Chronic SIBO
Updated: Jun 20
SIBO is an imbalance of the microbiome that is under-diagnosed, and under-treated. When the bacterial overgrowth is not sufficiently eradicated, SIBO easily comes back.
We can significantly reduce SIBO recurrence by helping the microbiome after eradicating the overgrowth. This step is often left out and leads to SIBO's reputation of being a chronic, recurrent condition.
In this post, let's review the basics of SIBO and what a thorough treatment regimen should include to give your gut the best shot at longterm health and recurrence prevention.
Why should we care about SIBO?
SIBO is common. In fact, some studies suggest that over 1/3 of people who have been diagnosed with IBS may also have SIBO (2). As most of us with IBS know, the treatment options available aren't always helpful. Knowing whether you have SIBO can be a helpful step towards feeling better.
Diagnosing SIBO
To properly identify SIBO, we need to discuss your comprehensive gut history, identifying any possible causes. A few common causes of SIBO are food poisoning, abdominal surgeries (like appendicitis, C-section, or hernia repair), concussions, traveller's diarrhea, or antibiotic use. This helps guide treatment and prevent SIBO from coming back.
SIBO can be diagnosed by a at-home breath test. At your visit, Dr. Sand will walk you through how to do this so you can feel confident in getting an accurate diagnosis.
Now that more expansive testing is available to asses for all three types of SIBO gasses (hydrogen, methane, and hydrogen sulfide), we are better able to create individualized and more effective treatment plans for our patients.
Dr. Sand uses a 3 step approach to treatment
1. Eradicate overgrowth
2. Prevent Recurrence
3. Restore the Microbiome
Eradicate Overgrowth
Success in killing the bugs depends on the type of gas found on the test, and the levels of the gas. Each type of SIBO needs a different approach to treatment and a discussion with the patient on whether herbs, antibiotics, and/or diet changes need to be used. It is generally advised not to restrict diet during this phase so as to target the SIBO bugs at different stages of their life cycle.
Prevent Recurrence
It is essential this step immediately follows Phase 1: Eradicate Overgrowth. Preventing recurrence needs to involve optimizing the Migrating Motor Complex to regularly clean out the small intestine, and strengthen the function of the small intestine. This Phase also typically involves a maintenance antimicrobial and/or diet changes to prevent SIBO bugs from regaining traction in the small intestine.
Restore the Microbiome
This is arguably the most important phase and what makes it much less likely for SIBO to come back. Restoring the microbiome involves decreasing inflammation, healing the gut (aka "leaky gut") and restoring the healthy bacterial populations. SIBO bugs can alter their environment to favor their growth, so rebalancing the landscape of the small intestine is essential to lasting microbiome health.
Treatment for SIBO should be individualized based on your risk factors, dietary needs, SIBO type, symptom picture, and health goals. Treatment should also be thorough, including time for SIBO relapse prevention and microbiome repair.
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If this picture seems like it matches your story, be sure to mention this at your next appointment. My approach to treatment is individualized to meet your needs and unique digestive picture.
Get the help you deserve.
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Works Referenced
1. Almario CV, Ballal ML, Chey WD, Nordstrom C, Khanna D, Spiegel BMR. Am J Gastroenterol. 2018 Nov;113(11):1701-1710. doi: 10.1038/s41395-018-0256-8. Epub 2018 Oct 15.
Burden of Gastrointestinal Symptoms in the United States: Results of a Nationally Representative Survey of Over 71,000 Americans.
2. Chen B1, Kim JJ1, 2, Zhang Y1, Du L1, Dai N3.J Gastroenterol. 2018 Jul;53(7):807-818. doi: 10.1007/s00535-018-1476-9. Epub 2018 May 14. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis.