What is SIBO? Part 4: SIBO Prevention

This is the last installment of a four-part series on SIBO, small intestine bacterial overgrowth.  Part 1 is about causes and symptoms.  Testing for SIBO is covered in Part 2, and Part 3 discusses treatment of SIBO.  

It is very common for SIBO to relapse in a person who has successfully treated the overgrowth.  This may be because the underlying condition resulting in SIBO has not been dealt with or has reoccurred.  

One common underlying condition is a sluggish migrating motor complex (MMC), which itself may be related to high stress, not drinking enough water, or another reason.  The MMC is a wave of electrical activity that sweeps through the intestines at regular intervals during fasting and between meals.  This cleansing wave helps to clear debris from the small intestine into the colon. If the MMC is sluggish, food particles may get trapped in the small intestine, causing bacteria to overgrow.

Another underlying condition could be anatomical alteration of the small intestine.  This could be the result of blockages in the small intestine from surgery, diverticulitis, or an absent or malfunctioning ileocecal valve (ICV) between the small and large intestine, allowing backflow from the large intestine to the small intestine. Any of these conditions could block partially digested food along the digestive tract and cause an overgrowth of bacteria.

Low stomach acid due to stress or from acid-reducing medications could be another underlying cause of SIBO.  

The key strategies recommended by Dr. Pimentel, who has studied SIBO extensively, are:

• Use a prokinetic to stimulate the MMC. Either pharmaceutical or natural prokinetic treatments can be used.  Prokinetics include ginger root and other herbal combinations. See here for options and recommended dosages.  All treatments should be taken at bedtime to stimulate the MMC into action during the night. 

• Follow a SIBO diet.  Links to SIBO diet resources are in Part 3 of this series.  

• Take supplement of hydrochloric acid (HCL).  Click here to find out more about low stomach acid. 

• Avoid acid-reducing medications such as proton pump-inhibiting drugs (PPIs)

• Correct Ileocecal valve (ICV) function. ICV function can be improved with self-massage. Here is a video by Dr. Jockers on how to do ICV self-massage.

• Reduce chronic stress.  This will help to activate the rest-and-digest state, improving digestion and reducing the likelihood of the buildup of unwanted bacteria in the digestive tract.  

You can see that SIBO can be a complicated condition to eradicate completely, and unless the underlying condition is dealt with, SIBO relapse is common.   Even after SIBO has been treated, following a SIBO diet is recommended, although often it does not need to be as restricted on a long-term basis.  

If you have an autoimmune disease and suspect that you have SIBO, it is absolutely necessary to treat the SIBO.  SIBO will perpetuate a leaky gut and the resulting autoimmune response.  

My recommendation is that if you think you may have SIBO and want to clear it quickly, see a functional medicine practitioner.  The sooner you get SIBO cleared, the sooner you will start to feel better and get on with your life!  If you need help following the SIBO diet, I know a great health coach to be by your side every step of the way ;)