Let me preface this by saying that taking probiotics for SIBO is not only a controversial issue, but is very complex. No two cases of SIBO are exactly the same. Considering that there are dozens of popular probiotic strains (not to mention the many probiotics which aren’t popularly marketed), it is no wonder that SIBO studies and users have mixed results with probiotics.
However, probiotics can be a very valuable part of SIBO treatment and some medical practitioners ever say they are a necessary part of SIBO treatment – so long as the right probiotics are chosen.
What Is SIBO?
Let’s start with a little review. Small Intestinal Bacterial Overgrowth (SIBO) is a condition in which you have too much and/or the wrong type of bacteria in your gut. The problem isn’t like an infection of strep throat where one “bad” bacteria has gotten into your throat. The problem is that the 100 trillion bacteria which live in your gut (yes, there really is that many bacteria in just your intestines!) have become imbalanced. This is known as gut flora dysbiosis.
As registered dietician Tamara Duker Freuman wrote about SIBO in US News and World Report:
“A common misconception is that SIBO involves overgrowth of ‘bad’ or ‘disease causing’ bacteria…In reality, there’s nothing inherently ‘bad’ about the bacteria in SIBO other than that they’re colonizing the wrong neighborhood; rather, SIBO is typically caused by good bacteria living in an inappropriate location.”
To see if you have SIBO, you will need to take a hydrogen/methane breath test.
UPDATE:
Good news! There are now SIBO breath tests that you can order directly without a doctor’s order! While I’m a HUGE fan of having a doctor’s guidance, I understand the need to know whether you have SIBO or not before you invest in a practitioner.
You can order the test directly and it will be sent to your home with instructions on how to take it and how to send it back and get your results!
What Are Probiotics?
As defined by The World Health Organization, probiotics are “live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host.”
The probiotic industry is expected to exceed $64 billion by 2023 thanks to all the trendy yogurts and supplements.1 I’ve even seen probiotic peanut butter being sold!
There are definitely proven benefits of taking probiotics – including for SIBO – but I mention the market size as a reminder to be wary. No probiotic is a magic bullet that will cure all of your problems!
Probiotics Could Be Triggering Your SIBO
Remember that SIBO isn’t caused by “bad” bacteria. Even “good” bacteria can cause SIBO if they grow out of control in your gut. Thus, taking probiotics could add fuel to the fire which is SIBO.
However, the problem with taking probiotics for SIBO usually isn’t that you’ve got too much of the bacteria strain in that particular probiotic. Rather, the issue is that most probiotics contain prebiotics.
Bacteria, like all living things, need to eat something. To help the probiotic repopulate in your gut, many probiotic manufacturers add prebiotics – which is basically just food for the probiotics to eat so they can reproduce.
The problem with prebiotics is that other bacteria will also feed off of them. If you’ve got SIBO, the last thing you want is to feed the bacteria in your gut! This would counter all of the work you’ve done by eating a gut-friendly diet (read this post about The Best Diet for SIBO).
In addition to prebiotics, some probiotics contain ingredients which trigger SIBO responses. On her website here, Functional Medicine Nutritionist Angela Pifer gives some examples of these ingredients which are found in popular probiotics:
- Jarro Dophilus: Contains maltodextrin, tapioca starch, dairy and soy
- Florastor: Contains lactose
- Align: Contains lactose
- Culturelle: Contains inulin
- Jarrow Ideal Bowel Support: Contains potato starch and soy
- Pears YB: Contains pectin
- Probio Pure’s: Contains tapioca starch
As Pifer says, taking any of these probiotics while you have SIBO would work against treatment. They’d just fuel the overgrowth of bacteria in the small intestines and make it harder to restore balance.
How (the Right) Probiotics Help SIBO
Just because some probiotics might trigger SIBO, it doesn’t mean that you should dismiss all probiotics immediately. Probiotics can be indispensable in helping you correct dysbiosis (unbalanced gut flora) after treatment – particularly treatment with antibiotics or herbal antibiotics for SIBO.3
There are three ways that probiotics could help fix dysbiosis and treat SIBO:
- Probiotics help modulate the gut’s immune system
- Probiotics produce anti-microbial compounds that help illuminate pathogens. These compounds are vital for keeping levels of “bad” bacteria under control and preventing and treating dysbiosis.
- Probiotics strengthen the gut mucosal barrier and prevent pathologic bacteria from clinging to the GI tract walls.
- Probiotics improve motility (read more about motility here).4
Scientific Studies on Probiotics for SIBO
It was only recently that doctors became aware of SIBO, so research is still in its infancy. Unfortunately, studies have had very mixed results.
