What is SIBO, how do you get tested, and how do you treat it? What’s the best diet for SIBO? Get answers to all these and more, plus how to book an appointment for one on one help from a registered dietitian.
Note from Dena: I’m excited to share this guest post on such an important topic. It was written by Marla Ramos, Dietetic Intern, as part of a new research partnership between Back To The Book Nutrition and post-graduate nutrition students from the University of Houston.
Bloating. Gas. Abdominal pain. Belching. Diarrhea. Constipation.
We all suffer from these from time to time, but if you’re one of many people who are experiencing one or more of these symptoms on a weekly – or even daily – basis, you may have SIBO. In fact, if you’ve been diagnosed with Irritable Bowel Syndrome (IBS), you’re almost guaranteed to have SIBO (Source).
What is SIBO?
SIBO stands for Small Intestinal Bacterial Overgrowth, and it can occur when either too many or the wrong type of bacteria multiply in the small intestine. In fact, an official medical diagnosis of SIBO defines it as an infection where 1,000 times more bacteria than normal are present in the small intestine. (Source)
What Causes SIBO?
The root causes of SIBO are still being understood, but it seems as though risk factors are similar to those for other gut disorders.
Contributors to SIBO
- Poor immune function
- Insufficient stomach acid
- Dysmotility (slowed passage of digested food through the small intestines). (Source)
These factors can lead to an overgrowth of bacteria in the small intestine in one of two ways:
- Small intestinal bacteria “feed” on food matter that doesn’t move through the small intestine as quickly as it should, allowing the bacteria to proliferate.
- Bacteria from the large intestine travel to the small intestine and proliferate (more common than #1).
This may not sound like a big deal. But it can wreak havoc on the GI system and, if it isn’t treated, can lead to other health complications.
Health Complications Related to SIBO
- Osteoporosis (due to vitamin D deficiency)
- Neuropathy (due to vitamin E deficiency)
- Night blindness (due to vitamin A deficiency)
- Anemia (due to iron and vitamin B12 deficiency)
- Weight loss (due to malabsorption)
- Irritable Bowel Syndrome (78% have SIBO)
- Rosacea (46% have SIBO)
- Fibromyalgia (100% have SIBO)
- Obesity (41% have SIBO)
How Do I Know if I Have SIBO?
If you have any of the following symptoms and are not getting better with treatment or diet changes, consider testing for SIBO.
- Excessive Gas
- Abdominal Pain
- Excessive Belching
How to Test for SIBO
Currently, there is no perfect test for SIBO. Scientists are hard at work exploring new methods of testing. Until then, the most common methods of testing for SIBO measure levels of methane and hydrogen in the breath after drinking a liquid solution of either lactulose or glucose.
These tests are simple, can be ordered online, and can sometimes be performed in your own home.
- 3-hour Lactulose breath test – at-home or in-office test, must be ordered by a doctor, dietitian, or other licensed practitioner
- Glucose breath test – at-home or in-office test, can be ordered by patient, but less accurate than lactulose test
- Stool testing using PCR (DNA) technology – at home stool test to identify common SIBO organisms as well as other pathogens, overgrowths, yeasts/fungi, and markers for leaky gut and glucose intolerance (Note from Dena: this is my preferred test since it gives a much more comprehensive look at what’s going on in the gut)
Note from Dena:
If you don’t already have a practitioner who can order these tests and discuss the results with you, I’d be happy to help! Contact me here for details and pricing.
SIBO Test Results – Methane vs. Hydrogen Dominance
This can get a little technical, but not all SIBO is the same – it can be divided into two main categories, depending on breath test results:
- Methane-Predominant SIBO – Caused by bacteria that produce primarily methane, giving rise to constipation, which is why this form is sometimes called SIBO-C.
- Hydrogren-Predominant SIBO – Caused by bacteria that produce hydrogen, which is associated with diarrhea or loose stools. Hence, this form is sometimes referred to as SIBO-D.
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I Have SIBO – How Do I Treat It?
There are a few different approaches to treating SIBO, and the latest research indicates that a combination of medical + nutritional therapies are most effective.
But here’s where it gets interesting.
