Best Probiotics for SIBO

Best probiotics for SIBO

Probiotics are a tricky topic in SIBO patients. There are some doctors who don’t recommend probiotics in SIBO patients and others who believe they are a necessary part of treatment.

The only way to find out if they can help you is to test a few well-researched strains in small amounts and see how your body reacts.

The most important thing to remember is that everyone has a unique microbiome and genetics so it really comes down to choosing the correct strain which delivers the necessary therapeutic action.

When choosing the best probiotic for SIBO it’s important that you test a strain that has been researched well, is made from a reputable company that guarantees the amount until expiration, and has the necessary therapeutic action you need based on symptoms.

In this review, we will outline the best probiotics for SIBO based on the scientific evidence so that you can find a probiotic strain that actually has positive therapeutic effects.

IMAGE PRODUCT FEATURES

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Florastor
  • Researched strain is Saccharomyces Cerevisiae Boulardii
  • Proven to help SIBO
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Jarrows 299v
  • Researched strain is Lactobacillus plantarum 299v
  • Proven to help IBS
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VSL #3
  • Mult-strain product
  • Proven to help IBS
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Metagenics Ultra Flora Acute Care
  • Researched strain is Bifidobacterium Lactis HN019
  • Proven to help slow transit
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Now Foods Clinical GI
  • Researched strain is Bifidobacterium Lactis HN019
  • Proven to help slow transit
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Activia Yogurt
  • Researched strain is Bifidobacterium animalis lactis DN-173 010
  • Proven to help IBS-C
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Align
  • Researched strain is Bifidobacterium infantis 35624
  • Proven to help IBS
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BioGai Protectis
  • Researched strain is Lactobacillus reuteri DSM 17938
  • Proven to help constipation
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Doctor’s Best 2 Billion
  • Researched strain is Bacillus coagulans MTCC 5856
  • Proven to help IBS-D
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Culturelle
  • Researched strain is Lactobacillus rhamnosus GG
  • Proven to help IBS
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All of the probiotics listed in the chart above have been proven in scientific studies to help with certain conditions like IBS and SIBO. Let’s dive a little bit more into these specific probiotic strains and highlight the studies and details of each one.

Below is a list of best probiotics for SIBO:

1.Florastor- Evidence in SIBOFlorastor probiotic for SIBO

Therapeutic Strain Included: Saccharomyces Cerevisiae Boulardii

EvidenceIn this study, ScB was used in the treatment of SIBO in pediatric patients with short bowel syndrome. The treatment was used for one month and patients showed decreased levels in hydrogen gas as well as significantly decreased digestive symptoms.

Who may benefit: This beneficial yeast is ideal for people with SIBO, IBS, immune deficiency, travelers diarrhea, and more. It is an all-around good strain.

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2. Jarrows Bowel Support 299v- Evidence in IBSjarrows bowel support probiotic

Therapeutic strain included: Lactobacillus plantarum 299v

Evidence: In this study, a 4-week treatment with L. plantarum 299v provided effective symptom relief, particularly of abdominal pain and bloating, in IBS patients fulfilling the Rome III criteria.

Who may benefit: This probiotic strain is ideal for people with IBS, abdominal pain and bloating.

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3. VSL #3- Evidence in IBSVSL #3 probiotic for SIBO

Therapeutic strain included: B. breve (DSM 24732), B. infantis (DSM 24737), B. longum (DSM 24736), L. acidophilus (DSM 24735), L. delbrueckii subsp. bulgaricus (DSM 247634), L. paracasei (DSM 24733), L. plantarum (DSM 24730), Streptococcus thermophilus (DSM 24731)

Evidence: In this study, after week 4 of probiotic therapy, six patients showed symptom improvement on global symptom assessment compared with baseline. VSL #3 has also shown to reduce IBS symptoms in numerous other studies.

Who may benefit: This probiotic strain is ideal for people with IBS symptoms, IBD, and other more severe intestinal dysbiosis. VSL #3 has to be refrigerated.

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4. Metagenics Ultra Flora Acute Care- Evidence for slow transit timeVSL #3 probiotic for SIBO

Therapeutic Strain Included: Bifidobacterium lactis HN019

Evidence: In this study, 100 people with functional gastrointestinal symptoms who tended towards constipation were given a high dose (17.2 billion cfu) of B lactis HN019, low dose (1.8 billion cfu), or placebo for 14 days. The result concluded that whole gut transit time decrease was statistically significant in both the high dose and the low dose groups. The strain also reduced other functional GI symptoms.

