I have treated my own small intestine bacterial overgrowth (SIBO) three times. I tested positive, treated, felt better. Then it came back, and this happened twice. Recurrence is common for people with impaired digestive systems from underlying conditions (like celiac for me!). The good news is my last treatment seems to have stuck, at least for the last 9 months. It feels amazing not to wake up looking three months pregnant before I even eat a meal. Having regular timely bowel movements is also pretty wonderful.

Throughout the process, I learned a ton. I spent hours listening to podcasts and interviews with the top researchers in the field, read many studies, and experimented with several types of treatment. This personal experience, plus my functional medicine program training, has prepared me to offer you the best treatment too!

Awareness about SIBO is growing. This is a common problem which leads to digestive discomfort. Symptoms include chronic bloating, cramps, gas, constipation or diarrhea. It is increasingly common that IBS resolves after treating SIBO (in fact, perhaps 70% of IBS cases are due to SIBO). If you feel bloated or gassy after most meals, there’s a good chance you have SIBO. I believe in treating SIBO holistically for long-term relief with minimal side effects.

SIBO Causes

SIBO can be caused by many factors. Antibiotics, antacids and PPIs, slow gut motility, low fiber diet, high sugar and carb diet, high alcohol intake, and stress can all contribute. Having food poisoning often will cause SIBO. SIBO occurs when highly fermentable foods like refined carbohydrates and sugar sit in the intestinal track where they feed pathogenic bacteria. This can happen because stomach acid is low, the gut is inflamed, or digestion is slow. Overgrowth of “bad” bacteria produces either too much hydrogen or too much methane in the gut, leading to symptoms.

If you mostly experience constipation, this is SIBO-C, mostly diarrhea is SIBO-D. Methane dominant SIBO tends to cause more symptoms of constipation.

SIBO Diagnosis

SIBO is diagnosed through a breath test. At Amaluna, we use the Commonwealth Labs SIBO glucose breath test, or the Biohealth labs lactulose SIBO test. Both are kits you take home and mail in. SIBO can be diagnosed by symptoms alone, but a breath test is a great way to discover whether you are methane or hydrogen dominant and to follow up to be sure SIBO has cleared after treatment. Fortunately, most SIBO breath tests are covered by insurance.

SIBO Treatment

SIBO can be difficult to treat. Oftentimes, herbal antibiotics will effectively wipe out the bacterial overgrowth, coupled with specific strain probiotics to rebalance gut flora. After the treatment phase, you will need to adhere to a SIBO diet, which is low in fermentable foods (also called FODmaps) or the Specific Carbohydrate Diet. This means no sugar and no refined carbohydrates. Some MDs will treat SIBO with prescription antibiotics, such as Rifaximin and Neomycin.  However, this SIBO study shows that herbal antibiotics are equally effective and have lower risk of side effects.

SIBO treatment may incorporate herbs, digestive enzymes, and lifestyle changes to increase gut motility, which is the amount of time it takes food to pass through the digestive tract. Constipation greatly increases the risk of developing SIBO and having SIBO reoccur. SIBO commonly comes back, and some people may need to adhere to a low-sugar, low-carb diet permanently. Fortunately, this diet is beneficial for multiple reasons and is associated with better cognitive function, lower rates of obesity and diabetes, lower cancer rates, and lower risks of cardiovascular disease.

In addition to herbs, diet, and lifestyle changes I recommend regular acupuncture. Acupuncture helps greatly with gut motility, inflammation, stress, and die-off reactions from the herbal or prescription antibiotics. Treating SIBO holistically means addressing all the contributing factors, and stress is a major component. SIBO will often reoccur during stressful periods of life.

SIBO Resources

The experts:

Dr. Allison Siebecker: www.siboinfo.com

Dr. Pimentel at Cedars-Sinai Lab 

Chris Kesser Interviews Dr. Pimentel on SIBO

Dr. Ruscio Digestion, Thyroid and Functional Medicine 

Podcasts:

• SIBO discussed with Dr. Melanie Keller
• Interview with Dr. Siebecker on SIBO
• Dr. Ruscio Talks Treating SIBO Holistically 

Are you in the Boulder area?