Can Probiotics Help With SIBO?

SIBO, or small intestinal bacterial overgrowth, profoundly influences the body's physiological functioning due to the intimate connection between gut health and overall well-being. This important connection has prompted extensive scientific research focused on understanding how to both prevent and diagnose SIBO. Probiotics are the most famous treatment protocol for SIBO — read on to learn why.

Probiotics and SIBO

Any unfavorable alteration in the gut's microbial balance can potentially lead to the onset of various diseases. Therefore, treatments to rebuild a healthy bacteria environment in the bowel are very popular for people with any kind of digestive system problems, including SIBO.

A viable solution exists for addressing gut-related ailments, which is probiotics. They are living organisms that are beneficial to human body health through participating in the microbiota, which is all the living organisms inside of us. With the gradual augmentation of beneficial bacteria through the consistent use of probiotics, the goal is to counteract the proliferation of harmful bacteria. This approach can potentially manage conditions such as SIBO, irritable bowel diseases, bloating, and other digestive concerns.

Numerous studies have illuminated the potential of probiotics in enhancing gut health. However, a pertinent question arises: Can probiotics tackle the intricate challenges posed by SIBO? Let's delve deeper into whether probiotic treatments can offer an effective treatment.

What is SIBO and how is it diagnosed?

SIBO refers to the increased level of bacteria, mainly harmful bacteria, in the digestive system and has been associated with various health situations, including conditions like non-alcoholic fatty liver disease, unexplained diarrhea, and irritable bowel syndrome.

There are two methods commonly used for diagnosing SIBO. One is taking cultures from the duodenum using an endoscope, and the other, more commonly, involves using hydrogen breath tests (HBTs) with substances like lactulose or glucose. While HBTs are easier for patients and simpler to conduct, they have been criticized for the variation in their sensitivity and specificity and their inability to identify bacterial overgrowth in the further parts of the small intestine.

SIBO treatment

In managing the patient with SIBO, attention should first be directed towards detecting and eliminating, where feasible, any underlying cause.

Bacterial overgrowth not only disrupts intestinal health but can also bring forth various health issues. For instance, SIBO can impair the absorption of many vitamins and minerals. Primarily, the absorption of dietary B12 is facilitated by intestinal bacteria, and these bacteria can also produce a portion of it. In SIBO, conditions like macrocytic anemia, forgetfulness, fatigue, and confusion can arise due to B12 deficiency.

Furthermore, the metabolites produced by the increased bacteria can damage the intestinal wall, leading to a loss of the protective function of the intestinal barrier, a condition known as leaky gut. This situation might lead to immune issues triggered by the passage of substances that shouldn't cross from the intestine into the body, potentially resulting in allergies and immune problems.

The compromised immune response due to disruptions in the gut flora can contribute to other infectious diseases and chronic conditions characterized by low-level inflammation.

How can probiotics help?

Before we proceed, it's important to clarify the concepts of probiotic, prebiotic, symbiotic, and postbiotic.

• Probiotics. Encompass live microorganisms that confer health advantages upon the host when consumed in sufficient quantities. These microorganisms are beneficial bacteria that support digestive health and overall well-being. Fermented foods like yogurt, kefir, sauerkraut, and kimchi are rich sources of probiotics. Alternatively, they can be taken in the form of supplements.
• Prebiotics. Non-digestible components within foods, often present in the guise of dietary fibers. Their role involves stimulating the growth and activity of beneficial microorganisms, specifically probiotics, within the digestive tract.
• Symbiotics. Specialized products that amalgamate prebiotics and probiotics. Essentially, they comprise probiotics and their essential nutrients, prebiotics, required for optimal growth and function.
• Postbiotics. Biologically active compounds are generated due to the metabolic processes of probiotics during fermentation. Unlike live probiotics, postbiotics are inactive components originating from the activities of these microorganisms. Examples of postbiotics are short-chain fatty acids, enzymes, peptides, and other metabolites. These substances can yield positive impacts on the health of the host.

In the context of SIBO, we can contemplate how probiotics directly impact human health, aided by prebiotics or symbiotics that sustain these microorganisms. Notably, postbiotics are pivotal in clarifying how probiotics orchestrate favorable effects on the body.

What does the literature say?

The treatment protocol for SIBO commonly includes probiotic supplements following an antibiotic treatment. Generally, broad-spectrum antibiotics are used to decrease bacterial overgrowth, but antibiotics kill any bacteria group. To rebuild a healthy microbiome again, physicians use probiotics or symbiotics after antibiotic treatment is complete.

Although scientific evidence is still limited, there are promising results that encourage health professionals to use probiotic or symbiotic treatment combined with antibiotics or alone in case of mild conditions. One study showed that Bacillus clausii probiotic treatment helped normalize the hydrogen breath test results, and these effects were comparable to antibiotics. In another study, both Lactobacillus casei and Lactobacillus acidophilus strains showed effective results in chronic diarrhea related to SIBO.

Additionally, one study showed probiotic efficacy combined with antibiotic treatment. Patients were divided into two groups: one group received probiotics following antibiotic treatment, and the other one received only antibiotics. After six months of the treatment protocol, the probiotic group showed important reductions in pain, bloating, belching, and diarrhea compared to patients receiving only antibiotics.

The last word

Probiotics are a powerful tool to rebuild a healthy microbiome, especially after antibiotic treatment in SIBO patients. However, they are still not enough. It is important to support probiotic treatment with a healthy SIBO diet to prevent harmful bacteria growth. Processed, high-sugar, high-fat foods are the most dangerous foods for microbiota. Elimination diets can help to reduce SIBO symptoms, but before starting any kind of treatment, supplementation, or dietary changes, ensure you talk to your doctor and registered dietitian first.