It is no secret that SIBO can be difficult to treat. Finding true resolution from SIBO requires an all encompassing approach that includes various dietary and lifestyle factors to balance the gut.

Dietary Interventions

Likely the most important dietary intervention in treating SIBO is eliminating inflammatory foods. Foods that are full of refined carbohydrates, sugars, preservatives, and artificial ingredients fuel bacteria that are proliferating out of control in the small intestine. Not only that, these foods drive systemic inflammation that can weaken the immune system. Conversely, focusing on real, nutrient-dense foods such as quality protein, vegetables fruits, and non-inflammatory fats will help to balance the microbiome.

There are many clinicians that prescribe other dietary interventions for SIBO including the low FODMAP diet, an elemental diet, the Specific Carbohydrate Diet (SCD), the Gut and Psychology Syndrome Diet (GAPS), Low Fermentation Diet (LF), or and low/no starch diet. What most of these diet have in common is limiting the types of carbohydrates consumed to avoid feeding the bacterial overgrowth in the small intestine. Many of these diets help the heal the gut lining, but sometimes offer incomplete reversal of bacteria in the small intestine.

The most restrictive of these dietary interventions is the elemental diet which includes several weeks of not consuming food and drinking only a solutions of easily assimilated nutrient including vitamins, minerals amino acids, fats, and certain sugars that will not make it to the small intestine. While this has shown some promise along with other antimicrobial and motility-activating nutraceuticals and/or medications, patient compliance is a consideration.

Probably the most utilized diet for SIBO is the Low-FODMAP diet which limits short-chain carbohydrates that are not completely absorbed in the gastrointestinal tract. These short-chain carbohydrates can linger in the small intestine and feed the overgrowth of bacteria which leads to various gastrointestinal symptoms. Oftentimes, removing FODMAPS from the diet offers short-term relief because it decreases symptoms. However, this diet does not eradicate the overgrowth of bacteria in the small intestine. Also, if an individual abides by a low FODMAP diet for a long period of time, they run the risk of harming the beneficial bacteria in the large intestine which are crucial for overall health. There is a significant distinction between tot experiencing symptoms and actually reversing the bacterial overgrowth in the small intestine. The large intestine needs fermentable carbohydrates to feed the beneficial bacteria in the large intestine. In fact, beneficial bacteria in the large intestine produce butyrate when adequate fermentable carbohydrates are consumed. Butyrate is a short-chain fatty acid with many health benefits including having an anti-inflammatory and protective mechanism on the health of the gut, namely the large intestine.

Restore Gut Integrity

Incorporating collagen and bone broth into your diet will help to sooth inflammation with the gut and restore its integrity. In addition, nutrients such as L-glutamine, zinc carnosine, lactose-free colostrum, and various immunoglobulins can help to rebuild tight cell junctions within the gut lining. Additionally, low stomach acid (HCl) can be a contributing factor to SIBO. HCl supplementation can be helpful to promote gastric motility, the release of gastric, pancreatic, and gallbladder secretions, and it also kills or hinders harmful bacterial species. Lastly, probiotic supplementation is controversial for treating SIBO, but if an individual can handle taking them, the are also helpful in healing the gut.

Modulate the Immune System

Compounds such as curcumin, resveratrol, and lipsomal glutathione have a profound impact on supporting the immune system. Oftentimes SIBO patients are nutrient depleted and have low vitamin D levels. Low vitamin D levels are associated with low immune function, so supplementing appropriately with vitamin D may be warranted. Additionally, removing potential exposures to environmental toxins, molds, and other pathogens such as viruses, fungal infections can help to boost immune function. Without adequate sleep, exercise, and stress management, it is difficult to have an optimally functioning immune system.

Incorporate Herbs

Herbal antimicrobials are powerful tools in helping to rebalance the bacterial colonies in the gut and squelch bacterial overgrowth in the small intestine. Some common herbal antimicrobials use for SIBO are berberine, oregano, allicin from garlic, and an herbal compound called Biocidin. Since a potential cause of SIBO is the decreased activity of the migrating motor complex (MMC) or a slowing of the gastrointestinal smooth muscle activity, prokinetic agetns are often recommended. Prokinetic herbs that increase the muscular contractions in the small intestine include ginger, globe artichoke, a combination supplement called Iberogast, and various Chinese herbal formulas.

Tone the Vagus Nerve

Known at the wanderer, the vagus nerve is the longest cranial nerve connecting the brain to the gut and the rest of the body. The vagus nerve is responsible to regulate the autonomic nervous system and the involuntary functions of the body such as breathing, blinking, the beating of the heart, organ stimulation, and digestion. When there is vagal nerve dysfunction it impairs the migrating motor complex and overall digestion. It is hard to say which came first, the SIBO or the slow migrating motor complex, but there is a direct correlation with vagal nerve tone. There are various strategies to tone the vagus nerve including singing, humming, gargling, taking cold showers, box breathing, massage, prayer and meditation, mindfulness, and managing stress. Perhaps the most important strategy is managing stress and stress has a profound impact on the gut physiology and gut function.

Medications

Some severe cases of SIBO may require the use of pharmaceuticals including antibiotics to reduce bacteria in the small intestine. Rifaximin and neomycin are fairly safe and well-tolerated antibiotics that have been shown to be about 85% effective in treating SIBO, depending on what kind of SIBO it is. As mentioned above, prokinetic medications including low-dose naltrexone (LDN) and erythromycin are often successfully prescribed to activate the MMC.

An Important Reminder

As with any health intervention, individualized treatment is far superior to a one-size-fits-all approach. I suggest working with a skilled functional or integrative medicine doctor to come up with a personalized plan based on your unique physiology to resolve gastrointestinal complaints and SIBO.