not to mention the fact that everyone has a different microbiome and genetics so while one type of probiotic may help one person, it may cause negative effects for someone else.
So, what does this mean for SIBO patients? Which probiotics are the best?
Well, that all depends on the person and their unique microbiome but the best method we have right now for figuring out is to experiment. It’s also important to note that I have experience meeting some SIBO patients who have had tremendous success with probiotics and others who have not had as much success using them. It’s really individualized.
In this article, I’m going to break down everything you need to know about probiotics. Which specific types are the best to try based on SIBO research and empirical evidence from doctors and patients.
If you just want to see the best probiotics for SIBO click here.
Table of Contents
What Are Probiotics?
Probiotics are defined as microorganisms (bacteria and yeast) that are believed to provide health benefits when consumed.
The term gained more popularity after 1980 and the probiotic industry has grown in size since then. It is now a multi-billion dollar industry! There are probiotic foods of all kinds now and so many different combinations of bacteria are used in these products. It’s important to remember that there is a lot of clever marketing right now, but still not a ton of useful research.
No doubt, there can be benefits of taking probiotics, including in some SIBO cases, but you will need to sort through all the different types of probiotics and clever marketing to see if you can find a brand that’s effective for you.
It’s also important to note that some people with SIBO cannot tolerate probiotics very well especially at the beginning of their healing journey. In my personal experience, I wasn’t able to tolerate them when my symptoms were severe but could tolerate small amounts when they were under control.
Beneficial Effects of Probiotics
Probiotics can provide many different beneficial effects and have been used in numerous medical conditions.
- Help improve immune function
- Protect against bad bacteria and infections
- Some help improve motility
- Improve digestion and absorption of nutrients
A Few Health Conditions Shown Helpful For:
- Irritable bowel syndrome & SIBO
- Ulcerative Colitis
- H Pylori
- C difficile infection
A Few Studies Using Probiotics in SIBO Patients
The science behind probiotics being used for SIBO is very limited. This may be the case because SIBO is a relatively new medical term.
On the other hand, probiotics have been used in many research studies with IBS patients. Remember that anywhere from 60-80% of IBS patients actually have SIBO as an underlying issue. So this means that evidence in IBS patients is also applicable to a lot of SIBO patients.
Below are 3 studies that show positive results using probiotics in SIBO patients:
- A small study showed that 64% of patients who took 65 mL of Yakult for 6 weeks which contains Lactobacillus casei had a negative breath test following. (Source)
- 25 patients were administered a combination probiotic containing Lactobacillus plantarum, Lactobacillus casei, Streptococcus faecalis, and Bifidobacterium brevis for 5 days and evaluated afterward. These patients were also put on the same diet as the antibiotic group which reduced alcohol, dairy, legumes, and leafy greens. The researchers then compared this group to 25 people who took metronidazole instead. 52% of patients who took metronidazole experienced improvement while 82% of patients put on the probiotic experienced improvement. (Source)
- A study using the probiotic Lactol as a maintenance therapy following antibiotic treatment was run. 30 patients with a positive hydrogen breath test and symptoms of abdominal pain and diarrhea were randomized into 2 groups. One who used Lactol following treatment for 15 days and the other who did not. The group receiving the maintenance probiotic Lactol had a better response after follow up 6 months later. The breath test turned negative 93% of the time for the probiotic group compared to 67% without probiotic maintenance. This is an interesting study because this probiotic brand contains FOS which is a prebiotic and not usually recommended with SIBO. (Source)
The bottom line is that there has been a small amount of evidence which shows probiotics can be beneficial in SIBO patients. We just don’t have enough research on timing, probiotic types, and specific strains to be used in specific cases.
If you are thinking about testing probiotics my advice would be to test slowly and make sure your gut motility is functioning well.
Remember, in the case of SIBO if someone has poor gut motility and you give them more bacteria, this can cause more fermentation. It’s important that you are able to sweep bacteria down from the small intestine into the large intestine to prevent overgrowth.
Can Probiotics Cause SIBO to Get Worse?
