Specific Health Concerns >> SIBO Small Intestine Bacterial Overgrowth
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SIBO-Small Intestine Bacterial Overgrowth
What is SIBO?
Small intestinal bacterial overgrowth occurs when the bacteria in our gut get out of balance and overgrow. I often say, “Too much of a good thing can be a bad thing.” How do we get too much of some bacteria over others? This can manifest in several different ways, and often occurs in those eating a diet high in sugar, alcohol and the Completely Refined And Processed (CRAP) carbohydrates. Certain strains of bacteria feed off of refined carbohydrates and break them down into mono-saccharides, creating gas and causing bloating.
Another strain of bacteria can break down bile salts before your body has a chance to use them. Bile salts are crucial for the breakdown of fats; without them, the end result is fat malabsorption or diarrhea.
Finally, a third type of bacteria can produce toxins that damage the lining of the small intestine. This prevents your body from absorbing the nutrients you need, much like what we see with a leaky gut.
What Causes the Bacterial Overgrowth?
Our gut relies on nerves, muscles, enzymes, and neurotransmitters to properly digest food. While enzymes mainly break down our food, the nerves, muscles and neurotransmitters physically move the food through our digestive tract from the stomach to the small intestine and to the colon. When this happens in a healthy gut, bacteria get passed through the digestive tract along with the food to its final destination in the colon. Problems arise when something interferes with this process.
Damage to the nerves or muscles in the gut can result in leftover bacteria in the small intestine, increasing your risk for SIBO. For example, diabetes and scleroderma can both affect the muscles in the gut, leaving room for SIBO to develop.
Physical obstructions in the gut, like scarring from surgeries or Crohn’s disease, can also cause an abnormal buildup of bacteria in the small intestine. Diverticuli, which are tiny pouches that can form in the wall of the small intestine, can also collect bacteria instead of passing it on to the colon, where it belongs.
There are also medications that influence or disrupt the normal gut flora, such as antibiotics, acid-blocking drugs, and steroids. And of course, as I mentioned above, the most common cause I see in my office is from a diet high in sugar, refined carbohydrates and alcohol.
10 Signs You Have Small Intestinal Bacterial Overgrowth (SIBO)
4. Abdominal pain or cramping
5. Constipation (much less common than diarrhea)
6. Diagnosis of irritable bowel syndrome or inflammatory bowel disease
7. Food intolerances such as gluten, casein, lactose, fructose and more
8. Chronic illnesses such as fibromyalgia, chronic fatigue syndrome, diabetes, neuromuscular disorders and autoimmune diseases.
9. B12 deficiency as well as other vitamins and minerals
10. Fat malabsorption
How To Test For SIBO?
Breath Test: This is the gold standard, however it’s quite cumbersome. Individuals must fast for 12 hours, breathe into a small balloon, ingest a precise amount of sugar, and repeat breath samples every 15 minutes for 3 or more hours. Abnormal breath tests can also signify pancreatic insufficiency and celiac disease.
Organix Dysbiosis Test: This functional medicine lab test the urine for by-products of yeast or bacteria in the small intestine. If your small intestine is housing a yeast or bacterial overgrowth, byproducts will appear in your urine, indicating their presence. This test is much easier for patients and only requires one single urine specimen.
Comprehensive Stool Test: This is also a functional medicine lab test looking at the flora of the large intestines. If I see all elevated levels of good bacteria, I suspect SIBO.
History: By listening to the patient’s history and symptoms, I’m often able to make a diagnosis.
Manual Muscle Testing: Working with a properly trained practitioner who has used Manual Muscle Testing in their practice for years continues to help put a person on the right path without the expensive tests. Experience in treating SIBO is vital for your restoring health to your body.
How Medicine Treats SIBO?
The standard Medical treatment for SIBO is an antibiotic called Xifaxan. Because Xifaxan is not well absorbed throughout the body, it mostly stays in the gut and is very effective against SIBO. The problem with Xifaxan is that most insurance companies have approved it for traveler’s diarrhea, but not for SIBO, so it can be very cost-prohibitive for most people.
Consider Dr. Huntoon's Advice below.
Dr. Huntoon has spent 30 plus years understanding the importance of all disease, what causes sickness to begin and what it takes to be and stay healthy. It is his passion and he can and will help you understand how to restore balance to your digestive system and your overall health. Please appreciate that any time you are exposed to antibiotics (70 percent of them are put into our food supply), you will disrupt your microbiome. Also of importance is understanding the Digestive System Disruptors of stress, over-the-counter medicines, prescription medicines, alcohol, refined and processed sugar, additives, preservatives, plastics etc., will contribute to having problems with your microbiome, thus leading to Leaky Gut Syndrome.
Placing patients on a diet low in carbohydrates and free of refined flours, sugars and alcohol. I also recommend a combination of herbs for 30 days, if Xifaxan is too costly. I recommend using our Microb-Clear, which is a blend of magnesium caprylate, berberine, and extracts from tribulus, sweet wormwood, grapefruit, barberry, bearberry, and black walnut. In addition, I follow a 4R program to heal the gut.
Similar to Yeast/Candida overgrowth, those who are susceptible to SIBO may have recurrence after treatment. It is advised to adopt a long-term diet that is low in carbohydrates and especially refined carbohydrates.
Why Is Diet Important for Treating SIBO?
