Probiotics and SIBO: Are They a Good Match?
Probiotics & SIBO
Probiotics can be a confusing topic, let alone if you are dealing with SIBO. Some practitioners do not recommend probiotics in SIBO patients at all while others believe they can be a helpful supplement in symptom management and maintenance. I am of the latter group, although I will say that the strain does matter.
What are probiotics?
Probiotics are living microorganisms, primarily bacteria and yeast, that provide health benefits when consumed in adequate amounts. They are often referred to as "good" or "friendly" bacteria because of their positive influence on our wellbeing. They can be helpful for many health conditions, and specific strains impact specific systems, including the immune system, mental health and of course, our digestive system. In this article, I will be mainly focusing on the effect of probiotics on gut health.
Probiotics are used for many different health conditions including:
Digestive disorders like IBS and IBD
Infections from pathogenic bacteria such as H. Pylori
With or post antibiotics
Digestive symptoms such as constipation, diarrhea, abdominal pain and bloating
Lactose intolerance
Immune deficiency
Anxiety and depression
Eczema and other skin issues
This is certainly not an exhaustive list but these are the main conditions that have been the most researched in respect to probiotics efficacy.
The Gut Microbiome
Within our gastrointestinal tract resides a vast and diverse community of microorganisms known as the gut microbiome. This complex ecosystem includes both beneficial and harmful bacteria, working together to maintain a delicate balance. Probiotics contribute to this balance by supporting the growth of beneficial bacteria and inhibiting the proliferation of harmful ones.
It is important to know that most probiotics do not colonize the intestinal tract, so unfortunately their benefit is only transient, meaning as long as you keep taking them. This is why food-based probiotics (kimchi, sauerkraut, miso, kefir, yogurt, etc.) are a convenient and more cost-effective way to get these good guys on a daily basis.
What Probiotics Can Do
Digestive Support: Probiotics aid in the digestion and absorption of nutrients by breaking down complex carbohydrates and promoting nutrient assimilation.
Immune Support: A significant portion of the immune system is located in the gut. Probiotics can help regulate the immune response and lower inflammation, enhancing the body's natural ability to fend off infections and diseases.
GI Symptom Relief: Probiotics are renowned for their role in alleviating various GI symptoms, including bloating, gas, constipation, and diarrhea. They contribute to a healthy gut environment, reducing the likelihood of digestive discomfort, and can enhance motility and regularity of bowel movements.
Balancing the Microbiome: By introducing beneficial bacteria, probiotics help boost the strength of the “good guys” already present in your gut microbiome. See them as cheerleaders, instead of colonizers. By doing so, they help maintain a diverse and balanced gut microbiome, preventing or working against dysbiosis. This equilibrium is crucial for optimal digestion and overall physical and mental health. In conditions where the balance of gut bacteria is disrupted, such as during and after a course of antibiotics, probiotics can help maintain or restore equilibrium.
What Probiotics Cannot Do
Instant Fix for All GI Issues: While probiotics can be highly effective, they are not a one-size-fits-all solution. Individuals respond differently and the benefits may take time to manifest.
Replace a Healthy Lifestyle: Probiotics complement a healthy lifestyle but cannot compensate for poor dietary choices, lack of exercise, inadequate sleep and other detrimental habits.
Cure All Ailments: Probiotics are not a panacea for every health issue. While they can offer substantial benefits for many aspects of health, their action is strain-specific meaning that all probiotics are not created equal. Quality matters and encapsulation methods do too. Make sure to look into manufacturing practices or consult with a health practitioner.
How Probiotics Can Assist in Managing SIBO
Understanding the role of probiotics in addressing Small Intestine Bacterial Overgrowth (SIBO) requires diving deep into the complexity of this digestive condition. SIBO, characterized by an excessive presence of bacteria in the small bowel, often leads to distressing symptoms such as gas, bloating, diarrhea, and constipation.
Given that SIBO is caused by an abundance of bacteria in the small intestine, where they shouldn’t be, the question is: How can probiotics potentially contribute to alleviating this condition?
There are a few reasons, and research is backing it up. Let’s have a look:
Antimicrobial Action: Certain probiotic strains, such as Lactobacillus Reuteri, have the capability to release antimicrobial compounds targeted against specific pathogens and bacterial species. This antimicrobial activity mimics that of natural antibiotics, potentially aiding in the reduction of SIBO. I recommend you look up the SIBO yogourt recipe.
Healing Leaky Gut: Some probiotic strains, such as Lactobacillus rhamnosus GG, have demonstrated effectiveness in promoting the healing of intestinal permeability, commonly known as leaky gut. As individuals with SIBO often experience leaky gut, probiotics may play a role in restoring the integrity of the compromised gut lining.
Improving Intestinal Transit: Probiotics have been shown to influence intestinal transit time. Given that individuals with SIBO often face challenges related to slow intestinal motility, selecting a probiotic strain that supports gut movement, such as Bifidobacterium lactis HN019, may contribute to the healing process.
Reducing Inflammation: Certain probiotic strains exhibit anti-inflammatory properties and can enhance the production of protective antibodies. Considering that SIBO is associated with heightened gut inflammation and compromised immune function, probiotics may assist in mitigating inflammation and boosting immune responses.
Essential Probiotic Qualities for Effectiveness
When considering probiotics for SIBO management, certain qualities are paramount to ensure efficacy:
General Rule: Most probiotics blends you can buy at your grocery story or on the shelves of the local pharmacy are usually not helpful for SIBO. To know for sure you have to look at the strains. Some of them also contain prebiotics like Inulin or FOS which can be aggravating for some patients.
Strain-Specificity: The supplement should target your specific needs, addressing your specific symptoms such as constipation, diarrhea, gas, or bloating. Fore more information on this, look into my article on Decoding Probiotics.
Viability: The product should contain sufficient live bacteria. Dosages generally start at a minimum of 5 Billion CFU, but this varies based on the strain. Start low and go slow.
Guaranteed Potency: Reputable supplement companies ensure the stated amount of bacteria until the expiration date. They also do third-party testing.
Proper Storage: While some products are shelf-stable, others require refrigeration. Following storage instructions is crucial for maintaining the potency of the probiotic.
Can Probiotics Aggravate or Trigger SIBO?
While probiotics offer potential benefits in managing and resolving SIBO, it's essential to acknowledge that not everyone will experience positive outcomes. For individuals with severe SIBO, characterized by significant issues with intestinal motility, caution is advised when considering probiotic supplementation. Also look into the excipients (other ingredients) as some might contain sugars such as maltodextrin and lactose, of which one might be intolerant.
In cases where intestinal motility is a primary concern, introducing additional bacteria into the small intestine may exacerbate symptoms. If the normal sweeping action of the small intestine is compromised, adding more bacteria could potentially worsen the problem. This is usually the case for constipation patients and those with Methane-dominant SIBO. For these patients, I recommend stopping probiotics temporarily or using only a specific strain that is known to aid in Methane reduction and motility.
In summary, it is trial-and-error when it comes to probiotics. I usually recommend to start with soil-based probiotics first as they seem to be better tolerated and as the capsules can be opened without interfering with the viability of the product. You can then start at a lower dose (let’s say a quarter or half a capsule) and see how/if you react. While probiotics may worsen SIBO for those with major motility issues, individuals without severe intestinal motility problems but facing inflammation and other digestive challenges may find probiotics beneficial for their healing journey.
It's crucial to consult with a health practitioner to determine the most appropriate approach based on your individual circumstances.