It’s important to note that for some people probiotics can make their symptoms worse. But, the only way to tell if this is the case with your gut is to test them out. There are a few reasons why this could happen:
- Migrating motor complex is not working effectively enough to clear bacteria in the small bowel. If someone has very weak cleansing waves in the small bowel adding more bacteria can just add to the issue, causing even more fermentation.
- The specific strain or type of bacteria is already in abundance or not right for you. The microbiota that colonizes your gut is extremely complicated. The type of probiotic you tried may not be helpful to your specific microbial diversity.
- The timing is not right. Your gut may be too sensitive or not ready to handle the effects of new probiotic bacteria at the current time.
How to Take Probiotics for SIBO
Probiotics are very case specific in SIBO patients. Some people may find them super helpful, others will have no change in symptoms, and some people will get worse when using probiotics.
Most gastroenterologists and SIBO specialists recommend careful testing when incorporating any probiotic as well as following the guidelines below.
- Avoid probiotics that contain prebiotics as a main ingredient. Prebiotics to look out for are FOS, GOS, MOS, Inulin, and Arabinogalactan. In people with SIBO, prebiotics can aggravate the gut since they feed all bacteria including the overgrowth.
- Experiment for 1-2 weeks and evaluate results. You should be able to tell after 1-2 weeks if there has been a benefit, no benefit, or regression in your symptoms.
- Test one at a time. It’s important to test one brand or strain at a time so you can monitor the effects of that particular type of probiotic. There is no way to determine which probiotic helps you if you don’t isolate the brand.
- Start with a very small dose. A lot of probiotics contain billions of microorganisms per dose. It’s smart to start in the millions range. You can even open up the capsules to try a small amount of the probiotic to start with. Most SIBO patients are sensitive and will be able to tell with a small dosage if they react negatively or not.
- Be aware of reaction within first 3 hours. When testing a probiotic start small and stay aware of initial negative reactions within the first 1-3 hours. If you have a negative reaction you may need to stop and try another probiotic that doesn’t cause bad side effects.
- Timing Matters. Some people may not be able to tolerate probiotics at the beginning of treatment or when they are more sensitive. When you get your gut under control a bit more and gut motility is functioning better you can test again in small amounts to see if they are helpful. Personally, I have found this tip important.
7 Best Probiotics for SIBO
Below are the 7 best probiotics you can try if you have SIBO. I chose these probiotics because of their reported success for SIBO in a few different groups: types practitioners have reported success with, types patients have reported success with, and studies which included specific strains.
- Lactobacillus plantarum (Jarrows brand)
This probiotic has been shown in numerous IBS studies to reduce bloating, normalize stool frequency, and improve gas symptoms. It can be found in a product made by Jarrows.
- VSL 3 (Blend)
This probiotic blend has been studied to be effective in IBS and other digestive diseases. I have also talked to a few people who have had good results with this probiotic with SIBO. It is a mixture of 8 bacterial strains, mostly lactic acid bacteria.
- Align (Bifidobacterium Infantis)
Align has been helpful in some SIBO patients. Bifidobacterium infantis has also been shown in a few studies to help with SIBO and IBS.
- Saccharomyces Boulardii (Ortho Molecular Blend)
This is a high-quality probiotic blend containing S Boulardii and other strains of bacteria. S Boulardii is actually a type of yeast not bacteria but it has been shown to produce probiotic effects in the gut.
- Lactobacillus reuteri Protectis (Helpful for constipation SIBO)
This strain is made by a company called BioGaia. It has been successfully used in patients with methane dominant SIBO with constipation. It is a baby formula but that’s perfectly fine because SIBO patients need smaller doses of probiotics anyways.
- LactoPrime Plus (Blend)
Blend that SIBO patients have had success with. Very high quality and made without prebiotics and additives.
- Prescript-Assist Soil-Based Probiotics (Blend)
Some patients with SIBO have reported success with soil-based organisms. This is a blend of soil-based organisms. It’s important to know that this brand contain prebiotics so you will have to test slowly and see how it affects you.
In summary, those are a few of the best probiotics for SIBO that would be worth testing. You can also test out Yakult which is available in some grocery stores in a drink formula.
Remember to start slowly with any probiotics and monitor your body’s reaction!