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.

Outlines

00:00

💡 Introduction to SIBO and Its Importance

In this introductory paragraph, Norm Robillard, founder of the Digestive Health Institute, introduces the topic of SIBO (Small Intestinal Bacterial Overgrowth). He emphasizes the ongoing research on SIBO diagnostics and treatment and explains how SIBO is a form of dysbiosis where bacteria overgrow in the small intestine, causing nutrient competition and damage to the host. Several bacteria species involved in SIBO, such as E. coli and Klebsiella, are mentioned, along with the theory that loss of bacterial diversity may contribute to symptoms.

05:01

🧬 Current Understanding of SIBO Diagnosis

This paragraph discusses two main methods for diagnosing SIBO: breath testing and bacterial culturing, although neither is perfect. Breath tests, especially lactulose-based ones, are common as they detect gases like hydrogen and methane, indicating bacterial fermentation in the gut. Glucose-based tests, while specific, are less effective for diagnosing SIBO in the lower intestine. Hydrogen and methane production in SIBO is associated with symptoms like diarrhea and constipation, while a newer test, TRIOSMART, includes hydrogen sulfide as another gas linked to inflammation and mucosal damage.

10:04

💊 Antibiotic and Herbal Treatments for SIBO

Antibiotics such as rifaximin and neomycin are the most common treatments for SIBO, targeting hydrogen-producing and methane-producing bacteria, respectively. However, antibiotics often do not address underlying causes, leading to recurrence. Resistance and tolerance to antibiotics are also common, and studies show high relapse rates. Herbal antimicrobials, while promising, lack strong evidence in human trials, and the limited studies that exist suggest they may be as effective as antibiotics in some cases.

15:05

🦠 Probiotics and Their Role in SIBO Treatment

Probiotics are controversial in SIBO treatment due to the question of adding more bacteria to an already overgrown small intestine. However, studies suggest some probiotic strains may be helpful in treating SIBO. Examples include combinations of bifidobacteria and lactobacilli, which have shown significant success in clinical trials. Some probiotics also reduce methane levels and improve bowel movements in patients with methanogen overgrowth. Still, probiotics can cause initial symptoms like bloating and loose stools, so they should be introduced cautiously.

20:07

🍽️ Dietary Supplements and Considerations for SIBO

Various dietary supplements can assist with SIBO treatment, including multivitamins, digestive enzymes, and mucosal support agents. Supplements such as L-glutamine and N-acetyl cysteine may help restore the intestinal lining, while others improve digestion and reduce fermentable carbohydrate intake. However, it's important to be cautious of over-supplementation, which can cause toxicity, interact with medications, or fuel bacterial overgrowth. Long-term use of supplements lacks sufficient research, so short-term and carefully managed use is recommended.

🥗 Diet as a Key Component in SIBO Management

Diet plays a crucial role in SIBO management, specifically limiting fermentable carbohydrates like lactose, fructose, and fiber that feed overgrowing bacteria. The Fast Track Diet system developed by Norm Robillard is highlighted for its effectiveness in reducing symptoms by controlling carb intake. Robillard explains that carbohydrate intolerance, a form of malabsorption, contributes to SIBO and its associated conditions. Limiting certain carbs can restore gut pH balance, reduce gas production, and improve overall digestive health, making diet a vital part of SIBO treatment.

Keywords

💡SIBO (Small Intestinal Bacterial Overgrowth)

SIBO refers to a condition where there is an excessive growth of bacteria in the small intestine, which can interfere with digestion and nutrient absorption. The video discusses its symptoms, causes, diagnosis, and treatment. SIBO is associated with several digestive disorders and systemic conditions, making its proper diagnosis and management crucial. The script highlights that SIBO involves an overgrowth of bacteria native to the gut rather than an invasion by pathogens.

💡Dysbiosis

Dysbiosis is an imbalance in the microbial communities within the body, particularly in the gut. In the context of SIBO, it refers to the abnormal proliferation of bacteria in the small intestine, which disrupts the natural balance of gut flora. The video explains that SIBO is a form of dysbiosis characterized by an overgrowth of native gut bacteria, leading to various digestive and systemic symptoms.

💡Breath Testing

Breath testing is a non-invasive diagnostic method used to detect SIBO by measuring gases produced by bacteria in the small intestine. The video describes two main types of breath tests: one using lactulose and the other using glucose. It highlights the limitations of these tests, such as false positives due to rapid transit time or inability to detect lower intestinal overgrowth with glucose.

