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Probiotics for SIBO

by Eilaf Meenai December 19, 2021

It’s hard to live with SIBO. And sometimes, it’s hard to diagnose and treat it too. That’s because it’s often confused with IBS, which leads to a delay in diagnosis. Plus, when you do begin treatment, it’s common to experience treatment failure, where you don’t respond to the first-line antibiotic the condition (rifaximin).

All of this might make you want to try alternative treatments for SIBO like probiotics and specialized diets. But do they work? Let’s find out.

Can probiotics treat SIBO?

There are mixed studies when it comes to treating SIBO with probiotics.

Some studies show that probiotics can worsen the condition. For example, this study looked at 30 patients with brain fog, which can sometimes occur in people with SIBO. All of the 30 patients were found to be taking probiotics and had SIBO. What’s more, when these patients stopped taking probiotics, their brain fog and abdominal symptoms both improved.

On the other hand, many studies show that probiotics are pretty effective for SIBO. For example, this review looking at 18 studies concluded that probiotics can get rid of the bacterial overgrowth, excessive gas production, and abdominal pain that’s associated with SIBO.

Let’s review some of the reasons why probiotics may or may not work for SIBO.

The reason why probiotics may or may not work for SIBO

SIBO stands for small intestinal bacterial overgrowth. Normally, your large intestine has a huge colony of bacteria living inside it while your small intestine is sterile, which means it’s relatively free of bacteria.

When the normal, good bacteria of your large intestine are allowed to grow in the wrong place — which is the small intestine — you get SIBO.

People against probiotic treatment argue that if SIBO occurs due to excessive bacterial growth in the small intestine, how can probiotics — which help bacteria grow — treat the condition?

On the other hand, supporters of probiotic supplements argue that your gut is a delicate ecosystem and bacterial overgrowth can occur if its balance is disturbed. By restoring this natural balance, probiotics can reduce the overgrowth of the wrong bacteria seen in SIBO.

And since we already have plenty of evidence to suggest that probiotics work for the condition, there’s nothing wrong with trying them out.

But remember, to truly treat SIBO and make sure it never comes back, you must treat the underlying cause behind it. SIBO always occurs secondary to some problem with your gut.

Factors that can promote bacterial overgrowth in the small intestine include:

  • Diverticulosis, which is when small outpouchings form in the gut. Bacteria can grow inside these.
  • Abdominal surgery, where a blind loop of the small intestine is created and bypassed. Bacteria can grow inside this loop.
  • Reduced motility due to conditions like IBS, diabetes mellitus, and scleroderma. If the small intestine can’t contract and flush its contents down the digestive tract, it can be inhabited by bacteria.
  • Inflammatory bowel disease, which has two subtypes — Crohn’s disease and ulcerative colitis.

Your SIBO is most likely due to one of these underlying conditions and to treat it effectively, your doctor must treat the underlying condition first.

Note: there are many more conditions that can lead to SIBO — the above list is not exhaustive.

What’s the best way to treat SIBO?

Although probiotics are effective for SIBO, the first-line treatment for the condition is antibiotics. Rifaximin is usually the drug-of-choice but sometimes, you might not respond to it. This is a common reason why many people resort to specialized diets and probiotics to try to treat their SIBO.

One reason why people don’t respond to rifaximin is that they have something called archaea overgrowing in their small intestine instead of bacteria. This tends to be more common if your SIBO is due to IBS. Archaea are methane-producing organisms that need to be treated with a combination of different antibiotics (instead of rifaximin alone).

Having an overlapping condition – like lactose intolerance – is another reason why people might not respond to rifaximin alone.

And again, while antibiotics will treat your current SIBO symptoms, there’s a high chance bacteria will re-grow in the small intestine if the underlying cause behind your SIBO is not addressed.

Does diet have a role in the treatment of SIBO?

Unfortunately, no studies have demonstrated that dietary modification can cure SIBO. The idea that you can somehow starve bacteria in the gut by reducing food intake is incorrect. Even if you were able to do this, you’d reduce colonic bacteria too (and not just small intestine bacteria), which would disrupt your gut microbiota and lead to even more problems.

Currently, doctors use dietary modifications for only symptom control in SIBO — it’s not used as a permanent, stand-alone treatment.

The most popular diet for SIBO is the low-FODMAP diet, which is especially good for those patients who also have IBS.

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are sugar molecules that are difficult to digest. And if the body can’t digest these sugars, bacteria will feed on them to release gas, which causes uncomfortable digestive symptoms.

So by restricting FODMAPs in your diet while you wait for antibiotics to kick in, you can reduce the severity of your SIBO symptoms. FODMAPs are found in a wide range of foods, and it’s best to talk to a healthcare provider and figure out how you can follow a low-FODMAP diet without becoming deficient in important nutrients.

You can also try out FODMAP digestive enzymes, which break down any FODMAPs in your diet and keep bacteria from feeding on them and releasing gas.

Elemental diets are also an option for symptom control, where you consume formulas with pre-digested nutrients. But they can be too expensive and taste bad, making it very difficult to stick to them.

Whichever diet you decide to follow, keep in mind that it’s a temporary treatment for symptom control only. Sticking to specialized diets once your SIBO is over is not recommended.

The bottom line

We have mixed studies when it comes to treating SIBO with probiotics. It’s best to talk to an experienced healthcare provider and follow their recommendations regarding probiotics. Yeast-based strains are a good idea because they won’t worsen your condition (if they don’t make it better).

Remember, the permanent cure for SIBO is antibiotics and treatment of any underlying conditions that led to it.

References:

Medically reviewed by Onikepe Adegbola, MD PhD

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