Can You Take Probiotics for SIBO?

Probiotics for SIBO are controversial, so you may have come across differing advice when researching this. As SIBO is an overgrowth of bacteria in the small bowel, it might sound odd to take bacteria to help treat it.

However, some evidence suggests that trying a probiotic alone or alongside antibiotic treatment may be beneficial in treating SIBO.

The success of probiotics and the type of probiotic required will depend on the underlying cause of your SIBO. 

This post will discuss the research on probiotics for SIBO so far.

Probiotics for SIBO as a sole treatment 

One meta-analysis, which combines the results of multiple research studies, found that taking a probiotic significantly improved treatment of SIBO compared to not taking any probiotics (1). 

The research also showed that probiotics improved hydrogen breath test results and abdominal pain scores (1).  

Hydrogen is produced by bacteria when they break down glucose. Therefore, hydrogen is measured in breath tests and can be used to determine whether somebody has an overgrowth of bacteria in their small bowel.

Unfortunately, using probiotics in this research didn’t seem to prevent SIBO.

However, this is an overview of different research studies. Individual SIBO cases are very different, so  it isn’t easy to accurately combine the results of multiple studies to provide one conclusion and recommendation.  

Therefore, probiotics will only work for some people with SIBO. We also need to determine which specific probiotics were used in each study.

Probiotics used alongside antibiotic therapy for SIBO

Antibiotics are currently the only proven treatment for SIBO. We also know that probiotics may help improve antibiotic treatment outcomes, which may be the best way to use probiotics in SIBO.

One study gave one group of participants with SIBO antibiotic treatment, and the other group was assigned a probiotic containing Saccharomyces boulardii alongside the antibiotic (2). 

The results showed that 55% of participants that received the antibiotic and probiotic combination had negative breath tests, compared to just 25% of participants in the antibiotic-only group. 

Another study gave all of their participants with SIBO a three-week course of antibiotics. 

They were then split into two groups, where one group received a further 14 days of antibiotics alone, and the other group had 14 days of antibiotics alongside a probiotic containing Bacillus coagulans MTCC 5856 (3).

The results showed a negative breath test result in 93% of participants that had both the antibiotic and probiotic in those 14 days, compared to 67% in the group that had the antibiotic only.

Probiotics for SIBO with IBS

IBS and SIBO have overlapping gut symptoms, such as bloating. We know that the two are linked, as people with IBS have been found to have SIBO (4).

You can take specific probiotics if you have IBS symptoms, which is discussed in our post, “Probiotics for IBS”. 

One small study showed that gut symptoms were improved when taking a probiotic in those with SIBO and IBS than those with IBS alone (5).

The probiotic used in the study contained the following: 

• Saccharomyces boulardii
• Bifidobacterium lactis
• Lactobacillus acidophilus
• Lactobacillus plantarum (Lactolevure®) 

Therefore, if you have both IBS and SIBO, a probiotic may help target both conditions.

How might probiotics help SIBO?

SIBO has an underlying cause, such as other health conditions like irritable bowel syndrome and gastroparesis. 

When using probiotics for SIBO, the probiotics may target the underlying cause of the SIBO. This means probiotics work using different mechanisms depending on the health condition causing the SIBO.

The following mechanisms are how probiotics may work to target underlying causes of SIBO:

• Targeting improving gut motility, for example, in gastroparesis or delayed gut transit.
• Competing with the bacteria that have colonised the gut.
• Targeting the gut-immune and the gut-brain axis.

Which probiotics for SIBO could you try?

Until more rigorous research is conducted, the jury is still out on specific probiotics for SIBO. As early research suggests benefits for some people, you could try it if you want to. 

If you want to try a probiotic and have a diagnosed health condition where probiotics are a known benefit, then you should choose a probiotic that contains the proven strain for that condition.

You then may also get an added benefit from a SIBO perspective. 

It is important to remember that probiotics will not guarantee results, and they can be expensive.

Can you take probiotics for methane SIBO (IMO)?

If you have methane-dominant SIBO – this is called intestinal methanogen overgrowth. This is not a bacteria overgrowth but rather an overgrowth of methane-producing archaea. 

Methane-dominant SIBO is associated with slow gut transit and constipation. Therefore, to target the underlying cause of your IMO, you want to target constipation and speed up your gut transit time. 

We can do this in many ways through diet and lifestyle modifications. Read more about this in our post “What Is Constipation and How Can You Treat It”.

You could try a probiotic that improves constipation, such as Activia probiotic yoghurts.

Summary

Whether or not probiotics will help treat your SIBO and which probiotic you should use are likely determined by your individual underlying cause of SIBO.

We have some early evidence to show that probiotics alone and alongside antibiotics can help treat SIBO. But more studies are needed that have larger sample sizes.

In this post, we have mentioned some probiotics that contain strains used in the research so far that you could try if you want to.

It is recommended that you discuss antibiotics alongside probiotics with your Gastroenterologist.

If you have IMO rather than SIBO, it is best that you aim to improve constipation through diet and lifestyle modifications. Or, choose a probiotic shown to improve gut motility and constipation.

Article written by Bethany Willson, Specialist Gastroenterology and IBS Dietitian, reviewed by Kirsten Jackson, Consultant Dietitian BSc Hons, RD, PG Cert