Jul 25, 2017
Pre and Probiotic Use in SIBO
In this episode, Dr Nirala Jacobi is in conversation with Dr
Jason Hawrelak on the topic of all things gut.
Dr Hawrelak is a researcher, lecturer, naturopath, and
nutritionist with over 16 years of clinical experience. He
also practices at Gould’s Natural
Medicine - a 135 year old natural medicine apothecary and
clinic in Hobart, Tasmania, Australia.
Dr Hawrelak completed his PhD examining the capacity of
probiotics, prebiotics, and herbal medicines to modify the
gastrointestinal tract microbiota. He is currently the senior
lecturer in Complementary and Alternative Medicines at the University
of Tasmania’s School of Medicine where he coordinates the
evidence based complementary medicines programs. Dr
Hawrelak also teaches the gastrointestinal imbalances unit, within
the Masters of Science and Human Nutrition, and Functional Medicine
Program at the University
of Western States, in Portland, Oregon.
Topics discussed in this episode include:
- Dr Hawrelak’s 2016 lecture on Pre
and Probiotics at the SIBO Summit 2017 - still available to
practitioners as part of the SIBO Fundamentals online
- The website Dr Hawrelak developed, Probiotic Advisor, to help
practitioners differentiate which probiotic strains and products
are appropriate to different conditions.
- Recent probiotic research (2017) in relation to SIBO treatment
and methane reduction.
- The importance of strain specificity in relation to therapeutic
- Reseeding the gut with exogenous probiotics as an outdated
concept, and the history of this ideology.
- Faecal transplants and the capacity of strains to remain in the
gut as compared to probiotics taken in capsule form that does
- What metabolic modulation actions do probiotics have in the
body, and how to integrate this with background changes to enhance
the therapeutic effect.
- D-lactate V.S. L-lactate producing probiotic strains, and what
systemic effects do each trigger?
- D-lactic acidosis and when this may occur.
- SIBO related symptom presentation and strain specificity for
probiotic therapy, for symptoms such as motility issues, abdominal
hypersensitivity, histamine issues, food reactions.
- Probiomax for motility Bifidobacterium Lactis HNO19 - 1-2
capsules per day.
- BB12 Bifidobacterium Lactis for motility.
- Suggestions on the combination use in children with
- Animal study showing probiotic strains that work on the
migrating motor complex function - prokinetic potential.
- Combination of L. Rhamnosus GG, Bifidobacterium BB12, and
Abdominal hypersensitivity in SIBO
- Bifidobacterium Infantis 35624
- Rhamnosus GG
- Functional abdominal pain in kids - meta analysis supporting
this therapeutic application.
- Nissle 1917 strain of E.Coli
- Bifidobacterium Lactis DN173010
- Speed up transit time
- Decrease pain and bloating
- Yoghurt brand, Activia, available in US, is the only available
form (as currently known)
- Probiotics useful in helping to repair leaky gut
- Rhamnosus LGG
- Biocodex preparation
of Saccharomyces Cerevisiae/Boulardii
- Infiltration of mast cells into the intestinal wall in SIBO and
- Probiotics and histamine degradation - investigating
- Probiotics and histamine upregulation - investigating
- High-fat diets producing many bile salts, which feed hydrogen
sulfide producing bacteria, and hydrogen sulfide gas contributing
to leaky gut.
- Higher fat diets contributing to diamine oxidase (DAO) enzyme
overuse in the small intestine and why this is relevant to
- Ketogenic diets and symptom resolution - why is this, and is it
- The impact of starving out butyrate producing colonic
- The risk of ketogenic diets.
- How to reintroduce foods to sensitive patients
- Heal gut
- Decrease inflammation
- Work on allergy axis to increase dietary diversity
- Partially hydrolysed guar gum (PHGG) as a prebiotic
- Probiotics as aiding in the recovery of the microbiome after an
insult, eg chemotherapy, antibiotics, radiotherapy etc.
- Prebiotics and changes of diet having a greater impact on the
- Jason’s prebiotic use
- PHGG - use in functional constipation patients, non-methane
type SIBO, and diarrhoea type stool conditions.
- Helps to normalise stool.
- Bimuno - galacto
- Bringing bifidobacterium, and faecalibacterium prausnitzii
- Faecalibacterium prausnitzii:
- The single species with the highest prevalence in healthy
- Predominant butyrate producer.
- Produces another anti-inflammatory gut healing compound, so
helpful for inflammatory bowel diseases.
- Higher levels as protective against metabolic syndrome and Type
- Accounts for 1-3% of the microbiome in healthy people.
- Eats mucin, therefore if inflamed guts producing a lot of mucus
can overgrow akkermansia.
- Use as a prebiotic.
- Increases faecalibacterium prausnitzii, akkermansia, and
- Use as a pH changer - moves environment to be more beneficially
- Amazing capacity to decrease Bacteroides numbers - which can
increase after multiple courses of antibiotics.
- SIBO positive on Lactulose breath test patients - to attend to
SIBO with therapy first before using Lactulose as a prebiotic.
- Lactulose uses in recurrent urinary tract infections as
supported by clinical trials - as it decreases levels of E.coli in
the gut so fewer pathogens can make the journey from the anus, to
the vagina, to the urethra.
- Prokinetic for small intestine and when it is appropriate to
use it in SIBO.
- Note: lactulose will increase gas, but not bloating. If
bloating, cease use.
- Discussion on soil based organisms as they relate to functional