Do Probiotics Cause SIBO?

A handful of studies looking at the effects of probiotics may be taken out of context. One study on Align probiotic (a Bifidobacterium infantis strain) showed that a few healthy people who took it for several weeks tested positive for methane on a SIBO lactulose breath test. No significant change in symptoms was noted, most likely indicating only that the probiotics had built up transiently in their digestive systems. The vast majority of evidence indicates that probiotics crowd out harmful bacteria without colonizing your gut. They are worth seriously considering to fight SIBO, fungal overgrowth, and leaky gut, and lessen many digestive symptoms.


Dr. Michael Ruscio, DC: Hey everyone, this is Dr. Ruscio. Let’s discuss if probiotics cause SIBO (small intestinal bacterial overgrowth). This is a very important question because if you have small intestinal bacterial overgrowth—a condition where there is excess bacteria in the small intestine—that has been correlated, or is one of the underlying causes of the symptoms of IBS. Gas, bloating, abdominal pain, constipation, and diarrhea all are some, but not the only, symptoms that small intestinal bacterial overgrowth can contribute to.

[Continue reading below]

Dr. R’s Fast Facts Summary

Do probiotics cause SIBO?

  • No

Study: Effect of Bifidobacterium infantis 35624 (Align) on the Lactulose Breath Test for Small Intestinal Bacterial Overgrowth

  • 19 people given Align probiotic, 3 had positive methane SIBO with no symptoms

Why did this happen?

  • Probiotics have a transient effect so while patients are taking the probiotic they will have a transient build-up of probiotics in the system which can result in a positive on a lactulose breath test

Probiotics are actually helpful!  

  • Fight SIBO
  • Fight fungal overgrowth
  • Reduce leaky gut
  • Reduce abdominal symptoms
  • Improve skin and mood (just to name a few)

When taking a Lactulose Breath Test:

  • Discontinue use of probiotics prior to the test as they may alter results

Looking for a good probiotic protocol?

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If you’re having those symptoms, you’re likely considering a probiotic as a treatment for those symptoms. So you’d really like to know, could a probiotic—something you’re trying to use to help you—actually make you worse?

The answer to this question is really no. Probiotics do not cause small intestinal bacterial overgrowth. The vast, vast majority of the evidence supports that statement. But every once in a while, there’s a reference or a study that is a little bit confusing and needs to be looked at and contextualized.

Understanding a SIBO Probiotics Study

I’ll put one study of such up here on the screen, entitled “Effect of Bifidobacterium infantis 35624 (Align) on the Lactulose Breath Test for Small Intestinal Bacterial Overgrowth Trusted SourcePubMedGo to source.” Some have cited this study as showing that probiotics cause SIBO, and this is really incorrect thinking. Allow me to explain why that is, and help you understand the findings.

SIBO

In this study, 19 people were given the Align probiotic. After a number of weeks on the probiotic, they were given a lactulose SIBO breath test. It was found that three of those 19 patients had a positive methane reading or a positive breath test for SIBO. But here’s the important context, the “why” underlying this. The part we need to understand here is none of these patients saw a significant increase in their symptoms. A lab finding changed, but symptoms did not change. Very important.

The other is to understand the physiology of probiotics, which are: the majority do not colonize you. While these people are taking probiotics, they’re transiently working their way through the system. Either they die off or come out the other end. There’s this transient effect that the probiotic has and then it’s gone. While people take the probiotic, they have this transient buildup of probiotics in their system. This can cause a positive on a lactulose breath test.

Does that mean anything bad? In truth, no. The vast majority of the evidence shows that probiotics can help to fight small intestinal bacterial overgrowth. Those bacteria crowd out the other bacteria, fight fungal overgrowth, reduce leaky gut. Most importantly, perhaps, they reduce a litany of abdominal symptoms like gas, bloating, constipation, diarrhea. And there’s even other evidence that probiotics can help with things like skin and mood, just to name a couple.

Even though we see a positive breath test finding in a small number of patients (three of 19), that is most likely underlaid by the fact that these probiotics are transiently in the system, causing the positive breath test. Ostensibly it is also improving much of what’s going on in that person’s intestine. It’s very important not to look at the study and misrepresent what the study is showing, which some people are doing. That’s really a travesty to a patient because probiotics can be a very effective and very helpful treatment. They’re not going to help everyone, but they’re certainly a great place to start.

Sponsored Resources

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Now if you go to kettleandfire.com/drruscio, they’re going to offer our audience 15% off and free shipping on orders of six cartons or more. So definitely check them out at kettleandfire.com/drruscio.

