Should Probiotics be Part of SIBO Treatment?
If you are looking at SIBO, like I am – that SIBO is a symptom of an extreme imbalance in the gut and not a primary condition, or infection, then probiotics must be part of your SIBO treatment therapy. Otherwise there is no way that you will be able to get your gut back into balance. Probiotic therapy must be a pillar of SIBO treatment. But, what should you take?
Which probiotics, when to include these during the treatment phase and how much to use, are all questions that should be asked as it pertains to your exact case. I do not use the same probiotics with each of my SIBO patients. But, at some point during the therapy, I do include probiotics as part of every patient’s SIBO treatment protocol.
I spoke at length about why probiotics should be included in a previous video; you can watch the video here: https://siboguru.com/sibo-why-probiotics-are-a-necessary-part-of-treatment/
Some doctors are recommending probiotics to their patients, but often times, they are recommending the wrong ones. Direct to consumer probiotics market directly to doctor’s offices. Yes, some do have studies showing that they can benefit the gut. But, we cannot infer that if these benefit the average gut, or if they benefit a person with an inflammatory bowel disease, that they will benefit a person who has SIBO.
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Whenever I work with a new patient, I have them line up their supplements and take a picture of what they have tried and what their experience was with the supplement. This is where these pictures came from. One patient had tried each of these products.
There are ingredients in these products that WILL trigger a SIBO response:
Jarro Dophilus – maltodextrin, tapioca starch, contains dairy (milk) and soy (if an issue)
Florastor – has 33 mg of lactose!!!
Align – has lactose (milk) and sucrose (latter isn’t an issue for most SIBO, but good to know)
Culturelle – has inulin
Jarrow Ideal Bowel Support – has potato starch and soy (if an issue)
Pears YB – has pectin
Probio Pure’s – has tapioca starch
Prescript -Assist – has prebiotics (this may work well for some – having prebiotics doesn’t cross this product off the list, yet, this should be disclosed from the start when trying to find a probiotic that will work well when SIBO is present).
VSL3 – has maltose (this is glucose, and SIBO patients do not usually react to this). Each 2 capsule serving has 225 billion lactic acid producing flora, the sachets have 450 billion, and this will trigger a reaction in the small intestine – this is too high a dose – when it comes to probiotics, more is not better. VSL3 has some studies showing that it is beneficial in study subjects with various inflammatory bowel conditions. For those patients, with an inflammatory bowel disease (in their colon) treatment would include 150-225 billion flora. You would need to target the large intestine with this dose.
Introducing any of these direct to consumer probiotic lines will work again SIBO treatment. Aside from VSL3, there are ingredients in each of these that should not be introduced until flora balance has been restored. These ingredients will continue to fuel the overgrowth of organisms in the small intestine and make it harder to knock out long term.
For patients with SIBO, I often start with less than 1 million dose of flora, taking targeted probiotic strains at 1/4 of a million dose. My patients are instructed to open the capsule and take a partial dose as we begin the introduction of probiotics into their SIBO treatment regimen.
Angela Pifer | Functional Medicine Nutritionist
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