Who may benefit: This probiotic strain is ideal for people with functional GI symptoms who tend towards constipation and have slow intestinal transit.

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5. Now Foods Clinical GI- Evidence for slow transitnow foods probiotic for SIBO 

Therapeutic Strain Included: Bifidobacterium lactis HN019

Evidence: In this study, which is the same as the study cited above, B lactis HN019 decreased intestinal transit time by 57%. Both Now Foods Clinical GI and Metagenics Ultra Flora Acute Care contain this strain of B lactis.

Who may benefit: This probiotic strain is ideal for people with functional GI symptoms who tend towards constipation and have slow intestinal transit.

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6. Activia Yogurt- Evidence in IBS-Cactivia probiotic yogurt for SIBO

Therapeutic Strain Included: Bifidobacterium animalis lactis DN-173 010

Evidence: In this study, it showed the B animalis lactis DN-173 010 decreased colonic transit time in women. There are also numerous other studies with this strain showing its effects in constipation and IBS-C.

Who may benefit: Patients with constipation, slow colonic transit, and IBS-C.

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7. Align- Evidence in IBSalign probiotic

Therapeutic Strain Included: Bifidobacterium infantis 35624

Evidence: In this study, B infantis 35624 was trialed in women with IBS at different doses. The results after 4 weeks in a large study of 362 IBS patients showed that the dosage of 108 CFU was superior to all the other doses and showed significant improvement in abdominal pain, bloating, bowel dysfunction, incomplete evacuation, straining, and gas. This is just one of many studies that show significant benefits in IBS patients.

Who may benefit: IBS patients and other functional gut disorders

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8. BioGai Protectis- Evidence in constipation & methane gasbiogai protectic probiotic for sibo

Therapeutic Strain Included: Lactobacillus reuteri DSM 17938

Evidence: In this study, L reuteri DSM 17938 was shown to decrease methane gas in constipation patients determined by the lactulose breath test.

Who may benefit: IBS-C, constipation, and methane gas producing patients

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9. Doctor’s Best 2 Billion- Evidence in IBS-Ddoctors best probiotic IBS

Therapeutic strain included: Bacillus coagulans MTCC 5856

Evidence: In this study, the concluded that B coagulans MTCC 5856 at a dose of 2 x 109 CFU per day was found to be effective in diarrhea-predominant IBS patients for 90 days. This means that this strain could be helpful for people with IBS-D

Who may benefit: IBS-D patients and others with Diarrhea

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10. Culturelle- Evidence in IBSculturelle probiotic IBS

Therapeutic Strain Included: Lactobacillus rhamnosus GG

Evidence: In this study, Lactobacillus rhamnosus GG was shown to reduce frequency and severity of abdominal pain compared to placebo in children with IBS.

Who may benefit: Patients with IBS especially children

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Probiotic Education 101

In order to select a quality probiotic that can help improve your health, it is important that you understand the basics of probiotics and what to look for in a “good” supplement.

There is a lot of marketing hype and many ineffective strains on the market currently, but if you understand the basics you can select a quality product for your specific need.

I learned a lot of my probiotic knowledge from Dr. Jason Hawrelak’s Probiotic Advisor Course. You can see my certificate of completion below:

probiotic prescribing certificate

What Exactly Are Probiotics?  

Probiotics are live microorganisms which when administered in adequate amounts, confer a health benefit on the host.1

  • Probiotics can come in capsules, powders, medicinal yogurts, drinks, oils
  • Most probiotics are from the Lactobacillus and Bifidobacterium Genus

What Are Probiotics Used For?

Probiotic pills

Below are just a few of the conditions probiotics are used for:

  • Digestive disorders like IBS and IBD
  • Infections from pathogenic bacteria
  • Digestive symptoms such as constipation, diarrhea, pain, bloating
  • With or post antibiotics
  • Lactose intolerance and other intolerance
  • Immune deficiency
  • Anxiety and depression
  • SIBO
  • Many other conditions and growing

How Do Probiotics Work?