Note that 84% of IBS cases are actually SIBO, and there have been numerous studies about using probiotics for IBS. However, as with the SIBO studies, these studies had very mixed results. Again, don’t let this dissuade you from probiotics completely. As one researcher who tried to do a meta-analysis of IBS researcher said, the studies were so diverse in terms of probiotic strains and concentration used, that it was impossible to determine efficacy.6
Here are a few studies which showed a positive result when using probiotics for SIBO:
- A pilot study compared probiotics to antibiotic treatment for SIBO. The group taking probiotics had an 82% improvement compared to 52% for the antibiotic group. Strains used were Lactobacillus casei, Lactobacillus plantarum, Streptococcus faecalis and Bifidobacterium brevis. Both groups also were on a diet that limited legumes, alcohol, leafy greens and dairy. (Source)
- A study had patients take a 6-week course of Lactobacillus casei. 64% of the patients had a negative breath test afterwards. (Source)
- A study gave SIBO patients two billion spores of Bacillus clausii 3x per day for 1 month. 47% of the patients had negative breath tests afterwards. (Source)
How to Take Probiotics for SIBO
There is no established medical consensus on probiotics for SIBO, and each case varies. However, SIBO experts do have some practical advice for how to take probiotics for treating SIBO.
- Avoid Probiotics with Prebiotics: Prebiotics can feed the bacteria in your intestines and worsen your SIBO.
- Avoid Probiotics with Additives: Likewise, these additives can feed bacteria in the gut. Avoid additives which aren’t advised while on the SIBO diet (such as lactose, starches, and soy).
- Start Small! Pifer has her patients start with a dose of less than a million flora. Most probiotics have billions of flora per capsule. You will need to open the capsule in order to take the partial dose. If you tolerate the probiotic, gradually increase to the full dosage.
- If you have reactions to the probiotic, stop taking it: Reactions are often in the first few hours after taking the probiotic.
- Find a probiotic which makes you feel better and stick with it: Everyone is different. What works for one person’s SIBO might not work for yours. So stick to the probiotics which do work for you.
- Use a supplement instead of fermented foods: Many people with SIBO react poorly to lacto-based probiotics which are found in fermented foods – especially if histamine intolerance is an issue.
- Time your probiotics right: At the beginning of treatment, some people do not tolerate any probiotics. That doesn’t mean you should avoid probiotics forever. Consider taking the probiotics after a course of antibiotics or herbal antibiotics to help restore gut flora.
- If you can’t tolerate any probiotics: Then focus on repairing your MMC and try reintroducing probiotics later.12,13
Best Probiotics for SIBO
I will remind you again that everyone’s SIBO is different. Probiotics which work for one person might not work for you. Start slow with low-dosages of the probiotics to see if they make you feel better or worse. If it works, stick with it. If it doesn’t, try another strain of probiotics. And, as always, check with your doctor. 15 , 16, 17, 18, 19
1. Saccharomyces boulardii
This is actually a type of yeast and not bacteria. It is the only yeast which is considered beneficial enough to be considered a probiotic. It helps fight off pathogenic strains of bacteria and reduces inflammation. Note that S. boulardii does not colonize the gut so it will need to be taken continuously and it is recommended to take it with a bacteria which will colonize the gut. Thanks to Dr. Alison Ramsden for letting me know about this brand of saccharomyces boulardii which doesn’t contain any prebiotics. You can buy it here.
2. Bifidobacterium infantis 35624
This probiotic is well-tested and shown to reduce abdominal pain, bloating, and bowel movement difficulty. Results suggest that it works by having an immune-modulating role. This specific strain is a bit difficult to find. However, Klaire Labs (a great company!) does make one probiotic with it and it has no prebiotics or other off-limit ingredients. It is called Lactoprime Plus and you can buy it here.
3. Bifidus lactis
This probiotic is shown to enhance the immune system, reduce occurrence of antibiotic-associated diarrhea, and support proper bowel movements. Kirkman makes a good probiotic with this strain. You can buy it here.
4. Lactobacillus plantarum
This probiotic is shown to reduce bloating, normalizes stool frequency, relieve abdominal pain, and improve IBS symptoms, prevent overproduction of yeast, and reduce bacterial translocation. This is also found in the same supplement which has s. boulardii. You can buy it here.
5. Bacillus Indicus (HU36TM)
Better known by its brand name MegaSporeBiotic, this is a soil-based probiotic which many SIBO and IBS sufferers have reported success with. Unfortunately, it is only available with a doctor’s prescription. Prescript-Assist is another soil-based probiotic which many people report success with and you don’t need a prescription for it. Note that it does contain prebiotics though, so you’ll need to see how you react to it or just go with one of the other prebiotics.
Disclaimer: None of these statements have been approved by the FDA. While some scientific evidence does exist that shows probiotics might help SIBO, there is no conclusive evidence. Talk to your doctor before taking any probiotics for SIBO.
