How do I test for SIBO?

SIBO is tested through a breath test. When you go to your Naturopathic Doctor, they will order in a kit for you. It is a self-administered test that will take between 2.25 to 3 hours (depending on the kit). You are required to breathe into 10 tubes, which collect your breath upon exhalation, and send them to labs to analyze the content. Different concentrations of gas in those tubes will identify the types of bacteria producing the gas, in addition to the location and the size of the bacteria colony. We encourage testing due to the fact that test results will not only indicate if someone has the condition, but also indicate how many rounds of anti-bacteria a person need to complete treatment.

 

I heard there are two kinds of SIBO breath test…

Yes – lactulose and glucose. With the SIBO lactulose test, there is a greater ability to diagnose SIBO in the distal end of the small intestine where overgrowth is most common. Therefore, lactulose is the most commonly done breath test. With the glucose test, the absorption of glucose occurs faster in the duodenum so it most accurately diagnoses SIBO in the initial parts of the small intestine. The idea behind both test is that the content should be rapidly absorbed by your body and not fermented by the bacteria to produce gas. You may also perform both tests. Best results are usually observed when the patient performs both tests.

 

How can your doctors help?

I have my SIBO patients go through a similar treatment protocol, but is also individualized to account for unique health factors.

1. 1. Break up the biofilms: I find this is one of the first mistakes that people make when it comes to treating SIBO. The assumed treatment method is to take pharmaceuticals or natural antibiotics to kill off the bad bacteria and then replenish with bacteria that goes to the right places in your gut. The thought process is 100% correct, but people often forget that bacteria has a defense system too. Some bacteria can form biofilm – sticky goo-looking clusters – that can prevent your attack. Employing the Art of War, you want to break them apart first before launching your attack.
      1. N-Acetyl-Cysteine (NAC)
      2. Proteolytic enzymes
   2. Diet – I sometimes recommend putting on a low-fermentation diet for patients that cannot (or choose not to) do SIBO testing. Usually if the patient feels better by changing his or he diet, this tells me that there is a higher chance that the patient has SIBO. Besides, if someone feels better by changing the diet alone, why not give that a try?

1. FODMAP diet (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) – IBS patients will generally feel better on this diet, so it is not a surprise that SIBO patient do as well.
2. Intermittent Fasting – One of the reason MMC is not working for people is the lack of rest in our digestion process. Therefore, it is recommended to wait at least 12 hours between dinner and next day’s breakfast to give your gut time to clean it out.

1. Eradication – In this phase, you would kill as much bacteria as possible by using natural or pharmaceutical antibiotics.
   1. Rifaximin – Not every types of antibiotics is good to kill off your bad bacteria. In fact, some antibiotics may, in fact, be the cause of your SIBO in the first place. Rifaximin is a pharmaceutical antibiotic that is specifically researched to improve SIBO patient’s condition.
   2. Herbal antibiotics – Mostly commonly known herbs in this category are as follows: berberine, goldenseal, oregano, oregon grape, caprylic acid.
2. Gut healing – Healing the gut lining can aid in recovery. Not only do we restore the ability to absorb nutrients, we are also allowing protective layers to be formed on top of our gastrointestinal lining that will prevent relapse of SIBO.
   1. L-Glutamine – an amino acid that is fantastic to build muscles as well as intestinal lining.
3. Look for other causes – Now that we did all the eradication, if we do not fix the issue that caused SIBO, remission will be sweet, but short for those who has SIBO.
   1. Thyroid – If you have not gotten your thyroid hormones checked, check them. Do a complete thyroid panel to see if you have hypothyroidism. Low functioning thyroid can cause low stomach acid, decreased peristalsis and also malabsorption of certain nutrients such as B12.
   2. Look for signs of yeast overgrowth – Small Intestinal Fungal Overgrowth (SIFO) goes hand-in-hand with SIBO in 25% of the patient. While you may eradicate it (for now) from your gut, there might be signs of fungal infection in other parts of your body.
   3. Medication use – medication such as PPI, narcotics and some antibiotic really set up the scene for bad bacterial invasion. This is where I see a lot of ‘never well since’ phrases come up during discussion. Look for ways to reduce those medications without suffering the symptoms by working with your healthcare provider through diet, lifestyle and supplements.
   4. Inflammation – Underlying diseases such as endometriosis, IBD, SIBO can cause narrowing or adhesion in the gut lining. Reducing inflammation to allow gut lining to purge the bad bacteria might be a path to explore.
4. Not all underlying causes of SIBO can be cured, but healthcare practitioners can help you control the symptoms of the following conditions:
   1. Genetic conditions
   2. Surgery or surgery related anatomical difference
      1. Bowel removal
      2. Cesarean section
   3. Advanced scleroderma or other autoimmune diseases
   4. Cancer
5. Stimulate Prokinetic – What this means to use nutrients or herbs that can increase the functioning of your MMC. This is recommended to used 6 months to 1 year after the treatment.
   1. Bitter herbs
   2. Low Dose naltrexone (pharmaceutical)

 

 

Disclaimer: the information in this article is not designed to diagnose or treat. It should be used as a reference. This treatment plan will not be applicable to someone who has external circumstances, such as medication, pregnancy or breastfeeding (many of the antibiotics are not safe in pregnancy or lactation). So please consult your healthcare practitioner before self-diagnosis or self-treat.