SIBO INFO Blog

Key Takeaway:
Resistant starch is generally considered detrimental when actively experiencing Small Intestinal Bacterial Overgrowth (SIBO) symptoms, as it can worsen discomfort. However, its role may shift once the condition is managed.
​
Discussion Highlights:

• SIBO and Prebiotics:
  Resistant starch is a type of fiber that acts as a prebiotic. For individuals currently suffering from SIBO symptoms, consuming prebiotics like resistant starch can ferment in the small intestine, potentially aggravating symptoms and causing discomfort.
• Potential Role Post-SIBO Management:
  Once SIBO is brought under control, resistant starch may be tolerated and can then serve its function as a prebiotic, which is beneficial for gut health.
• Cautious Reintroduction:
  A careful and gradual reintroduction of fibrous prebiotic foods, such as resistant starch, is advised after SIBO has been successfully treated, to be able to monitor individual reaction. 

This video discusses the use of binders, specifically Modified Citrus Pectin (MCP) and charcoal, in the context of SIBO treatment and managing die-off symptoms.
Key Points:

• Binder Necessity: There's a question about whether binders are essential for SIBO treatment. One perspective suggests that many patients can be treated successfully without them, but can be used for symptomatic control when specifically needed.
• Modified Citrus Pectin (MCP):
  • MCP is a prebiotic and highly fermentable, which can lead to bloating and gas, making it poorly tolerated by many with SIBO and sensitive individuals.
• Charcoal:
  • Activated charcoal functions as a binder by adsorbing die-off metabolites.
  • It is used for symptomatic control when necessary.
  • Alternative sources of charcoal beyond coconut shells are mentioned, including bamboo (e.g., Takasumi Supreme).
• Perception vs. Reality: The idea that binders are essential for SIBO treatment may be influenced by binder manufacturers or confusion with protocols for managing mold, which is a potential underlying cause of SIBO in some cases. It's noted that not all SIBO cases involve mold.
• Individual Sensitivity: The discussion emphasizes that approaches must consider individual patient sensitivity, as direct use of certain binders like MCP can cause adverse reactions.
  
  
  

Products mentioned:

• Takesumi Supreme (Bamboo charcoal): Pills or Powder
• ​Activated Charcoal: (Amazon) or (15% off at Fullscript)

This video addresses a common question regarding the use of probiotics for Small Intestinal Bacterial Overgrowth (SIBO), particularly during or after treatment.

Please see the Probiotics for SIBO page, for the most up-to-date information and recommendations.

The Probiotic-SIBO Paradox

• Study Findings: Research suggests that certain probiotics can be highly effective, even showing potential to eradicate SIBO.
• Clinical Discrepancy: However, this success often doesn't translate into clinical practice. Practitioners frequently struggle to replicate these positive outcomes with patients.

Probiotics Studied for SIBO:
Studies have investigated several types of probiotics for SIBO, including:

• Spore probiotics (e.g., Bacillus clausi)
• Lactobacillus and bifidus strains (e.g., Lactobacillus reuteri)
• Probiotic yeasts (e.g., Saccharomyces boulardii)

All these types have demonstrated significant positive results in research settings.

Real-World Clinical Experience:
Despite promising study results, clinical application shows varied outcomes:

• Intolerance: Many individuals cannot tolerate probiotics at all, reporting worsened digestive symptoms.
• Modest Benefit: A significant portion of people experience a moderate benefit (around 20-25%), which is helpful but not transformative.
• Rare Success: A small number of individuals report feeling substantially better.

Specific Probiotic Strains to Consider:
While studies show a broad range can be beneficial, some strains have specific associations:

• Lactobacillus reuteri: Has been noted for its potential to help lower methane and constipation (and also hydrogen levels).
• Lactobacillus plantarum: Is considered very helpful.
• Bifidis infantis: (marketed as Align in the US) is also reported to be very beneficial.

Guidance for Choosing Probiotics
Given the complexities, the advice is to:

• Consider strains like L. reuteri, L. plantarum, and B. infantis.
• Refer to Dr. Siebecker's curated lists of probiotics that have shown clinical benefit or strong research backing at Fullscript and on the Probiotics for SIBO page.

Products Mentioned:
- SIBO Probiotics at Fullscript (15% off)
- L. reuteri (Amazon)
- L. plantarum (Amazon)
- Align (Amazon)