 Hey everyone this is Dr. Ruscio and 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's too much bacteria in the small intestine that has been correlated or is one of the underlying causes of the symptoms of IBS. So gas, bloating, abdominal pain, constipation and diarrhea all being some but not the only symptoms that small intestinal bacterial overgrowth can contribute to. So 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 I'm trying to use to help me actually make me worse. And 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 there's a study that is a little bit confusing and needs to be looked at and contextualized. So I'll put one study of such up here on the screen entitled Effective Bifidobacterium Infantist or Align Probiotic on the Lactulose Breath Test for Small Intestinal Bacterial Overgrowth. Now some have cited this study as showing that probiotics cause SIBO and this is really incorrect thinking but allow me to under or to explain why that isn't and help you understand this. So in this probiotic 19 people were given the Align Probiotic and after a number of weeks on the probiotic they were given a Lactulose SIBO breath test and 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 under underlying this. Part of the reason or part of what we need to understand here is none of these patients saw a significant increase in their symptoms. So a lab finding changed but symptoms did not change, very important. The other is to understand I guess you could say the physiology of probiotics which are the majority do not colonize you but rather they have a transient effect. So while these people are taking probiotics they're kind of transiently working their way through the system and then they die off or come out the other end. So there's this transient effect that the probiotic has and then it's gone. So while they're taking the probiotic they have in the system this transient buildup of probiotics. Now this can cause a positive on a Lactulose breath test. Does that mean anything is bad? Well in truth no. The majority of the evidence, the vast majority of the evidence shows that probiotics can help to fight small intestinal bacteria overgrowth. Those bacteria crowd out the other bacteria, fight fungal overgrowth, reduce leaky gut and most importantly perhaps is to reduce a litany of abdominal symptoms like gas, blood and constipation, diarrhea. And there's even other evidence that probiotics can help with things like skin and mood just to name a couple. So even though we see in a small number of patients three of nineteen a positive breath test finding that is most likely underlined by the fact that these probiotics are transiently in the system causing this positive breath test but also improving much of ostensibly what's going on in that person's intestine. So it's very important not to look at this study and misrepresent what the study is showing which some people are doing and 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. So a good probiotic protocol can do volumes for your gut health for the symptoms of IBS or just general symptoms and for small intestinal bacterial growth. And 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 and Bifidobacterium blends, a saccharomyces bilarity and a soil-based probiotic. And by using these three together you really provide a good broad stimulus of probiotic to your gut and 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. So to the question, does using a probiotic cause small intestinal bacterial growth? No, certainly something to try. A small number of people may have a negative reaction to a probiotic and that's okay if so just as continue whatever probiotic you're using to cause that reaction but for the majority of people they will see a benefit from probiotics and 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. So this is Dr. Richo and hopefully this helps you better understand the issue of probiotics and SIBO and get healthy and get back to your life. Thanks.