💡Antibiotic Treatment

Antibiotic treatment is a common approach to managing SIBO, aiming to reduce bacterial overgrowth. The video mentions rifaximin and a combination of rifaximin and neomycin as the primary antibiotics used. However, it also points out the limitations, such as the risk of recurrence, bacterial resistance, and the inability of antibiotics to address underlying causes of SIBO.

💡Dietary Management

Dietary management involves adjusting the diet to limit specific carbohydrates that fuel bacterial overgrowth in SIBO patients. The video discusses various diet strategies, including the Fast Track Diet, which restricts fermentable carbohydrates like lactose, fructose, and resistant starch. This approach helps manage symptoms and prevents recurrence by reducing the bacteria's food supply.

💡Leaky Gut

Leaky gut, or increased intestinal permeability, occurs when the lining of the small intestine becomes damaged, allowing undigested food particles, toxins, and bacteria to enter the bloodstream. The video links leaky gut to SIBO, noting that the overgrowth of bacteria can damage the mucosal surface, leading to systemic immune responses and potentially contributing to autoimmune diseases.

💡Methanogen Overgrowth (IMO)

Intestinal Methanogen Overgrowth (IMO) is a type of dysbiosis where archaea, such as Methanobrevibacter smithii, overproduce methane in the gut. This condition is often associated with constipation, contrasting with hydrogen-producing bacteria, which are more linked to diarrhea. The video distinguishes between SIBO and IMO, noting that both need different diagnostic and treatment approaches.

💡Underlying Causes

Addressing underlying causes is essential for the effective treatment of SIBO. The video emphasizes that without identifying and managing the root issues—such as motility disorders, low stomach acid, pancreatic insufficiency, or anatomical abnormalities—SIBO is likely to recur. This comprehensive approach is critical for long-term symptom resolution and prevention.

💡Probiotics

Probiotics are live beneficial bacteria that, when taken in adequate amounts, can help restore gut balance. The video discusses their controversial use in SIBO treatment, as adding more bacteria to an already overgrown environment seems counterintuitive. However, certain probiotics have shown potential in managing SIBO symptoms and even eradicating the condition in some studies.

💡Elemental Diet

The elemental diet is a treatment approach that involves consuming a liquid diet composed of pre-digested nutrients. This diet is designed to eliminate complex carbohydrates and reduce bacterial food sources, effectively starving the bacteria causing SIBO. The video mentions its effectiveness in resolving SIBO, particularly in cases where other treatments have failed.

Highlights

SIBO (Small Intestinal Bacterial Overgrowth) is a form of dysbiosis where native gut microbiota overgrow in the small intestine.

SIBO is linked to various health conditions, including IBS, GERD, obesity, diabetes, fibromyalgia, and autoimmune diseases like Hashimoto's and Celiac disease.

The symptoms of SIBO include gas, bloating, abdominal pain, acid reflux, diarrhea, constipation, brain fog, and fatigue.

The primary diagnostic methods for SIBO are breath testing and bacterial culture from the small intestine, with breath testing being the most common.

SIBO breath tests measure gases like hydrogen, methane, and hydrogen sulfide, produced by fermenting sugars and carbohydrates in the small intestine.

Antibiotics like rifaximin and neomycin are commonly prescribed to treat SIBO, though recurrence is common if the underlying causes are not addressed.

Herbal antimicrobials, such as oregano oil and berberine, are sometimes used for SIBO, though more research is needed to confirm their effectiveness.

Probiotics, though controversial, may help in treating SIBO. Studies have shown some probiotics resolving SIBO in specific patient groups.

Dietary strategies play a crucial role in managing SIBO, with the Fast Track Diet emphasizing limiting fermentable carbohydrates like lactose, fructose, and resistant starch.

Carbohydrate intolerance, a form of malabsorption, can contribute to SIBO by providing excess fuel for bacterial overgrowth.

Other treatments for SIBO include digestive enzymes, betaine HCL, and mucosal lining support supplements such as L-glutamine and zinc.

The elemental diet, which eliminates complex carbohydrates, is an effective treatment for SIBO in some cases.

Addressing the underlying causes of SIBO, such as low stomach acid, pancreatic insufficiency, and bile acid issues, is key to preventing recurrence.

Behavioral factors, such as meal timing, food preparation, and slow eating, are important for improving digestion and absorption in SIBO management.