Probiotics can work in a number of different ways to improve health outcomes. Below are just a few ways they can help the body:

  • Compete with pathogenic organisms for space
  • Secrete antimicrobial compounds
  • Help train and balance the immune system
  • Increase protective antibody levels in the gut
  • Can modify gut transit time
  • Reduce inflammation
  • Can improve intestinal barrier and leaky gut
  • Produce beneficial compounds like short chain fatty acids

Characteristics that all quality probiotics have

A quality probiotic product will contain a specific strain that has been shown in research to do the following things:

  1. Can survive the upper part of the GI tract and reach colon (bile salt and acid stable)
  2. Can adhere to intestinal mucosa and cells
  3. Can temporarily colonize gut (*current probiotics can only temporarily colonize)
  4. The strain has clinically documented health effects

The Importance of Strain Specificity

strain specificity in probiotics

This is something that a lot of people don’t understand. The probiotic product must be strain specific. Bacteria are named with 3 different naming classes: genus, species, and strain. For example, Lactobacillus would be the genus, plantarum would be the species, and 299v would be the strain.

Put together, this bacteria would be called Lactobacillus plantarum 299v.

The most important thing to remember is that the actions of the probiotic differ based on the specific strain. It is not enough just to know the genus and species of bacteria. The product must be a well-researched strain specific bacteria.

Red Flags to be Aware of in Probiotic Supplements

bad probiotic products

If a probiotic supplement has any of these, it probably isn’t a good product:

  • When supplement companies don’t name the strain
  • When companies refer only to the species in studies
  • When companies extrapolate that species have the same effects for all strains

Qualities the best probiotics for SIBO and IBS have

  1. The supplement is strain specific, chosen for the individual’s needs, and has all the characteristics discussed above in the quality probiotic section
  2. Adequate amounts of bacteria that are alive
    • Most quality dosages are at minimum 109 CFU, but can differ based on strain
    • Supplement company guarantees this amount until the expiration date
  3.  Storage and shipment of the product at the right temperature
    • Some products are shelf stable but others need to be refrigerated

What to Know When Using Probiotics for SIBO

using probiotics in SIBO

Using probiotics in patients with SIBO can be a bit trickier than the person with the average digestive complaint.

The following are points you should keep in mind:

  • For some SIBO patients probiotics can make their symptoms worse. This may be because they have slow gut motility in the small intestine and already too much bacteria present which they can’t clear out effectively. In these types of people, it’s best to try the strains that have been shown to improve intestinal transit time.
  • Patients with SIBO and IBS may need to start small and slow to monitor the changes in their body. When in a severe disease state the gut and nervous system can be much more reactive.
  • It may be best to try the probiotic strains without prebiotics
  • Test a specific strain with the necessary therapeutic action without combining numerous different products to conduct an accurate test.

In summary, if you have SIBO or IBS finding the correct probiotic may be a bit trickier. The chart below will help you find the best products to try based on strain-specific research done in IBS and SIBO.

Decide what therapeutic action you need help with (constipation, diarrhea, slow transit, etc) and pick one of the quality products below to test slowly.

Top-Rated Probiotics for SIBO and IBS

IMAGE PRODUCT FEATURES

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Florastor
  • Researched strain is Saccharomyces Cerevisiae Boulardii
  • Proven to help SIBO
Check On Amazon

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Jarrows 299v
  • Researched strain is Lactobacillus plantarum 299v
  • Proven to help IBS
Check On Amazon

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VSL #3
  • Mult-strain product
  • Proven to help IBS
Check On Amazon

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Metagenics Ultra Flora Acute Care
  • Researched strain is Bifidobacterium Lactis HN019
  • Proven to help slow transit
Check On Amazon

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Now Foods Clinical GI
  • Researched strain is Bifidobacterium Lactis HN019
  • Proven to help slow transit
Check On Amazon

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Activia Yogurt
  • Researched strain is Bifidobacterium animalis lactis DN-173 010
  • Proven to help IBS-C
Check On Amazon

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Align
  • Researched strain is Bifidobacterium infantis 35624
  • Proven to help IBS
Check On Amazon

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BioGai Protectis
  • Researched strain is Lactobacillus reuteri DSM 17938
  • Proven to help constipation
Check On Amazon

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Doctor’s Best 2 Billion
  • Researched strain is Bacillus coagulans MTCC 5856
  • Proven to help IBS-D
Check On Amazon

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Culturelle
  • Researched strain is Lactobacillus rhamnosus GG
  • Proven to help IBS
Check On Amazon