EP.140/ Three Safe Probiotics for the Endo Belly, Endo Related IBS and SIBO
Today’s episode is all about probiotics which are suitable for SIBO and endo related IBS.
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Now of course, this is a huge topic and there are so many different probiotics out there, which can often just get confusing and overwhelming, so with this podcast my intention is for it to be succinct and easy to digest, with a smaller array of probiotics to start exploring on your initial steps to gut healing.
Unfortunately, I think over the years probiotics have been a little misunderstood, and of course, we’re still learning so much about the gut microbiome (which is the good gut bugs found in our large intestine) that this area of research is still developing.
But regardless, what often happens is that we’re led to believe that we should just take a broad-spectrum probiotic, meaning it has lots of different strains in it – and that we should take this if we have gut health issues, and that will sort the problem out.
Unfortunately, that’s really not always the case and for our community, I would exercise caution when choosing probiotics.
We know that many people with endo have IBS related symptoms, and we now know that the majority of IBS is actually caused by SIBO – which stands for small intestine bacterial overgrowth, a condition where normal gut bacteria grow in the small intestine, rather than the large intestine. The small intestine is designed for the majority of our nutrient absorption, it wasn’t intended to house lots of bacteria, so this overgrowth damages the small intestine and our ability to absorb nutrients, but this bacteria also ferments our food, making gases that are harmful for us and cause symptoms like bloating, constipation, diarrhea and abdominal pain.
And we also now have recent research showing that up to 80% of endo patients have SIBO, so quite possibly, your IBS symptoms are largely down to SIBO. If you’d like to understand why SIBO occurs so frequently in the endo population, I’ve linked to some of my podcasts and articles on the subject in the show notes.
Unfortunately, when you have SIBO, taking probiotics can often make the situation worse, especially if you also have histamine intolerance, which I’ve talked about multiple times on the show already, and I’ve linked to a couple of episodes about this in the show notes, if you’d like to learn more. But if you think about it, if we’re adding bacteria to a small intestine full of bacteria already, we’re just going to be adding more fuel to the fire.
So, when it comes to trying probiotics for SIBO, we have to proceed with caution. Some people with SIBO just can’t tolerate probiotics at all at first, so their symptoms tend to get worse, but often, they’ve tried a couple of probiotics with lots of strains, and that could be the problem.
Instead, when it comes to SIBO clients or clients with very sensitive stomachs, we start with specific strains, so a probiotic with literally only one type of bacteria, and then we can build up over time. That way, if a person reacts badly to that probiotic, we know straight away that that particular strain is not well tolerated at this stage in time.
So today, what I wanted to do was to offer you three probiotic options, which have been researched for specific IBS symptoms that are often reported by endo patients, and are in most cases, safe for SIBO and are also safe for histamine intolerance, which is very common with endo.
If you do have SIBO, I want to state it’s best to proceed with extra caution, as everyone’s tolerance is different and without knowing exactly what types of bacteria are overgrowing in your small intestine specifically, we can’t guarantee that we won’t be adding to the load.
As always, what works for one person won’t necessarily work for another, so it’s very important that you tailor to your needs and approach this with an open mind – if these guys don’t work for you, it doesn’t mean all the other strains won’t either. I’ve only listed three to keep this simple, but there are a couple of others that are safe for SIBO and histamine, not many, but a few, so do some extra research if you find these aren’t the right ones for you.
I also want to be clear that probiotics aren’t a quick fix. If there’s an imbalance in the microbiome, SIBO, a parasite, an infection, an allergy, or intolerance, we need to address those because otherwise we’re just sort of pouring water into a bucket with a hole in the bottom, so whilst probiotics are part of the healing picture, they’re supportive and won’t necessarily fix or treat the root cause if it’s as extensive as a parasite or SIBO.
And finally, please let your GP know when starting with any new supplement regime.
1. Number one is lactobacillus plantarum 299v. Lactobacillus plantarum 299v is great for bloating and general IBS symptoms, so loose stools, pain, cramping, diarrhea, constipation, etc.
In one large study of 214 patients, 78.1% who took l.plantarum 299v rated their symptom improvement as good or excellent, in comparison with just 8.1% of those who took a placebo. The study showed that l.plantarum was particularly effective for bloating and abdominal pain.
Additionally, two meta-analyses (which are large reviews of all the studies) have proved the effectiveness of lactobacillus strains on IBS symptoms, including diarrhea and loose stools, but generally, they’ve been shown in multiple studies to be effective for all IBS symptoms.
If you’re concerned about the reaction of l.plantarum 299v on SIBO, l.plantarum was also included in a multi-strain probiotic used to treat SIBO, which was found to be more effective than one of the commonly used SIBO antibiotics, metronidazole.