Relapse rates for SIBO after antibiotic treatment can be high, with one study showing 64% of patients requiring retreatment.

Transcripts

hi I'm Norm rebelad founder of the

Digestive Health Institute and creator

of the fast track diet

today's topic is sibo small intestinal

bacterial overgrowth and how to address

it effectively to prevent recurrence

sibo is a complex topic and research is

ongoing for improving both Diagnostics

and treatment

let's talk about what we know so far

what is sibo

back in 1949 a researcher named Fraser

described sibo as fecal bacteria

colonizing the small intestine and

competing with the host for essential

nutrients and perhaps winning

he was an expert in nutritional

malabsorption

and his description is still relevant

today

sibo is a form of dysbiosis involving an

overgrowth of our native gut microbiota

as opposed to an invading pathogen

culture Studies have identified several

different bacterial species some

negative some native to the small

intestine and some migrating from the

lodge bowel into the small intestine and

there's a wide variety of these strains

they include strep E coli klebsiella

Proteus staff micrococcus lactobacillus

bacteroides clostridia villanella

fusobacterium and peptosreptococcus

new research is trying to determine the

most prominent bacterial strains in sibo

for instance the Pimentel lab reported

that E coli aromonas and klebsiella

species predominant a predominant on the

other hand a group of genomics

researchers sephorian colleagues

suggested that it's actually a loss of

diversity in the small intestine that's

more important for symptoms than sibo

itself now one limitation of that study

potentially skewing their findings

Placebo is that they included patients

with other diagnoses such as celiac

disease colitis pancreatic insufficiency

and even patients that underwent GI

surgery

regardless the current prevailing view

is that sibo sufferers have too many

bacteria where they don't belong these

bacteria produce proteases enzymes gases

and other end products causing symptoms

but also damaging the mucosal surface

and villain

this damage can impact the ability to

digest and absorb nutrients minerals and

vitamins the result is poor digestion

which shunts nutrients to overgrowing

bacteria cause an officious cycle of

damage malabsorption and overgrowth in

the words of Elaine gotcha

sibo is linked to many digestive

disorders and also health issues

including IBS gerd obesity esophagitis

Crohn's diverticulitis non-alcoholic

fatty liver disease and cirrhosis

diabetes fibromyalgia chronic fatigue

syndrome asthma rosacea restless leg

syndrome interstell Interstitial

cystitis cystic fibrosis Parkinson

Parkinson's disease and heart disease

and also autoimmune conditions including

Celiac Hashimoto's and Scleroderma as

well as type 1 diabetes and this list

continues to grow

the exact number of sibo sufferers is

unknown but it's likely well over a

hundred million people in the U.S alone

given the number of conditions linked to

sibo

so what are the symptoms of sebum

sibo symptoms include gas bloating

distension flatulence abdominal pain

cramps acid reflux diarrhea nausea

dehydration fatigue brain fog and skin

conditions constipation is another

common symptom that often occurs in

concert with intestinal methanogen

overgrowth or IMO most notably involved

in the organism it's an Ikea methanol

brevibacter smithii

more severe symptoms of sibo may include

weight loss failure to thrive in

children

stiatorea which is fat malabsorption

anemia bleeding or bruising night

blindness bone pain and fractures as

well as leaky gut and autoimmune

reactions these symptoms are not a

complete surprise because sibo occurs in

the small intestine the mucosal surface

in the small intestine is sensitive to

damage that not only impacts digestion

but also impacts its barrier function

leaky gut allows undigested food

particles bacterial antigens and toxins

to enter systemic circulation

leaky gut coupled with something called

molecular mimicry is considered a

Hallmark of autoimmunity

now how to diagnose sibo

there are really only two methods at

this time one is breath testing and the

other is actually culturing bacteria

from the small intestine which is

considered the gold standard

but neither test is truly a gold

standard each method has drawbacks and

limitations

eventually better methods for sampling

the small intestine coupled with

Advanced genomic testing of the

bacterial populations present will prove

superior but when not there yet

so right now non-invasive breath testing

is the most common way of diagnosing

sibo

breath testing is based on the idea that

excess bacteria in the small intestine

can ferment sugars and other

carbohydrates and produce unique gases

these include hydrogen which can be

further metabolized into hydrogen

sulfide and methane in the case of

sulfate reducing bacteria and archaea

organisms respectively

these gases diffuse into the bloodstream

and they're exhaled through the lungs

you know these gases are coming from

your gut microbes because other than

tiny amounts of hydrogen sulfide none of

these gases is produced by humans

there's two types of breath testing that

have routinely used Placebo one uses the

sugar lactulose it's non-digestible but

fermentable the other uses glucose

another fermentable type of sugar

I recommend lactulose breath testing

even though it's less specific for sibo

