When I was diagnosed with small intestinal bacterial overgrowth back in 2003, there was very little talk about the condition called, SIBO. SIBO presents with symptoms that mimic IBS, especially upper GI bloating and distention after eating. I am grateful that testing is becoming more available (though, we still have a way to go!) and more importantly that more GI docs are willing to order testing. The research continues to expand in this area.
Experiencing SIBO is not a walk in the park. Like IBS, SIBO can stop you in your tracks. Many sufferers are able to function (barely) but getting through the daily grind can be challenging. Eating exacerbates SIBO symptoms and humans need to eat! This can be a conundrum for the person diagnosed with SIBO. It is easy to be swayed into limiting your diet to a very restrictive diet that results in weight loss and possibly malnutrition…but your body needs good nutrition to heal from the infection and your don’t want to starve ALL the bacteria.
Some patients switch up their diet and consume very little carbohydrate and large quantities of protein. The problem is …protein ferments too —and the by-products of protein breakdown in the intestine may in the end, be more damaging… potentially leading to inflammation in the gut. In animal studies by-products from protein: ammonia, phenols, amines and hydrogen sulfide are associated w/ intestinal permeability, DNA damage, inflammation & cancer. The diet needs some balance!
There is NO one evidenced based diet for treatment of SIBO. Modifying fermentable carbohydrates, our gut microbe’s favorite food source, is generally recommended. This can be achieved in a number of ways. Mark Pimentel’s group uses the low fermentable diet, I tend to recommend the low FODMAP diet and others suggest the specific carbohydrate diet, GAPs and/or paleo.
What diet is best for SIBO? The answer is, we don’t know. In my humble opinion, I feel the diet should be the least restrictive as possible to manage symptoms. I look forward to the time when we have more nutritional research to provide evidenced based nutritional guidelines for SIBO. I do think that the diet may need to be individualized based on the person’s microbiota. Different microbes ferment different food substrates—and we all have our own gut microbial footprint. In clinical practice, I find the low FODMAP diet works well for most, BUT, there is not enough research in this area to prove that diet alterations will prevent SIBO from relapsing.
Addressing and fixing the underlying causes of this condition, when possible, is the goal.
- Did you suffer from food borne illness which may lead to partial small bowel paralysis? You may benefit from a prokinetic therapy such as low dose erythromycin or even the herbal supplement, Iberogast.
- Have you been on long-term PPis? PPis increase the pH (lower acidity) of the small bowel and are associated with slowing down small bowel motility. Is it possible to reduce your dose or discontinue? Of course, work with your gastroenterologist to find what is best for you.
- Are you chronically constipated? Methane producing microbes are associated with slowing down bowel motility, when undergoing breath test for SIBO, be sure both hydrogen and methane gas production is evaluated. Methane gas is associated with constipation and reduction of methane gas improves constipation. (Chatterjee, S et al Am J Gastro 2007;102:837-841;Ghoshal, UC et al J Neurogastroenterol Motil 2011;17: 185-188) Patients with methane +SIBO have better outcomes with dual therapy antibiotics as sometimes using rifaximin alone is often not enough.
- Do you suffer with pancreatic insufficiency? Checking stool elastase to evaluate for insufficient pancreatic enzyme production is a good test to rule this out. Perhaps you may need pancreatic enzymes to help your body digest food.
Want to learn more?
I am excited to speak at the Gut Microbiome Conference in Huntington Beach, California, at the end of September 2016 on food and the gut microbiome! I attended this conference last year and it was fantastic! I look forward to learning again from the other top speakers about the microbes that reside in our gut and how they play a role in SIBO, IBS and other health conditions. One topic that I find very interesting is how alcohol can be created in the gut by our microbes! Also, Mark Pimentel’s group has a Global Outreach SIBO symposium coming in November 2016, click below to register or learn more!
For now, here are a few tools to help you navigate a SIBO diagnosis and upcoming programs to consider attending to learn more:
- A recap from the SIBO conference I attended in Portland, Oregon at the Natural College of Natural Medicine back in 2014. Although this info is 2 years old, it still applies.
- Understanding potential causes of SIBO, one of my past posts .
- My $10 SIBO review of all the information I have gathered which can serve as a great handout for health professional or patient use, purchase here.
- Upcoming programs: 2016 Global Outreach Symposium on IBS & SIBO, register here! and the Gut microbiome conference, click here.