If You Have SIBO, Avoid This Massive Myth
“You can’t take probiotics if you have SIBO.”
If it wasn’t for the functional medicine and natural health community, I wouldn’t have a passion. This space has provided me with so many fulfilling challenges, vast arrays of knowledge, and endless opportunities to do what I love. If it hadn’t been for the hard work of several doctors in this industry, Small Intestinal Bacterial Overgrowth (SIBO) would not be as recognized as it is today. Without that work, people with SIBO would go to their doctor complaining of bloating and abdominal pain, and would likely be told “You probably have IBS”, or, “It’s all in your head.”
However, there are some tidbits of information that are constantly being tossed around in the industry that I believe are misleading patients and practitioners alike. Many have to do with probiotics. I previously wrote about 5 Probiotic Myths, and there is one myth I intentionally left out because I wanted to devote an entire article to it. In my early years of learning functional medicine, I heard this statement at many seminars and talks: “For your SIBO patients, don’t give probiotics. There’s already an overgrowth of bugs, so we don’t want to give them more bugs.” Let’s address these erroneous claims and the implications for probiotics.
Out with The Old, In With The New
Take the next 20–30 seconds and think about what Small Intestinal Bacterial Overgrowth implies. Ah yes, you guessed correctly! Too many bacteria in the small intestine. Now think about this, many used to believe that probiotics could directly colonize the microbiome. Better said, whatever probiotics you took, they would automatically become “new residents” in your gut. Having that as your background, logically, you wouldn’t want to give more bugs to someone that has too many.
Yeah, that’s what we thought we knew, but here’s what we know now: 1) SIBO might actually be considered more of a dysbiosis than a nominal overgrowth (dysbiosis meaning too many bad bugs and/or not enough good bugs), 2) Probiotics don’t directly become new residents in the gut. In that sense, probiotics are a great tool to help support gut dysbiosis. They offer food (prebiotics) to the resident good bugs, give off antimicrobial peptides that fight off bad bugs, and support inflammation within the gut environment.
Support for SIBO
With how frequently it was drilled in seminars I attended that probiotics should be avoided, when I started doing my research on “Probiotics and SIBO” I wasn’t expecting to find many favorable outcomes. Wow, was I dead wrong! To start with, a systematic review and meta-analysis (highest standard of research) on probiotics for SIBO found that probiotics were effective in relieving abdominal pain and hydrogen breath test concentrations (1). The most efficacious way to measure SIBO is via hydrogen and methane breath testing. The lower the better. Abdominal pain is also a hallmark symptom of SIBO. Less symptoms plus better test results, seems compelling so far.
If you ever find yourself researching probiotics, whether in the store or on the internet, keep in mind that there are basically 3 categories of probiotics: 1) Lactobacillus / Bifidobacterium strains, 2) Saccharomyces Boulardii strains, and 3) Bacillus strains (click HERE to learn more about the naming of probiotics).
93% of people in the probiotic group had a negative hydrogen breath test by the end.
Category 2 probiotics may be just as effective as antibiotics in improving diarrhea, abdominal pain, gas and bloating in those with SIBO (2). Not to mention similar clearance of SIBO in both groups via hydrogen breath test. That’s huge! Probiotics can be just as effective as antibiotics, with less adverse events and side effects. Category 3 probiotics may reduce SIBO-related pain, gas, belching, and diarrhea (3). 93% of people in the probiotic group had a negative hydrogen breath test by the end. Again, we see improvements in both symptoms and lab testing results.
A combination of category 1 & category 3 probiotics reduced subjective measures of gut symptoms and reduced the number of positive SIBO breath tests (4). Here we see multiple categories being effective, which is my preferred method of recommendations, all 3 categories at one time.
