Managing SIBO Naturally with Diet and Supplements

Small intestinal bacterial overgrowth (SIBO) happens when there is an increase in the number or type of bacteria in the upper gastrointestinal tract. 

Your body will start to experience problems such as diarrhea, constipation, bloating, indigestion, malabsorption of nutrients leading to weight loss and malnutrition.

The reason for these symptoms is because bacteria produce various toxic agents that have systemic effects. These toxic agents include ammonia, D-lactate, ethanol, and others. In addition, there are often increased endotoxin and bacterial compound levels that stimulate the production of proinflammatory cytokines in the blood [1, 2].

Microscopic inflammatory changes occur in the structure of the small intestines. Scientists found small intestinal mucosal breaks (erosions or ulcers) in 16/18 patients with chronic myopathic or neuropathic motility disorders of the small bowel using wireless-capsule endoscopy. [3]

The body usually prevents this bacterial overgrowth by producing gastric acid, increasing gut motility, and increasing bile secretion. 

However, this may not always function suitably due to an underlying disease requiring medical and nutritional support.

SIBO is frequently found in people with irritable bowel syndrome (30%-85%) [4-9]. However, research does show that SIBO does not play any significant role in the pathogenesis of irritable bowel syndrome [10].

SIBO is also frequently found in Crohn’s disease (25%), coeliac disease (9% to 55%) [11-14], diabetes mellitus (50%-70%), and in 100% of people with fibromyalgia [15]. found that 42/42 (100%) 

SIBO Diagnosis:

SIBO is diagnosed by non-invasive hydrogen and methane breath tests after glucose or lactulose challenge.

Standard management of SIBO involves:

  • Treatment of the underlying disease
  • Nutritional support of malnutrition, weight loss, and nutrient deficiency
  • Antibiotics, especially rifaximin[16-23] with low gastrointestinal absorption and good bactericidal activity.[24]. Rifaximin eradicates small intestinal bacterial overgrowth in up to 80% of patients[25,26]. However, the recurrence rate is very high.

Natural Methods to Manage SIBO 

Nevertheless, natural methods to manage SIBO can support the standard treatment methods and prevent relapse.   

Take Probiotics and Prebiotic Foods Daily

Studies show the effectiveness of certain probiotics on SIBO. [27-30].

Probiotics strengthen the gut’s barrier function, restrain several pathogens, modify the inflammatory response of the bowel, and reduce visceral hypersensitivity [31-34].

Probiotics are effective in normalizing gastric microbiota, just as they are in normalizing intestinal microbiota. Therefore, consuming probiotics regularly can help normalize intestinal motility and stomach acids necessary to inhibit gastric and intestinal bacteria growth. [35]

Probiotics are found in kombucha, kefir, kimchi, and sauerkraut and can help revive healthy bacterial communities in the stomach and intestines and prevent bacterial overgrowth. One of the most convenient ways to take probiotics is by drinking a probiotic drink each day or taking probiotic supplements. However, you should note that you want to ensure some bacteria reach the gut while others affect the stomach. This is because certain strains of bacteria are hardy enough to survive the high acidity in the stomach and can reach the intestines. These include Lactobacillus acidophilus, Lactobacillus paracasei, and Bifidobacterium lactis

If you choose enteric-coated probiotics, these will ensure they reach the gut, but none will reach the stomach. So, either go for two probiotic supplements, one enteric-coated and the other not, or take one probiotic supplement that has many different strains of bacteria, including those mentioned above, to ensure the bacterial strains reach your entire digestive system. 

But please note that Lactobacilli-based probiotics are contraindicated in people with a risk of D-lactic acidosis. This rare condition occurs primarily in people with a history of short bowel syndrome. 

Also, aim to consume prebiotics, foods for these friendly bacteria. The bacteria use prebiotics for food to thrive. Prebiotic-rich foods include vegetables, especially: artichokes, garlic, leeks, potatoes, carrots, asparagus, and fruits, especially bananas, apples, oranges, and apricots.

