Dr. Paul Deglmann
Meghan Feir Walker
Small intestinal bacterial overgrowth (SIBO) can be a persistent problem. It disrupts the gut health of tens of millions of people each year and can even cause IBS, which is why SIBO treatment and testing has become a hot topic.
While the Western medicine approach to SIBO treatment and testing has helped various patients, the recurrence rate is high. Patients have around a 45% recurrence rate for SIBO after taking antibiotics for months to treat the bacterial imbalance.
Extending far beyond taking rounds of antibiotics, functional medicine’s approach to gut health and SIBO integrates nutrition, lifestyle, and personalized protocols for each patient.
One size does not fit all when it comes to fixing gut health. This is why we take the functional medicine approach in our clinic.
Read on to learn more about SIBO treatment in functional medicine, Western medicine, and our approach at RHS.
What is small intestinal bacterial overgrowth (SIBO)?
To properly absorb nutrients and have a healthy digestive system, you need a diverse microbiome. While you need specific microorganisms in different areas of your digestive system, sometimes certain types can become unbalanced, or unwelcome intruders can cause issues.
When bacteria from the colon enter the small intestine, SIBO can occur. But what is SIBO?
Small intestinal bacterial overgrowth simply describes an overgrowth of bacteria in your small intestine. You need the right balance of bacteria to support optimal gut health, but symptoms can arise when certain bacteria grow or invade the small intestine from the colon. This can also lead to further complications, like inhibiting your body’s ability to digest and absorb nutrients from food.
Are IBS and SIBO the same?
There are a few distinct differences between SIBO and IBS, although they share similarities and symptoms often overlap.
Here are a few of the key differences between SIBO and IBS:
- SIBO can be tested, whereas IBS is a bit of a catch-all term for various chronic digestive issues.
IBS is a functional condition without a concrete, known cause that can contribute to symptoms such as bloating and gas, abdominal pain, constipation and/or diarrhea. However, there is no test to diagnose IBS.
Although you can test the presence of SIBO, some issues have occurred. The breath test is the gold standard for diagnosing SIBO, but many practitioners are questioning its reliability due to the many false positives and false negatives these tests have produced.
- Another difference between SIBO and IBS is how they are caused. In SIBO, bacterial overgrowth in the small intestine contributes to symptoms. However, IBS can be caused by various things, including environmental factors, stress, medications, certain antibiotics, antacids, pain medicines, food sensitivities, possibly genetics, and even SIBO! Yes, that’s right; IBS can be caused by SIBO.
In recent years, researchers have been finding that SIBO can be a cause of irritable bowel syndrome (IBS), which is said to affect 10-15% of adults in the United States. Since only some patients seek help from doctors for this condition, this is likely a conservative estimate. The frequency of SIBO among patients presenting with IBS varies greatly from study to study with results ranging from 4-78%, yet these studies back up what functional medicine doctors have been discovering through their practices for years. - IBS can typically be improved with diet and lifestyle changes alone, whereas SIBO often needs antibiotics and/or herbs, supplements, and lifestyle modifications to be solved.
Common signs and symptoms of SIBO
It can be hard to distinguish between IBS and SIBO symptoms, but there are some key differences. IBS symptoms primarily affect the large intestine, while SIBO symptoms typically affect the small intestine. However, the breadth of SIBO and IBS’ impact can extend far beyond the digestive system, affecting even the brain. After all, the gut produces 90-95% of the body’s serotonin (the brain produces the remaining 5-10%), yet it is essential for your central nervous system to work properly.
While SIBO can present in numerous ways, the most common SIBO symptoms include the following problems.
Common SIBO symptoms:
- Bloating/gas (especially after eating)
- Abdominal pain
- Constipation
- Diarrhea
- Heartburn
- Indigestion
- Nausea
- Fatigue
- Brain fog
- Malnutrition
- Sense of fullness after eating
- And more
Many of these symptoms occur from the bacteria in the small intestine feeding on and fermenting undigested foods or specific carbohydrates.
These bacteria produce certain gases (such as hydrogen, methane, and hydrogen sulfide) and cause inflammation, contributing to worsened symptoms.
What causes SIBO?
In order to address SIBO, you need to know what caused bacteria to move from your colon to your small intestine in the first place. This is important so you can stop SIBO from recurring.
Some common causes of SIBO include:
- Structural abnormalities in the small intestine
- Low stomach acid or hypochlorhydria
- Dysfunctional immune system
- Antibiotic use that causes dysbiosis
- Slow motility or constipation
- A history of gastrointestinal surgeries that may impact the stomach, small intestine, ileocecal valve, or colon
- Mold and mycotoxin exposure
To learn more about these causes in greater depth, take a look at our previous article on SIBO.
Risk factors associated with SIBO
If you have certain conditions, SIBO is much more likely to occur. These conditions include:
- Celiac disease
- Scleroderma
- IBS
- Crohn’s disease
- Ulcerative Colitis
- Diabetes
- Hypothyroidism
- Cirrhosis
- Gastroparesis
- HIV
- Parkinson’s disease
- Diverticulosis of the small intestine
- Radiation treatment to the abdomen
- Chronic stress
- Other chronic inflammatory conditions
- And more
How is SIBO diagnosed?
