Last week, I shared my experience with IBS and SIBO and typical symptoms to help you identify if your gut health is off.

This week, I want to talk about recovery from SIBO, or Small Intestinal Bacteria Overgrowth, which causes about 60% of IBS, or Irritable Bowel Syndrome. Let’s dive in!

TESTING FOR SIBO

You can learn if you have SIBO through a breath test, which is what I’ve done.

The test collects traces of methane and hydrogen within the breath. You start by fasting the night before and taking a lactose solution the next day. Over three hours, you collect your breath through a tube every 20 minutes. The test will reveal how much gas is being emitted from bacteria, from your small intestine to your colon. If you have a high amount of hydrogen or methane during the first 80-120 minutes of testing, you’re positive for SIBO.

When I took my first test, I had a methane baseline over 12, and it would go up to 30, peaking in my large intestine. So, I had methane-dominant SIBO.

SIBO TREATMENT OPTIONS

If your SIBO test comes back positive, there are several ways you can treat it, including through:

• Basic diet
• Antibiotics
• Herbal antimicrobials
• The elemental diet
• Prokinetics

A combination of these remedies are needed for the best results.

BASIC DIET TREATMENT

The overarching diet tip for SIBO symptoms is to avoid raw foods, salads and beans. You must also be careful with whole grains, nuts, seeds and winter squash, which depending on portion size, are highly fermentable by the bacteria in the small intestine. How fermentable a food is relates to how severe your SIBO symptoms will be.

So, a more common approach by most doctors is to focus on eating low-fermentable fruits and veggies and eliminating high-fiber foods, this is called the low-FODMAP diet. There are a lot of resources out there now to help implement this diet, starting with Monash University’s FODMAP website is a good start. Keep in mind, dietary success differ from one person to the next. Specific diets are useful general guidelines to follow, but it’s all about experimentation.

ANTIBIOTIC TREATMENT

Many people think they can control SIBO symptoms through diet alone, but your body’s reaction can change often. So, it’s essential to consider the other ways to eliminate SIBO and prevent it from returning.

Rifaximin is a common antibiotic used to treat SIBO, especially for people with IBS and diarrhea. For constipation-dominate cases, you might pair the antibiotic with neomycin and metronidazole.

After two weeks of antibiotics, you should redo the SIBO breath test. SIBO is tricky to get rid of, so you might have to do two to three rounds of treatment.

HERBAL ANTIMICROBIAL TREATMENT

If using pharmaceuticals is not your thing, you can also treat SIBO with herbs.

Berberine, oregano and neem are great in combination for diarrhea-prominent cases. Allicin is well researched for treating constipation dominant SIBO.

You need to take herbal antimicrobials longer than antibiotics—about one month to six weeks. Most need to do multiple rounds to feel lasting results.

Naturopaths are the most skilled in prescribing these types of treatments because they are very individualized.

THE ELEMENTAL DIET

Another, more intense, treatment option is the elemental diet.

An elemental diet requires you to 100% fast for at least 14 days, and drink a meal replacement supplement instead.

Physicians’ Elemental Diet from Integrative Therapeutics is my go-to.

Once the drink goes into the small intestine, it gets totally absorbed. This two-week process starves the bacteria living in the small intestine, as well as giving your bowels a rest from working, allowing it to repair.

Be aware that this restrictive process may result in irritability and headaches in the beginning. You can drink watered-down coffee while on the elemental diet, but resist consuming anything else. If done correctly, this diet works wonders in eradicating symptoms, with an 80% success rate with just one treatment.

PROKINETICS FOR PROACTIVE HEALTH

Once you’ve completed your rounds of treatment and taken another breath test to show your SIBO is under control, you’ll want to start prokinetics.

This process helps an impaired MMC, the Migrating Motor Complex I discussed last week. If your MMC isn’t working correctly, taking an oral component will help, so bacteria do not overgrow again.

Common prokinetics include low dose erythromycin (LDE), prucalopride (Motegrity), and low dose naltrexone (LDN). The last one is especially beneficial for those with autoimmune conditions!

Herbal prokinetics include Iberogast and MotilPro. I have taken both types of prokinetics, which worked similarly in my case.

This prevention phase is the most important because it proactively treats the root cause of SIBO-related gut issues.

FINAL THOUGHTS ON GUT HEALTH

I won’t sugar-coat it: Gut rebalancing is a beast. We develop bodily imbalances over our lifetime, and there is a lot of underlying gut work that needs to be done to treat SIBO, in most cases. But, one common reason why the uncomfortable symptoms bounce back is that people are not invested in the recovery process for the long haul.

I urge you to be kind to your body and take the time to focus on healing it. That includes managing stress as an underlying cause, which wreaks havoc on your digestive tract. For tips on how to reduce stress and get better sleep in the process, click here.

Want a customized plan to solve the bloat and gas for good? Book an in-person or virtual appointment with me here.

HOW TO TREAT POOR DIGESTION'

If you suspect you have poor digestion, there are diet and lifestyle modifications you can make to improve it, including:

• Eat real, whole foods
• Eliminate common food allergens/sensitivities from the diet.
• Do a 30-day elimination diet. (Whole 30 and AIP are great options!)
• Fill your plate with plenty of fiber.
• Choose only organic produce and organic, pasture-raised meats, with no antibiotics or hormones.
• Consume bone broth and fermented foods like sauerkraut daily.
• Take antibiotics only when absolutely necessary.
• Find ways to reduce or better manage stress.

PROFESSIONAL HELP AND TESTING

If you want assistance investigating your gut health, the best option is a naturopathic doctor or functional medicine practitioner who is trained to investigate the gut from a function perspective. Some types of nutritionists can also do lab testing and interpretation.

I recommend taking a stool test, since this provides the most comprehensive look at digestive function. GI-MAP and CDSA are great options. Stool testing will evaluate for pathogens and infections, levels of good bacteria, digestive enzyme secretion, immune activation in the gut, inflammation, and bleeding in the digestive tract.

A SIBO breath test may also be helpful for those experiencing IBS-like symptoms. You can learn more about SIBO and IBS and how to evaluate for it here.

Lastly, food sensitivity testing is great to determine which foods may be causing digestive issues and immune system activation in the body. This helps tailor a specific diet to the person that removes trigger foods.

Ready to explore your digestive health? I am here to help! You can order each of the testing options from me and schedule an appointment here to review your results, or book an appointment so we can explore your symptoms together and develop a plan of action.