The Role of Probiotics in Managing SIBO: Helpful or Contraindicated?
Small Intestinal Bacterial Overgrowth (SIBO) is a condition characterized by an excessive growth of bacteria in the small intestine, a part of the digestive tract that is relatively sterile, compared to the rest of the microbiome.
When there are too many bacteria in the small intestine, it can lead to symptoms such as bloating, abdominal pain, diarrhoea, and malabsorption – particularly in response to carbohydrates.
The management of SIBO often involves antibiotics, dietary changes, and increasingly, probiotics. The diagnosis of SIBO typically involves a breath test which measures exhaled methane and hydrogen levels.
However, the use of probiotics in SIBO treatment is a topic of debate, with studies showing both positive outcomes and potential contraindications.
Symptoms of Small Intestinal Bacterial Overgrowth (SIBO)
- Bloating: especially after meals rich in carbohydrates.
- Abdominal Pain and Discomfort: which can range from mild discomfort to severe pain.
- Diarrhoea: as the presence of excess bacteria can lead to carbohydrate malabsorption, resulting in loose, watery stools.
- Constipation: constipation is often linked to methane-producing bacteria in the small intestine
- Flatulence and Excessive Gas: many SIBO sufferers complain of having a stomach that ‘pops out’ and gets larger throughout the day
- Unintentional Weight Loss: as displaced bacteria consume nutrients that would otherwise be absorbed by the body
- Fatigue and poor concentration: as bacteria interfere with the absorption of essential nutrients
- Nausea: from the build-up of air in the abdomen and stomach
- An Uncomfortable Feeling of Fullness After Eating
- Foul-Smelling, Greasy, Oily stools
- SIBO can also cause non-digestive symptoms such as fatigue, poor concentration, and neuropathy (tingling sensations) due to vitamin deficiencies. These symptoms highlight the systemic impact of the condition.
Understanding Probiotics
Probiotics are living microorganisms that, when administered in adequate amounts, confer health benefits to the host.
Probiotics improve gut health by modulating the gut microbiota, and in doing so, provide systemic benefits such as enhancing the immune system, and producing antimicrobial compounds. These properties make them a potential therapeutic option for gastrointestinal disorders, including SIBO.
Probiotics in SIBO Treatment: The Evidence
Research indicates that probiotics can be effective in treating SIBO, with some studies suggesting they may be more beneficial than antibiotics in certain cases (1) (2) .
Probiotics have been shown to improve symptoms and lab values in SIBO patients, potentially offering a safer alternative to antibiotics, which can disrupt the gut microbiota and lead to resistance.
A meta-analysis found that probiotics significantly increased the SIBO decontamination rate compared to non-probiotic treatments, although they were not effective in preventing SIBO (3).
Additionally, probiotics have been found to improve breath test results and symptom relief in SIBO patients, supporting their role in managing this condition.
So why the major fear around the use of probiotics in SIBO?
The Debate: Are Probiotics Always Beneficial?
Despite the promising evidence, the use of probiotics in SIBO treatment is not without controversy.
Some studies have reported that certain probiotic strains may exacerbate symptoms in certain individuals, leading to increased methane production and post-meal fullness.
The variability in individual responses to probiotics suggests that they may not be suitable for everyone, and their efficacy can depend on factors such as the specific strains used, the source of bacteria, and the timing of administration.
Moreover, the complexity of the gut microbiota and the unique microbiome of each individual make it challenging to predict the outcomes of probiotic therapy.
Probiotics: A Complementary Approach
Given the mixed evidence, probiotics should be considered as part of a comprehensive SIBO treatment plan rather than a standalone solution.
Combining probiotics with other treatments, such as dietary modifications, herbal antimicrobials, and digestive enzymes support, is a better route to enhancing their effectiveness and lead to long-term success in managing SIBO.
Multispecies probiotics, which contain a variety of beneficial bacteria, have been found to work synergistically to improve gut health and may be more effective than single-strain probiotics.
Conclusion: Navigating the Probiotic Landscape
The role of probiotics in SIBO management is useful but should be used in a wider strategy rather than a standalone – and they should always be combined with stomach acid support, digestive enzymes and antimicrobials.
To date, Sporebiotics have demonstrated that they are safe and effective, and there is currently no evidence that they should not be used for any particular gut problem, including SIBO.
By integrating probiotics into a broader treatment strategy and considering individual responses, patients can work towards achieving better gut health and alleviating the symptoms of SIBO.