According to Dr. Mark Pimentel, MD, Director of the Gut Motility Program at Cedar-Sinai Medical Center and leading expert in SIBO, well-fed bacteria are easier to kill with antibiotics (both conventional and natural) than those that have first undergone a period of diet changes.
Because of this, it’s recommended to treat a SIBO infection with medical therapies before making restrictive diet changes. The entire process of medical + nutritional therapy can take 6-12 months. (Source) It’s important to consult with qualified providers about which of the following medical treatments and dietary approaches might be best for you.
Conventional Medical Treatments for SIBO:
Antibiotics, two in particular, have shown to have great results in the treatment of SIBO.
- Rifaximin (brand name Xifaxan) for Hydrogen-predominant SIBO (Source)
- Rifaximin + Neomycin combination for Methane-predominant SIBO (Source)
Prokinetic agents (such as Metoclopramide) are often given alongside antibiotics to help move things through the gut more quickly and reduce risk of feeding the bacteria.
Natural Medical Therapies for SIBO:
If you prefer not to take prescription antibiotics, a recent study showed herbal therapies may work just as well, and usually with fewer side effects.
- Olive leaf
- Cat’s Claw
- Atrantil (blend of several botanicals) – Works best on methane-predominant SIBO.
Neurological Therapy for SIBO:
Functional neurologist Dr. Datis Kharrazian suggests that many individuals with SIBO have a problem with their brain-to-gut connection, which allows the overgrowth to occur in the first place. He maintains that many of his patients with SIBO benefit from simple, at home therapies (such as aggressive gargling, inducing a gag reflex, etc.) that can be done several times daily to re-train the brain-to-gut connection. These therapies essentially repair the motility problem for which conventional doctors might prescribe prokinetics. Here is an excellent interview with Dr. Kharrazian in which he discusses a number of gut-brain issues. The entire hour-long interview is fascinating but, if you want to skip straight to the at home therapies and discussion of SIBO, they’re around minute 12 and 18, respectively.
Best Diet for SIBO:
There are several different diets recommended for the treatment of SIBO. Each of these uses similar principles and show success relieving symptoms. But, such restrictive diets can be difficult to maintain, and it’s best to work with a registered dietitian to help determine which one is best for you, and to help you make personalized adjustments along the way to help you get the best results. (Sources: 1, 2)
But remember, it is not recommended that you start any of these diets until after medical treatment.
- Low FODMAPs Diet
- Specific Carbohydrate Diet (SCD)
- Gut and Psychology Syndrome Diet (GAPS)
- SIBO Specific Diet
- Elemental Diet
- Cedars-Sinai Diet (Less restrictive and developed by Dr. Pimentel, the pioneer of the SIBO-IBS connection)
Will My SIBO Come Back?
Unfortunately, our understanding of SIBO and how to effectively treat it is still evolving. Even with effective treatment, SIBO has a recurrence rate of 44%. (Source)
To reduce the risk of recurrence, it’s important to treat the underlying causes listed above, such as inflammation, poor immune function, insufficient stomach acid, and dysmotility.
Steps to Reduce Risk of SIBO Recurrence
- Eat a nutrient dense, SIBO-preventive diet, such Pimentel’s SIBO Diet or another diet listed above.
- Minimize intake of inflammatory foods like processed vegetable oils, refined foods, and added sugars.
- Manage stress.
- Get adequate sleep.
- Exercise regularly, but not excessively.
- Avoid unnecessary antibiotics and other medications that disrupt gut flora.
Get Help with SIBO Today!
Need help getting to the bottom of your SIBO, GI complaints, or other nutrition-related concerns? I (Dena) am currently booking client appointments – times are flexible and we can meet via phone or video call so you never even have to leave home!
About the author: Marla Ramos is a Dietetic Intern, with a B.S. in Human Nutrition and Foods from the University of Houston. She has a particular interest in gut health due to her own personal experience with Crohn’s Disease.
Disclaimer: Information on this site is intended only for informational purposes and is not a substitute for medical advice. Always consult with a trusted healthcare provider before implementing significant dietary change. Read additional disclaimer info here.