Should You Take Probiotics After Small Intestinal Bacterial Overgrowth Diagnosis?

SIBO, a condition that occurs when microbiota from the large intestine infiltrates and colonizes the small intestine, might improve from taking probiotics to balance bacterial growth, but the benefits of treating small intestinal bacterial overgrowth with probiotics are very much in debate based on the available research.

Some scientific findings on the effects of probiotics on SIBO have had mixed results, and recommendations to use probiotics in the treatment of SIBO have been equally varied.

One study in Sweden in which 17 SIBO-afflicted patients were administered the probiotics strain, Lactobacillus fermentum KLD, produced no difference in results in the test group from the placebo-control group, according to the U.S. National Library of Medicine. Three of the patients did not complete the 14-week trial. However given the small sample size, it’s difficult to draw a meaningful conclusion regarding the use of probiotics to treat SIBO.

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While Lactobacillus is common species of probiotics, it’s possible that this specific strain was unable to produce positive effects.

In another clinical trial in Argentina, 22 SIBO patients were given two other Lactobacilli strains, L. casei and L. acidophillus in single, identical capsules, to study the occurrence of SIBO-related diarrhea when treated with probiotics.

The study found that the probiotics significantly reduced the occurrences of chronic diarrhea during the 21-day trial, which held for two weeks after withdrawal of the probiotics.

While the results were encouraging, the sample size of this group was only slightly larger than the earlier study.

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However, registered dietician Tamara Duker Freuman wrote for U.S. News and World Report that it was a mistake to treat SIBO with probiotics. “Taking a (bacterial) probiotic when you have SIBO — or frankly, even when you have a past history of SIBO — is therefore likely to be more hurtful than helpful,” she said.

“A common misconception is that SIBO involves overgrowth of 'bad' or 'disease causing' bacteria … there’s nothing inherently 'bad' about the bacteria in SIBO other than that they’re colonizing the wrong neighborhood. … So by pouring billions of extra colony-forming units of would-be 'neighbors' into a small bowel that’s proven itself so hospitable to overgrowing them, you’re literally replenishing the population you’re trying to eradicate,” Freuman wrote.

Given the limited amount of research on probiotics and SIBO, Freuman’s advice is worthwhile until strains of probiotics are found to reverse the effects of SIBO. In the event that such probiotics are never found, the consequences of worsening SIBO can be avoided.

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