Postoperative abdominal surgeries (gastric bypass, hysterectomy, appendectomy, bowel resection) are one factor that can contribute to and result in SIBO, so it would likely be a good idea to have tools on hand that could support the gut post-surgically. Probiotics may reduce bloating in those undergoing gastric bypass surgery, however there was no effect on the actual prevalence of SIBO via diagnostic testing (5). While the actual prevalence of SIBO wasn’t changed, the symptoms were. I’m not sure about you, but I’d rather feel better than just have a lab value change.
I believe my colleagues were coming from a good place by telling us to avoid the use of probiotics for SIBO. In my view, what I think happened was their patients were reacting to the PREbiotic fibers that are so often put in with PRObiotics.
The healthier your gut is, the wider array of food, and fiber, you can likely handle. The more you can handle, the more of your life you can live. If you’re looking for healthcare providers who understand the innermost workings of the gut, probiotics, and SIBO, I invite you to check out The HIVE Natural Health Center.
As always, Trust in Your Gut.
Disclaimer: The contents of this article are for educational purposes only, and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.
References
- Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017;51(4):300–311. doi:10.1097/MCG.0000000000000814
- García-Collinot G, Madrigal-Santillán EO, Martínez-Bencomo MA, et al. Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis. Dig Dis Sci. 2020;65(4):1134–1143. doi:10.1007/s10620–019–05830–0
- Khalighi AR, Khalighi MR, Behdani R, et al. Evaluating the efficacy of probiotic on treatment in patients with small intestinal bacterial overgrowth (SIBO) — a pilot study. Indian J Med Res. 2014;140(5):604–608.
- Shi J, Gao F, Zhang J. Effect of Combined Live Probiotics Alleviating the Gastrointestinal Symptoms of Functional Bowel Disorders. Gastroenterol Res Pract. 2020;2020:4181748. Published 2020 Sep 17. doi:10.1155/2020/4181748
- Wagner NRF, Ramos MRZ, de Oliveira Carlos L, et al. Effects of Probiotics Supplementation on Gastrointestinal Symptoms and SIBO after Roux-en-Y Gastric Bypass: a Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Obes Surg. 2021;31(1):143–150. doi:10.1007/s11695–020–04900-x
If it wasn’t for the functional medicine and natural health community, I wouldn’t have a passion. This space has provided me with so many fulfilling challenges, vast arrays of knowledge, and endless opportunities to do what I love. If it hadn’t been for the hard work of several doctors in this industry, Small Intestinal Bacterial Overgrowth (SIBO) would not be as recognized as it is today. Without that work, people with SIBO would go to their doctor complaining of bloating and abdominal pain, and would likely be told “You probably have IBS”, or, “It’s all in your head.”
However, there are some tidbits of information that are constantly being tossed around in the industry that I believe are misleading patients and practitioners alike. Many have to do with probiotics. I previously wrote about 5 Probiotic Myths, and there is one myth I intentionally left out because I wanted to devote an entire article to it. In my early years of learning functional medicine, I heard this statement at many seminars and talks: “For your SIBO patients, don’t give probiotics. There’s already an overgrowth of bugs, so we don’t want to give them more bugs.” Let’s address these erroneous claims and the implications for probiotics.
Out with The Old, In With The New
Take the next 20–30 seconds and think about what Small Intestinal Bacterial Overgrowth implies. Ah yes, you guessed correctly! Too many bacteria in the small intestine. Now think about this, many used to believe that probiotics could directly colonize the microbiome. Better said, whatever probiotics you took, they would automatically become “new residents” in your gut. Having that as your background, logically, you wouldn’t want to give more bugs to someone that has too many.
Yeah, that’s what we thought we knew, but here’s what we know now: 1) SIBO might actually be considered more of a dysbiosis than a nominal overgrowth (dysbiosis meaning too many bad bugs and/or not enough good bugs), 2) Probiotics don’t directly become new residents in the gut. In that sense, probiotics are a great tool to help support gut dysbiosis. They offer food (prebiotics) to the resident good bugs, give off antimicrobial peptides that fight off bad bugs, and support inflammation within the gut environment.
