Part 2

‍Why is SIBO So Hard to Treat?

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SIBO, or small intestinal bacterial overgrowth, is a GI condition related to a cascade of symptoms and many root causes. In the previous blog we discussed the five types of SIBO, SIBO causes, and SIBO’s relationship with IBS, histamine intolerance, and autoimmunity. To read Part 1 of this series. (CLICK HERE)

In today’s article, I’ll discuss my approach to using functional medicine to treat SIBO in my practice. We will cover SIBO testing, issues with the low FODMAP diet, and how to heal SIBO naturally, once and for all!

A Functional Medicine Approach to SIBO

SIBO is a complex medical condition that is difficult to treat. The conventional approach is to kill the overgrowth with antibiotics, which may be initially successful, but the recurrence rate for SIBO is quite high. In fact, about 44% of SIBO patients treated with antibiotics may develop the condition again within nine months. 

While killing the overgrowth is often a necessary part of the treatment plan, it doesn’t address the root cause. I always ask why SIBO developed in the first place and also address the underlying pieces. 

The first step in a functional medicine approach is SIBO testing. Since SIBO symptoms may be similar to other GI conditions, I want to make sure the diagnosis is correct. 

SIBO breath testing involves drinking a lactulose or glucose solution and then capturing the air released from the lungs over time. The gasses, (methane, hydrogen, and in some tests hydrogen sulfide), are measured. A spike in the gas may indicate small intestine fermentation and SIBO. 

It’s important to note that testing isn’t 100% accurate. There may be cases where SIBO testing is negative, but a patient responds well to treatment and other cases of false positives. It’s essential to use this testing in the context of the patient’s history, symptoms, and story. 

SIBO natural treatments will vary from patient to patient, depending on their unique root causes. My treatment plans often include medications or botanicals and diet and lifestyle suggestions. 

Some interventions to consider are:

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• Antibiotics or antimicrobials – Depending on the type of SIBO and patient preference, specific antibiotic or antifungal medication, or antimicrobial herbs are used to remove the overgrowth from the small intestine. 

• Gut healing and repair – After the antibiotics or antimicrobial herbs, it’s helpful to focus on gut healing. This might include an elimination diet along with gut-healing foods and nutrients. In addition, it’s a good time to rebuild the microbiome in the colon with fermented foods. 

• Stimulate the vagus nerve – The vagus nerve connects the brain to the digestive system Stimulating it helps improve the migrating motor complex that prevents bacteria from migrating to the small intestine. Some ways to stimulate the vagus nerve include breathing exercises, gargling, and singing. 

• Adjust meal timing. Resting the digestive system between meals supports the migrating motor complex and helps prevent SIBO recurrence. For many, this means reducing snacking between meals and in the evening before bed. 

• Optimize stomach acid. Many with SIBO have low stomach acid. Increasing stomach acid helps normalize the pH throughout the digestive system and prevent overgrowth. Some ways to increase stomach acid include taking apple cider vinegar or digestive bitters before meals or supplementing with HCl during meals. Digestive enzymes for SIBO prevention may be helpful for some as well. 

• Manage stress. It’s incredibly difficult to heal from SIBO when stress is high. HPA-axis dysfunction affects digestion by lowering digestive secretions, including stomach acid, and slowing movement through the GI tract. 

SIBO and the Low FODMAP Diet

You’ll often hear of the low FODMAP diet as the diet for SIBO treatment. FODMAPs are fermentable carbohydrates found in plant foods and essentially provide the food for the bacteria in the small intestine to consume. 

Removing these foods may provide relief to symptoms, but a low FODMAP diet for SIBO doesn’t address the root cause. I caution against using this approach long-term because it may contribute to nutrient deficiencies and negatively impact the microbiome. It is also challenging to avoid so many nutritious foods. And quite frankly the foods you’ll often avoid are the exact foods you need to heal.

If a FODMAP diet is used short-term along with other interventions, my goal is to expand the tolerable whole plant foods in the diet as much as possible.

Do you suspect you have SIBO or have symptoms that haven’t been resolved with conventional interventions? You may need a functional medicine, root cause approach in order to finally heal. Please contact me to learn more about working together.  

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References

1. Lauritano, E. C., Gabrielli, M., Scarpellini, E., Lupascu, A., Novi, M., Sottili, S., Vitale, G., Cesario, V., Serricchio, M., Cammarota, G., Gasbarrini, G., & Gasbarrini, A. (2008). Small intestinal bacterial overgrowth recurrence after antibiotic therapy. The American journal of gastroenterology, 103(8), 2031–2035. 

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