The Best Probiotics For SIBO Treatment

I’m a very proud dietitian today as my wonderful research intern Kasia Wyrebek and writing intern Kathryn Durston combined to great effect to bring to life today’s article, which I’ve reviewed for scientific integrity and a few minor flow edits of course.

Today’s article takes a look at some of the probiotic strains that have been used in the management of SIBO with the primary goal to offer up some insight into the state of the research in this area.

I truly hope you enjoy it.

The Best Probiotics For SIBO Treatment

Written by Kathryn Durston with supporting research provided by Kasia Wyrebek

Small intestinal bacterial overgrowth or SIBO is a common gastrointestinal disorder that has come up frequently in our past research on topics such as skin disorders, like rosacea, and other GI disorders, including IBS & IBD.

SIBO is characterized by an increase or abnormality of bacteria in the small intestine and symptoms include diarrhea, bloating, abdominal pain, and malnutrition.

The treatment of SIBO can be tricky and often includes the use of broad spectrum antibiotics, but due to a high recurrence rate in patients treated only with antibiotics, a search for alternative treatment strategies is often warranted.

While researching diet & SIBO, I came across emerging and quite compelling evidence on the use of probiotics to treat intestinal overgrowth by restoring a healthy gut microbiome in patients.

And although the term probiotic is not new for many of us, with numerous different strains and supplements on the market, it can be overwhelming to know where to start.

That led to today’s article where I will dive into four distinct probiotic species that have some level of proven efficacy in the context of SIBO management.

So what are the best probiotics for SIBO?

Let’s find out.

Bifidobacterium – Various Species

Bifidobacterium is thought to be one of the first bacterium species to colonize our GI tract and is known for its numerous health-promoting qualities.

It is considered one of the most prominent probiotic strains for optimizing gut health and is frequently added as an active ingredient in many functional foods.

A 2016 randomized controlled trial out of the Turkish Journal of Gastroenterology gave bifidobacterium capsules to 126 patients with SIBO and colorectal cancer and found that 81% of patients tested negative on a routine SIBO breath test after four weeks of supplementation compared to only 26% testing negative in the placebo group.

There is also emerging evidence that a blend of multiple different probiotic strains may be beneficial for SIBO, such as this 2014 trial out of of the European Journal of Gastroenterology and Hepatology that saw a substantial decrease in SIBO symptoms and prevalence after administering a probiotic blend of six different strains, three of which were bifidobacterium species.

Species used were Bifidobacterium bifidum, Bifidobacterium lactis and Bifidobacterium longum.

Saccharomyces boulardii

Saccharomyces boulardii is a live probiotic yeast that has been used medicinally for decades as an anti-diarrheal and recently caught attention for its potential to treat gastrointestinal disorders.

Clinically S. boulardii has exhibited an ability to regulate intestinal microbial homeostasis, stabilize the GI barrier, and modulate the immune system by mimicking the protective effects of healthy gut flora.

It has even been shown to enhance nutrient absorption, which is crucial for patients with SIBO suffering from malnutrition and nutrient deficiencies, two possible symptoms associated with the condition.

A 2019 RCT out of the Journal of Digestive Diseases and Sciences gave SIBO patients S. boulardii capsules for four weeks and saw a significant decrease in diarrhea, abdominal pain, and gas/bloating, as well as a 33% eradication of SIBO with just S. boulardii supplementation alone (a 55% eradication was seen when treated with a combination of the probiotic with an antibiotic).

Bacillus coagulan 

Bacillus coagulan is a spore-forming probiotic bacteria known for its exceptional stability and efficacy in treating intestinal disorders, and it has even been recognized as a safe probiotic strain by the FDA.

It is thought to be one of the best probiotics for SIBO & a hot topic in the medical community due to its curative effects on gut health via inhibiting the growth of pathogenic bacteria, facilitating excretion & digestion through enzyme secretion, and normalizing immune function.

This 2014 pilot study out of the Indian Journal of Medical Research concluded that 30 patients with SIBO saw a significant decrease in SIBO symptoms such as diarrhea, gas and abdominal pain after three weeks of supplementing with the probiotic B. coagulans alongside an antibiotic regimen, as well as 93.3% testing negative for SIBO after treatment compared to 66% who only took the antibiotic.

Although more RCT’s need to be conducted on B. coagulan supplementation alone, the current literature is promising noting it’s therapeutic effect on GI disorders such as small intestinal overgrowth.

Lactobacilli – Various Species

Lactobacilli are lactic-acid forming bacteria that are notorious for playing a prominent role in food fermentation, as well as having a diverse clinical and experimental profile in disease treatment.

This species of probiotic has been recently studied for its ability to colonize the GI tract and restore microbiota-host symbiosis, an important element in treating gastrointestinal pathologies such as SIBO.

Multiple strains of lactobacillus display probiotic qualities beneficial for SIBO, for example this clinical trial concluded that supplementation with both Lactobacillus casei and Lactobacillus acidophilus was effective in treating bacterial overgrowth and related symptoms in patients who also suffer from IBS.

Additionally, a 2019 study out of the Journal of Probiotics and Antimicrobial Proteins found a promising reduction in both SIBO prevalence and symptoms after patients supplemented with a four-strain probiotic containing both L. acidophilus and Lactobacillus plantarum, as well as S. boulardii mentioned above.

Final Thoughts

The information I have presented to you today demonstrates some reasonable level of evidence that certain probiotic strains may be beneficial in the management of intestinal overgrowth, especially in patients with other gastrointestinal comorbidities.

Deciphering and implementing this evidence into your daily life is a step that can be made in conjunction with the support and guidance of your healthcare provider.

If you are looking to utilize the services of a registered dietitian to improve your digestive health, Andy is only an e-mail away.

A special thank you once again to both Kat and Kasia for their excellent work on today’s post.