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If your stomach often feels so gassy and bloated that you have trouble buttoning up your pants, your intestinal inflammation may have progressed into Small Intestinal Bacterial Overgrowth (SIBO). Imbalances in your gut microbiome – made up of 1,000 different species of bacteria with over 3 million genes - can cause severe health issues. Research has found that over 80% of patients with Irritable Bowel Syndrome have a small intestinal bacterial overgrowth that can be treated, offering a long-term cure for what used to be a lifelong condition.

Besides severe gas, bloating, cramping, and diarrhea, SIBO symptoms may include:

  • irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)
  • intolerances of gluten, casein, lactose, fructose, and histamine
  • chronic autoimmune dysfunctions (fibromyalgia, chronic fatigue syndrome, and diabetes)
  • vitamin and mineral deficiencies (vitamins A, B12, D, and E)
  • fat malabsorption (presents with pale, bulky, malodorous stools)
  • leaky gut (intestinal permeability)
  • rosacea and other skin rashes
  • migraine headaches

Finding the root cause is most often a process of hypothesis and eliminating possible causes.

SIBO may have been caused by low stomach acid, use of antibiotics or acid-blocking medications, food poisoning, hypothyroid, chronic stress, immunodeficiency, scar tissue, or a dysfunctional ileocecal valve. Our doctors may investigate and address any underlying causes that set the stage for your SIBO, which will help to prevent relapses.

What is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) is a bacterial imbalance that occurs when the small intestine has become chronically infected with an overgrowth of bacteria. Typically, the small intestine does not house much bacteria. Still, if circumstances permit, opportunistic bacteria will make their way into the small intestine and cause an abnormal overgrowth known as SIBO.

When overgrown, certain bacterial species produce large amounts of hydrogen, methane, or hydrogen sulfide gas. This excess amount of gas production is irritating and inflammatory to the intestinal lining, where most digestion and nutrient absorption takes place. As you can guess, this results in vitamin deficiencies, immune dysregulation, diarrhea, constipation, bloating, and more.

SIBO bacteria have even been noted to breakdown the body's digestive enzymes, further interfering with normal digestive processes. When SIBO disrupts the Migrating Motor Complex (an electromechanical pattern of gastrointestinal smooth muscle activity that cleans out your small intestine between meals), it slows down your motility leading to painful constipation and improper clearing of waste from the GI tract, or it can cause excess amounts of water to pour into the intestine leading to severe diarrhea.

Hydrogen-dominant SIBO typically leads to diarrhea. Methane-dominant SIBO is usually associated with constipation. Some patients have a mixture of bacteria in the small intestine that causes both diarrhea and constipation, commonly diagnosed as IBS-Mixed. Using specialty testing, in correlation with the patient's history, our doctors will detect the type and underlying root cause of your unique SIBO imbalance.

How to test for SIBO

After discussing your symptoms, health history, and physically examining and listening to your stomach – Dr. Schertell and Dr. Mauss will perform one of these diagnostics:

  • breath test: this is the most common way SIBO is diagnosed at Vibrant Health. A lactulose or glucose sugar solution is ingested and feeds your gut bacteria releasing certain gases that can be measured as you exhale
  • dysbiosis test: urine analysis detects by-products of yeast or bacteria in the small intestine
  • comprehensive stool test: detects bacteria, candida, and other yeast and parasites
  • intestinal permeability test: checks the urine for higher than normal levels of mannitol or lactulose, which confirms "leaky gut syndrome"
  • endoscopy/colonoscopy: observation of intestine functions
  • smartPill: when ordered by a gastroenterologist, this ingestible capsule measures pressure, pH, transit time, and temperature in the gastrointestinal tract
  • LPS (lipopolysaccharide) test: this blood test detects bacterial toxins in the blood that can be due to SIBO or leaky gut, and can contribute to weight gain and immune dysfunction
  • IB smart blood test: detects the anti-Cdtb and anti-vinculin antibodies of IBS in the blood

Working with practitioners who know how to treat SIBO

Our providers have treated hundreds of patients with SIBO and IBS successfully, even after multiple failed attempts elsewhere. Each patient's unique imbalance and root cause requires customizing the following steps:

Starve overgrown bacteria with a SIBO diet

Removing foods that feed in your small intestine bacteria is critical. We offer medically supervised elemental diet protocols, low FODMAP guidance, or low sulfur/high FODMAP diets for patients with suspected hydrogen sulfide SIBO. You'll be coached through a medical nutrition protocol and encouraged to enjoy non-starchy vegetables, leafy greens, lean proteins, and healthy fats.

Kill or flush out bacteria

You may be prescribed a blend of herbs or supplements such as oregano, berberine, sweet wormwood, grapefruit, barberry, bearberry, black walnut, bismuth, or other herbs to kill off the bad bacteria while rebuilding the good.

Sometimes killing stubborn pathogens requires a short antibiotic protocol, and when necessary, our doctors use a cutting-edge antibiotic treatment to rid SIBO effectively, yet unlike other antibiotics, it ONLY works in the small intestine where we need it. Amazingly, this antibiotic actually improves healthy probiotic levels in the large intestine and gets rid of SIBO at the same time. If you're questioning how that's possible, we can explain during your appointment, and we have the research and clinical experience to back it up. Using a natural biofilm treatment selected by our doctors, along with bile acid salts, may help to improve the efficacy of your SIBO protocol.

Flushing out rather than killing the bacteria is often the most thorough approach. With methane dominant SIBO, taking a prokinetic peptide, bile acid salts, or an herbal motility blend can help bring long term gut stabilization.

Restore MMC

Eating low-fermentation foods that can be more fully digested will optimize your MMC and nutrient absorption while supporting your immune system. Supplements like collagen, bone broth, and our "Vibrant Life SBI Powder" may also be prescribed to bind up the problematic bacteria and promote healing and regeneration of the intestinal lining.

Once you've rebalanced your gut biome, you'll need to avoid over the counter NSAIDs, PPI's, prescription steroids, birth control pills, and antibiotics as much as possible to prevent a relapse.

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Dr. Tenesha Wards, DC
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Dr. Nitya Eisenheim, ND
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