Bacteria are part of the natural structure of our guts, and it actually serves many important roles in our bodies which range from aiding in digestion to regulating mood. Just like all other living organisms, bacteria have to eat something. And what do bacteria primarily eat? Carbohydrates.
When you eat a diet which is full of carbs (especially simple carbs like the sugary and starchy foods found in the typical Standard American Diet), bacteria will have a field day. They eat up those excess carbs, proliferate, and then you’ve got an overgrowth problem on your hand.
It certainly doesn’t help that the SAD diet also is full of inflammatory foods like gluten which can damage the lining of the stomach and decrease stomach acid production (stomach acid helps kill and regulate bacteria).
As we talked about in the Causes of SIBO section, low stomach acid means you will have undigested particles of food in your small intestine, which the bacteria can then eat.
Option 1: The Low FODMAPs Diet for SIBO
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, which are the four classes of fermentable sugars/sugar alcohols. The Low FODMAP diet was originally derived as a dietary treatment for IBS but can be adapted for treating SIBO.
The idea behind the Low FODMAPs diet is that you get rid of foods which contribute to intestinal fermentation. FOMDMAPs diet is very effective in treating gastrointestinal conditions like IBD and IBS.
However, it is important to note that the Low FODMAPs diet does not restrict polysaccharide and disaccharide sources of carbs such as grains, starch, starchy vegetables, and sucrose.
These carbs are normally well-absorbed, but with SIBO they aren’t absorbed well and bacteria can feed off of them and worsen the problem. So, to treat SIBO, these carbs must also be removed.
Note: It’s LOW FODMAP, not NO FODMAP, so try not to drive yourself too insane
Option 2: SCD Diet for SIBO
SCD stands for Specific Carbohydrate Diet. It was originally developed by a pediatrician for treating Celiac disease and was later popularized by Elaine Gottschall in her book Breaking the Vicious Cycle. SCD limits complex carbs (disaccharides and polysaccharides), lactose, sucrose and other man-made (read: crappy) ingredients.
These ingredients are harmful to the digestive system and lead to yeast overgrowth, bacteria overgrowth, and inflammation. According to data from surveys, SCD has a 75% to 84% success rate.
Here are some examples of SCD foods:
Option 3: GAPS Diet for SIBO
GAPS stands for Gut and Psychology Syndrome. The diet was created by Dr. Natasha Campbell-McBride. It is based on the idea that all disease starts in the gut – which is supported by the fact that 90% of all cells and genetic material in the human body belongs to gut flora.
Campbell-McBride says that modern life damages the gut flora and leads to diseases including autism, ADD, epilepsy, depression, as well as many other diseases.
GAPS diet is similar to SCD diet, but allows/excludes a few different items and also has a very clear outline. There are seven phases to the GAPS diet. The introductory stage is basically a fast which allows very little food, room temperature water, and probiotics.
As you move through the phases, you are allowed to add more foods to the diet – such as egg yolks, avocado, and squash. There are some foods which are not allowed at any phase of the diet. GAPS diet also heavily focuses on detoxing.
Not Allowed During Any Phase:
There isn’t any scientific evidence supporting GAPS diet for SIBO. Because the diet removes starches and certain sugars, as well as difficult-to-digest foods like beans, it can help reduce inflammation and intestinal fermentation. However, the diet does not remove high FODMAPs foods.
These foods act much like sugars and starches, meaning that you could still be feeding the bacteria in the gut. For this reason, even GAPS diet will have to be adapted if it is going to be used to effectively treat SIBO.
Option 4: Elemental Diet for SIBO
I’m hesitant about even including Elemental under the “diet” category, because it is really a short-term protocol for treating SIBO and not something you can live off of long term (at least not without completely losing your marbles).
Like with the other SIBO diets, the goal is to starve the bacteria — but in a really hardcore way. You don’t eat anything!
To prevent the body from starving, you take a very specific liquid which contains the basic nutrients your body needs. It’s basically a tube feeding formula that you drink and has the nutrients to keep you alive. The nutrients are in a predigested form so they can be easily absorbed into the bloodstream, allowing the gut to heal while the bacteria die off. Elemental diet is most often used for treating Crohn’s disease, but some studies have shown that a short-term elemental diet can be very effective for treating SIBO.
I did an Elemental Diet while also taking herbal antibiotics for SIBO. The experience was not at all pleasant but, in my case, it definitely helped kill off the bacteria so I think it was worth it.
Option 5: Cedars-Sinai Diet for Preventing SIBO
The other diets mentioned above are used for treating SIBO. By contrast, the Cedar-Sinai Diet is designed to prevent SIBO. It was devised Dr. Mark Pimentel, Director of the Gastrointestinal Motility Program at Cedars-Sinai Medical Center.
The diet isn’t as strict as the ones listed above, but follows the same general principles: you’ve got to reduce foods which are hard to your body to digest so bacteria don’t end up using them as food. Pimentel’s diet also advises against frequent eating because this can affect the migrating motor complex which helps empty and clean the bowels.
Key Points of the Cedars-Sinai Diet:
The protocol also involves taking a prokinetic drug to improve motility and supplementing with Hydrochloric Acid, if deficient.
If you have any questions, feel free to contact Dr. Huntoon directly at 845-561-2225. He looks forward to serving you.
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Dr. Richard A. Huntoon