Small Intestinal Bacterial Overgrowth (SIBO) Treatment and Management
Learn about the treatments and strategies to address SIBO.
CONTACT USOverview of SIBO Therapy
Following SIBO diagnosis, there are a range of strategies to treat small intestinal bacterial overgrowth. The primary aim of many of these strategies is to lower the bacteria levels in the small intestine. For example, with the use of antibiotics.
Secondary strategies to the treatment are also considered in the form of prokinetic medications.
Depending on the individual case of SIBO, health history and test results may require different and personalised approaches.
SIBO Natural Treatment
Natural approaches for SIBO have been found to be as effective in the treatment of SIBO as antibiotics. They may also provide a wider degree of support and improve treatment success. While antibiotics may only focus on reducing the levels of bacteria in the small intestine, natural approaches support and focus on additional areas.
The aim of these is to address overgrowth itself, plus the factors involved with the onset of the overgrowth. These can include approaches to:
- address the support for the lowering of the less beneficial organisms in the small intestine
- promote the key species in the microbiome that help to regulated the gut
- lower inflammation and support the healing of the gut lining
SIBO Herbal Treatment
Herbal medicines have been studied for their use in SIBO treatment. This is due to their antimicrobial properties which can help to lower the levels of bacteria in the small intestine.
For those with SIBO, it can be common for there to be a fungal imbalance of overgrowth in the small intestine. This has been referred to as SIFO (small intestinal fungal overgrowth). Herbal antimicrobial medicines and supplements also have anti-fungal properties to take this into consideration.
These include herbs such as:
- Garlic extract
- Oregano
- Berberine
- Neem
Methane SIBO Herbal Treatment
SIBO results may be positive for hydrogen gas, methane gas or both.
The specific treatment is often influenced by factors such as the types of gas and their gas levels as well as symptoms and health history.
Herbal antimicrobials considered for methane SIBO include:
- Garlic
- Oregano
- Neem
- Berberine
- Atrantil
Probiotics for SIBO
Probiotics can be used as part of a SIBO treatment. This is due to probiotics not adding more bacteria to the gut, but supporting gut health in several ways. Instead of contributing to the gut bacteria probiotics work by supporting a response from the gut lining.
This can be via activating the release of antimicrobial compounds from the gut lining to lower the levels of less beneficial bacteria in the small intestine. It can also be via reducing inflammation in the small intestine, a common underlying cause of SIBO.
The exact strain of probiotic bacteria used in SIBO treatment can depend on gas levels, symptoms and health history.
Natural Treatment and Supplements for SIBO
Due to their antibiotic properties, natural herbal supplements have been studied in SIBO treatment. Alongside these herbs, additional supplements can also be considered to support the small intestine and address underlying factors.
These include:
- Probiotics
- Prebioitics
- Antimicrobial herbs
- L-Glutamine
- Colostrum
- Sodium Butyrate
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Nutritional Support and Vitamin Supplementation
SIBO can lead to nutritional deficiencies and insufficiency. This may be due to poor absorption in the small intestine which is the result of a bacteria overgrowth. It may also be caused by undereating which can result in overly restricting foods in an attempt to reduce symptoms.
In these cases using blood tests to diagnose deficiencies can be helpful. Following this, nutritional supplements may be required to address these deficiencies. In cases where absorption is significantly impacted, sublingual or transdermal supplements may be required.
Dietary Modification as SIBO Treatment
The dietary approach for SIBO has 2 main aims.
- Identify and limit trigger foods to manage symptoms
- Ensure the diet is diverse and nutrient-rich to support the gut microbiome
While food restrictions will not treat bacterial overgrowth, they can provide symptomatic relief. This can be a central area of support in the initial stages of treatment.
Alongside any restrictions, the diversity and fibre content of the diet will support the gut microbiome and health of the small intestine.
High-Fat, Low-Carbohydrate Diet for SIBO
Dietary approaches can be considered for SIBO. These can involve elimination processes to improve symptoms but also ensure adequate nutrition and calories to prevent weight loss or malnutrition.
For many with SIBO, the removal or reduction in fermentable carbohydrates can improve symptoms. This is a short-term approach to identify triggers and provide more predictability around triggers.
To balance calorie intake, it can be important to ensure adequate protein and also fat with meals. This may lead to the inclusion of high levels of healthy fats being included with meals.
Addressing Underlying Causes in SIBO Therapy
Successful SIBO treatment can require the underlying cause of symptoms to be addressed. This can be especially true for patients where following a time of being symptoms-free following SIBO treatment, symptoms return. This can indicate that an underlying issue has yet to be addressed.
The possible underlying causes of SIBO include:
- Low grade inflammation
- Digestive insufficiency
- Hypothyroidism
- Chronic stress
- Medications
Long-Term Management and Prevention of SIBO Recurrence
Once SIBO has been addressed and treated, supporting and maintaining long-term gut health is a central consideration to prevent relapse. For many SIBO patients, reducing the exposure to risk factors is crucial. These include factors such as mediations, food poisoning, travellers’ diarrhoea and stressful events.
In additional to this there can be a focus on long-term dietary patterns that aim to support the gut microbiome. This can often include appropriate levels of plant fibre as well ad dietary diversity. In some cases of chronic SIBO, long-term management with the use of prokinetics may be needed to prevent symptoms relapse.
Antibiotics for SIBO Treatment
Pharmaceutical antibiotics are considered for the treatment of SIBO to lower the bacterial load in the small intestine. For hydrogen-positive SIBO, the antibiotic Rifaximin is often prescribed. This is an antibiotic used for SIBO therapy that is only active in the small intestine and not the large intestine.
In case of methane-positive SIBO results, a second antibiotic called Neomycin is often considered and prescribed alongside Rifaximin.
It is common for symptoms to improve during treatment or over the 2 weeks following the courses of antibiotics.
Empirical Use of Antibiotics in SIBO Therapy
SIBO breathing testing is not 100% conclusion. Therefore it is possible to have false negative SIBO breath test results. This means that while the results are negative for SIBO, there may be a bacteria overgrowth in the small intestine.
The reasons for this include gases other than hydrogen and methane being produced in the small intestine or an irritated gut lining, altering how much gas is absorbed from the small intestine.
This leads some specialised to treat SIBO empirically. This means that SIBO tests are not used, but the patient is treated for SIBO based on their symptom, health history and response to SIBO focused treatments.
Conclusion
A SIBO diagnosis can be an important step in getting the treatment needed to resolve symptoms. The exact treatment required can depend on factors such as individual symptoms and the underlying cause of the bacterial overgrowth.
Working with an experienced SIBO specialist can support and guide the steps needed to address the overgrowth and resolve symptoms.
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Learn more about the dietary and nutritional approaches that can be used in SIBO.
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