Hi Christina! I like Culturelle (health and wellness formula) NOT the digestive version which has inulin OR Align for a good general probiotic for IBS patients. Align has more research–but in my experience both work for many patients. Typically, I review my client’s past history and current symptoms to determine the best probiotic.

I know you’ve mentioned a brand before but can’t seem to find it (and am going on vacation and would love it beforehand), but which brand probiotic to you suggest for someone with IBS/Symptoms??

Thanks ! You really should be president of healthcare 🙂
Christina

Leslie, you bring up an excellent point—and that is that gums even though they are not FODMAPs by definition –they are longer chains of carbs (FODMAPs contain small carb chains)–BUT still can be rapidly broken down by gut bacteria contributing to gas. This is why I recommend whole foods in their natural state as much as possible to minimize intake of gums. You are not alone–many individuals are sensitive to gums–especially in large quantity.

HI Karen, It does seem odd that antibiotics may contribute to SIBO-and yet we treat SIBO often w/ antibiotics!! But I believe the rifaximin often used for SIBO treatment is targeting small intestinal bacteria–so may have less of an impact on altering bacteria systemically in the body. ALSO, it is key to determine why/how you developed SIBO in the first place–SIBO is really not a diagnosis on its own but rather an end result of something else. Lots to learn in this area–the research is just emerging. There are no tests for salicylate and amine sensitivity to my knowledge–individuals undergo an elimination diet and then re-challenge with foods separately. Royal Prince Alfred Hospital in Sydney, Australia has some great educational resources in this area: http://www.sswahs.nsw.gov.au/rpa/allergy/resources/foodintol/salicylates.html

Hi Nici, Lots of great questions. The lactulose breath test is the most commonly used breath test for SIBO– sometimes glucose is used as well. Be sure the test you had tested both methane and hydrogen. Not everyone has bacteria that produced hydrogen…so if this was your case–your test would be negative simply for this reason.
Dumping syndrome can be an overlapping diagnosis w/ IBS– I have had a few patients with dumping syndrome–and this requires some additional dietary changes …for instance–beverages should NOT be consumed at meal time but in between. The meal should include some fat (healthy fats) and some fiber to help delay stomach emptying. Some of my clients do best when the protein is consumed first during the meal. Warm liquids–speed up gastric emptying –so should be limited. Fructans/GOS increase bifida bacteria in the intestine. Certainly trying a bifida based probiotic could be helpful—such as align.

I tested negative for SIBO, but I see that the researchers say the tests are not very accurate. Is there anything I can do to get a more accurate result on the SIBO test? I have a theory that my stomach empties too fast for the SIBO test to catch the “dump” into my small intestine … my GI doc confirms that my stomach empties very fast.

Do we know which good bacteria the fructans (for example) support so that we can supplement with targeted probiotics? Thanks so much!

Thank you so much. So it’s especially good to try and reintroduce foods from the fructans/GOS groups? I don’t know about SIBO but I’ll look into it now you’ve pointed that out. As I say, thank you!

Iddy, we just don’t know the long term impact of the low FODMAP diet–and since we know it does reduce probiotic bacteria in the colon–it is presumed that long term use of the diet might contribute to health risk such as colon cancer in the long run. BUT…we really don’t know. We don’t know how many fructans/GOS would be necessary to up these probiotic bacteria–maybe its requires only small amounts — and since tolerance to FODMAPs can vary over time—you can try to reintroduce every couple months. When my clients have very little wiggle room adding back any FODMAPs–I always consider the potential of small intestinal bacterial overgrowth…so this might be something you would want to get evaluated.