What is SIBO Part 3: SIBO Treatment

Small intestine bacterial overgrowth, or SIBO, can cause chronic intestinal distress symptoms like IBS, IBD, constipation, diarrhea, both constipation and diarrhea, bloating, gas, abdominal pain, iron, and other deficiencies, and over time SIBO can damage the gut lining enough to trigger autoimmune disease. SIBO is not commonly tested for or treated in conventional medicine, so many people have symptoms for years and go untreated. Symptoms of SIBO were the focus of Part 1 of this series. 

It is estimated that about 80% of people with IBS have SIBO.  Considering that about 10-15% of the population has IBS, that is a lot of suffering.  

Part 2 discussed the lactulose breath test which is the most common method of testing for SIBO, although not commonly available in a conventional medicine setting.  In the absence of testing, one could consider treating for SIBO and monitor to see if symptoms reduce.  

What is the treatment for SIBO?  Dr. Allison Siebecker is one of the world experts on SIBO, and I have provided links throughout this blog to her excellent website, siboinfo.com. 

With a SIBO treatment plan, the first goal is to reduce the bacteria to acceptable levels.  Normally, the small intestine has very little bacteria, just trace amounts.  With SIBO the bacteria in the small intestine has become overgrown, causing a host of symptoms. One of the following four methods are used to reduce bacteria in the small intestine:

• Antibiotics: Rifaxamin or Neomycin are commonly prescribed.  These antibiotics have been studied and proven to be 91% effective in treating SIBO. See Dr. Siebecker’s recommended dosages here. 

• Herbal antimicrobials:  Herbal treatments for SIBO are as effective as antibiotics. Herbal remedies include allicin, oregano, berberine, neem, and cinnamon.  See this link for recommended dosages.

• Elemental formula:  This approach essentially starves the bacteria while feeding the person.  According to Dr. Siebecker’s website, the elemental diet is 80-84% effective in eradicating SIBO. The elemental diet includes required calories and nutrients in a liquid form, which must be taken for two weeks, replacing all meals.  Commercial formulas are available but can be expensive.  Alternatively, the formula can be made at home. Click here for more information on the elemental diet and a recipe for the homemade formula. 

• Dietary treatment: Diet can be a suitable approach for treating SIBO without the presence of a leaky gut (remember, though, that leaky gut is present with all autoimmune diseases).  Dietary approaches strive to feed the person but starve the bacteria by limiting bacteria food sources.  These include fermentable carbohydrates.  A dietary treatment approach usually requires a longer term than the previous three methods.  Diets include:

  • SCD (Specific carbohydrate diet)

  • GAPS diet

  • Low FODMAP

  • SIBO Bi-Phasic Diet

  • Combinations of the above

  • Versions of paleo or the Fast Track Diet for IBS

Refer to this page for more information on dietary treatments for SIBO.

Once the bacteria has been eradicated or reduced to trace levels, the next step is to prevent relapse and repair the gut lining.  These topics are covered in Part 4 of this series. 

FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.  You can see why using the term FODMAP is just so much easier!  Identifying foods high in FODMAPs can be tricky because, for some foods, the portion size can make it a high FODMAP or not.

For example, 1/2 cup of broccoli would be low in FODMAPs, but 1 cup would be high.  Also, the flowers of broccoli are ok but the stems are high FODMAP.  Here is an excellent guide to help identify FODMAP foods.

Another useful resource when following a low FODMAP diet is an app developed by Monash University in Australia.  It is called the Monash University FODMAP Diet.  Here is a link to the app.

My own treatment of SIBO was through the use of herbal antimicrobials for 18 weeks. At that point a breath test indicated that the hydrogen gas levels had gone from severe to mild level. I continued for another two months with herbal antimicrobials, followed a low FODMAP diet, and then finally had a negative breath test result. From start to finish, including time to test and wait for results, the treatment took 8 months. I have had a couple of mild relapses and had to treat them again with success.

I have noticed that there is some conflicting information across some of the FODMAP diet resources.  Like any diet, listen to your body, monitor symptoms, and go by how you feel.

Following a low FODMAP Diet isn’t easy, but it is necessary in order for SIBO to be cleared.  Need help with staying on track?  As your health coach, I can help you do just that.  Plus, I have been down this road and understand what you are going through.  

My next article is about preventing SIBO from relapsing. Meanwhile, I hope you found this article about SIBO treatment useful and informative.  If you have any questions about SIBO, please comment below or send me a message.