Do Probiotics Cause SIBO? - FMF LogoAlso to Functional Medicine Formulations, which is the line of probiotics that I’ve developed. I am super excited to be able to offer you the same probiotics that I’ve been working on and developing for years and years. I use these in the clinic and they are now available to you. In this line you will find my favorite three probiotics, in each of the three probiotic categories, which work synergistically together to help fight dysbiosis like SIBO candida yeast, H. Pylori, help to eradicate parasites, help to reduce leaky gut and repair the gut barrier, can improve gas, bloating, diarrhea, constipation and abdominal pain and may even improve mood, skin, sleep and thyroid function. You can learn more about these three probiotics at drruscio.com/probiotics.

Probiotics Recommendations for SIBO, IBS

So a good probiotic protocol can do volumes for your gut health, for the symptoms of IBS, for general digestive symptoms, and for small intestinal bacterial overgrowth. I recommend three probiotics, both in my clinic and in the book, that give you a quality formula from each one of the three major categories of probiotic; lactobacillus-bifidobacterium blends, a Saccharomyces boulardii, and soil-based probiotic. By using these three together, you really provide a good broad stimulus of probiotic to your gut. I’ve seen that to be very effective, and there’s a good amount of evidence to support all three of these different probiotic formulations.

Do Probiotics Cause SIBO? - fmf probioticsTo the question, does using a probiotic cause small intestinal bacterial overgrowth? No. Certainly, it’s something to try. A small number of people may have a negative reaction to a probiotic, and that’s okay. If so, just discontinue whatever probiotic you were using that caused that reaction. But for the majority of people, there is a benefit from probiotics. It’s certainly something to consider adding into your regimen if you have small intestinal bacterial overgrowth, IBS, or really any digestive condition… and perhaps any condition, because we’re finding the gut has such a far-reaching effect on many systems and parts of the body.

This is Dr. Ruscio, and hopefully, this helps you better understand the issue of probiotics and SIBO and get healthy and you get back to your life. Thanks.

What do you think? I would like to hear your thoughts or experience with this.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

52 thoughts on “Do Probiotics Cause SIBO?

  1. I wish I had been able to wait the 6 months to see you. Or it would have been wonderful to have seen this. I’m going to give the probiotics a chance to help me along. Thank you for this write up. Thank you for your book, which I have purchased.

  2. Hi Dr Ruscio,

    If a probioic is transient, how we do get a probiotic to colonise after antibiotics? Surely, the whole point of probiotics is to colonise and seed, as well as push the bad guys out?

    cheers

    rob

        1. Also, what is the best strategy to bring in friendly bacteria that have been destroyed by herbs or antibiotics that will actually remain in the gut? From what you are saying, it’s like once the bacteria are destroyed, there is no return?

  3. I wish I had been able to wait the 6 months to see you. Or it would have been wonderful to have seen this. I’m going to give the probiotics a chance to help me along. Thank you for this write up. Thank you for your book, which I have purchased.

  4. Hi Dr Ruscio,

    If a probioic is transient, how we do get a probiotic to colonise after antibiotics? Surely, the whole point of probiotics is to colonise and seed, as well as push the bad guys out?

    cheers

    rob

        1. Also, what is the best strategy to bring in friendly bacteria that have been destroyed by herbs or antibiotics that will actually remain in the gut? From what you are saying, it’s like once the bacteria are destroyed, there is no return?

          1. Hi Rob,

            I’d recommend following the protocol in Dr Ruscio’s book, “Healthy Gut, Healthy You”, since it’s an easy-to follow process to help restore balance to your microbiome. You can find it here: https://www.drruscio.com/getgutbook

  5. The three probiotics you recommend- what is the protocol for taking these? All three together at the same time of day? Or at different times or days? Thanks!

    1. Hi Autum,

      S. boulardii and lacto/bifido are fine to take together, preferably on an empty stomach. Soil-based can be taken with a meal. I’d recommend picking up a copy of Dr Ruscio’s book, “Healthy Gut, Healthy You” where he lays out an easy-to-follow plan for improving gut health that includes specific protocols (including probiotics). You can find it here: https://www.drruscio.com/getgutbook Hope this helps!

  6. The three probiotics you recommend- what is the protocol for taking these? All three together at the same time of day? Or at different times or days? Thanks!

    1. Hi Autum,

      S. boulardii and lacto/bifido are fine to take together, preferably on an empty stomach. Soil-based can be taken with a meal. I’d recommend picking up a copy of Dr Ruscio’s book, “Healthy Gut, Healthy You” where he lays out an easy-to-follow plan for improving gut health that includes specific protocols (including probiotics). You can find it here: https://www.drruscio.com/getgutbook Hope this helps!

