SIBO – Small Intestine Bacterial Overgrowth is one of the most challenging conditions to overcome. Because many of SIBO’s outward symptoms are the same as other gastrointestinal maladies (IBS/IBD and many others) getting diagnosed may take months or even years.
If you have been given this diagnosis and had the standard hydrogen/methane breath test then you have undoubtedly searched the internet for information on what the treatment options are for SIBO. There is good deal to sift through and the answers you read can be downright confusing. Proper diagnosis is critical and highly dependent upon correctly interpreting the Hydrogen Methane breath test. As a result, most people who do finally get a diagnosis are left wondering where to start.
If you have NOT been diagnosed with SIBO but wonder if you may have SIBO please read this post with a check list of symptoms that point to a strong correlation your symptoms are due to SIBO. Because SIBO isn’t typically diagnosed until other potential gastrointestinal and bowel disorders have been ruled out, too many people suffer its effects for months and even years before getting this diagnosis.
In this post I’ll share with you some of the “pearls” I have come across in various functional medical publications and from doctors considered to be experts in SIBO treatment/management. Keep in mind that there is still a great deal we don’t understand about how to work with this condition. This is largely because very often, other co-conditions are present that need to be uncovered and addressed before SIBO can be resolved.
Anti-biotics or herbal antimicrobial?
The question of using prescription medication or herbals is very often the first one many patients have.
When considering using Antibiotics here are a few things to keep in mind:
Many gastroenterologists will prescribe Rifaximin, Neomycin, or Metronidazole. Both Rifaximin and Neomycin are non-systemic treatments, meaning they mostly don’t get absorbed into the bloodstream and instead stay in the intestines, allowing them to kill bacteria residing in the intestines and not elsewhere. Metronidazole is a systemic antibiotic (meaning it does get into your blood and circulate through your body). These are usually prescribed for 10 – 14 days.
Very often one round of anti-biotics does not completely do the job and in severe cases you may end up having to take three to four rounds of anti-biotics to kill the bacteria.
There are distinct downsides to using long term, multiple antibiotics. The first is that your gut microbiome will be significantly impacted because these medications destroy not only the pathogenic bacteria but beneficial and commensal bacteria as well. Second many people become resistant to these treatments. A third concern is the cost of these prescriptions.
Herbal anti-bacterial/ antimicrobial have distinct advantages
A multi-center study, including John’s Hopkins, found “herbal therapies are at least as effective as Rifaximin” with “similar response rates and safety profiles”. One consideration is that many patients experience fewer side effects using herbs vs. antibiotics.
Costs issues are another important consideration. The medication Rifaximin is expensive ($1250/month), and because it’s not FDA approved for SIBO, some patients may have to pick up the costs. Patient costs even under Medicare are over $600+/month. 
Many patients do not respond to anti biotics yet they do respond to herbal anti-bacterial agents.
While treatments vary somewhat depending upon methane or hydrogen dominant there are numerous herbs and herbal combinations that are quite effective.
What other co-conditions are present?
All successful programs must include resolution of other co-conditions and not just SIBO!
SIFO or small intestine fungal overgrowth (also known as Yeast over growth / Candida) is a common co-condition. Since many of the anti-bacterial herbs used to treat SIBO also contain excellent anti-fungal properties clinicians can effectively treat both conditions with the same herbs.
Mycotoxin exposure is another co-condition  Molds produce mycotoxins. These substances, although unseen by the naked eye, are ingested and then enter the body through the skin, mucous and airways. Once ingested, mold has the requirements to colonize and spread. In doing this, it can compromise the immune system and damage everyday processes of the body.
Histamine intolerance is often caused by SIBO.  Histamine is found in foods and can be produced in the body when you have SIBO. Histamine causes your blood vessels to swell, or dilate, so that your white blood cells can quickly find and attack the infection or problem. This is part of the body’s natural immune response, and typically enzymes will break down the histamine so that it doesn’t build up. If for some reason you don’t break down histamine properly, it begins to build up and you develop what we call histamine intolerance. This is common in SIBO.
This is partial list and only a few of the more common co-conditions found in addition to SIBO. Here is more complete list of the conditions associated with SIBO http://www.siboinfo.com/associated-diseases.html
What causes SIBO?
