Qaly Wellness | SIBO: What everyone is talking about!

Small intestinal bacterial overgrowth (SIBO) is a state of dysbiosis in which microbes normally found in the large intestine become overgrown in the small intestine. Common SIBO symptoms include gas, bloating, abdominal pain, diarrhea, constipation, malabsorption, and steatorrhea, although some patients may be asymptomatic. Risk factors for developing SIBO include hypochlorhydria, motility disorders, organ system dysfunction, age, certain medications, anatomic abnormalities, and certain conditions such as irritable bowel syndrome (IBS), celiac disease, inflammatory bowel disease (IBD), and nonalcoholic liver disease. SIBO is highly associated with IBS, as IBS patients have a significantly increased risk of SIBO compared to healthy controls and non‑IBS patients. Although most cases present with mild‑to‑moderate symptoms, some patients may experience more severe symptoms. The diagnosis for SIBO generally results from the clinical presentation and a positive breath test, although a stool test may also be utilized. A positive hydrogen breath test is generally associated with diarrhea‑predominate IBS and IBS with mixed bowel habits. A positive methane breath test is associated with methanogen overgrowth and constipation‑predominate IBS. Treatment commonly incorporates antimicrobial medicinal and/or herbal treatments and probiotics to restore the gut microbiome homeostasis. An estimated 44% of patients may experience recurrence of SIBO within 9 months after treatment. This clinical protocol is designed to support a healthy gut microbiome, particularly in the small intestine. *

Diagnostic Biomarkers and Clinical Indicators of SIBO

• Hydrogen breath
  • ≥20 parts per million from baseline within 90 minutes of substrate ingestion
• Methane breath test
  • ≥10 parts per million at any time
• GI Map (Microbial Assay Plus) comprehensive stool testing
• Small bowel aspirate and culture
  • ≥103 CFU/mL

Therapeutic Diet and Nutritional Considerations

• Recommend the trial of a low FODMAP diet, as it has been shown to improve symptoms of IBS, which is highly associated with SIBO. Note that this diet requires monitoring and counseling, and it is not intended for long‑term use.
• Counsel patients on creating an anti‑inflammatory dietary pattern, as inflammation is associated with SIBO.
• Recommend patients consume fermented foods to support a healthy microbiome noting; however, that intake of fermented foods may need to be reduced or eliminated if they exacerbate symptoms. These foods may be reintroduced after the bacterial overgrowth is resolved:
  • Kefir · Kimchi · Miso · Sauerkraut · Tempeh · Yogurt

Lifestyle Interventions

• Recommend reducing or eliminating alcohol intake, as moderate alcohol consumption is a risk factor for SIBO.
• Counsel patients on smoking cessation, as smoking is highly associated with SIBO.
• Advise patients to maintain a healthy sleep pattern, as sleep fragmentation and short sleep duration are associated with gut dysbiosis.
• Advise patients on stress relief strategies, as chronic stress is associated with alterations in the gut‑brain axis, including altering gastrointestinal motility and the microbiome.

Treatment commonly incorporates antimicrobial medicinal and/or herbal treatments and probiotics to restore the gut microbiome homeostasis. An estimated 44% of patients may experience recurrence of SIBO within 9 months after treatment. This clinical protocol is designed to support a healthy gut microbiome, particularly in the small intestine.