Drink Herbal Teas

In a study led by a Biochemistry Group, College of Medicine, Care of Grove Reception, Swansea University, essential oils like peppermint, fennel, lemon balm, and coriander seed showed to have strong antibacterial effects and the ability to kill bacteria present in the small intestine. [36] I do not recommend ingesting essential oils in any way as they may be very toxic; however, you can get the benefits by consuming these teas. 

The culinary herbs found in teas are “food-grade” and can have benefits for reducing harmful bacterial overgrowth. Go for 100 percent therapeutic grade Mentha Piperita mint tea, fennel, lemon balm, and coriander seed tea with whole and coriander seeds soaked in hot water.

Consume Antimicrobial Herbs

Although antibiotics remain the mainstay of SIBO treatment, various herbal combinations are beneficial. There is accumulating evidence demonstrating the antimicrobial properties of a growing number of herbs, including garlic, black cumin, cloves, cinnamon, thyme, all-spices, bay leaves, mustard, and rosemary. This has prompted an interest in herbal therapy for the treatment of SIBO.[37]

I recommend adding these condiments regularly to your food. 

Follow a Low FODMAP Diet 

FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. A low FODMAP diet is one without fermentable carbohydrates; it eliminates foods that feed harmful intestinal bacteria. However, this diet is very limiting. Because chronic diarrhea is a symptom of SIBO, the condition can lead to malnutrition, making it crucial to eat nutritious food while avoiding foods that exacerbate SIBO symptoms. [38]

You may follow a low FODMAP diet for three months, and then you can reintroduce foods higher in fermentable carbohydrates gradually. Test different foods one by one for three days each until you know which types of FODMAPs you tolerate and how many of FODMAPs you tolerate.

You can see foods high in FODMOP’s in the image below.

Takeaway

Taking antibiotics for extended periods may lead to bacterial resistance and an imbalance in intestinal and gastric bacteria. Antibiotic treatment with SIBO is also not sufficiently effective, and the recurrence rate is high.

For managing your SIBO symptoms, healthy long-term dietary change can shift the microbiota composition and bring balance to the gut.  

Feel free to comment below and let me know what you liked best about this article.

Thank you for taking the time to read this. I’d be honored if you would share it with your family, friends, and followers by clicking the Like, Tweet, and Share buttons. If you are serious about improving your health no matter what your age or circumstances, and are ready to finally achieve optimal health and lose the weight you’ve been struggling with, then click HERE to check out my online Guerrilla Diet Wholistic Lifestyle Bootcamp for Healthy and Lasting Weight Loss.

If you are not already on my mailing list where you will receive my weekly articles packed with scientifically based health, and nutrition content, as well as many FREE bonuses and special offers, and much more, then  click HEREto subscribe.

