Ok.. So leading on from my last blog on all you need to know about SIBO, this blog is going to focus on treatment.
So how to treat SIBO
Once you have determined that you have SIBO, here's some suggestions and explanations on the current treatment of SBIO. This is again constantly being researched and new information is always being presented.
Before I venture into the treatments, it's important for you to remember that everyone is different and everyone's presenting symptoms are different. So what i have found is that one treatment protocol does no suit everyone.
Antibiotics - I can hear you all go WHAT, Why would a naturopath recommend antibiotics, wont that make my SIBO worse? Well the general consensus is that the 1st line of treatment should be antibiotics, along with a diet low in fermentable carbohydrates and then re-test in 3 months.
There are a class of antibiotics that have shown to have 91% success rate for killing unwanted bacteria in the small intestine and eradicating SIBO. These antibiotics differ from others because they stay in the intestines and only work on the areas needed, reducing harsh side effects. Such antibiotics are called Rifaximin and Neomycin, I will not go into dose etc as this is really not my area but I also want you to keep in mind that whilst antibiotics maybe helpful in the initial stages of healing SIBO, like any medication they are treating the symptom and not the underlying cause. For this reason, Dietary and lifestyle changes are required alongside antibiotics. Also diet alone can't be the only treatment.
Prokinetics Prokinetics are agents that help with that movement or brushing of the small intestine and if you remember from the last blog, people with SIBO seem to have a problem with this brushing cleaning action. Erythromycin at low dose at night has been shown to improve small intestine motility but it needs to be taken on an empty stomach.
Other more natural products that can support this brushing action is IBEROGAST, a German homeopathic product that has been known to help with IBS symptoms. This also needs to be taken at night before bed, about 60 drops.
Ginger and 5-HTP a precursor to serotonin has also been shown to be effective.
There is a differing opinion in regards to the use of probiotics for SIBO. This may explain why some of my IBS clients tell me that probiotics make their symptoms worse.
There definitely needs to be more research around this topic. What I have found is that specific strains of bacteria in a probiotic often work better than others, whether or not a probiotic supplement is the right choice will depend entirely on the individual.
Of course there are some very effective anti-microbial herbs that have been shown to be effective with SIBO. These include herbs that contain berberine, lemon balm, garlic, neem and chinese skullcap. Essential herbs such as oregano, thyme and garlic are also effective. These are powerful herbs and can also have side effects so please do not self prescribe here.
There is no evidence based diet to use with SIBO and more research is needed by specialist dealing with SBIO. Low FODMAPS, Specific Carbohydrate diet (SIX) and a combination of both seem to be the diets most prescribed.
What these diets have in common is that they reduce specific sugars and carbohydrate that appear to feed the bacteria and increase fermentation. What's interesting to note with diets is that foods that you would consider not healthy seem to be the best tolerated by SIBO patients eg White flour and bread but also table sugar :(, So again identifying foods that you can and cannot tolerate is important.
A) Specific Carbohydrate Diet (SLD) - This diet was introduced by Elaine Gottschall.
The goal of the SLD diet is to heal the GI Tract by removing sugar, carbs and other foods that tend to cause irritation. It's a lesser version of the Paleo Diet, it removes grains but you can have some legumes and dairy products. Starchy vegetables and sweeteners are off limits, stevia is allowed on occasion and you are allowed animal proteins, ripe fruit, nuts, seeds and non-starchy vegetables eg zucchini, broccoli and leafy greens.
B) Low FODMAPs Diet
This diet is prescribed for IBS patients and it stands for Fermentable, Oligosaccharides , Disaccharides, Monosaccharide's and Polyols - So basically FODMAPS are foods that contain fermentable sugars that feed unhealthy bacteria, encourage growth and produce excessive gas.
C) SIBO Specific Food Guide
This is Dr Allison Siebeckers dietary protocol for SBIO. Check out her diet online, along with cookbooks and meal plans.
Some Key Points to take away
Healing SIBO may sound overwhelming at first, but it's not impossible, it takes time and patience and often there are setbacks but with perseverance, patience and professional support you can get back a better quality of life with your gut symptoms.
Remember SIBO is not a diagnostic term, it's actually a conclusion that arises from something else. IT;s important to be persistent in determining the cause, otherwise it's likely to return.
To improve the Migrating Motor Complex (MMC) or cleasning waves which is often the pimrary cause of SIBO, you must be in a fasting state. So avoid grazing and try to space snacks and meals 3-4 hours apart - Water is ok.
I am happy to discuss the possibility of SIBO as a cause of your gut symptoms, Please call the clinic on 02 6021 0557 to arrange an appointment.