Over the years, I have been committed to learning everything I can about SIBO (small intestinal bacterial overgrowth) because I’ve had it, and many of my clients have it. In fact, according to Dr. Pimentel, one of the leading SIBO experts, 84% of IBS cases are actually SIBO. Therefore, if you have IBS, there is a high likelihood that it’s actually SIBO.
I listened to a webinar by Dr. Allison Siebecker the other day that offered a lot of great information in terms of treatment and prevention of SIBO. I am a huge fan of Dr. Siebecker, and she is one of top SIBO experts. She has a phenomenal website called SIBOinfo.com where she provides a wealth of information.
Depending on the person, SIBO can be fairly easy or very difficult to treat. While IBS has been around for a while, SIBO is a relatively new discovery. For years, doctors simply didn’t know what the cause of IBS was. Many doctors still claim that there’s no cause of IBS.
However, thanks to recent research by Dr. Pimentel and his team, we now know that bacterial overgrowth is the culprit in most cases. There’s still a lot of research that needs to be done, so SIBO can be easier to diagnose, treat, and prevent.
For now, I just wanted to share a few of the topics Dr. Siebecker covered in this webinar. If you’d like to listen to the webinar, you can do so at this link. My friend, Sean Croxton, is the one who interviewed her, and I always enjoy his interviews.
In this interview, Sean actually asked his followers to submit questions, and he picked the top 9 questions to ask Dr. Siebecker. I’ve listed them below along with her answers.
Q: Is it fair to say that if you have SIBO, you also have leaky gut?
A: There are 2 studies that have been done on the connection between SIBO and Leaky Gut. These studies showed that if you have SIBO you don’t necessarily have leaky gut. In the first study, 50% of the patient with SIBO also had leaky gut. In the second study, 55% of the patients also had leaky gut. Therefore, SIBO does not always cause leaky gut. The study also showed a 4% rate of leaky gut in healthy controls. Therefore, if you have SIBO, you have a 50% increased risk of leaky gut.
Q: How do you heal leaky gut if you have SIBO?
A: According to the studies, treating SIBO will likely eradicate leaky gut. In one study, 100% of leaky gut was healed once the SIBO was eradicated. In the other study, 75% of the people had their leaky gut healed upon eradication of SIBO. The only thing these patients did to heal their leaky gut was eradicate the SIBO. In the studies, this was done using pharmaceutical antibiotics. No supplements or diet intervention was given. This proves that when you remove the cause, the body will heal on it’s own.
Q: What is Candida’s role in this?
A: Before SIBO, a lot of people were misdiagnosed with Candida. In the alternative health world, if you had digestive issues, it was either a parasite or Candida. In Dr. Siebecker’s experience, roughly ¼ of her patients with SIBO also have Candida. Therefore, SIBO and Candida don’t go together. Candida can also cause leaky gut, just like other infections. However, if you have SIBO, it doesn’t mean you have Candida.
Q: How do you go about treating a patient with SIBO, Candida, and Leaky Gut?
A: This is a very complex question, and there is no 1 right answer. You can successfully treat them simultaneously or sequentially. You can treat SIBO first or Candida first. It’s usually best to treat the condition that causing the most symptoms. If your primary symptoms are SIBO symptoms like bloating, constipation, diarrhea, and pain, then treat that first. If your primary symptoms are Candida symptoms like a severe intolerance to simple sugars, then treat that. Herbal antibiotics are also antifungals, so they can treat SIBO, candida, and parasites. However, there’s also the chance for double die-off. If you treat SIBO with herbal antibiotics and you have Candida, then you may experience double die-off reactions, which can be unbearable for some people. You may have to start at a lower dose if this occurs.
Q: How do you know if it’s helpful to eat fermented foods or take probiotics with SIBO?
A: There are two schools of thought here; some who think probiotics make SIBO worse and others who think it helps SIBO. There are a few cons in regards to using probiotics and fermented foods with SIBO. There is concern with adding bacteria in the form of probiotics to an overgrowth of bacteria that’s already there. There is also concern that probiotics might create a relapse. That’s why many doctors don’t use probiotics when treating SIBO. Additionally, there are some patients whose symptoms are aggravated by probiotics, especially if they contain prebiotics.
Now for the pros. There are 9 studies done on probiotics in the use of SIBO. All of the studies have shown benefit when using probiotics. 6 studies have actually used probiotics as the treatment instead of antibiotics with successful results. There are a few reasons for the this. Probiotics secrete antibiotics and kill other bacteria. Probiotics also improve motility.