with more false positives it's more

sensitive at detecting sibo throughout

the length of the small intestine

the problem with glucose is that it's

rapidly absorbed in the early part of

the small intestine so it can't detect

sibo in the lower part of the small

intestine very well

most breath tests measure two gases

hydrogen and methane hydrogen is linked

mostly to diarrhea while methane tends

that's produced by these Ikea tends to

be linked with constipation

the newest breath test called Trio smut

measures three gases hydrogen methane

and also hydrogen sulfide

hydrogen sulfide is a gas produced by

sulfate reducing bacteria and there's a

wide variety of these to sulfavibrio to

sulfobacter and desulfur bulbous but

also below Fila

pseudomonas citrobacter aeromonas and

several others

levels hydrogen sulfide is actually a

beneficial anti-inflammatory

gazotransmitter or signaling molecule

contributing to physiological health

but excessive amounts have been linked

to diarrhea and possibly constipation

genotoxicity inflammation and also

altered mucosal integrity

challenges with breath testing still

remain

for example Rapid Transit how quickly

food in this case sugar moves through

your small intestine may give false

positives for instance if the lactulose

sugar moves too quickly through the

small intestine it ends up measuring

colonic fermentation instead of sibo

also there's a question about the

ability of breath testing to accurately

diagnose sibo when there's very few

bacteria present as little as 10 to the

three that's a thousand bacteria per ml

is technically positive for sibo but can

such a small number of bacteria produce

measurable amounts of these gases in the

breath test

also keep in mind that sibo is only one

of several forms of dysbiosis being sibo

negative does not necessarily exclude

the possibility of other forms of

dysbiosis including small intestinal

fungal overgrowth

cfootestinal methanogen overgrowth IMO

or even large intestinal bacterial

overgrowth olibo as well as significant

imbalances in individual strains in your

gut could be the cause of your symptoms

additional tests to consider would sibo

include a comprehensive blood test

comprehensive stool tests and in some

cases endoscopy and colonoscopy

okay what are the treatment options for

sibo

unfortunately the most common treatment

is antibiotics a class of drugs that

I've researched and developed when I was

in Fama

the top two antibiotics for sibo or

rifaximin approved for ibsd a

sibo-related condition mostly to address

hydrogen producing bacteria and then a

combination of rifaximin with neomycin

for constipation to address both sibo

and the intestinal methanogen overgrowth

it's reasonable to think that sibo is an

infection and therefore something that

needs to be killed

antibiotic treatment is based on this

notion

but we should keep in mind that sibo

arises primarily from bacteria and our

own large and small intestine

these bacteria are part of our commensal

population

they play an important role in nutrition

immunity bile acid levels appetite

regulation fat storage and protection

from True pathogens

so keeping them contained in balance in

the right place instead of Killing Them

seems like the best strategy

also we don't want to kill off

indigenous small intestinal biotolerant

bacteria that have an important role in

digestion and health

now antibiotics can be useful when your

symptoms are severe for instance if you

become malnourished experience

significant weight loss or have other

serious symptoms or sibo-related health

issues

antibiotics won't work in all cases but

they'll often reduce the overgrowth

improve symptoms and help restore small

bowel function

unfortunately antibiotics do not address

the underlying causes and without that

sibo or IMO or other forms of dysbiosis

will likely come back so with or without

antibiotics the underlying cost piece

must be part of the overall treatment

strategy

another challenge with antibiotics is

that they're not as effective as you

might think

many intestinal bacteria are resistant

or tolerant to antibiotics regarding

rifaximin a 2016 study showed that 64

percent of sibo-related ibsd patients

relapsed and required a second treatment

and retreatment was only 6.6 percent

more effective than placebo

now at least rifaximin is one of the

safer antibiotics because it stays

mostly in the intestine minimizing

systemic reactions and the same is true

for neomycin moving to more powerful and

systemic antibiotics increases the risk

of side effects including clostridious

difficile infection allergic reactions

and bacterial resistance which renters

it renders antibiotics less effective

for fighting serious infections in the

future

how about herbal antimicrobials

many herbal extracts are known to

possess antimicrobial activity based on

testing in the lab with a test tube but

this activity has not been confirmed in

well-controlled human trials also

individual herbal extracts tend to be

less potent than synthetic antibiotics

and that's why they're often used in

combination including things like

Allison berberine oregano oil and Neil

in combinations

while a variety of these extracts have

been proposed for sibo treatments

there's not much published literature

on the efficacy a small study in 2014

found that a combination of herbal

antibiotics

was at least as effective as rifaximin

but we need more definitive studies to

