Should You Take Probiotics For SIBO?
There is currently no convincing evidence that shows you should take Probiotics for SIBO but they may help. Some probiotic strains can be an effective treatment for SIBO and can be used alone or in combination with other treatments whilst other probiotic strains may be both helpful and harmful for SIBO.
SIBO, or Small Intestinal Bacterial Overgrowth, is a condition characterized by an abnormal increase in bacteria within the small intestine, leading to digestive symptoms and nutrient malabsorption.
Probiotics are live microorganisms that, when consumed in adequate amounts, confer health benefits by positively influencing the balance of beneficial bacteria in the gut.
What Is SIBO?
SIBO, or Small Intestinal Bacterial Overgrowth, is a condition characterized by an abnormal increase in the overall bacterial population in the small intestine, particularly types of bacteria not commonly found in that part of the digestive tract.
SIBO can cause symptoms such as bloating, abdominal discomfort, diarrhea, and may require testing, diagnosis, and management through treatments and dietary modifications. Antibiotics are the mainstay of SIBO treatment to reduce bacterial overgrowth in the small intestine according to a 2022 study authored by SJ Sorathia.
Another 2000 study authored by M Pimentel, found that among the 202 subjects with irritable bowel syndrome, 78% of them had small intestinal bacterial overgrowth suggesting a link between IBS and SIBO.
Treatment with antibiotics to eradicate the overgrowth resulted in an improvement in IBS symptoms, particularly diarrhea and abdominal pain. 48% of the subjects who had successful eradication of SIBO no longer met the diagnostic criteria for IBS.
What Causes SIBO In Humans?
Small intestinal bacterial overgrowth (SIBO) is caused due to factors that disrupt the normal balance of bacteria in the small intestine. According to Dr. Maya Kuczma, SIBO does not suddenly occur randomly.
11 of these causes can include conditions such as: 1. surgery, 2. low stomach acid (hypochlorhydria), 3. small intestine dysmotility, 4. diabetes, 5. lupus, 6. connective tissue disorders, 7. weakened immune system, 8. irritable bowel syndrome, 9. intestinal inflammation, 10. hypothyroidism, and 11. antibiotic overuse.
These 11 disruptions create an environment in the small intestine that promotes the overgrowth of bacteria, leading to symptoms such as bloating, diarrhea, pain, malnutrition, and weight loss.
How To Diagnose SIBO?
There are 4 main methods for diagnosing SIBO with varying rates of success but breath testing is most commonly recommended as a reliable and noninvasive method for diagnosing SIBO.
- 1A breath test, which measures the levels of hydrogen or methane gas in the breath after consuming a mixture of glucose and water can be used to diagnose SIBO.
- 2The second diagnostic method is small intestine aspirate and fluid culture, which is considered the gold standard test for diagnosing bacterial overgrowth because of accuracy.
- 3Stool tests are also a means to detect signs of SIBO, such as changes in bacterial composition and fat malabsorption.
- 4Blood tests for vitamin deficiencies and protein deficiencies may also be used to aid in the diagnosis of SIBO.
How To Diagnose SIBO At Home?
You can diagnosis SIBO at home with a home hydrogen breathe test kit. Hydrogen and methane breath tests for small intestinal bacterial overgrowth can be performed by patients independently at home with a success rate of over 95%.
Research suggests that home testing using postal test kits is a viable, safe, and convenient alternative to in-clinic appointments for diagnosing SIBO.
Common issues with home testing, including invalid samples (2.1% of tests) and high baseline hydrogen scores (2.6% of tests) that may affect the reliability of the diagnosis and patient error accounted for a small percentage (0.1%) of the total tests performed.
Are Probiotics Good For SIBO?
There is a mixed opinion on if probiotics are good for small intestinal bacterial overgrowth. Some research suggest that probiotics can be effective in treating SIBO and improving digestive health, while others indicate that there is not enough convincing evidence to support their use.
Which Probiotics Are Best For SIBO?
The Best Probiotic strains for SIBO based on research are, Soil Based probiotics, Lactobacillus probiotics and Saccharomyces boulardii probiotics yeast as shown in this graphic below.
A study authored by LMB Fernández, found that the use of S. boulardii CNCM I-745 (Sb) yeast in combination with dietary advice reduced bacterial overgrowth and improved digestive symptoms in patients with small intestinal bacterial overgrowth associated with diarrhea-predominant irritable bowel syndrome. It is unclear if all Saccharomyces boulardii probiotic yeast strains have this same effect on SIBO.
A 2014 study authored by AR Khalighi, found that the addition of soil-based Bacillus Coagulans to the maintenance therapy of SIBO patients receiving routine antibiotic therapy was beneficial in improving clinical symptoms and hydrogen breath test results. B. coagulans Unique IS-2 has not been studied for SIBO so not all Bacillus strains may work.
A 2022 study authored by D Gaon, found that Lactobacillus Casei and Lactobacillus Acidophilus was effective in reducing the number of daily stools and decreasing breath hydrogen levels in patients with SIBO related chronic diarrhea.
Can Probiotics Make SIBO Worse?
Yes, Probiotics make SIBO worse according to some research. Probiotic use, especially within one month, was independently associated with an increased likelihood of a positive breath test for methane in patients with suspected SIBO symptoms according to a 2020 review authored by TGO Achufusi. You should not take Saccharomyces boulardii probiotics if you are pregnant.
Dr. Sara Mesilhy has a Master’s degree in Gastroenterology and holds a membership with the Royal College of Physicians of the United Kingdom. She completed her Bachelor of Medicine, Bachelor of Surgery (MBBS) at Cairo University and is currently part of the ProbioticReviewGirl medical team.