Probiotics can be a confusing topic if you are dealing with SIBO. There are some doctors who don’t recommend probiotics in SIBO patients and others who believe they can be a helpful supplement in SIBO treatment and maintenance.

When choosing the right probiotic for your condition 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 your symptoms.

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

Top SIBO Probiotics Reviewed

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Florastor
  • Researched strain is Saccharomyces Cerevisiae Boulardii
  • Proven to help SIBO
  • Benefeicial yeast studied well in numerous GI issues
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Jarrows 299v
  • Researched strain is Lactobacillus plantarum 299v
  • Proven to help IBS
  • Studied fairly well
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Visbiome (Previously known as VSL#3)
  • Mult-strain product studied extensively
  • Proven to help IBS
  • Previously known as VSL#3
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Metagenics Ultra Flora Acute Care
  • Researched strain is Bifidobacterium Lactis HN019
  • Proven to help slow transit
  • Contains multiple strains
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Now Foods Clinical GI
  • Researched strain is Bifidobacterium Lactis HN019
  • Proven to help slow transit
  • Contains multiple strains
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Activia Yogurt
  • Researched strain is Bifidobacterium animalis lactis DN-173 010
  • Proven to help IBS-C
  • Medicinal yogurt
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Align
  • Researched strain is Bifidobacterium infantis 35624
  • Proven to help IBS
  • Studied very well in IBS and other GI issues
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BioGai Protectis
  • Researched strain is Lactobacillus reuteri DSM 17938
  • Proven to help constipation
  • Shown to reduce methane gas
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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
  • Well studied probiotic
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All of the probiotics listed in the chart above have been proven in scientific studies to help with IBS or SIBO. Let’s dive a little bit more into these specific probiotic strains and highlight the studies conducted on them and the details of each product.

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 probiotic yeast strain. If you are someone who does not do well with lactobacillus and bifidobacterium species trying this yeast based probiotic may be helpful.

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

Therapeutic strain included: Lactobacillus plantarum 299v

EvidenceIn 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. Visbiome (Previously VSL3)- Evidence in IBSVisbiome (previously VSL#3)

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)

EvidenceIn this study, after week 4 of probiotic therapy, six patients showed symptom improvement on global symptom assessment compared with baseline. Visbiome or the “De Simone Formulation” 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. Visbiome has to be refrigerated.

**It’s important to note that Visbiome was previously marketed under the brand name VSL#3 but after the inventor stepped away from the company they changed the brand and created Visbiome with the same De Simone Formula previously studied under the name VSL3. Visbiome is the orginal formulation that went through numerous scientific trials.

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4. Metagenics Ultra Flora Acute Care- Evidence for Slow Transit VSL #3 probiotic for SIBO

Therapeutic Strain Included: Bifidobacterium lactis HN019

EvidenceIn 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. This product does contain multiple different strains but it also contains the strain studied to help with slow transit, Bifidobacterium lactis HN019. Overall, this is one of the best probiotics for gut motility to try.

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5. Now Foods Clinical GI- Evidence for Slow Transitnow foods probiotic for SIBO 

Therapeutic Strain Included: Bifidobacterium lactis HN019

EvidenceIn 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. This product is also a multi-strain formulation.

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

Therapeutic Strain Included: Bifidobacterium animalis lactis DN-173 010

EvidenceIn 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. This product is a medicinal yogurt and can be just as effective if not more than probiotic capsules. Yogurt has traditionally been one of the best delivery mediums for probiotics and beneficial bacteria.

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7. Align- Evidence in IBSalign probiotic

Therapeutic Strain Included: Bifidobacterium infantis 35624

EvidenceIn 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. Align is a well researched probiotic strain and may be effective for anyone dealing with bowel issues. It’s easy to get and relatively cheap as well.

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8. BioGaia Protectis- Evidence in Constipation & Methane Gasbiogai protectic probiotic for sibo

Therapeutic Strain Included: Lactobacillus reuteri DSM 17938

EvidenceIn 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. Methane gas has been associated with constipation in numerous scientific studies and this product was shown to help decrease methane gas production, ultimately aiding in constipation relief.

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

Therapeutic strain included: Bacillus coagulans MTCC 5856

EvidenceIn 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. This product has not been studied as extensively as some of the other probiotics on the list but it has shown some promise helping those with diarrhea type symptoms.

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10. Culturelle- Evidence in IBSculturelle probiotic IBS

Therapeutic Strain Included: Lactobacillus rhamnosus GG

EvidenceIn 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. Culturelle is a very well studied probiotic, easy to access, and relatively cheap option for people struggling with IBS and other digestive symptoms.

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What Exactly Are Probiotics?  

probiotic bacteria

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

Probiotics are used for many different health conditions including:

  • 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

Probiotics can work in a number of different ways to improve health outcomes:

  • 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

For more information on the health benefits of probiotics, see our guide here.

How Can Probiotics Help SIBO?

bacteria

This is where it can get a little bit confusing. SIBO stands for small intestine bacterial overgrowth, which means that someone has too much bacteria in their small bowel.

Too much normal or bad bacteria in the small intestine can cause numerous debilitating digestive symptoms such as gas, bloating, diarrhea, constipation, and more.

SIBO can be caused by anything that slows down the intestines or anything that alters the structure of the bowel. For example, nerve damage in the gut which leads to intestinal dysmotility or adhesions which cause structural issues in the small intestine. Even certain medication like proton pump inhibitors or opioids can be a cause of SIBO.

