Understanding what Small Intestinal Bacterial Overgrowth (SIBO) is and how to get rid of it.
Overview
Small intestinal bacterial overgrowth (SIBO) occurs when there is an excessive amount of bacteria in the small intestine. In addition to the to the number, the type of bacteria present in the small intestine can also impact the signs and symptoms one my experience.
SIBO typically presents with GI or digestive symptoms such as bloating, diarrhea, and abdominal pain. However, it may also manifest as skin conditions such as systemic sclerosis, psoriasis, and rosacea. Bloating is the number one symptom that makes me suspect someone has SIBO. Especially bloating in relation to sugar or high FODMAP foods. Despite removing multiple foods from their diet, suspecting food sensitivities or leaky gut, many find themselves at a loss for how to fix their GI issues. It can feel hopeless. Some will experience periods of relief, while others simply never feel like themselves again, no matter what they do.
If this sounds like you, we are here to help! First, please understand there can be many reasons for having SIBO, and if the root cause is not addressed, SIBO can, and usually does reoccur. So the thinking, “what do I take for SIBO?”, is not going to fully resolve this issue. Sure, we recommend certain supplements for eradicating the bacteria that don’t belong in the small intestine. However, more care needs to be taken to understand how, in each case, what allowed the bacteria to get there. Was it poor digestion, which could include low pancreatic enzymes, low digestive acid (HCL), or sluggish bile that created an environment conducive to SIBO? Then there’s the microbiome. Is there sufficient diversity of beneficial bacteria (probiotics)? If so, are we eating, or able to eat the foods containing fiber that feed these beneficial bacteria? Are there enough and the right kinds of beneficial bacteria, to protect to keep inflammation pathogens (yeast, fungus, mold, bacteria etc) from over populating? And then, yes, there may be food sensitivities to figure out too or medication causes, such as proton pump inhibitors and histamine 2-receptor blockers.
Are you beginning to see that there is no one-size-fits all approach to your GI symptoms of bloating, gas, pain etc.?
Testing
The gold standard of diagnosis of SIBO is breath tests using glucose or lactulose to test for hydrogen or methane dominant SIBO with widely varying accuracy. Standard medical treatment for SIBO is antibiotics (Ghoshal 2017), though recurrence rates tend to be high; one study noted a 43.7% recurrence rate at 9 months post-antibiotic treatment (Lauritano 2008).
SIBO is often found to be present with other coexisting conditions such as IBS, recurrent upset stomach with no known or obvious cause (functional dyspepsia FD for short), and H. Pylori to name a few.
A variety of therapeutics can benefit SIBO directly, or its frequent coexisting conditions. Certain probiotic strains my improve the efficacy of antibiotics and may have an efficacy on their own (Garcia-Collinot 2020). Herbal antimicrobials, such as cinnamon and others, were found in one study to be as effective as pharmaceutical antibiotics for SIBO eradication (Chedid 2014). Vitamin D tends to have a beneficial effect on gastrointestinal flora (Bashir 2016)
Based on current research, and my16 years experience in Natural and Functional Medicines, the ingredients in the protocol below have been associated with improved health outcomes in people with SIBO.
Supplements
1. Probiotics. Two to four weeks or more of various strains, of perhaps Bifidobacterium strains or S. Boulardii, at 5 billion CFU.
I like RestoraFlora by Microbiome Labs see details below
2. Peppermint oil. 180 mg of enteric-coated capsules 2-3 times daily for 4-8 weeks.
Peppermint oil’s antispasmodic action can help reduce diarrhea and abdominal pain associated with irritable bowel syndrome (IBS). Approximately 1 in 4 individuals with IBS also have SIBO (Ghoshal 2020)
As a result, peppermint oil supplementation may also help alleviate SIBO-related symptoms.
I like Peppermint Oil G.I. by Protocol for Life Balance see details below
1 gel, three times a day for 1-2 months
3. Anti-microbial herbs or combination formulas for a minimum of 4 weeks.
Garlic, specifically for its effects on H. pylori
FC Cidal + Dysbiocide or Candibactin-AR + Candibactin-BR as antimicrobial herbals
Cinnamon because its found to be effective for resolving chronic diarrhea (not necessarily SIBO)
I like Allicillin by Designs for Health See details below
4. Vitamin D at a maximum of 9800IU per day for four weeks, followed by another four weeks of half of these doses.
I like D3 Liquid by Metagenics see details below
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I’m all for researching and trying things on your own…I believe YOU know your body best. With that said, there are times when getting help from a functional or integrated practitioner will save you years of frustration, not to mention needless ongoing damage while trying to figure things out. If you are frustrated and ready for testing or a customized plan made uniquely for you by a professional, please set up an today with our provider today! We’d love to help you.
