Dealing With SIBO? Don't Make One Of These 5 Common Mistakes

The road to healing from SIBO isn't always a straight line, so as you work with your health care provider, avoid these five mistakes to boost your treatment success and prevent SIBO from recurring:

Diet is part of the treatment, and carbohydrates feed bacteria, so it goes without saying that sugars from sweets, breads, pastries, soda, juices, alcohol, and others are not your best friends. Healthy carbohydrates in excess, or the wrong types of carbohydrates, can slow down your healing process as well. Some people can't tolerate simple sugars like lactose and fructose while others have a hard time with complex starches like potatoes and rice.

Timing your meals is also important. The migrating motor complex (MMC) is a wave of contractions1 that starts in the stomach and goes through the small intestine, and interruptions in MMC increase the risk of SIBO2. Think of the MMC as "housekeeping"; it sweeps bacteria and undigested food and dumps them into the large intestine. The MMC needs 90 to 120 minutes to complete this job2, but it gets stopped and has to reset every time you eat. If you take more than an hour to nibble on meals because you're too distracted or because you think it's healthier, or if you eat every two hours or less, you're interfering with your MMC. Instead of grazing, sit down and eat your meal mindfully, then "close the kitchen" for three to four hours.

What interferes with proper motility? Food poisoning and infectious gastroenteritis with certain bacteria, viruses, or parasites can damage the cells that act as the pacemaker4 and control the MMC. Uncontrolled diabetes has a similar effect, and hypothyroidism, gastroparesis, celiac disease, and Parkinson's disease slow down motility2 as well. To top it off, stress triggers the fight-or-flight response that shuts down digestion.

Unfortunately, SIBO can be stubborn to treat, and it can come back. So whether you chose antibiotics or herbals, retest within the first week of completing treatment to confirm that it's gone. If you wait too long, or never retest, and your symptoms come back a few weeks or months down the road, you're back at the starting line. When you confirm that the treatment was successful, you can confidently transition to a maintenance and prevention plan. If you test positive, your practitioner can prescribe a different medication or herbal protocol. Understand that your healing journey may include a plan B or C, or even a plan D, but without retesting, you have too many unknowns. If it turns out that your SIBO is stubborn, ask your provider about the elemental formula diet.

Having SIBO doesn't rule out other gut infections. You may also have yeast, mold, viruses, parasites, H. Pylori, clostridia, or other bacteria. You may have small intestine fungal overgrowth5 (SIFO). My functional medicine mentors stress the importance of ruling out H. Pylori and obtaining a thorough assessment of the colon, whether SIBO is positive or not. If your SIBO retest is negative but you continue to experience symptoms, search for other sources of gut dysbiosis and infections.

Extra bacteria in your intestine? Blast them with antibiotics and your job is done, right? Not so much. Treating SIBO by shooting just one arrow at the target doesn't work. Replacing antibiotics with herbals isn't integrative enough. To completely heal and prevent recurring SIBO, you must understand why it happened in the first place. In addition to slow motility, low gastric acid (or high stomach pH), a weakened immune system, reduced pressure at the ileocecal junction3 (the muscles that separate the large from the small intestine), and dysbiosis in the large intestine can cause SIBO2. That's why, along with killing bacteria, your treatment must aim to:

You can do this by including motility agents and addressing the root cause of slow gut transit if at all possible.

Include betaine HCL if tolerated. If taking acid-lowering medications, discuss weaning off with your doctor. Treating SIBO may reduce your heartburn and reflux.

Incorporate digestive enzymes, bile, and digestive bitters. The ability of your intestine cells to produce brush border enzymes on their own should start to improve as SIBO clears

As I mentioned before, treating SIBO can be a process, and you have to be ready to test, retest, and adapt your treatment plan as you go. The good news is that by avoiding these five mistakes, you can save yourself time and, hopefully, set yourself on a quicker path to healing your gut for good.