Thank You, 🙂

Dr. Galit Goldfarb

References

  1. Spinucci G, Guidetti M, Lanzoni E, Pironi L. Endogenous ethanol production in a patient with chronic intestinal pseudo-obstruction and small intestinal bacterial overgrowth. Eur J Gastroenterol Hepatol. 2006;18:799–802. 
  2. Vanderhoof JA, Young RJ. Etiology and pathogenesis of bacterial overgrowth. Clinical manifestations and diagnosis of bacterial overgrowth. Treatment of bacterial overgrowth. UpToDate online, vol 18.1; Wellesley, 2010
  3. Hoog CM, Lindberg G, Sjoqvist U. Findings in patients with chronic intestinal dysmotility investigated by capsule endoscopy. BMC Gastroenterol. 2007;7:29. 
  4. Lin HC. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA. 2004;292:852–858. 
  5. Lupascu A, Gabrielli M, Lauritano EC, Scarpellini E, Santoliquido A, Cammarota G, Flore R, Tondi P, Pola P, Gasbarrini G, et al. Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22:1157–1160. 
  6. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.
  7. Scarpellini E, Giorgio V, Gabrielli M, Lauritano EC, Pantanella A, Fundarò C, Gasbarrini A. Prevalence of small intestinal bacterial overgrowth in children with irritable bowel syndrome: a case-control study. J Pediatr. 2009;155:416–420.
  8. Ford AC, Spiegel BM, Talley NJ, Moayyedi P. Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7:1279–1286. 
  9. Mann NS, Limoges-Gonzales M. The prevalence of small intestinal bacterial vergrowth in irritable bowel syndrome. Hepatogastroenterology. 2009;56:718–721.
  10. Posserud I, Stotzer PO, Björnsson ES, Abrahamsson H, Simrén M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802–808.
  11. Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA. Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol. 2009;43:157–161.
  12. Ghoshal UC, Ghoshal U, Misra A, Choudhuri G. Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance. BMC Gastroenterol. 2004;4:10. 
  13. Krauss N, Schuppan D. Monitoring nonresponsive patients who have celiac disease. Gastrointest Endosc Clin N Am. 2006;16:317–327. 
  14. Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol. 2003;98:839–843.
  15. Pimentel M, Wallace D, Hallegua D, Chow E, Kong Y, Park S, Lin HC. A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann Rheum Dis. 2004;63:450–452.
  16. Frissora CL, Cash BD. Review article: the role of antibiotics vs. conventional pharmacotherapy in treating symptoms of irritable bowel syndrome. Aliment Pharmacol Ther. 2007;25:1271–1281.
  17. Di Stefano M, Strocchi A, Malservisi S, Veneto G, Ferrieri A, Corazza GR. Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms. Aliment Pharmacol Ther. 2000;14:1001–1008. 
  18. Koo HL, DuPont HL. Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases. Curr Opin Gastroenterol. 2010;26:17–25. 
  19. Lauritano EC, Gabrielli M, Lupascu A, Santoliquido A, Nucera G, Scarpellini E, Vincenti F, Cammarota G, Flore R, Pola P, et al. Rifaximin dose-finding study for the treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2005;22:31–35. 
  20. Peralta S, Cottone C, Doveri T, Almasio PL, Craxi A. Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin. World J Gastroenterol. 2009;15:2628–2631. 
  21. Pimentel M. Review of rifaximin as treatment for SIBO and IBS. Expert Opin Investig Drugs. 2009;18:349–358. 
  22. Rana SV, Bhardwaj SB. Small intestinal bacterial overgrowth. Scand J Gastroenterol. 2008;43:1030–1037. 
  23. Scarpellini E, Gabrielli M, Lauritano CE, Lupascu A, Merra G, Cammarota G, Cazzato IA, Gasbarrini G, Gasbarrini A. High dosage rifaximin for the treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2007;25:781–786. 
  24. Ojetti V, Lauritano EC, Barbaro F, Migneco A, Ainora ME, Fontana L, Gabrielli M, Gasbarrini A. Rifaximin pharmacology and clinical implications. Expert Opin Drug Metab Toxicol. 2009;5:675–682.
  25. Peralta S, Cottone C, Doveri T, Almasio PL, Craxi A. Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin. World J Gastroenterol. 2009;15:2628–2631.
  26. Pimentel M. Review of rifaximin as treatment for SIBO and IBS. Expert Opin Investig Drugs. 2009;18:349–358. 
  27. Leventogiannis K, Gkolfakis P, Spithakis G, et al. Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth [published correction appears in Probiotics Antimicrob Proteins. 2018 Mar 28;:]. Probiotics Antimicrob Proteins. 2019;11(2):627–634. doi:10.1007/s12602-018-9401-3
  28. Gabrielli M, Lauritano EC, Scarpellini E, Lupascu A, Ojetti V, Gasbarrini G, Silveri NG, Gasbarrini A. Bacillus clausii as a treatment of small intestinal bacterial overgrowth. Am J Gastroenterol. 2009;104:1327–1328. 
  29. Schiffrin EJ, Parlesak A, Bode C, Bode JC, van’t Hof MA, Grathwohl D, Guigoz Y. Probiotic yogurt in the elderly with intestinal bacterial overgrowth: endotoxaemia and innate immune functions. Br J Nutr. 2009;101:961–966. 
  30. Stotzer PO, Blomberg L, Conway PL, Henriksson A, Abrahamsson H. Probiotic treatment of small intestinal bacterial overgrowth by Lactobacillus fermentum KLD. Scand J Infect Dis. 1996;28:615–619. 
  31. Preidis GA, Versalovic J. Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomics era. Gastroenterology. 2009;136:2015–2031. 
  32. Quigley EM, Quera R. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology. 2006;130:S78–S90. 
  33. Quigley EM. Bacteria: a new player in gastrointestinal motility disorders–infections, bacterial overgrowth, and probiotics. Gastroenterol Clin North Am. 2007;36:735–748, xi. 
  34. Spiller R. Review article: probiotics and prebiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2008;28:385–396.
  35. Koga Y, Ohtsu T, Kimura K, et al. Probiotic L. gasseri strain (LG21) for the upper gastrointestinal tract acting through improvement of indigenous microbiota. BMJ Open Gastro 2019;6:e000314. doi:10.1136/ bmjgast-2019-000314 
  36. Thompson A, Meah D, Ahmed N, et al. Comparison of the antibacterial activity of essential oils and extracts of medicinal and culinary herbs to investigate potential new treatments for irritable bowel syndrome. BMC Complement Altern Med. 2013;13:338. Published 2013 Nov 28. doi:10.1186/1472-6882-13-338
  37. Lai PK, Roy J. Antimicrobial and chemopreventive properties of herbs and spices. Curr Med Chem 2004;11:1451–60.
  38. Sorathia SJ, Rivas JM. Small Intestinal Bacterial Overgrowth. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546634/

