Small Intestinal Bacterial Overgrowth, or SIBO, is a common digestive disorder that occurs when bacteria grow in the small intestine. This can lead to several digestive symptoms, including bloating, gas, irregular bowel movements, diarrhea, and more.
Who Can Have SIBO
While anyone can have SIBO, research has found some groups of people have a higher predisposition than others. Individuals who have been diagnosed with IBS are more likely to have SIBO. This is because IBS is a diagnosis of exclusion, meaning that the doctor couldn’t find a cause for the patient’s digestive complaints. As of 10/2023, there is an established ICD-10 Diagnosis code for SIBO. The K63.8211 code now firmly establishes this condition as an official medical diagnosis and prevents certain providers from claiming “it isn’t a real diagnosis” anymore.
What SIBO Does
The high levels of bacteria in the digestive tract can create malabsorption, preventing the body from properly utilizing nutrients. The body could have a number of digestive issues because of food not processing properly. The digestive tract could have rotting food, food not being removed from the body, or a number of other issues listed below.
Symptoms of SIBO
SIBO symptoms can include belching, flatulence, stomach pain, and diarrhea. If you have constipation instead of diarrhea, you may have IMO. Because bacteria in the stomach can interact differently, each case of SIBO can present a different combination of symptoms. The classic telltale symptom of SIBO is that symptoms are usually worse at night and better with rest for most mild cases. This might not be true for moderate or severe cases in which case the symptoms can be unrelenting.
Diagnosis
A diagnosis of SIBO takes a couple of steps to procure. First, the patient’s symptoms have to line up with those listed above. Second, the patient needs to take a hydrogen breath test that shows a high level of hydrogen-producing bacteria within the first 2 hours.
This breath test has become the “gold standard” for testing SIBO and IMO, with one of the keys being preparation. Beginning 24 hours before the test, the patient needs to switch to a clean diet. Patients can have turkey, chicken, or fish that is only baked or boiled, and seasoned with only salt and pepper. The patient can also have white rice, cooked and seasoned in the same fashion. For the last 12 hours before the test, the patient needs to fast. During this 12-hour period, the patient can only have water and their prescription medications. The test also requires that patients don’t exercise or smoke for at least one hour beforehand. Patients shouldn’t take any antibiotics, acid-controlling medications, or substances with stool-inducing effects such as magnesium, coffee, laxatives, or others.
Taking the Test
When the patient walks through the door, they will provide a baseline sample for the breath test. They will then be given a sugary drink that feeds the bacteria in the gut and will provide another breath test sample every 20 minutes for the next 2-3 hours. The test monitors the sugary drink as it travels down the digestive tract, and if there is a colony of bacteria that feed on the drink, there will be a spike in the breath test results.
If the hydrogen level reaches 20PPM (parts per million) over the baseline number, then the patient can be safely diagnosed with SIBO. If the CH4 levels are above 10PPM the patient can be diagnosed with IMO. And if neither level spikes and there are still SIBO/IMO symptoms, then there could be a hydrogen sulfide (H2S) producing bacteria that should be tested for. The TrioSmart test can detect H2S production, and can be used to help diagnose Intestinal Sulfide Overproduction (ISO).
Once the test is completed a doctor will review the test results with you and discuss the pros and cons of the three main treatment options. Antibiotics, Herbal Antibiotics, or the Elemental Diet. Once a treatment has concluded and the infection has been cleared and confirmed with repeat breath testing a repopulation and repair phase will begin. Usually during this time period, an investigation will continue as to the cause of the SIBO in the first place.
DXX
Doctors need to rule out other conditions in order to diagnose SIBO. A hydrogen and methane breath test can either diagnose or rule out SIBO and IMO. This is because these gases are only produced by microorganisms in the human digestive system. Other medical conditions need to be ruled out if the breath test comes back negative, such as inflammatory bowel disease (either ulcerative colitis or Crohn’s disease), collagen-based disorders such as Ehlers-Danlos syndrome, cancer, Celiac’s disease, parasitic infections, Small Intestinal Fungal Overgrowth (SIFO), post-infectious IBS, a Helicobacter pylori infection, and more.
Allopathic Treatment
Rifaximin has become a popular antibiotic among allopathic physicians to fight off SIBO. This drug works by killing off bacteria in the small intestine, creating an environment where good bacteria like Bifidobacteria and Lactobacilli can thrive. However, simply creating room for good bacteria doesn’t always mean that good bacteria will grow. Patients who have a fever, bloody stool, or liver disease shouldn’t take rifaximin.
The thought process is that these antibiotics can flush everything out, removing the cause of the symptoms. With everything wiped out, good bacteria can then take over the vacated areas. However, because antibiotics wipe out all the bacteria in the gut, these can lead to the gut needing additional time to recover and regulate their bacteria.
Natural Treatment
Personalized Natural Medicine can offer different treatment protocols based on the individual’s needs and responses to different remedies.
His most common treatment plan utilizes the BBB Protocol which includes Berberine, Biome Clear, and Binder. But other herbal medicines and treatment options can be utilized. After completing the antibacterial cycle, Dr. Brody will ask them to come back in. This follow-up will entail a check-in and another breath test to assess treatment efficacy.
Citations
Grover, S. (2007). Blueprints Pocket Gastroenterology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.