How to fix SIBO & Prevent Recurrence

Summary

Norm Rebelad, founder of the Digestive Health Institute, discusses Small Intestinal Bacterial Overgrowth (SIBO) and effective strategies for addressing it. He covers SIBO's causes, symptoms, and the role of gut bacteria in nutrient malabsorption. Diagnostic methods like breath tests and treatment options, including antibiotics, herbal remedies, probiotics, and diet changes, are explained. Rebelad emphasizes the importance of addressing the underlying causes of SIBO, limiting fermentable carbohydrates, and adopting pro-digestion habits to prevent recurrence. He also suggests the Fast Track Diet for managing symptoms and restoring gut health.

Takeaways

• 🔍 SIBO (Small Intestinal Bacterial Overgrowth) is a form of dysbiosis where bacteria overgrow in the small intestine, causing digestive issues and nutrient malabsorption.
• 📜 SIBO was first described in 1949 by Fraser as fecal bacteria colonizing the small intestine, competing with the host for nutrients.
• 🦠 Research identifies several bacteria linked to SIBO, including E. coli, Klebsiella, and other native and migratory strains, with some studies indicating a loss of microbial diversity may contribute to symptoms.
• 💡 Common symptoms of SIBO include bloating, gas, abdominal pain, diarrhea, constipation, fatigue, and more severe cases may involve weight loss and nutrient deficiencies.
• 🔬 Diagnosing SIBO is primarily done through breath testing (hydrogen, methane, and hydrogen sulfide) or bacterial culturing, though both methods have limitations.
• 💊 Antibiotics like rifaximin and neomycin are common treatments, but they often only provide temporary relief and do not address the root causes of SIBO.
• 🌿 Herbal antimicrobials and probiotics are alternative treatments, with some studies showing that certain probiotics and herbs can be as effective as antibiotics in managing SIBO.
• 🍽️ Diet plays a crucial role in managing SIBO, especially by limiting fermentable carbohydrates (lactose, fructose, resistant starch, etc.) to reduce bacterial fuel and alleviate symptoms.
• 🔄 Long-term treatment for SIBO should focus on identifying and addressing underlying causes such as low stomach acid, motility issues, or enzyme deficiencies to prevent recurrence.
• 📚 Further information and personalized guidance on SIBO management can be found in resources like the Fast Track Diet books, app, and consultation services.

Q & A

What is SIBO (Small Intestinal Bacterial Overgrowth)?

SIBO is a condition where there is an overgrowth of bacteria in the small intestine, typically involving the native gut microbiota rather than an invading pathogen. These bacteria can disrupt digestion and cause symptoms such as gas, bloating, and malabsorption.

What are the main bacterial strains involved in SIBO?

Common bacterial strains found in SIBO include E. coli, Klebsiella, Streptococcus, Lactobacillus, Bacteroides, Clostridia, and Methanobrevibacter smithii, among others. Research is still determining the most prominent strains.

What are some common symptoms of SIBO?

SIBO symptoms include gas, bloating, abdominal pain, diarrhea, constipation (often linked to methanogen overgrowth), acid reflux, fatigue, brain fog, and skin issues. More severe symptoms can include malabsorption, weight loss, and nutrient deficiencies.

What is the relationship between SIBO and other health conditions?

SIBO is linked to numerous health conditions including IBS, GERD, Crohn’s disease, diabetes, fibromyalgia, chronic fatigue syndrome, asthma, and autoimmune diseases such as celiac disease and Hashimoto’s thyroiditis.

How is SIBO diagnosed?

SIBO is typically diagnosed through breath testing or culturing bacteria from the small intestine. Breath tests measure gases like hydrogen, methane, and hydrogen sulfide, which are produced by bacterial fermentation of carbohydrates in the small intestine.

What are the challenges with current SIBO breath testing methods?

Breath testing can have limitations such as false positives, particularly with rapid intestinal transit times, and difficulties detecting SIBO in the lower part of the small intestine with glucose-based tests.

What treatment options are available for SIBO?

Treatment options include antibiotics like rifaximin and neomycin, herbal antimicrobials, probiotics, dietary changes, and supplements aimed at improving digestion and nutrient absorption. However, antibiotics may not prevent recurrence without addressing underlying causes.

Are antibiotics effective in treating SIBO?

Antibiotics can reduce bacterial overgrowth and improve symptoms in some cases, but they don't address underlying causes, making relapse common. Rifaximin, while relatively safe, has a high relapse rate, and other antibiotics can pose risks such as bacterial resistance.

What role do diet and dietary behaviors play in treating SIBO?

Diet is crucial in managing SIBO. Limiting fermentable carbohydrates (such as lactose, fructose, and resistant starch) can help reduce bacterial overgrowth and symptoms. In addition, behaviors like eating slowly and chewing well also support digestion.

What are some recommended dietary supplements for SIBO?

Supplements like multivitamins, digestive enzymes, betaine HCL, L-glutamine, zinc, and NAC may be beneficial for nutrient absorption, digestion, and mucosal support. However, over-supplementation can cause complications, so careful use is advised.