How do I know if I have SIBO?
If you have one or more symptoms listed in the previous post, get tested! The standard test is a breath test. A Functional Medicine practitioner can order a test kit you can do at home. A gastroenterologist can perform this test in-office. You may find the home kit more comfortable. Or, you may prefer going through your doctor, and doing it at an office.
Before the breath test, you do a prep diet for one day. This consists of food that is not fermented by small intestine gut bacteria. This includes meat, fish, eggs, fat, and broth. It can also include white bread and white rice, which quickly break down into glucose for absorbtion. It is just one day!
The morning of the test, you take a breath sample. Then you drink a lactulose solution and take breath samples over the course of two-three hours. Lactulose is highly fermentable, and as it transits through your small intestine, hungry bacteria quickly ferment it. They produces gases that show up in your breath samples. The gases rise at various times during the test, and to varying levels. This tells us the type of bacteria, the overall load, and where the overgrowth is taking place in your small intestine.
What happens if I test positive?
If you test positive, it is for bacteria that produce hydrogen or methane gas. Often a gastroenterologist won’t give this level of detail, she or he may just say that you are positive. Functional Medicine clinicians tend to provide more detailed information when we test for SIBO. We have more time to do so, and we emphasize patient education. Hydrogen gas typically indicates bacteria that cause diarrhea. Methane gas producers are actually a slightly different organism called archaea. They are similar to bacteria but not technically classified as bacteria. High levels of methane gas typically cause constipation.
It is important to know what type of bacteria you have, and how high the gases measure in the test, because this will determine specific treatment choices and duration.
What is the core SIBO treatment?
Pharmaceutical antibiotics or antimicrobial herbs work equally well, according to research. The antibiotic and herbal combinations vary according to which type of overgrowth you have. The decision whether to use drugs, herbs, or both, is made on a case-by-case basis. Herbs are plants that have strong wide-spectrum antimicrobial properties, and are often better tolerated. Antibiotics can be very effective as well and insurance may be cover them.
The most common, most effective antibiotic is called Xifaxin. At the time of this writing, this medication is expensive, and difficult to get insurance companies to approve. Some find it easier to order it from overseas, with some sources being superior to others. Xifaxin is an excellent drug because it specifically targets the small intestine bacteria, without knocking down beneficial bacteria in the large intestine. It also does not get absorbed into the bloodstream and go through the liver. It’s a smart use of a drug. Methane producing organisms often require an additional drug.
Botanical (herbal) SIBO treatment takes more time, but are often better tolerated. There are a variety of antimicrobial herbs that work. Herbs are plants, and plants evolved with powerful broad-spectrum antimicrobial properties. We choose botanical combinations based on:
- Type of gas.
- Level of gas.
- Constitution and presentation of patient.
- Whether or not there are coexisting gut infections (bacteria, yeast, parasites).
- The levels of beneficial bacteria that are present.
What else helps treat SIBO?
One important project is breaking up bacterial biofilms. Bacteria and yeast create sticky gluey biofilms that protect them. Breaking down biofilms with specific enzymes can make a big difference in SIBO treatment.
Another adjunctive approach in SIBO treatment is to feed the bacteria, to draw it out in order to kill it. There is evidence this works. We can do this with prebiotic fibers or foods. Some practitioners recommend a low fermentable diet during treatment, but I believe it is better to feed the bacteria during treatment. However, after treatment, you might need to follow a somewhat lower fermentable diet in order to prevent relapse.
SIBO treatment includes probiotics and motility agents. There is no research at this time that probiotics improve treatment efficacy. However, SIBO comes with an imbalance in the gut microbiota, and restoring good bacteria in the gut makes sense. This is trickier than one may think, because most probiotics contain aerobic lactobacillus strains that feed bacteria in the small intestine. Some of the strains produce histamine, which is a problem for many people. Probiotics that grow in the large intestine, with anti-microbial properties, are better tolerated.
Many people relapse after SIBO treatment, in particular if they don’t follow up with a prevention plan. The next and final post in this series is about preventing relapse. In this post I will dive deeper into motility agents.
Stay tuned. In the meantime, please add your comments or questions!