SIBO Myth #3: Antibiotics are enough to get rid of SIBO

Many doctors prescribe Xifaxan (Rifaximin) as the most popular antibiotic for SIBO for hydrogen overgrowth, as well as additional antibiotics such as Neomycin/ Metronidazole in the case of a methanogen overgrowth. ⁽¹⁾ These indeed reduce bacterial overgrowth, but most clients relapse as soon as they come off the medications. Why is that happening so often?

I believe the main reason is that antibiotics don't address the underlying causes. Other reasons can be that some people may need several rounds of antibiotics to see results; some may not even react to the meds. The same goes for herbal antimicrobials. Biofilm formation also needs to be considered, which means that bacteria hide behind a protective layer that makes them resistant to any medications. ⁽¹³⁾

SIBO Myth #4: Diet alone can cure SIBO

So far, I haven't found any evidence that would show that diet alone can cure SIBO. The only exception is the 14-day-long Elemental Diet, which has an 80% success rate in SIBO treatment. An elemental diet is a liquid formula composed of amino acids, fats, sugars, vitamins, and minerals that can be used for symptom management and treatment. ⁽¹⁴⁾

There is a lot of information and discussions about the different diets that can be used for SIBO. The following diets are mainly recommended for SIBO: Low-FODMAP, Gut And Psychology Syndrome diet (GAPS), Specific Carbohydrate Diet (SCD), SIBO Specific Food Guide (SSFG), Bi-phasic diet, Fast Tract Diet, Paleo and Ketogenic diet, and so on. So overwhelming, right?

The FODMAP diet (Fermentable, Oligo-, Di-, Mono-saccharides, and Polyols) has gained popularity among IBS and even SIBO patients as a dietary approach to managing functional digestive disorders. ⁽¹⁵⁾ It is excellent for symptom management, reducing the uncomfortable symptoms of bloating, gas, and diarrhea by removing certain carbohydrates, but these foods are rarely the root cause of the issue.

Maybe you start strictly cutting out all of the high-FODMAP foods, but several months later, you still get stuck on the low-FODMAP diet, and you keep restricting more and more foods that lead nowhere good. FODMAPs are actually beneficial for good bacteria in the colon, so long-term use of this diet might not be the best idea.

Generally, all of these diets can help reduce symptoms and inflammation and identify triggering foods by removing certain carbohydrates, but they won't solve the root causes of the overgrowth. Deliberately starving bacteria may cause them to be inactivated and dormant.

Many people get stuck on the elimination phase of diets for too long due to food fear or think they might relapse. A reintroduction phase should follow every elimination phase to expand the diet as much as possible.

A general anti-inflammatory food plan can be beneficial, but remember, what works for one will not work for all.

SIBO Myth #5: Probiotics are a cure for SIBO

Probiotics for SIBO are pretty controversial.

Some practitioners say they are necessary, and some say no because they feed the bacteria! So, where is the truth?

The truth is – what many of you hate hearing – it depends! As this can be individual. Some clients feel better when adding probiotics later, which I call 'in the gut-healing phase.'

High-potency multi-strain probiotics tend to worsen the symptoms, while certain specific bacteria strains can be beneficial. It is especially true when somebody has histamine intolerance, for instance, where strains matter a lot!

There are more and more studies coming out on the effects of specific probiotic strains on SIBO. One example is Lactobacillus reuteri (DSM 17938). According to a study, Lactobacillus reuteri was found to lower methane production and reduce chronic constipation, but no effect was seen on lowering hydrogen levels. ⁽¹⁶⁾

A meta-analysis published that "the present findings indicated that probiotics supplementation could effectively decontaminate SIBO, decrease H2 (hydrogen) concentration, and relieve abdominal pain, but were ineffective in preventing SIBO." ⁽¹⁷⁾

Generally, Saccharomyces boulardii (a beneficial yeast) ⁽¹⁸⁾ and soil-based organisms ⁽¹⁹⁾ are well tolerated as they are less likely to colonize the small intestine.

The Bottom Line

Finding out what type of SIBO you have can be a good start, as different SIBO types require different approaches.

SIBO is a complex functional disorder in many cases. It requires a holistic approach, such as customized food plans, lifestyle changes, healthy sleep hygiene, conventional or herbal treatments, prokinetics, vagus nerve stimulation, etc. But the most important thing is to find the 'why", the root cause(s) behind your condition.

In addition, I want to highlight that there is no one-size-fits-all approach to defeating SIBO. Some clients improve on herbal antimicrobials; some may get better after taking probiotics and prebiotics, while others may improve after they work on their digestive function, gut motility, or nervous system.

Just because one approach hasn't worked for you, don't give up! Keep going and try another one. Trust your body that it can heal.

 

This post is only for informational purposes and is not meant to diagnose or treat any disease.  I advise consulting with your healthcare practitioner regarding any treatment options or dietary changes.