References

  1. Spinucci G, Guidetti M, Lanzoni E, Pironi L. Endogenous ethanol production in a patient with chronic intestinal pseudo-obstruction and small intestinal bacterial overgrowth. Eur J Gastroenterol Hepatol. 2006;18:799–802. 
  2. Vanderhoof JA, Young RJ. Etiology and pathogenesis of bacterial overgrowth. Clinical manifestations and diagnosis of bacterial overgrowth. Treatment of bacterial overgrowth. UpToDate online, vol 18.1; Wellesley, 2010
  3. Hoog CM, Lindberg G, Sjoqvist U. Findings in patients with chronic intestinal dysmotility investigated by capsule endoscopy. BMC Gastroenterol. 2007;7:29. 
  4. Lin HC. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA. 2004;292:852–858. 
  5. Lupascu A, Gabrielli M, Lauritano EC, Scarpellini E, Santoliquido A, Cammarota G, Flore R, Tondi P, Pola P, Gasbarrini G, et al. Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther. 2005;22:1157–1160. 
  6. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506.
  7. Scarpellini E, Giorgio V, Gabrielli M, Lauritano EC, Pantanella A, Fundarò C, Gasbarrini A. Prevalence of small intestinal bacterial overgrowth in children with irritable bowel syndrome: a case-control study. J Pediatr. 2009;155:416–420.
  8. Ford AC, Spiegel BM, Talley NJ, Moayyedi P. Small intestinal bacterial overgrowth in irritable bowel syndrome: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7:1279–1286. 
  9. Mann NS, Limoges-Gonzales M. The prevalence of small intestinal bacterial vergrowth in irritable bowel syndrome. Hepatogastroenterology. 2009;56:718–721.
  10. Posserud I, Stotzer PO, Björnsson ES, Abrahamsson H, Simrén M. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Gut. 2007;56:802–808.
  11. Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA. Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol. 2009;43:157–161.
  12. Ghoshal UC, Ghoshal U, Misra A, Choudhuri G. Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance. BMC Gastroenterol. 2004;4:10. 
  13. Krauss N, Schuppan D. Monitoring nonresponsive patients who have celiac disease. Gastrointest Endosc Clin N Am. 2006;16:317–327. 
  14. Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol. 2003;98:839–843.
  15. Pimentel M, Wallace D, Hallegua D, Chow E, Kong Y, Park S, Lin HC. A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann Rheum Dis. 2004;63:450–452.
  16. Frissora CL, Cash BD. Review article: the role of antibiotics vs. conventional pharmacotherapy in treating symptoms of irritable bowel syndrome. Aliment Pharmacol Ther. 2007;25:1271–1281.
  17. Di Stefano M, Strocchi A, Malservisi S, Veneto G, Ferrieri A, Corazza GR. Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms. Aliment Pharmacol Ther. 2000;14:1001–1008. 
  18. Koo HL, DuPont HL. Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases. Curr Opin Gastroenterol. 2010;26:17–25. 
  19. Lauritano EC, Gabrielli M, Lupascu A, Santoliquido A, Nucera G, Scarpellini E, Vincenti F, Cammarota G, Flore R, Pola P, et al. Rifaximin dose-finding study for the treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2005;22:31–35. 
  20. Peralta S, Cottone C, Doveri T, Almasio PL, Craxi A. Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin. World J Gastroenterol. 2009;15:2628–2631. 