If you have symptoms of SIBO, you should definitely have testing done. To help you decide which route you want to go, we’ll cover a few of your options.
Breath tests
If you choose the standard Western medicine route for testing and treating SIBO, they will have you do a breath test for diagnosing SIBO. Many functional medicine practitioners still use breath tests as well.
As with any condition, it's important to get accurate and thorough results. However, the standard test for diagnosing SIBO is the breath test and its reliability has been questioned due to its susceptibility to showing false positive and false negative test results.
That being said, during the breath test, they will look at the bacterial fermentation in your gut. You drink a glass of water mixed with glucose or lactulose solution, and after a while, they test methane and hydrogen levels in your breath.
There are three types of SIBO. SIBO can be determined by a rapid overproduction of hydrogen, methane, hydrogen sulfide, or a combination of these gases.
In order for there to be a positive SIBO diagnosis, you must meet one of the following criteria:
- Hydrogen-dominant SIBO: This means your hydrogen levels rose by at least 20 ppm within the first 90 minutes after drinking the solution, indicating excess hydrogen production. This can be caused by E. coli, Enterococcus, and Klebsiella, bacteria that produce hydrogen gas. This type of SIBO often leads to diarrhea.
- Methane-dominant SIBO (IMO): This means your CH4 (methane) levels reached 10 ppm or higher at any point during the test, indicating elevated levels of methane in the small intestine. This type of SIBO is often due to slow motility/constipation issues and delayed transit in the small bowel and colon. Using PPIs if you have IBS or IBD can increase your risk of developing methane-dominant SIBO.
- Hydrogen sulfide-dominant SIBO: This means your hydrogen sulfide levels were at 3 ppm or higher at any point during the test. In hydrogen sulfide-dominant SIBO, certain bacteria produce excess hydrogen sulfide gas. Hydrogen sulfide might relax smooth muscle, which can encourage inflammation in the GI tract. play a role in relaxing smooth muscle and contributing to inflammation in your GI tract. This type of SIBO can often cause diarrhea.
Additional tests for discovering SIBO
Many functional medicine practitioners are opting for testing beyond the traditional breath test. This is because of the prevalence of false negatives and false positives.
From stool tests to thyroid panels, cortisol panels to organic acid tests, various areas in the body can be tested to indicate potential root causes of SIBO symptoms.
We like to use various tests like these at Restorative Health Solutions to show us the whole clinical picture. We test several things, including genetic testing for gluten sensitivity, food allergy panels, food sensitivity profiles, stool testing, organic acid or OAT testing, nutritional deficiencies, adrenal or cortisol panels, and more.
While we can’t diagnose SIBO by looking at a stool test, we can look at different findings that may suggest bacterial overgrowth. This additional testing can help us individualize the diet along with proposing a personalized supplement protocol. Remember, this is a one-size-fits-one approach, not a one-size-fits-all approach.
SIBO treatment in functional medicine: The RHS approach
Steps to discover root causes and customize SIBO protocols
The functional medicine approach to SIBO is to get to the root cause and construct a comprehensive, personalized plan. SIBO treatment in functional medicine consists of an individualized diet, lifestyle modifications, and a supplement protocol. These custom protocols may consist of herbs, certain types of probiotics, vitamins, minerals, essential fatty acids, digestive enzymes, antioxidants, and amino acids.
At RHS, we personalize your diet and supplement protocol through comprehensive testing.
While this is a basic outline and can vary significantly from person to person, these are the five steps we address with every patient in our clinic.
SIBO steps in our approach at RHS:
- Remove inflammatory or trigger foods.
- Provide digestive support, like stomach acid, digestive enzyme, and bile support, if needed, based on patient symptoms and test results.
- Provide support for the gut barrier or gut lining, if needed. Once again, this is specific to each patient based on their history and test results.
- Use antimicrobial herbs to help address bacterial overgrowth. On a side note, we want to make sure you are having daily bowel movements before starting this step. Some common antimicrobial herbs used at this step are oil of oregano, berberine, grapefruit seed extract, olive leaf extract, and others.
- Supplement with specific probiotics after finishing the antimicrobial herbs. This can vary significantly from patient to patient.
Taking a comprehensive step-by-step approach based on your history, symptoms, and test results can significantly increase your chances for long-term success when addressing SIBO.
As always, please consult your functional medicine practitioner to see which approach is best for you.
Take control of your gut health
Book your free consultation with Dr. Paul
At RHS, we believe in a one-size-fits-one approach, not a one-size-fits-all approach.
If you suspect you may be experiencing symptoms of SIBO, a professional consultation can provide clarity and guide you toward effective options. Schedule a free consultation with Dr. Deglmann today to discuss your symptoms and explore tailored solutions for your digestive health.
We hope this article helped you learn more about our functional medicine approach to SIBO.
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Key points
- For long-term relief, it’s important to not only treat SIBO but to address the root causes. This can help lower the chance of recurrence of SIBO.
- The breath test isn’t the only way you can understand and help SIBO. Various tests can help you understand why you developed SIBO symptoms in the first place.
- Personalized plans for diet, lifestyle modifications, supplements, exercises, and more can help address SIBO and its root causes.
Sources
Ghoshal UC, Srivastava D. Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype. World J Gastroenterol. 2014;20(10):2482-2491. doi:10.3748/wjg.v20.i10.2482