You can learn more about SIBO here.

Also, when someone has SIBO they can also have intestinal permeability, autoimmunity, and inflammation in conjunction with bacterial overgrowth. It really is a vicious cycle which causes many symptoms in the body due to the altered gut flora in the small intestine.

So, if SIBO is an issue of too much bacteria in the small intestine, how may probiotics possibly help?

  • First, some probiotic strains can actually secrete antimicrobial compounds against specific pathogens and species of bacteria. This may be why a few probiotic strains have shown positive results in people with SIBO. Some strains may work as natural antibiotics in the gut which help in eliminating SIBO.
  • Second, some probiotic strains have been shown to help with intestinal permeability also known as leaky gut. For example, Lactobacillus rhamnosus GG has been shown to aid in healing leaky gut. If someone has SIBO, they may also have intestinal permeability so probiotics may play a role in helping to heal the altered gut lining.
  • Third, some probiotic strains have been shown to help with intestinal transit time. People with SIBO often can have issues with slow intestinal motility so using a strain that helps the movement of the gut may aid in healing from SIBO.
  • Fourth, some probiotic strains may help reduce inflammation in the gut and increase levels of protective antibodies. When someone has SIBO they also usually have higher gut inflammation and reduced immune function which is why these actions of probiotics may aid in healing.

Can Probiotics make SIBO Worse or Possibly Trigger it?

intestines

Even though probiotics may help some people in healing from and eliminating SIBO due to the actions discussed above, there are still people who may not benefit or who may get worse from probiotics if they have SIBO.

There are many doctors and researchers that do not advise patients with severe SIBO to use probiotics because in these types of people severe intestinal motility may be an underlying cause.

If someone has a major issue with intestinal motility, adding more bacteria that can stick in the small intestine may make symptoms worse. If the small bowel just isn’t sweeping normal bacteria and food residue down and out, then adding more bacteria can add to the problem.

So in summary, yes it is possible that probiotics can make SIBO worse for those people who have major issues with motility in the small intestine.

In general, if you are someone with a motility disorder it may be best to test a probiotic strain that has been shown to help intestinal transit time. If that and a few other tests don’t help, then it may be the case that you are just adding more fuel to the fire.

On the other hand if someone has SIBO without severe intestinal motility and deals with inflammation and other digestive challenges, using probiotics may be beneficial to aid in healing.

It really depends on the individual case which is why it’s important to talk with your doctor about it.

Probiotic Qualities Necessary for Efficacy

  1. The supplement is strain specific and chosen for the individual’s needs whether they are dealing with constipation, diarrhea, gas or bloating
  2. The product contains adequate amounts of bacteria that are alive
    • Most quality dosages are at minimum 10CFU, but can differ based on strain
    • Supplement company guarantees this amount until the expiration date
  3.  Quality Storage and shipment of the product
    • Some products are shelf stable but others need to be refrigerated

How to Take Probiotics 

taking probiotics

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:

  • Test a specific strain with the necessary therapeutic action without combining numerous different products to conduct an accurate test
  • Take probiotic products that do not contain prebiotics
  • Start small and slow to monitor the changes in your body. When in a more severe disease state the gut and nervous system can be  more reactive. Try starting with 1 million to 1 billion CFU’s instead of billions at once.
  • If you have negative reactions to a product discontinue and try a different strain
  • If probiotics make you worse or you just can’t tolerate them, it may be the case that you need to improve gut motility before you can introduce any additional bacteria, or that adding bacteria may not be good for you. Listen to your gut and test them again at a later date when your intestines are functioning better.

In summary, try taking a very small dose of a probiotic strain that has been proven effective in helping with the symptoms you currently have. Test this out for a week and then re-evaluate. If it makes you worse or causes a reaction discontinue. If it helps keep taking the product in a small dose and try increasing the amount very slowly until you reach your maximum tolerance level.

Probiotic FAQ’s

  1. What probiotic is best for SIBO?
    • The best probiotic for SIBO depends on your symptoms and the type of bacterial overgrowth you have. Overall, Florastor brand is one of the best products to try if you are dealing with SIBO. 
  2. Are probiotics safe for SIBO?
    • Probiotics are safe if someone is dealing with SIBO. While they may help some people and not help others with digestive symptoms, there are no severe side effects or risks associated with taking probiotics.
  3. Is Align probiotic good for SIBO?
    • In our opinion, Align is a quality probiotic to try if you are dealing with SIBO. Align has been studied in many scientific trials in patients with IBS.
  4. Can probiotics make SIBO worse?
    • In some people probiotics can make SIBO worse. This could be due to the specific strain or because someone has an underlying cause like severe dysmotility.
  5. Are probiotics with prebiotics ok with SIBO?
    • Doctors usually do not recommend probiotics with prebiotics in people with SIBO. This is because prebiotics may help feed bacterial overgrowth.
  6. Are soil based probiotics better for SIBO?
    • There is no conclusive research showing that soil based probiotics are better than other types of probiotics. There have been a few small studies showing that soil based probiotics like Bacillus coagulans can help people with IBS and SIBO but there have also been studies showing that yeast based probiotics and Lactobacillus & Bifidobacterium probiotics can work just as effectively.
  7. What is the best strain for methane SIBO?
    • The best strain for methane overgrowth is Lactobacillus reuteri DSM 17938 which is in the product known as BioGai Protectis. This strain was studied and shown to reduce methane gas.
  8. What is the best probiotic strain for diarrhea?

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