In my training with world leading SIBO doctors, Dr Allison Siebecker and Dr. Jacobi, they both recommend l.plantarum 299v for symptomatic relief, but of course, naturally say to proceed with caution as they can’t guarantee a patient won’t react.
I also just want to be clear here that if you want to try and treat SIBO with probiotics alone, it’s not yet an industry standard, more research needs to be done and you would need to work with a practitioner who could provide you with the exact strains and take you through the treatment. But as it stands right now, antimicrobials, the elemental diet and antibiotics are the gold standard of SIBO treatment and I don’t know many practitioners who are attempting to use probiotics alone for SIBO.
So if you’d like to try l.plantarum 299v, start low and increase gradually over time – don’t rush to full dose, maybe stagger it over a few weeks. In my training with Dr Nirala Jacobi, she recommends taking l.plantarum 299v at a dose of one capsule, twice a day for SIBO related IBS symptoms. I’ve linked to a few brands in the show notes, and of course, if you don’t have SIBO, you can just follow the label dose.
Now, some probiotics actually increase histamines in the gut, but l.plantarum 299v should be safe as it’s been found to be histamine neutral, so it doesn’t raise histamines and actually, some strains of l.plantarum actually reduce histamines. I couldn’t find any research on l.plantarum 299v reducing histamine specifically, but it lowers inflammation, supports gut health as we’ve discussed and at the very least, doesn’t add to the histamine load.
2. Number 2 is saccromyces boullardi. This is actually a yeast, rather than a bacteria, but it’s not a “bad” yeast – it’s not going to cause candida to overgrow. In fact, it actually helps to reduce candida and keep it at healthy levels.
But it’s also wonderful for aiding with leaky gut healing, and as you guys probably know by now, leaky gut is super common with SIBO, is a strong risk factor for developing autoimmune diseases, causes chronic inflammation and is normally a root cause of histamine intolerance. I’ve linked to a couple of episodes on leaky gut in the show notes.
In my training with Dr Siebecker, she also recommends saccromyces boullardi for abdominal pain and diarhhea, and it’s been found in multiple studies to be effective for various types of diarhhea.
It also improves immune function, by increasing the production of one of our essential antibodies, called immunoglobulin A . IgA lines the intestines and other surfaces in the body like the nostrils, and is often low in patients with SIBO, and when it’s low, we’re more vulnerable to bad bacteria, parasites, viruses, etc. because IgA is normally one of our first line of defence against these baddies.
It also binds lipopolysaccharides (LPS), which are toxins released from pathogenic (bad) bacteria, gram-negative bacteria and often, the bacteria found in SIBO. LPS has been found in the pelvic cavity of people with endo and has been shown to contribute to the growth of endometriosis. IgA binds LPS and helps to eliminate it from the body, so there’s less of it to leak through out gut, and into our blood stream and pelvic cavity. I talk about this in a couple of episodes on leaky gut, so will share in the show notes.
Because s.boulardii can improve the immune system and heal leaky gut, it can also have a very positive effect on reducing intestinal and full body inflammation, making it helpful for endo, which we know is an inflammatory disease.
The dose actually varies depending on the brand, so either follow the brand instructions or if you have SIBO, you can follow some of the brand and dose recommendations in the show notes, which are from my training with Dr Nirala Jacobi. Again, as always, try with caution and slowly build up to see how you respond, especially if you have SIBO.
3. Number three is lactobacillus rhamnosus GG. This is recommended in my SIBO practitioners course with Dr Allison Siebecker for diarhhea and has been shown to be helpful for various types of diarrhea, from acute watery diarhhea to travellers’ diarhhea, and diarhhea from antibiotic use. But it’s also used in SIBO treatment by Dr Jacobi because it’s been shown in studies to aid with constipation, abdominal discomfort, and leaky gut healing and in general, has been shown in research to be effective for IBS. I will quickly say though, that from my understanding, it appears that the research for constipation is a little inconsistent and needs further investigation and the leaky gut evidence is mainly based on animal studies at present.
Whilst more research needs to be done on this area specifically, it’s also been found to be helpful with histamine tolerance, as it lowers histamines receptors and allergy receptors in cells, so in the simplest of terms, allergens and histamines can’t lock onto cells to cause a reaction, and this calms down inflammation.
Generally, the dose from my training with Dr Nirala Jacobi for SIBO is 1 capsule twice a day. If you don’t have SIBO, you can just follow the label dose.
So that’s it! Please be sure to try one probiotic at a time, and really, give it at least a month or so before adding in another.