Support for SIBO
With how frequently it was drilled in seminars I attended that probiotics should be avoided, when I started doing my research on “Probiotics and SIBO” I wasn’t expecting to find many favorable outcomes. Wow, was I dead wrong! To start with, a systematic review and meta-analysis (highest standard of research) on probiotics for SIBO found that probiotics were effective in relieving abdominal pain and hydrogen breath test concentrations (1). The most efficacious way to measure SIBO is via hydrogen and methane breath testing. The lower the better. Abdominal pain is also a hallmark symptom of SIBO. Less symptoms plus better test results, seems compelling so far.
If you ever find yourself researching probiotics, whether in the store or on the internet, keep in mind that there are basically 3 categories of probiotics: 1) Lactobacillus / Bifidobacterium strains, 2) Saccharomyces Boulardii strains, and 3) Bacillus strains (click HERE to learn more about the naming of probiotics).
93% of people in the probiotic group had a negative hydrogen breath test by the end.
Category 2 probiotics may be just as effective as antibiotics in improving diarrhea, abdominal pain, gas and bloating in those with SIBO (2). Not to mention similar clearance of SIBO in both groups via hydrogen breath test. That’s huge! Probiotics can be just as effective as antibiotics, with less adverse events and side effects. Category 3 probiotics may reduce SIBO-related pain, gas, belching, and diarrhea (3). 93% of people in the probiotic group had a negative hydrogen breath test by the end. Again, we see improvements in both symptoms and lab testing results.
A combination of category 1 & category 3 probiotics reduced subjective measures of gut symptoms and reduced the number of positive SIBO breath tests (4). Here we see multiple categories being effective, which is my preferred method of recommendations, all 3 categories at one time.
Postoperative abdominal surgeries (gastric bypass, hysterectomy, appendectomy, bowel resection) are one factor that can contribute to and result in SIBO, so it would likely be a good idea to have tools on hand that could support the gut post-surgically. Probiotics may reduce bloating in those undergoing gastric bypass surgery, however there was no effect on the actual prevalence of SIBO via diagnostic testing (5). While the actual prevalence of SIBO wasn’t changed, the symptoms were. I’m not sure about you, but I’d rather feel better than just have a lab value change.
I believe my colleagues were coming from a good place by telling us to avoid the use of probiotics for SIBO. In my view, what I think happened was their patients were reacting to the PREbiotic fibers that are so often put in with PRObiotics.
The healthier your gut is, the wider array of food, and fiber, you can likely handle. The more you can handle, the more of your life you can live. If you’re looking for healthcare providers who understand the innermost workings of the gut, probiotics, and SIBO, I invite you to check out The HIVE Natural Health Center.
As always, Trust in Your Gut.
Disclaimer: The contents of this article are for educational purposes only, and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.
References
- Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017;51(4):300–311. doi:10.1097/MCG.0000000000000814
- García-Collinot G, Madrigal-Santillán EO, Martínez-Bencomo MA, et al. Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis. Dig Dis Sci. 2020;65(4):1134–1143. doi:10.1007/s10620–019–05830–0
- Khalighi AR, Khalighi MR, Behdani R, et al. Evaluating the efficacy of probiotic on treatment in patients with small intestinal bacterial overgrowth (SIBO) — a pilot study. Indian J Med Res. 2014;140(5):604–608.
- Shi J, Gao F, Zhang J. Effect of Combined Live Probiotics Alleviating the Gastrointestinal Symptoms of Functional Bowel Disorders. Gastroenterol Res Pract. 2020;2020:4181748. Published 2020 Sep 17. doi:10.1155/2020/4181748
- Wagner NRF, Ramos MRZ, de Oliveira Carlos L, et al. Effects of Probiotics Supplementation on Gastrointestinal Symptoms and SIBO after Roux-en-Y Gastric Bypass: a Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Obes Surg. 2021;31(1):143–150. doi:10.1007/s11695–020–04900-x
