Feeling worse on probiotics? Your mysterious tummy woes are about to be explained!
Nobody wants to be the gassy one at the party (except maybe a five year old).
Standing over the buffet table wondering which thing is going to set you off this time. Debating whether one beer is worth feeling like the keg for the rest of the night, eyeing the spinach dip as if it might betray you.
You might be struggling to find out what's wrong, or maybe you've already had a diagnosis like GERD or IBS, but nothing seems to be working.
And then someone tells you probiotics will help.
So you hop on Google, where people are hailing probiotics as a miracle for tummy troubles. You stock up on yogurt, grab a spoon, and kiss your sneaking-off-to-the-bathroom days goodbye, only to be struck down like you ate five pounds of Taco Bell!
Are you one of the many people who jumped on the good-bacteria bandwagon, or maybe your doctor recommended probiotics to help with a diagnosis like IBS, only to experience even more gas, bloating, or an upset stomach?
You're not crazy. And it doesn't necessarily mean probiotics are bad for you.
Sometimes the problem is that we're adding more bacteria to a digestive system that already has too much bacteria in the wrong place.
If you started taking probiotics because you are dealing with tummy troubles, only to have your situation mysteriously worsen, you may actually be suffering from a condition known as SIBO! SIBO stands for Small Intestinal Bacterial Overgrowth and while it sounds like a mouthful, if you take a minute to really slow it down it’s exactly what it sounds like. In certain situations, someone may have too much bacteria (even the good guys!) in their upper intestine, which can lead to just as many problems as not having enough.
Could SIBO Be the Reason Probiotics Make You Feel Worse?
If you started taking probiotics because you're dealing with digestive problems and your symptoms mysteriously got worse, SIBO may be one possibility worth considering.
SIBO stands for Small Intestinal Bacterial Overgrowth. In simple terms, it means that excessive amounts of bacteria are present in the small intestine, where there should normally be far fewer bacteria than in the colon.
Your digestive tract is supposed to contain bacteria. That's a good thing.
The problem is where those bacteria are and how much is there.
Think of your intestines as an ecosystem.
There are hundreds of different types of microorganisms living throughout your digestive tract. Some are beneficial, some can cause problems under certain circumstances, and many can be either helpful or problematic depending on where they are and how much is present.
Your small intestine and large intestine are not supposed to have the exact same microbial environment.
When bacteria become overly abundant in the small intestine, they can ferment carbohydrates before they are properly absorbed. This can contribute to gas, bloating, abdominal discomfort, and changes in bowel habits.
And this is one reason some people can feel worse after starting a probiotic.
A probiotic may be helpful for one person while being poorly tolerated by another. If you're already dealing with an abnormal amount or distribution of bacteria in your small intestine, adding another bacterial product may not be the solution your digestive system needs.
That doesn't mean that probiotics cause SIBO or that everyone with SIBO will react badly to probiotics. It means that "more good bacteria" isn't automatically the right answer for every digestive problem.
So what are the symptoms of SIBO?
SIBO can cause symptoms that overlap with many other digestive conditions, which is one reason it can be difficult to recognize.
Common symptoms include:
Gas
Bloating, particularly after eating
Abdominal discomfort or pain
Diarrhea
Constipation
Alternating diarrhea and constipation
Excessive belching
Other symptoms can include:
Nausea
Feeling overly full after eating
Changes in bowel habits
Symptoms associated with poor digestion or malabsorption
More significant or prolonged cases can sometimes interfere with nutrient absorption and may contribute to nutritional deficiencies.
The important thing to remember is that these symptoms don't prove that you have SIBO.
IBS, food intolerances, celiac disease, pancreatic problems, motility disorders, and several other digestive conditions can cause very similar symptoms. That's why simply matching yourself to a list on the internet isn't enough to determine what's actually going on.
So What Should You Do?
If you're disappointed that your probiotic seems to be doing the opposite of what you expected, don't give up on finding an answer.
Instead, take a step back.
The important question isn't:
"Which probiotic should I take?"
The better question is:
"Why am I having these symptoms in the first place?"
If you're super disappointed that taking a probiotic is doing the opposite of solving your digestive woes and now you're starting to suspect you might have SIBO, don't give up yet!
There are some interesting studies showing that certain herbal therapies may be effective for SIBO. In one clinical study, one of the herbal therapy regimens we use in our office performed similarly to rifaximin, a commonly used antibiotic treatment, based on follow-up breath testing. Other research has also explored herbal approaches to SIBO, so conventional antibiotics aren't necessarily the only treatment option worth discussing.
Not to mention, some of these alternative treatment options may have fewer side effects or be more cost-effective than conventional treatments, depending on the specific therapy and the individual.
Our Top Tips for Those With SIBO
1. Pay Attention to Your Carbohydrate Intake
This doesn't mean that all carbohydrates are bad.
But bacteria ferment carbohydrates, and some people with SIBO find that reducing certain fermentable carbohydrates can significantly reduce gas and bloating.
The right dietary approach depends on the individual. A very restrictive diet isn't necessarily the long-term answer, either.
The goal should be to identify the foods and dietary patterns that aggravate your symptoms while still maintaining adequate nutrition.
2. Be Thoughtful About Antibiotic Use
Antibiotics can alter the bacterial environment of the digestive tract, so repeated or unnecessary antibiotic use may contribute to changes in the gut microbiome.
That does not mean you should avoid antibiotics when you actually need them.
There are situations where antibiotics are absolutely appropriate and important. The goal is simply to make sure you're using them when they are medically indicated and to understand that they can affect your gut microbiome.
3. Don't Assume Every Probiotic Is Right for You
This is probably the biggest lesson I want you to take away from this article.
Probiotics aren't one-size-fits-all.
There are many different strains, combinations, and formulations, and different people can respond very differently to them.
If a probiotic consistently makes your gas, bloating, or abdominal discomfort worse, don't assume that you just need to push through it because probiotics are "good for you."
It may be worth stepping back and figuring out why you're reacting that way.
4. Look for the Underlying Cause
SIBO often isn't just a matter of having "too many bacteria."
Something may be contributing to the environment that allowed the bacterial overgrowth to develop in the first place.
Problems with intestinal motility, structural abnormalities, previous gastrointestinal surgery, and other digestive conditions can all be relevant when evaluating SIBO.
This is why simply treating the overgrowth without considering why it happened may not provide a lasting solution.
This is one reason I don't believe in simply throwing another supplement at every digestive problem.
You Don't Have to Live With Constant Bloating
If you're constantly planning your day around your digestive system, avoiding foods you love, or wondering why the probiotic that was supposed to make you feel better is actually making you feel worse, there may be more going on than simply needing "more good bacteria."
SIBO is one possibility, but it's not the only one.
The goal isn't to assume that SIBO is the answer.
The goal is to figure out what is actually driving your symptoms.
That's where a more individualized approach can be helpful.
You CAN feel great again!
Start Your Personalized Care Plan
If you’re ready to better understand what’s contributing to your symptoms and take a more complete, natural approach to your health, we’re here to help.
About the Author
Dr. Caroline Ricker, DC, DABCI, MTAA, is the founder of Whole Health & Wellness in St. Louis. Her practice combines functional medicine, clinical nutrition, functional laboratory testing, chiropractic care, acupuncture, and other integrative approaches for patients with chronic and recurring health concerns.
Learn more about Dr. Caroline Ricker and Whole Health & Wellness