How to fix SIBO & Prevent Recurrence
Summary
TLDRNorm 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
💡 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.
🧬 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.
💊 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.
🦠 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.
🍽️ 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.
Mindmap
Keywords
💡SIBO (Small Intestinal Bacterial Overgrowth)
💡Dysbiosis
💡Breath Testing
💡Antibiotic Treatment
💡Dietary Management
💡Leaky Gut
💡Methanogen Overgrowth (IMO)
💡Underlying Causes
💡Probiotics
💡Elemental Diet
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
video please share and subscribe and
I'll see you next time
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