I hope this episode was useful to you, and if you’d like to learn more about gut health with endo and you’re interested in accessing some support from me on your journey, you can now sign up to the waiting list for my online course, Live and Thrive with Endo. If you’re looking for free resources on gut health, I would start with the articles and episodes I’ve linked in the show notes.
I would love to hear if you try any of these and how you respond. Please feel free to let me know on Instagram!
Show Notes
SIBO
The SIBO, Endometriosis and Interstitial Cystitis Connection wth Dr. Allison Siebecker
How To Treat SIBO with Dr Allison Siebecker
Understanding The Endometriosis Belly, Part 3: SIBO Symptoms
How Do You Know When to Test for SIBO?
Histamine intolerance
Histamine Intolerance 101 Dr. Becky Campbell
https://www.thisendolife.com/this-endolife-podcast-episodes/strategies-for-lowering-histamine-reducing-allergies-endometriosis
https://www.thisendolife.com/this-endolife-podcast-episodes/association-between-endometriosis-allergies
Endometriosis, SIBO, Interstitial Cystitis and Allergies: The Histamine Connection
L.Plantarum 299v research
https://meridian.allenpress.com/jfp/article-abstract/80/10/1682/199965/Degradation-of-Histamine-by-Lactobacillus?redirectedFrom=fulltext
https://pubmed.ncbi.nlm.nih.gov/21381407/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316997/
https://www.optibacprobiotics.com/uk/professionals/latest-research/general-health/which-probiotic-for-histamine-intolerance
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419998/
https://journals.lww.com/jcge/Abstract/2017/04000/Probiotics_for_Preventing_and_Treating_Small.4.aspx
https://www.wjgnet.com/1007-9327/full/v14/i17/2650.htm
L.Plantarum 299v brands
Jarrow Ideal Bowel Support 299V, at one caps twice a day (Dr. Jacobi)
Metagenics Ultra Flora Intensive Care, at one caps twice a day (Dr. Jacobi)
CAUTION: If looking for your own brands to buy, avoid probiotics containing probiotics, as these may worsen SIBO symptoms. For a list of ingredients to be mindful of when choosing probiotics, see Dr Allison Siebecker’s handout here.
Leaky Gut
https://www.thisendolife.com/this-endolife-podcast-episodes/endometriosis-leaky-gut
https://www.thisendolife.com/this-endolife-podcast-episodes/-the-endometriosis-belly
https://www.thisendolife.com/this-endolife-podcast-episodes/understanding-the-endometriosis-belly-part-2
https://www.thisendolife.com/this-endolife-podcast-episodes/root-causes-of-bloating-endometriosis
LPS
https://www.thisendolife.com/this-endolife-podcast-episodes/endometriosis-leaky-gut
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519769/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2327198/
https://www.cell.com/cell-host-microbe/pdf/S1931-3128(16)30161-5.pdf
S.Boulardi research
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375115/
https://pubmed.ncbi.nlm.nih.gov/26316791/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/immunoglobulin-a-deficiency
https://www.optibacprobiotics.com/professionals/latest-research/gut-health/probiotics-best-for-candida
https://pubmed.ncbi.nlm.nih.gov/18584523/
https://academic.oup.com/ecco-jcc/article/11/8/999/3044359
https://www.wjgnet.com/1007-9327/full/v14/i17/2650.htm
S.Boulardi brands and doses
Klaire Labs Saccharomyces boulardi, at two caps taken twice a day (Dr. Jacobi)
Invivo Bio.Me S. boulardii, at two caps daily
Bioceuticals SB Floractiv, at two caps taken twice a day (Dr. Jacobi)
CAUTION: If looking for your own brands to buy, avoid probiotics containing probiotics, as these may worsen SIBO symptoms. For a list of ingredients to be mindful of when choosing probiotics, see Dr Allison Siebecker’s handout here.
L.rhamnosus GG research
https://pubmed.ncbi.nlm.nih.gov/18813028/
https://pubmed.ncbi.nlm.nih.gov/21390145/
https://pubmed.ncbi.nlm.nih.gov/30040527/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239510/
https://pubmed.ncbi.nlm.nih.gov/22946635/
https://pubmed.ncbi.nlm.nih.gov/15756221/
https://www.wjgnet.com/1007-9327/full/v14/i17/2650.htm
L.rhamnosus GG brands and doses
Nutrigold L. Rhamnosus GG, label dose (caution: contains brown rice flour)
Metagenics, Ultra Flora LGG® 60, at one cap twice a day (Dr. Jacobi)
CAUTION: If looking for your own brands to buy, avoid probiotics containing probiotics, as these may worsen SIBO symptoms. For a list of ingredients to be mindful of when choosing probiotics, see Dr Allison Siebecker’s handout here.
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