a guide to sibo

Written By Katie Carter

When I was a functional medicine patient, a doctor referred me to a local hospital for a breath test for SIBO (Small Intestinal Bacterial Overgrowth). “No way am I spending half a day in a hospital for this. It is definitely a scam,” I thought to myself.

Low and behold, a few years later, I was working at that practice. And watching the fax machine as test after test for SIBO came back positive. My estimate is that 90-95% of SIBO breath tests at that practice were positive. And it definitely seemed to coincide with patients who came in saying, “I can’t eat anything. Even water makes me bloat.” The fact is, SIBO is related to 60-70% of IBS cases.

So what is SIBO? Small Intestinal Bacterial Overgrowth (SIBO) is the overgrowth of bacteria and/or archaea in the small intestine that impairs structure and function of the small intestine and results in symptoms. It is an issue difficult to eradicate, and it tends to recur frequently. Types of SIBO include methane, hydrogen and hydrogen sulfide. Hydrogen is the most common type, and is often associated with diarrhea and bloating; methane often coincides with constipation; hydrogen sulfide may include diarrhea and gas/breath smelling of rotten eggs. About 60-70% of IBS cases are related to SIBO. There are many possible causes of SIBO, but the most common include low stomach acid, constipation, fat malabsorption and medications such as proton pump inhibitors.

SYMPTOMS OF SIBO:

  • Bloating

  • Belching

  • Gas

  • Constipation

  • Diarrhea

  • Brain fog

  • Anxiety and depression

  • Malabsorption

  • Heartburn

  • Joint pain

HOW SIBO IS DIAGNOSED:

The SIBO breath test is the most commonly utilized test, and is a non-invasive alternative to the gold standard of small intestinal (duodenal) aspiration. Bacteria and archaea in the gastrointestinal tract ferment carbohydrates and produce hydrogen, methane, and hydrogen sulfide gases. These gases diffuse into the bloodstream from the digestive tract and are exhaled through the lungs. SIBO breath tests take advantage of these bacterial digestive byproducts to help identify SIBO. The breath test is offered in the digestive health departments of some hospitals, but the most common way to complete this test is at home. Options include the SIBO Breath Test (Genova Diagnostics, $225) or the Trio-Smart Sibo Breath Test (Gemelli Biotech, $349). 

A comprehensive stool test cannot diagnose SIBO or IMO, but it can offer insight into potential underlying factors predisposing the patient to overgrowth. Large intestinal overgrowth of SIBO-associated bacteria, digestive enzyme deficiencies, and decreased immune function within the large intestine can contribute to SIBO and IMO development. Options for these include the GI Map Test (Diagnostic Solutions $311) or the GI Effects Comprehensive Stool Test (Genova Diagnostics $339).

TREATMENTS TO ELIMINATE SIBO:

SIBO is a stubborn condition that may take several rounds of treatments to eradicate, and will require constant vigilance to keep it at bay. Typically, doctors will start with a prescription antibiotic, and advise long-term rotation of herbs and probiotics to keep SIBO from recurring.

Antibiotics:

  • Rifaxamin 

  • Doxycycline 

  • Metronidazole

  • Tetracycline

  • Amoxicillin

  • Bactrim

  • Cephalexin

  • Ciproflaxin

  • Neomycin

  • Norfloxacin

AND/OR

Herbs:

  • Berberine

  • Oregano

  • Caprylic Acid

  • Neem

  • Olive Leaf

Examples of combination herbal products:

  • Candi-Bactin BR and/or AR

  • GI Synergy

  • Monolaurin

  • Atrantil

  • Biocidin HPF

  • Intenstinin-ol

  • FC Cidal

  • Yeastinol

  • Candida Control

The typical herbal treatment is two capsules twice a day, starting with one and building up to the full dose. Once a bottle is complete, pause for a few weeks and begin taking a different herb.

CAUTION: It is not uncommon to initially feel worse during the first week or two of treatment.

WITH/FOLLOWED UP BY:

PROBIOTICS are important to keeping the good bacteria plentiful. It is a good idea to rotate different types as having diverse strains is beneficial. Take 1-2 capsules of a quality probiotic daily.


TREATMENT OF SYMPTOMS: 

Pain is usually caused by smooth muscle contraction against gas accumulated in the intestines. Muscle relaxants and anti-spasmotics help, as does anything that moves gas out.

OPTIONS FOR PAIN:

  • Peppermint oil: can help with multiple GI issues with symptom reduction over four weeks.

  • Activated Charcoal: decreases gas, but may take a few hours to do so. Take away from meals and medications. Suggested dose is 1000 mg. 30 minutes before the meal, then repeat one hour later for the best effect. Or it can be taken as needed. It can worsen constipation. 

  • Simethicone (Gas X): breaks gas into smaller bubbles, which helps with position. Works within 30-60 minutes.

  • Simethicone and charcoal can work together, with simethicone breaking gas into smaller bubbles and charcoal absorbing it. 

OPTIONS FOR BLOATING:

  • Charcoal reduces breath hydrogen levels and symptoms of bloating. Take away from medications and supplements, or 30 minutes before and one hour after a meal.

  • Prokinetics move gas out of the GI tract. Options include fennel, ginger or bitter orange.

OPTIONS FOR CONSTIPATION:

Types of Laxatives:

Osmotic:

  • Miralax

  • Saline

  • Magnesium (oxide, glycinate or citrate 500-2000 mg away from food. 1000 mg. is a typical dose. Magnesium hydroxide is stronger.)

  • High dose vitamin C

Stimulant:

  • Senna, aloe, rhubarb

  • Dulcolax

  • Glycerin suppository

  • Castor oil

Bulking:

  • Fiber (i.e. psyllium husk, Metamucil)

OPTIONS FOR DIARRHEA:

  • Charcoal: helps absorb fluid. 2-4 capsules every 1-3 hours(up to 4 g/day)

  • Pepto Bismol: Absorbs fluids, works within 30-60 minutes

  • Imodium: Slows transit and contractions, works within 60 minutes

The key to SIBO treatment is to be persistent and vigilant. Ideally, you can determine what led to the bacterial overgrowth to begin with (i.e. constipation) and address it. But once you have SIBO, you are prone to getting it back if you do not stay on top of it. A rotation of herbs, probiotics, and just generally staying on top of gut health will help.

*All information in this article is based on research but is for informational purposes only. See your medical professional before using any medications and/or herbs to make sure they are safe for you.

Katie Carter
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