  7. Hello. IRT seems like it may a be a good thing to try for my daughter. Can you explain what the ingredient immunoglobulin is and how it’s derived? (from cow blood, not from cow milk?) She has a dairy intolerance, as well as gluten, etc. How are the cows raised?
    Thank you

  8. Hello. IRT seems like it may a be a good thing to try for my daughter. Can you explain what the ingredient immunoglobulin is and how it’s derived? (from cow blood, not from cow milk?) She has a dairy intolerance, as well as gluten, etc. How are the cows raised?
    Thank you

    1. Hi Mark,

      Probiotics have antibacterial affects, so they can often cause uncomfortable die-off reactions in people with digestive issues (e.g. bacterial overgrowth).

    1. Hi Mark,

      Probiotics have antibacterial affects, so they can often cause uncomfortable die-off reactions in people with digestive issues (e.g. bacterial overgrowth).

  9. I have Celiac Disease and Collegenous Colitis. Does the doctor have experience with these problems? I have been on every diet out there and am now on the Plant Paradox for the past year. It helped for awhile but I am now in a flare which has lasted four months.

  10. I have Celiac Disease and Collegenous Colitis. Does the doctor have experience with these problems? I have been on every diet out there and am now on the Plant Paradox for the past year. It helped for awhile but I am now in a flare which has lasted four months.

  11. I have recently tried the Intestinal Repair Formula. Although it would be great for me to take for my gut issues (my functional doc is in favor) it contains too much mold. I am highly mold sensitive and often supplements or meds are grown on molds or yeasts. If the manufacturer does not clear these well enough then someone like me can’t take the very thing we need. I had a huge allergic reaction to the Formula twice. Wish I could find one prepared better for sensitive people.

    1. Hi Linda,

      I’m so sorry to hear about your reaction. Feel free to contact customer service for a refund. That being said, there’s no mold in the product. It’s not grown on mold or yeast and it’s analyzed for those two with none detected. The only reaction I’ve heard of people having to this product is that it can be slightly dehydrating, so it’s a good idea to increase water intake. Unfortunately, no one supplement will work for everyone. Thanks for your feedback and good luck!

  12. Hello,

    I made sauerkraut at home last month and ate around a little bow with its juice. That night i had nrurological burning pain on my legs and also burn in my rectum. I could not release gas out for few days maybe. Also constipation occured. Few days after spinach gave me allergy that i look like have hiatamine intoperance. Weight loss, skin eye dryness ,rosacea. I wonder if you saw someone with sibo due to fermented food? Really appreciate your comment.

    1. Hi there,

      If you have a problem with histamine, it’s possible that was the culprit, not the probiotics themselves. Sauerkraut is very high in histamine. Have you tried a low histamine diet? There’s some good info on this site about histamine intolerance:

      https://drruscio.com/reacting-to-fermented-foods-could-be-a-histamine-intolerance/

      https://drruscio.com/histamine-intolerance-mcas-with-dr-jill-carnahan/

      Hope this helps!

      1. Thanks a lot doctor , I am trying low histamine diet for few days. But my body pain at muscles, tendons is really unbearable. I am already a floxie due to fluoroquiolone antibiotics who has tendinitis and fibromiyalji. So this sauerkraut triggered my pains again. Do you suggest SIBO test also? I had a microbiome test and waiting results.

        1. Unfortunately we can’t give medical advice on this forum. I’d suggest working with your practitioner on this one. Good luck and I hope you feel better soon!

  13. I have recently tried the Intestinal Repair Formula. Although it would be great for me to take for my gut issues (my functional doc is in favor) it contains too much mold. I am highly mold sensitive and often supplements or meds are grown on molds or yeasts. If the manufacturer does not clear these well enough then someone like me can’t take the very thing we need. I had a huge allergic reaction to the Formula twice. Wish I could find one prepared better for sensitive people.

    1. Hi Linda,

      I’m so sorry to hear about your reaction. Feel free to contact customer service for a refund. That being said, there’s no mold in the product. It’s not grown on mold or yeast and it’s analyzed for those two with none detected. The only reaction I’ve heard of people having to this product is that it can be slightly dehydrating, so it’s a good idea to increase water intake. Unfortunately, no one supplement will work for everyone. Thanks for your feedback and good luck!

  14. Hello,

    I made sauerkraut at home last month and ate around a little bow with its juice. That night i had nrurological burning pain on my legs and also burn in my rectum. I could not release gas out for few days maybe. Also constipation occured. Few days after spinach gave me allergy that i look like have hiatamine intoperance. Weight loss, skin eye dryness ,rosacea. I wonder if you saw someone with sibo due to fermented food? Really appreciate your comment.

    1. Hi there,

      If you have a problem with histamine, it’s possible that was the culprit, not the probiotics themselves. Sauerkraut is very high in histamine. Have you tried a low histamine diet? There’s some good info on this site about histamine intolerance:

      https://drruscio.com/reacting-to-fermented-foods-could-be-a-histamine-intolerance/

      https://drruscio.com/histamine-intolerance-mcas-with-dr-jill-carnahan/

      Hope this helps!

