Treating Small Intestinal Bacterial Overgrowth

SIBO is the overgrowth or imbalance of bacteria in the small intestine (Small Intestinal Bacterial Overgrowth).

It’s a common cause of digestive issues and IBS and can be responsible for symptoms such as

• Bloating
• Altered toilet habits (constipation or diarrhoea or a mixture of the two)
• Belching and flatulence
• Abdominal pain or discomfort
• Malnutrition
• Food intolerances
• Leaky gut
• Brain fog

Treating SIBO commonly leads to an improvement in symptoms like these.

I’ve covered the underlying causes of SIBO previously in a blog post, but I wanted to give you more of an idea of what treatment looks like. This is a simplified version of what treatment may look like (it usually takes around 4 months):

Testing for SIBO
It helps guide treatment to know what is going on in your gut, and a breath test is the best tool we have available to test for SIBO.

To perform a breath test, you drink a provided sugar solution which will stimulate bacterial growth in the small intestine if there is an overgrowth of bacteria. These bacteria produce Hydrogen and Methane gases which we measure by exhalation into a collection device at regular time intervals over a 3 hr period. By measuring when we see a spike in these gases, we can find out how far along the small intestine the bacteria are, and the type of microbes that are producing the gases. All of this, helps me guide treatment!

TEATMENT: Phase 1 – Reduce and Repair
Whilst we are waiting for the SIBO test results, we start the first phase of treatment, known as ‘Reduce and Repair’. Here, we are reducing the bacterial overgrowth and your annoying symptoms diet and also repairing the gut and supporting digestion (which I won’t cover in detail here, sorry).

For most people we use the Bi-Phasic Diet as developed by Dr Nirala Jacobi. At its foundation, this diet reduces certain types of natural sugars in your diet which feed the bacteria in your small intestine, which produce the gas and disturb you digestion and can cause bloating. This diet decreases symptoms by reducing (but not eliminating) the bacterial overgrowth.

However for some people, this diet may be too restrictive for their wellbeing, for these people there are alternatives that still allow us treat SIBO so please don’t worry that a restrictive diet is your only option! We will always meet you where you are at..

At the same time we may use herbs, supplements, or foods to repair and quieten any inflammation in the gut. We also support digestion so that you are producing the stomach acid and digestive enzymes needed to digest your food well. The Bi-Phasic diet is helpful in reducing symptoms and discomfort, but it doesn’t clear SIBO itself. For that we need to tend to use specific anti-microbial herbs..

TEATMENT: Phase 2 – Remove
There are several strategies we can use to Remove the bacterial overgrowth, with anti-microbial herbs being the most common in our practice.

During this phase, your diet is loosened up a bit, and we use herbs specific to your type (hydrogen or methane) of SIBO as identified in your breath test. Each round of herbs lasts 4 to 6 weeks and you may need one round or more depending on your case.

An alternative approach makes use of specific antibiotics for SIBO, although anti-biotics have the disadvantage of not treating any fungal overgrowth (such as Candida) which is commonly found with SIBO. In fact, they can make a fungal overgrowth worse as the antibiotics reduce bacteria in the small intestine, allowing fungi to multiply and take over. Herbs reduce both a fungal and bacterial overgrowth,

TEATMENT: Phase 3 – Onwards
Once the SIBO is clear, and we have worked on the underlying cause of your SIBO, we will use diet, supplements and lifestyle to repair any leaky gut and support a healthy balance of bacteria in your gut. By now, you should enjoying most foods again and eating a diverse and nutritious diet.