  21. Pimentel M. Review of rifaximin as treatment for SIBO and IBS. Expert Opin Investig Drugs. 2009;18:349–358. 
  22. Rana SV, Bhardwaj SB. Small intestinal bacterial overgrowth. Scand J Gastroenterol. 2008;43:1030–1037. 
  23. Scarpellini E, Gabrielli M, Lauritano CE, Lupascu A, Merra G, Cammarota G, Cazzato IA, Gasbarrini G, Gasbarrini A. High dosage rifaximin for the treatment of small intestinal bacterial overgrowth. Aliment Pharmacol Ther. 2007;25:781–786. 
  24. Ojetti V, Lauritano EC, Barbaro F, Migneco A, Ainora ME, Fontana L, Gabrielli M, Gasbarrini A. Rifaximin pharmacology and clinical implications. Expert Opin Drug Metab Toxicol. 2009;5:675–682.
  25. Peralta S, Cottone C, Doveri T, Almasio PL, Craxi A. Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin. World J Gastroenterol. 2009;15:2628–2631.
  26. Pimentel M. Review of rifaximin as treatment for SIBO and IBS. Expert Opin Investig Drugs. 2009;18:349–358. 
  27. Leventogiannis K, Gkolfakis P, Spithakis G, et al. Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth [published correction appears in Probiotics Antimicrob Proteins. 2018 Mar 28;:]. Probiotics Antimicrob Proteins. 2019;11(2):627–634. doi:10.1007/s12602-018-9401-3
  28. Gabrielli M, Lauritano EC, Scarpellini E, Lupascu A, Ojetti V, Gasbarrini G, Silveri NG, Gasbarrini A. Bacillus clausii as a treatment of small intestinal bacterial overgrowth. Am J Gastroenterol. 2009;104:1327–1328. 
  29. Schiffrin EJ, Parlesak A, Bode C, Bode JC, van’t Hof MA, Grathwohl D, Guigoz Y. Probiotic yogurt in the elderly with intestinal bacterial overgrowth: endotoxaemia and innate immune functions. Br J Nutr. 2009;101:961–966. 
  30. Stotzer PO, Blomberg L, Conway PL, Henriksson A, Abrahamsson H. Probiotic treatment of small intestinal bacterial overgrowth by Lactobacillus fermentum KLD. Scand J Infect Dis. 1996;28:615–619. 
  31. Preidis GA, Versalovic J. Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomics era. Gastroenterology. 2009;136:2015–2031. 
  32. Quigley EM, Quera R. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology. 2006;130:S78–S90. 
  33. Quigley EM. Bacteria: a new player in gastrointestinal motility disorders–infections, bacterial overgrowth, and probiotics. Gastroenterol Clin North Am. 2007;36:735–748, xi. 
  34. Spiller R. Review article: probiotics and prebiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2008;28:385–396.
  35. Koga Y, Ohtsu T, Kimura K, et al. Probiotic L. gasseri strain (LG21) for the upper gastrointestinal tract acting through improvement of indigenous microbiota. BMJ Open Gastro 2019;6:e000314. doi:10.1136/ bmjgast-2019-000314 
  36. Thompson A, Meah D, Ahmed N, et al. Comparison of the antibacterial activity of essential oils and extracts of medicinal and culinary herbs to investigate potential new treatments for irritable bowel syndrome. BMC Complement Altern Med. 2013;13:338. Published 2013 Nov 28. doi:10.1186/1472-6882-13-338
  37. Lai PK, Roy J. Antimicrobial and chemopreventive properties of herbs and spices. Curr Med Chem 2004;11:1451–60.
  38. Sorathia SJ, Rivas JM. Small Intestinal Bacterial Overgrowth. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546634/

Leave A Response

* Denotes Required Field