What is small intestinal bacterial overgrowth (SIBO) and how can it be treated? Learn more about causes, symptoms, diagnosis and supplemental interventions.
– SIBO diagnoses are on the rise,
but what actually is SIBO,
and what can we do about it?
Well, this is what the science says.
(upbeat music)
Small intestinal bacterial
overgrowth, or SIBO,
is characterized by
excessive amounts of bacteria
in the small intestines
where it shouldn't be.
Symptoms of SIBO are pretty nonspecific,
and it makes it difficult to differentiate
with symptoms of other GI conditions
such as IBS and food intolerances.
They can also vary from mild to severe,
depending on the individual,
the underlying cause,
and the type of the
microbial flora involved.
In patients affected with SIBO,
you'll tend to see symptoms such like
bloating, abdominal pain or distension,
chronic diarrhea, weight loss,
malabsorption and nutrient deficiencies,
particularly fat-soluble vitamins,
also B12 and iron deficiencies.
You can also see things like osteoporosis,
fatigue and weakness,
and, as well, neuropathies.
So, how can you be sure
if your patient has SIBO?
Thanks to improvements
in diagnostic testing,
we are now able to better diagnose it.
The most common tests available
are bacterial cultures
which gather information
on the anerobic and
aerobic bacteria counts
in the small intestines.
There is also breath tests
for lactulose or glucose,
and blood tests for CdtB
and vinculin antibodies.
Due to the challenges involved
with bacterial cultures,
breath tests are actually now
the predominant testing method used
and a great place to start for diagnosis.
During a breath test,
patients follow a one to
two week preparatory diet,
then drink a glucose
or lactulose solution.
This solution is meant
to feed the bacteria.
Breath samples are then
collected every 15 to 20 minutes
for two to three hours
to measure bacterial gasses
of hydrogen and methane.
If the gasses are present
during the first two hours,
this indicates the presence of bacteria
in the small intestines
and a positive result of SIBO.
If the gasses are present
during the third hour only,
bacteria is only present
in the large intestines.
In order to treat SIBO,
we must first look at the
risk factors and other factors
contributing to the pathogenesis.
Inadequate secretion of gastric acid.
Irritable bowel syndrome.
Metabolic disorders such as
diabetes and hypochlorhydria.
Elderly individuals are
actually more susceptible.
Small intestinal dysmotility
and celiac disease and gastroparesis.
Poor gut immune function
and immunodeficiencies.
Anatomic abnormalities of the GI tract
such as diverticula and strictures
in the small intestines.
And also use of certain medications
such as recurrent antibiotic use
and gastric acid suppressors.
There's also things to look for
like dysfunction in certain organs
such as cirrhosis, renal
failure, pancreatitis,
celiac disease or Crohn's disease.
Since there are so many
possible contributing factors,
it is first important to understand
which ones are involved
in a case by case basis
as this could impact your
approach to treatment.
SIBO treatments generally
include a combination
of dietary interventions,
review of medications,
and antimicrobials to
address the overgrowth.
When treating patients with SIBO
it is so important to
identify the underlying cause.
Number one.
Have your patient follow a SIBO safe diet.
While a number of diets exist,
they all reduce carbohydrate intake,
which is the primary
food source for bacteria.
The Elemental Diet aims to
starve and eliminate bacteria
while providing adequate overall
nutrition for the patient,
and it involves consuming
liquid meal replacements
comprised of predigested nutrients
for a two to three week
period with no solid foods.
The FODMAP diet.
FODMAP stands for
fermentable oligo-, di-,
mono-saccharides and polyols.
These are highly fermentable carbohydrates
that can alter the gut microbiota,
and have been identified
as a possible factor
contributing to the development of SIBO.
There's also the Specific
Carbohydrate Diet,
otherwise known as SCD, and originally,
this was developed as a
treatment for celiac disease.
And it also limits the intake
of certain carbohydrates
in order to promote a
favorable composition
of bacteria in the gut.
The SCD diet has also shown some promise
in the treatment of digestive
conditions like IBD.
Other diets include
Cedars-Sinai Low
Fermentable Diet, the CSD,
the SIBO Specific Food Guide, the SSFG,
and the Fast Track Digestion Diet.
So, number two.
Correct nutritional deficiencies.
Common nutrient deficiencies
that may require supplementation
include vitamin B12,
fat soluble vitamins like A, D, E, and K,
calcium, and magnesium.
Number three.
Address the overgrowth.
While the conventional treatment of SIBO
typically involves the
prescription of antibiotics
like neomycin and rifaxamin,
research has actually shown
that certain herbal antimicrobials
are as effective without
the negative side effects.
Rates of SIBO recurrence
indicated by positive glucose breath tests
also appear to remain high
following antibiotic treatment.
So, these herbal antimicrobials include
things like berberine, oil of
oregano, neem, and allicin.
So, not the whole garlic,
because that is highly fermentable.
And number four.
Focus on prevention.
Prevention of reoccurrence.
Follow a low carbohydrate diet,
limit stress as much as possible,
consume meals four to five hours apart
with a 12 hour overnight fast,
use an herbal prokinetic
to enhance GI motility,
and also Visceral Manipulation,
such as abdominal massage,
can also be very helpful.
Now, if you've had experience
with treating patients with SIBO,
by all means, like this
post and comment below,
'cause we're gonna keep
this conversation going.
And for more information about
SIBO and a SIBO protocol,
visit Fullscript's Practitioner
Medical Education Hub
at www.fullscript.com/hcp.
(upbeat music)

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