Many patients with SIBO do find benefit with probiotics, although it may be subtle. Also, when you look at the SCD and GAPS diets (two effective diets for SIBO), they highly emphasize the use of probiotic foods and pills. Of course, everyone is different, so you have to see how they affect you. You also may need to try different strains and combinations to find the right one. Additionally, probiotics can cause die-off, so you may experience a worsening of symptoms temporarily. When choosing a probiotic, look for one that makes you feel better and stick with it. The three most beneficial strains for SIBO have shown to be bifidus infantis, bifidus lactis, and lactobacillus plantarum.
Q: Are there any concerns with using herbal antibiotics?
A: There is a concern with using herbal antibiotics. They are powerful agents and can disrupt the gut flora balance in the colon. For this reason, first line therapies such as diet, digestive supplements, reducing stress, and exercise is always recommended. When that doesn’t work, then try second line therapies like herbal or pharmaceutical antibiotics. One herbal antibiotic that has shown not to kill probiotics, specifically lactic acid bacteria is allicin from garlic.
Q: How long does it take to heal from SIBO and Leaky Gut?
A: Everyone is different, so there’s no solid answer. Studies on patients with alcohol-induced leaky gut showed 2 weeks to heal the gut. Patients with Celiac seem to take longer; between 6 months to 1 year. For patients with SIBO and leaky gut. Leaky gut generally heals less than a month after SIBO is eradicated.
The time is takes to get rid of SIBO can take 2 weeks to 1 year depending on the method used. It usually takes about 2 months. In many cases of SIBO, there is damage to the ICC cells which are responsible for the migrating motor complex. It can take 1 month to 6 years to heal these damaged cells.
Q: Are biofilm busters necessary for treating SIBO?
A: No, biofilm busters are not needed to treat SIBO. In Dr. Siebecker’s experience, she has not seen a difference between using them and not using them. They are definitely needed for yeast, but not necessarily for SIBO. However, there is no harm in using them.
Q: How do you prevent a relapse of SIBO?
A: Prevention requires some type of low carb diet with a prokinetic. There are both pharmaceutical and natural options for a prokinetic. According to Dr. Siebecker, the pharmaceutical options are the best. These include Erythromycin, Resalor, and LDN (Low Dose Naltrexone). While many people love LDN because it has a number of other benefits, it isn’t strong enough for everyone. For approximately ¼ of people, LDN doesn’t work well enough. In that case you can switch to a stronger prokinetic or add a natural prokinetic with the LDN. Resalor is the strongest and Erythromycin is in the middle.
If you prefer to avoid prescriptions and go the natural route, your options include Iberogast, MotilPro, and ginger. Ginger seems to work well, but many people become tolerant to it, so it stops working after a few months. Additionally, ginger can cause acid reflux and what’s known as “ginger burn”. MotilPro is a combination of ginger and 5-HTP. Many people also have problems with it because of the “ginger burn”. In terms of natural prokinetics, Dr. Siebecker recommends Iberogast. It’s been around for many years, and it’s been well studied. In fact, studies have been done comparing Iberogast to 2 pharmaceutical prokinetics (not the ones mentioned above), and Iberogast was shown to work better.
PERSONAL NOTE: The likelihood of a SIBO relapse is very high and is often times expected. I’ve experienced this personally, and I now know the mistakes that I and my practitioners made. For one, while I maintained a healthy, paleo-style diet, it wasn’t always low carb or low FODMAP. Additionally, I never took a prokinetic. When you don’t implement a good prevention plan, then your SIBO will very likely return, as it did for me. Not for everyone, but for many people. I’ve accepted now that I will probably need to follow a low carb diet permanently, and that’s okay.
Below is Dr. Siebecker’s recommended dosing for all of the prokinetics mentioned.
**All prokinetics should be taken at night before bed.**
- Erythromycin – 50 mg
- Resalor – ½ mg
- LDN – 2.5 mg for those who tend toward diarrhea, 4.5 or 5mg for those who tend toward constipation
- Iberogast – 20 drops
- MotilPro – 2-3 capsules
- Ginger – 1000mg
I hope you find this information helpful in your healing journey. If you’re ready to work with someone who’s personally experienced SIBO, and who understands the condition, then I would love to chat with you. click here to schedule your 30-minute strategy session.