confirm these results and off also keep

in mind that rifaximin was only 10

percent better than Placebo in the study

used to get FDA approval

now what about probiotics you may have

heard that sibo patients should not take

probiotics because why would you add

more bacteria when you already have an

overgrowth

well probiotics are not a Panacea some

may be helpful based on some studies

there's a few that come to mind in a

2016 study a combination of

bifidobacterium bifidum lactobacillus

acidophilus and streptocalis and GI

cancer patients with sibo showed that

sibo was resolved in 81 percent of the

treatment group compared to 25 percent

in the placebo group

a 2014 study looking at a probiotic

containing a combination of

bifidobacterium and lactobacillus

strains along with strep thymophilus

resolve sibo and 24 of liver disease

patients in the treatment group but none

in the control group

a 2020 study of saccharomyces bellate

with the antibiotic metronidazole given

Alona together to systemic sclerosis

patients for two months showed that

Escalade resolves C bone 33 percent of

the patients compared to metronidazole

which resolve sibo and 25 percent of the

patients together the results were

additive in other words over 50 percent

which might suggest that each works by a

different mechanism

a 2009 report on 40 sibo patients with

diarrhea and other symptoms that were

given bacillus clausiai for one month

they reported a 47 percent sibo

eradication rate

keep in mind this was a letter to the

editor not a full-blown publication so

the details were a little Limited

a study on 20 patients with constipation

right I'm ontestinal methanogenovo

growth showed that lactobacillus rooteri

given for four weeks significantly

improved weekly bowel movements and

reduced methane levels

now while probiotics can be helpful some

people may experience symptoms such as

loose stools bloating abdominal pain

particularly when they first start

taking them

let's talk about other dietary

supplements

a variety of dietary supplements are

promoted for treating sibo and some of

them can be quite helpful here's some

examples a multivitamin with minerals to

address address nutritional deficiencies

digestive enzymes with or without bile

salts to improve digestion

and by the way improved digestion limits

the fuel for sibo

betaine HCL and sublingual B12 if you

suspect you have low stomach acid also

see my video on IU at risk for low

stomach goes through stomach acid goes

through the risk factors and of course

you always want to get to the bottom of

why do I have low stomach acid in the

first place and address the cause

L-glutamine zinconazine and acetyl

cysteine these are some of the

supplements that have been proposed for

mucosal lining support integrity and

potentially for antibiofilms

antibiofilm agents are mostly enzymes

and they're effective at disrupting

biofilms in the laboratory but there's

limited data to show that they work in

patients

it's true that most of our microbes in

fact most microbes on the planet exist

in biofilms but most of these are

healthy biofilms so disrupting biofilms

in the gut is at the very least a little

bit questionable I can see these for

invasive biofilms like what you get in

wounds and or what is seen in colon

cancer but on the mucosal surface we

have this mucus that can be sloughed off

to take care of biofilms on its own so

it's a question of whether we need

additional help there or not

there's five things to keep in mind when

taking supplements

one make sure that you're not taking

toxic levels of certain vitamins or

minerals for instance a d e B6 zinc iron

and calcium are some that can be toxic

consider that some supplements can

impact other medications you might be

taking and three make sure they don't

contain excess fermentable carbohydrates

which can further fuel sibo

most supplements are meant to be taken

for weeks to a couple of months

long-term use may carry health risks

because there's no studies that will

show what happens after taking them a

long time number five read up on all

possible health risks and and side

effects before taking them look at the

labels carefully again supplements can

be quite helpful when used judiciously

but over supplementation is common and

unfortunately it can complicate things

in treating sibo

so I'm very careful when evaluating and

recommending specific supplements to my

clients as part of my consultation

program

finally let's talk about diet

last but not least your diet and dietary

behaviors are two of the most important

factors along with identifying and

addressing underlying causes

the pervasive view on diets for sibo is

that sibo diets only address the

symptoms

but the symptoms are not just floating

out there in space they're being caused

by something a few years ago I gave a

talk at sibocon and it was focused on

this exact point for more information

you can watch that presentation on this

channel

my conclusion was that diets that limit

specific carbs or overall carbohydrates

are effective at resolving symptoms but

they also reduce intestinal gases short

chain fatty acids they restore pH

balance and they address dysbioses and

sibo-related conditions including IBS

obesity and epilepsy

and views on science-based diets are

changing for instance 91 percent of 1500

gastroenterologists

believe that diets are as good or better

as medical therapies for IBS this was

based on a survey conducted in 2018.