If you are ready to be done with SIBO once and for all, download the eBook The SIBO Solution. You’ll find detailed information on SIBO causes, treatment protocols, diets for SIBO and even recipes for SIBO. Buy The SIBO Solution Here.
Have you tried probiotics for SIBO? I’d love to hear what worked/didn’t work for you!
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Is Visbiome a good choice. My gastroenterigist has recommended it.
Also, Ive been taking aloe vera juice in hopes of healing gut. Is this not good for SIBO?
Can you suggest a natural doctor that could help me on this journey of SIBO. Particularly choosing a probiotic and testing. Im from Brainerd MN.
Ginnie
How about Renew life 150 billion ?
What is the best combination of the probiotics you suggested? Or should one, experiment one at a time?
Megaspore made things so much worse for me. My SIBO C has turned to issues with very loose and partial evacuation…. So yay for both D and C issues at the same time. Been doing the SCD diet for months with no relief. Once I stopped the megaspore, things did feel better within days. But now I’m a few weeks with no probiotic and no longer improving. I gotta find the right balance soon.
Hi @TheTrophyWife…. has anyone helped you in the last few months since this post by suggesting Plexus probiotics? It’s the only one with an antifungal which sounds like what you need. If you know someone who represents Plexus Worldwide, get with them and ask about it. If not, I can help you. I struggled for 20 years and this is the only thing that’s come CLOSE to helping. It’s saved my life.
Hello sir,
can you recommend some probiotics in India
How do I get the book.
Is there a brand of probiotics you recommend?
Also any Drs in Texas , South Texas you can recommend?
Good morning, a very informative and intersting article. I live in South Africa. Would the ingredients in this probiotic be ok.?
Many thanks
After three years of numerous tests and self diagnosis I am now about to take the sibo breath test. Within the past three years I have seen an osteopath done visceral massage and colonics none of which eliminate the symptoms. Pretty sure I have methane sibo because of constipation and slow gut motility and numerous other symptoms (almost all) I am following a low fodmap diet but also find through reading different sites that the diets recommended vary. This leads me to the understanding that each gut is individual and a food diary is necessary to track results. I had blood test done for food intolerances which showed gluten dairy and egg yolk as main culprits. Went gluten/dairy free for a year but symptoms remained which lead me to sibo. Before starting sibo diet I tested positive for candida which I treated through diet and supplements for six months signs of candida gone as shown through colonics. I have an ongoing symptom of throat irritation as if I have a lump in my throat which I had scope done ultrasound on thyroid to show nothing. Again, leads me to sibo treatment and low fodmap diet. Will do my sibo breathe test this weekend and go from there. Needless to say this has been a very long journey with no help from family physician or gi specialist as they admit they know nothing of sibo. I have spent thousands of dollars and I’m not exaggerating on treatments supplements .Presently working with a naturopath hoping to get to the end of this. In all this I come to conclude the gut is complex. You are what you eat which is what my own grandma always said she was ahead of her time that was over one hundred years ago! Good luck everyone with your journey to eliminate Sibo. I am in canada with no found resources here.
Thank you for your blog very informative.
All the symptom you have I have. What came of the breath test? What supplements are you taking now?
@bonnie how did you cure candida?
please answer Kaitlyn Henry’s post since I am in the same boat
Bifidobacteria, without fail, GIVE me gut problems, they do not solve them. The highly touted B. Lactis, mentioned here and in numerous other sites, gave me, with ONE dose, complete stop of bowel movements for days.
This has occured with several other experiments with other bifido strains over the years.
There is such a thing as Bifido Overgrowth.
Is there a reason you don’t recommend all the other probiotics that were actully IN the study that helped stop SIBO? Doesn’t make any sense.
None of these tips separate between C and D versions of SIBO, thereby not helpful for those of us with the C version.
This is Josh over at SIBO Survivor. Another great post. I’m wondering if you have much experience seeing people have success with probiotics during or after treatment? I personally have to be careful with probiotics and have found that they can make my gut get out of whack but still think if you find the right one for your individual microbiome they can be helpful. Basically wondering if you have had any success with probiotics personally or if you have seen certain trends with people?
Sylvie, is there any way to have a quick consult with you??
Hi Rickelle, I don’t do consultations but if you’d like to email us for a doctor referral, I’m happy to point you in the right direction. support@hollywoodhomestead.com
Hi Sylvie! This is Amy Hollenkamp from the SIBO diaries! Just wanted to say hi and thank your for sharing my work on your blog! I had never visited your site before and you have some great articles on here. Keep up the good work my fellow SIBO sister!
Thank you Amy! So appreciate you stopping by. Thanks for your excellent work as well! Great to meet you 🙂
Hi Sylvie – thanks for this post. Not sure if you were aware that the NOW foods Saccharomyces Boulardii and the Ther-biotic complete both contain inulin (a prebiotic). Orthomolecular products sells Orthobiotic which has the plantarum strain and the Saccharomyces without any prebiotics.