      1. Thanks a lot doctor , I am trying low histamine diet for few days. But my body pain at muscles, tendons is really unbearable. I am already a floxie due to fluoroquiolone antibiotics who has tendinitis and fibromiyalji. So this sauerkraut triggered my pains again. Do you suggest SIBO test also? I had a microbiome test and waiting results.

        1. Unfortunately we can’t give medical advice on this forum. I’d suggest working with your practitioner on this one. Good luck and I hope you feel better soon!

  15. Thanks for the great information! Is there any evidence that indicates using probiotics when you have a motility disorder (Gastroparesis) causes SIBO? Should you adhere to the same dosing guidelines for the three probiotics as given above, or should the protocol be altered?

  16. Thanks for the great information! Is there any evidence that indicates using probiotics when you have a motility disorder (Gastroparesis) causes SIBO? Should you adhere to the same dosing guidelines for the three probiotics as given above, or should the protocol be altered?

  17. I believe you are saying that probiotics can cause positive SIBO breath tests. For how many days do you recommend stopping the probiotics before the SIBO breath test is taken? Could you point me to any studies about this so that I can show my practitioner?

    Thank you!

  18. I believe you are saying that probiotics can cause positive SIBO breath tests. For how many days do you recommend stopping the probiotics before the SIBO breath test is taken? Could you point me to any studies about this so that I can show my practitioner?

    Thank you!

  19. Hello Dr. Ruscio and Team,

    First, I like how you disect studies and walk us (the general public) through them. With the condition of the healthcare industry as a whole and BigPharma influencing doctors to prescribe certain meds, seeing doctors back up their claims with existing evidence is reassuring.

    I have read your book “Healthy Gut, Healthy You” and found it insightful. I was battling a bad case of SIBO and i liked the regimented protocols for probiotics, enzymes, and antimicrobial herbs it spelled out. With that said, I had a fairly bad experiece with the lacto-bifido probiotic blend. I started to get severe histamine reactions after I ate almost anything.. Eventually I went on a fast to really clear my body of all the bacteria I loaded up on and things returned to normal.

    With all of that said, before I started the probiotic regimen I was not aware about histamine procuding versus degrading strains of probiotics. I know the encompassing “may not be for everyone” and “talk to you doctor before starting anything new” may cover this, but I think a note or at least a warning about that specific reaction belongs in the book. As you say, and I believe from experience, the effects of probiotics seem to be transient. However, inititally it was worrying though having reactions to foods I have always been able to eat.

    I feel as if probiotics are advertised to be totally harmless, and while they may be in the long run, in the short run if you are taking the wrong strains you may have issues.

    Anyway, thank you for continued work in this area of study. It is interesting and very helpful!

    1. Hi Luke,

      Thanks so much for sharing your experience. With probiotics, we find that while a few histamine-sensitive people will react to them, many patients actually find that they improve their histamine tolerance. But again, thanks for bringing that up and I’ll definitely pass it along!

  20. Hello Dr. Ruscio and Team,

    First, I like how you disect studies and walk us (the general public) through them. With the condition of the healthcare industry as a whole and BigPharma influencing doctors to prescribe certain meds, seeing doctors back up their claims with existing evidence is reassuring.

    I have read your book “Healthy Gut, Healthy You” and found it insightful. I was battling a bad case of SIBO and i liked the regimented protocols for probiotics, enzymes, and antimicrobial herbs it spelled out. With that said, I had a fairly bad experiece with the lacto-bifido probiotic blend. I started to get severe histamine reactions after I ate almost anything.. Eventually I went on a fast to really clear my body of all the bacteria I loaded up on and things returned to normal.

    With all of that said, before I started the probiotic regimen I was not aware about histamine procuding versus degrading strains of probiotics. I know the encompassing “may not be for everyone” and “talk to you doctor before starting anything new” may cover this, but I think a note or at least a warning about that specific reaction belongs in the book. As you say, and I believe from experience, the effects of probiotics seem to be transient. However, inititally it was worrying though having reactions to foods I have always been able to eat.

    I feel as if probiotics are advertised to be totally harmless, and while they may be in the long run, in the short run if you are taking the wrong strains you may have issues.

    Anyway, thank you for continued work in this area of study. It is interesting and very helpful!

    1. Hi Luke,

      Thanks so much for sharing your experience. With probiotics, we find that while a few histamine-sensitive people will react to them, many patients actually find that they improve their histamine tolerance. But again, thanks for bringing that up and I’ll definitely pass it along!

    1. Hi Michael,

      Good question. It depends on the probiotic, but once you stop taking them, most probiotics will leave your system in a few days.

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