In SIBO bacteria that is normally found in only small quantities migrates and becomes an overgrowth in the small intestine. It feeds on starches and sugars and can ferment causing gas which causes discomfort and pain.
Reading through the prevailing research there appears to be two major triggers people who get SIBO have in common. First, is an infection from surgery to remove a constriction in the GI tract or often times after other gastric surgery. The second most common trigger is a food poisoning infection usually traced back to three months before symptoms begin to appear. Other common factors in SIBO are low stomach acid, poor motility and immune deficiency.
SIBO is actually a common co-condition for many with autoimmune disorders, autism, neurological and psychiatric conditions, IBS/ IBS, eczema and other skin conditions.
Diet – which is best? SCD/GAPS? FODMAPS? Or a Hybrid?
Naturopathic doctors and integrative physicians often advise that patients follow a SIBO diet along with antimicrobial therapy for best results. A SIBO diet is primarily a low-carbohydrate diet, since bacteria use carbohydrates as their energy source and ferment them to gas. The SIBO diet can directly reduce symptoms by decreasing the amount of gas produced and possibly by reducing the overall bacterial load as the food supply shrinks.
The SIBO diet is a combination of either the specific carbohydrate diet (SCD) or the gut and psychology syndrome diet (GAPS) with parts of the low FODMAP diet (the FODMAP fruit and vegetable recommendations). With both the SCD and GAPS diets, all grains, starchy vegetables, lactose, sweeteners other than honey, and beans are eliminated. Eliminating these normally well-absorbed carbohydrates is essential in SIBO because these polysaccharide and disaccharide sources feed the inappropriate bacteria in the small intestine, creating symptoms and worsening the problem. The exact protocols for the SCD and GAPS diets can be found in the hyperlinks above.
By further eliminating the highly fermentable fruits and vegetables recommended in the low FODMAP diet, even more of the bacteria’s food source is reduced. The low FODMAP diet is an irritable bowel syndrome treatment diet and was not specifically designed for SIBO; therefore, it does not eliminate all polysaccharide and disaccharide sources such as grains, starch, starchy vegetables, and sucrose unless combined with either the SCD or the GAPS diet. Use the FODMAP hyperlink above to find the list of fruits and vegetables to avoid.[4
Refining the diet and eating for long term health
~ All long term restricted diets have drawbacks
While restricting specific carbohydrates and other fermentable foods does help alleviate bloating and other bowel symptoms these are not diets you want to stay on indefinitely. This is because we know that these foods do contain many important micronutrients for good health, in particular SFCA’s.
The latest research on the microbiome is showing us how important short chain fatty acids (SCFA’s) are to helping good bacteria take hold. And, until good bacteria can flourish we will have a dysbiotic microbiome environment that is more favorable to SIBO and SIFO.
SCFA’s are one of the most important products of the microbiome and are essential for mucus production, energy production, maintaining intestinal barrier and due to their ability to contribute to acidic conditions, help inhibit pathogens. Including these foods speeds the healing in the intestines and bowel that is essential to a successful both SIBO and yeast clearing.
From a nutritional perspective, completely removing foods so rich in short chained fatty acids means we are taking away those nutrients that help promote the growth of short chained fatty acids.
Current study of the human microbiome confirms the importance of short chain fatty acids promoting the growth of healthy microflora. Some of the highest sources of SCFA’s come from fruits such as apples, berries and vegetables such as parsnips and sweet potatoes.
Emerging research and alternative treatment options…
Much of what seems to be emerging seems to suggest that we might be better off shifting our focus away from such lengthy bacterial killing to reestablishment of beneficial bacteria. So instead of just focusing on killing these bacteria need to strive to find the right balance of gut building foods, nutrients and healing herbs to successfully healing SIBO.
Finally, no SIBO healing program is complete without doing the long term work of healing leaky gut!
If you have unresolved gastrointestinal or bowel problems, IBS/IBD or autoimmune condition perhaps it’s time for a new approach? Let’s talk. Just fill out my CONTACT ME Form and I will be in touch.
References & resources used:
- Treating SIBO (Part 7): Antibiotics for SIBO – Hollywood Homestead http://www.hollywoodhomestead.com/antibiotics-for-sibo/#ixzz4OmTXtqfQ