You’re right Alison! Thanks for noting that.
How do you know which ones are best for who.. I had hydrogen dominant -did the elemental for 2 weeks and it’s been just over a week eating regular foods – have to wait for results from breath to see where I am at – but just wondering for my case (hydrogen – pains – bloating and alternating d and c mostly loose stools not really d) which one is best? When it comes to started them slowly – opening up a capsule too avoid too much at once – how do you do that? Won’t the powder be destroyed by stomach acid because it’s not in a capsule? Thank you!
Hmm, I’ve tried 2 very strong probiotics: Prescript Assist and also VSL 3. Neither made any difference for me even when I was taking two or three a day. I can’t see how Klaire labs could be any different. I saw a few people on Amazon saying it did nothing for them, which is what I’m afraid of. So tired of wasting money, but I really need to build my gut bacteria back up.
Megaspore initially was too strong for me, causing D after a few doses. But I had read this may be the case for more severe gi issues so I backed off and started with just 1/4 capsule. It took about a month to get up to a full capsule, then another month to get to two capsules. I’ve been on it over a year but I’m still fighting sibo and gi infections.
My Ubiome test came back with non existent lactobacillus and bifidus so I have started bifidus and have ordered a d-lactate free version of probiotic that is a blend of bifidus and a couple lactobacillus that do not flare up the histamine response. The brand is “custom probiotics.” I use the powder formula. There are no fillers or additives. I have also used prescription assist with success in years past. I have been following a gluten and cow dairy free diet for two years, and autoimmune Paleo diet. I had to give up goat milk, but goat cheese has been ok.
I have used Sacc. Boulardii in the past but after a while I did get sicker. Makes me wonder about the lactose….. But I think it became too much in my system as a strange yeast started showing up in my still testing and wouldn’t go away til I stopped the Sacc. Boulardii. (Geotrichum)
But I fell off the wagon at Christmas and tests have shown sibo is still here and bad critters are back. I suspect they were never really gone as I’m still intolerant/allergic to so many foods. So I’m starting another round of shorter term herbal program and some heavy doses of probiotics. It seems difficult to get rid of bad guys if there’s no good guys to fill in the spots. My Ubiome test showed very poor microbiome diversity. 65% of people tested had better diversity than me. You can imagine I’m pretty I’ll.
Past treatment with antibiotics and chemotherapy has causes chronic damage to my immune system. And in case you don’t know, a huge component of the immune system is in your gut.
Hope this helps someone….
Hi Lisa, yes, U sound really I’ll. I’m newly diagnosed with SIBO. Took terrible breath test and was positive. Ridiculous priced RX get from the north. Immune system is the key to recovery and healing. It is primary. Look for custom made immune system remedies from naturopath. I’m taking liquid gold, silver and iridium with oxygen infused water and it works. Glands under jaw not swollen after 8 months. Remedy started Oct 2018. Body will heal. I’m with y’all, don’t know what kind, but took xifaxam for 4 3/4 mos. Waiting to take breath test again. I feel terrible, feet on fire, in lava. Told eat what I want….whaat? I am covered by ins to go to UCSF in San Francisco which is plan B. This sh*t is horrible and someone knows how to fix this. I’m also getting acupuncture and think that may be the cure + strong immune system. Keep the ideas coming friends, we have a life to live!
This article does delineate between SIBO-D and SIBO-C. Does it matter? Are all these probiotics useful for SIBO-C? I would hate to make my digestive sluggishness worse. TIA
I was desperate since this SIBO and been hanging on since summer. I decided to take the antibiotic Rifaximin. Have been following the SIBO diet mostly 95%. Been on the antibiotic for a week now but am taking also probiotics and other stuff listed in your book. I’m hoping all of this will do the trick. I can’t afford to lose much more weight since I”m 102 now. So far not much improvement. I don’t know what else to do.
Sharon, are you working with a doctor? What is he/she advising?
Megaspore was bad for me as well. Garden of life probiotics work for me.
Thanks, I’m appreciative of all the info and have the Sibo solution. My gut is now cured of bugs but after so many antibiotics I ended up with leaky gut though I’m relatively healthy and don’t eat gluten or dairy. Have been in a simple diet of bone broth and steamed veg (low fodmap) but still not coming good. After reading this and further research discovered many of my naturopathic treatment have lots of pectin, aloe and other ingredients that feed bacteria- so will now stop suspect supplements and see how that goes. Thanks again.
Anytime, Nic. Would love to hear how it goes.
Thanks for this post. I’m at the tail end of SIBO treatment and am in the process of reintroducing probiotics. Sacromycin has been fine, the megaspore was not so fine. Excited to have some other options to try out. Previously, I was definitely that person who could not tolerate probiotics at all!
Anytime, Leslie!