in the past many of the symptoms we now

associate with sibo were recognized as

carbohydrate intolerance sound familiar

this is an important point because

carbohydrate intolerance is a form of

malabsorption that can lead to dysbiosis

and help feed sibo for instance lactose

intolerance it's very common in sibo

patients and it's been recognized for

over a century

while fructose intolerance which is also

linked to sibo was first documented in

the 70s

recently sugar alcohols except for

erythritol as I've talked about before

and dietary fiber intolerances have been

added to the list

and I make a case in the fast track

digestion books that resistant starch

is related to dietary fiber and should

also be limited for sibo and other

conditions involving carbohydrate

intolerance

according to the Merck Manual the

standard treatment for carbohydrate

intolerance is to limit the offending

species of carbohydrate this simple

conclusion is supported by the textbook

a primary and acute care medicine

which states that dietary alterations

that to reduce intestinal gas a hammock

of sibo require the reduction of lactose

fructose certain oligosaccharides

resistant starch fiber and sugar

alcohols

this is precisely the group of

carbohydrates that the fast track diet

limits

the very same recommendations for IBS

are also found in the nice European

guidelines and these are based on

Cochrane reviews and other published

literature

Mike Sweeney a dietitian in the UK and

his colleagues used the fast track diet

for their IBS patients and reported its

Effectiveness in his service evaluation

and you can see a link to the uh the

transcript video of this evaluation

there's also a pilot study it's still in

the pre-print stage demonstrating the

effectiveness of the carnivore diet in

resolving sibo

and finally the elemental diet which

eliminates all complex carbs is quite

effective at addressing sibo

now regardless of whether you take

synthetic antibiotics or antimicrobial

herbs a diet that limits fermentable

carbohydrates is required for addressing

sibo and once your symptoms are fully

resolved then you can experiment with

reintroducing certain carbohydrate

species slowly and safely as your

digestion improves

to pull this all together

all four elements I talked about can

play a role in addressing sibo for

serious cases of sibo with nutritional

deficiencies antibiotics may be

recommended and appropriate but for

fully addressing sibo and preventing

recurrence there's three key elements

that can't be ignored

one do everything you can to identify

and address the underlying cause or

causes which will vary from person to

person and there is a total of at least

25 or 30 possible underlying causes

on this topic a chapter in the

fast-track digestion books will be

helpful

some examples include pancreatic

insufficiency antibiotics bile acid

issues right too much or too little or

excessive bile deconjugation by certain

bacteria

resulting in poor reabsorption of the

bile acids brush border enzyme

deficiencies

Villi damage low stomach acid and

anything that alters motility including

GI infections medications excessive

methane levels

Scleroderma surgery adhesions diabetes

Etc

number two limit fermentable

carbohydrates in your diet but

particularly lactose fructose resistant

starch fibers and sugar alcohols

you want to match your diet with your

ability to digest and absorb the

nutrients

particularly carbohydrates sibo bacteria

depend on carbohydrates is the primary

fuel source either directly or is

Downstream byproducts of fermentation

for instance the methanogens sulfate

reducing bacteria use hydrogen produced

from the primary fermenters

number three

incorporate pro-digestion pro-absorption

behaviors and practices

this area is often overlooked but plays

a critical role in addressing sibo and

other forms of dysbiosis how are you

selecting your foods and how are you

preparing them how are you storing them

and importantly how are you consuming

them do you leave spaces between your

meals do you eat slowly and chew well do

you have a fast

and what's your approach to Breaking

fast what dietary supplements have you

tried aimed at improving digestion each

of these three elements of features of

the fast track diet for more information

about the diet system you can read the

fast track digestion IBS book there's

also one on hotburn or you can use the

fast track diet mobile app for

implementing the diet

for questions and support you can join

the fast track diet Facebook group and

for individual consultation you can

contact me through

digestivehealthinstitute.org

thank you for watching if you like this

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