Not that long ago, small intestinal bacterial overgrowth (SIBO) was not even on the radar of most healthcare practitioners. Today, it is the underlying condition of …
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– Hi, folks.
Welcome to Dr. Crew Review.
I'm Dr. Alex Keller.
I'm here with my colleague,
Dr. Holly Lucille.
And we're gonna talk about SIBO today,
small intestine bacterial overgrowth,
and the products that you
can use to treat SIBO.
So, Dr. Holly.
– Yes, sir.
– Where do you wanna start with SIBO?
Can you maybe take us through what is
small intestine bacterial overgrowth?
– Right, so when I think about SIBO,
so small intestinal bacterial overgrowth,
or actually SIFO, small
intestinal fungal overgrowth,
I kind of think about real
estate in a way, right?
Location, location, location.
So, where do we want those bugs?
Not in our small intestines.
We want them in our large intestines
and when they start to colonize
in the small intestines,
people are very uncomfortable.
And what I see in my practice
when I'm suspecting SIBO
is really the big thing
is constant bloating,
stomach distension, abdominal pain.
But you can see things
like nutrient deficiency,
osteoporosis, hypochlorhydria.
If I do a stool test, I'll usually see
high fecal fats, products
of protein breakdown
in the stool as well.
So that kinda keys me up
that something's going on.
– Yeah, so any digestive
symptoms in general
could be SIBO or SIFO.
But what's become kind
of confusing is that
there's so many other
situations that can cause
those kinds of symptoms as well.
– Exactly, they're overlapping for sure.
– Exactly.
So what kind of testing
do you typically do?
– Yeah, that's a good question.
You know, I graduated from
Naturopathic Medical College in,
Southwest College of
Naturopathic Medicine in 2001,
and back then, we
weren't talking about it.
It has just been, like, in the last decade
that we actually know that this exists.
So the testing that I use,
mostly, is breath testing.
So because of the
fermentation of those bacteria
and we do a breath test
two or three hours,
I usually run the three hours.
If you've got an increase
in methane or hydrogen
in those first two hours,
it's usually indicative
of some aspects of small
intestinal bowel overgrowth.
– Right.
Cause early on in the digestive tract
when fermentation is happening,
then those gases are released,
you have two different types
of bacteria or fungus that can
release those kinds of gases.
– Yeah, I always, when I'm
talking to my patients,
one of the things I say as I'm trying
to help them understand what's going on,
is like we breathe in oxygen,
what do we breathe out, right?
A waste product.
Carbon dioxide.
And this is exactly what
we're trying to measure
when those little guys
have their respiratory,
– Fermentation.
– Yeah, and that's, and
so, they kinda get it then.
And it's not supposed to be there.
– Exactly.
– Yeah.
– So in treating SIBO, what we usually use
is some form of four R
or five R type program.
– Right.
– Walk me through that.
– So many manufacturing
companies have this set up
and I've seen it in many variations.
There's three R's, four R's,
sometimes up to seven R's.
But we're thinking about
just the concept of the gut
and the first R, most
important, remove, okay?
So removing, we've gotta
stop feeding first.
And that's, so a dietary intervention
with SIBO is very important.
There's FODMAP, there's the
specific carbohydrate diet
that's been very popular,
there's a SIBO-safe diet
that's out there that I know about,
but there's also the
Physician's Elemental Diet.
This is by Integrative Therapeutics.
Now, this is what I use a
lot, if patients are willing
because this is a meal replacement,
usually two to three weeks,
and you dose based on
caloric need and this is
something that is able
to actually feed and nourish the body
and starve the bacteria and
that's what we need to do
to get on this process, cause
it's very difficult to treat.
It can be very, very difficult to treat.
So removing with a dietary
intervention first.
Then, yes there are antibiotics available,
but there are also herbal antimicrobials.
Priority One has SIBO, SIBOtic, right?
So a nice combination formula blend.
Garlic, berberine, caprylic
acid, oregano leaf.
And then Bio-Botanical Research
has their own four R program,
and this is something
that I use all the time,
especially in children if
there is a degree of dysbiosis,
because it's liquid and you can taper it,
if you're starting to have
somewhat of a die-off reaction,
it's easy to slow down.
They also have capsules
with the Biocindin.
And then of course, the Olivirex here,
continuing to remove and also
encouraging detoxification
as we're removing, so that's the first R.
I would say the second R across the board
is something like replace.
What are you gonna replace?
Any nutrients that might have
been deficient in the process
because of the condition.
Any digestive enzymes
that they were lacking
that kind of contributed to getting
this condition in the first place.
Second R.
Third R, reinoculate.
Now, this is a little controversial.
I know that probiotics,
especially probiotics
that contain prebiotics,
are contraindicated
in somebody with SIBO cause
they can feed the bacteria
and the patient gets worse.
But there are a couple ones,
Saccharomyces Boulardii,
really important.
Doesn't have prebiotics
so I use this quite a bit.
And then the bifidobacteria
infantis, sorry,
from Lactoprime Plus, Klaire Labs.
Wonderful for abdominal
distension, abdominal pain.
So those are two sort of SIBO-safe things
that I use all the time
when we're looking at that
third R of reinoculate.
And I would say that fourth R, repair.
You know there's a degree
of hyperpermeability,
leaky gut, once again because
of it and maybe a cause of it.
So contributing factor as well.
And so zinc-carnosine, wonderful for
repairing the gut barrier.
And then we think about
things like glutamine
which you can find, of
course, out there all the time
in a powder form, Integrative Therapeutics
has the glutamine forte, which
has that curcumin in there.
Wonderful for any GI inflammation.
And so, and then of
course, glutamine being
the preferred fuel source
for the enterocytes.
So we're gonna heal that up.
So it is definitely a
multi-pronged approach,
sometimes difficult to treat.
Definitely on the rise because
I think we know about it more
and we're able to test
and with clinical acumen,
we can sort of single in on that diagnosis
and get the job done.
– Fantastic.
So you've given us the entire overview,
which is essentially determine
what you're dealing with
through breath testing.
And then apply some derivative
of the four or five R program
which is remove, replace,
repair, reinoculate,
or some variation of it.
So different types of
practitioners may change it up.
You may change it up based
on what you're dealing with.
– Right.
Every case, obviously,
is still individual.
– Exactly.
So is there anything that you would do?
– You know, I would say
what's really important,
getting rid of SIBO is one thing,
helping the patient not have
it come back is another one.
I think this is a really important point,
cause I've seen it so many times.
So during this treatment, yes, removing,
very, very important.
Getting all of that stuff in.
And then at the end, using
dietary intervention.
So that five hour,
eating every fifth hour.
Like, four or five hours, and then having
a good 12 hour fast, along
with using prokinetics.
Like Priority One has their SIBO MMC,
that migrating motor complex.
So keeping gastric motility going.
Getting that autophagy there,
so the cells are cleaning out
and you can just decrease your chances
of SIBO returning.
So those are really important
interventions at the end.
So prevention is the cure.
– And that is such an important part
that people don't often
realize is that SIBO,
due to the vagal connection
between the gut and the brain
can very much be-
– Or the gut and the brain.
– The gut and the brain.
– The gut and the brain.
(both laugh)
– The brain and the gut.
Can very much be a
factor when dealing with
the migrating motor complex where,
if you have stress, if you
have any psychological issue
or brain issue, that it can
directly effect that MMC.
And then you can have
the passage of bacteria
coming up from the large
intestine to the small intestines.
– Yeah, and that's why, I mean,
I have seen adaptogens being used.
Bio-Botanical does have
an adaptogen formula
that kind of fits in here as well,
and I think that's exactly for that case.
– Exactly.
Awesome.
Thank you, Dr. Holly.
And thank you for tuning into this episode
of Dr. Crew Review.
Check in next time when
we talk more products
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