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The Top 5 Mistakes When Healing SIBO

December 17, 2020

The Top 5 Mistakes When Healing SIBO

If you haven’t found out already, SIBO can be quite a challenge to get under control and treat. If you’re unfamiliar with SIBO, or simply new to the diagnosis here’s a little run down before we dive into the top 5 mistakes when healing SIBO.

What is SIBO?

woman sitting on bed bent over and holding stomach in pain with white background

SIBO stands for Small Intestinal Bacterial Overgrowth. Under normal circumstances, your Large Intestine should carry the majority of your gut bacteria, but sometimes that bacteria translocates to your small intestine where it can cause issues with gut health.

There are 3 main types of SIBO: 

  • Methane dominant
  • Hydrogen dominant
  • Hydrogen Sulfide dominant

These are most commonly diagnosed by breath test or endoscopy of the small intestine, but also have some specific individual symptoms. Aside from bloating and inflammation, constipation is extremely common in methane dominant SIBO while diarrhea is extremely common in hydrogen dominant SIBO and sulfur smelling gas is a telling sign of hydrogen sulfide SIBO.

Common causes of SIBO include:

  • Food poisoning
  • IBS
  • Gastroenteritis
  • Hypothyroidism
  • Chronic stress
  • Low pancreatic enzymes

Treatment for SIBO is extremely individualized because the gut microbiome is so complex. As capable as you are to take your health into your own hands, this is certainly a condition where you want to work with a practitioner. If you are struggling with healing SIBO right now, you definitely want to keep reading.

Below are some the most common treatment mistakes people make when trying to heal SIBO:

1. Only working on REMOVING without REPAIRING

doctor in white lab coat holding out antibiotics and other medications

Fully treating the gut and healing SIBO involves a multi-step approach. I use the 4R’s of treatment which is not only comprehensive, but also easy to remember too. The 4R’s are Remove, Replace, Reinoculate, and Repair. 

With a condition like SIBO, it’s easy to focus on the “remove” part. However, if all you do is treat with antibiotics without replacing the good gut bugs or repairing the gut lining, you aren’t doing yourself any favors. The antibiotics that work to kill off bacteria in the small intestine can actually deplete the large intestine of bacteria that you need!

Tips for repairing while on antimicrobials:

  • Support your gut with supplements like zinc carnosine, bone broth, and aloe.
  • Take IgG and SPI supplements which can help relieve the gut of the endotoxin load.
  • Include prokinetics either during or once you finish your antibiotic treatment. Prokinetics stimulate the Migrating Motor Complex (aka MMC) and work to increase motility in the upper gut. If the activity of the MMC is deficient, as is common in SIBO, then there is an increase in inflammation in the gut.
  • Incorporate probiotics and prebiotics to help reinoculate the good bacteria. However, you have to be cautious on how you take pre/probiotics with SIBO in an effort not to make it worse. 

2. Trying to STARVE the Overgrowth 

woman with white tape over mouth and donut on plate in front of her with light background

You can google “SIBO diet” and find a thousand different approaches. Specific Carbohydrate Diet, low FODMAP diet, Biphasic Diet, SIBO Specific Diet, low carb diets, no carb diets, and so much more… It’s a little overwhelming right? 

All of these diets have one thing in common: the manipulation of carbohydrates. This seems to make sense because carbohydrates are what can ferment in the gut and promote the growth of bacteria (good or bad). However, many classic “SIBO diets” restrict TOO much and this can cause problems. 

When you consume an extremely low carb or low calorie diet, the bacteria will “hide” until carbs become available again. This not only hinders antibiotic treatment, but also once you eventually eat carbs again, the bacteria returns as well. These diets can also hurt the good gut bugs and body functions that are trying to help you out!

Problems created by restriction:

  • The availability of necessary micronutrients is reduced, preventing your body from obtaining the vitamins and minerals needed to heal and promote a healthy functioning body.
  • The lack of carbohydrates can offset the HPA axis, which may exacerbate cortisol or thyroid dysfunction. 
  • Eliminating fermentable fibers from carbohydrates can actually prevent the repair of the gut lining. Fermentable fibers form the mucosal lining that protects the gut from bad bacteria. If this lining isn’t strong, this can trigger a leaky gut and lead to other systemic issues.
  • An extremely restrictive diet can lead to food fears and potentially promote orthorexia or other disordered eating patterns. 

A restrictive diet may feel good at first, but trust me, it will hurt you in the long run.

3. Making SIBO your identity

You are not your disease.

It can be easy to get wrapped up in the treatment of SIBO, because yes, it is a lot. However, if you only focus on the foods you can and cannot eat, the medications, the supplements, how crappy you feel, or the fear of relapsing, you will miss out on life!

Keep a couple things in mind here:

  • Some lifestyle adjustments may need to happen. Eating out and ordering whatever you want four times a week may not be in the cards anymore, but you can still go to lunch with your friends or dinner with your family. 
  • Healthy relationships and social time are an important factor in your overall health and may be a way to destress (step away from that “fight or flight” for a while).
  • Our mindset can have a huge impact on our physical health. If your only focus is on how sick you are, you might just stay that way. If you instead focus on the positive and don’t sit in a blackhole of SIBO despair, you may find yourself feeling better sooner.
family eating dinner together shot from above

Trust the treatment. Although there may be some sacrifices made in order to prioritize your healing and some added resilience with the trial and error associated with treatment, don’t make your disease your identity. Your mental health is just as important as your physical health.

4. Trying to treat your own SIBO

Yes, gastric distress from SIBO can be extremely uncomfortable. However, you should never try to treat your own SIBO because in the end, you could end up doing more harm than good. There are several reasons why this is a condition where it is important to TEST not GUESS.

Reasons to seek professional help:

dietitian wearing white lab coat in meeting with patient with food on table between them
  • Hydrogen or methane dominant SIBO need different approaches to treatment.
  • Your symptoms may match SIBO according to Google, but your condition could actually be SIFO (Small Intestinal Fungal Overgrowth), which requires different treatment
  • You may have Leaky Gut or Candida instead of SIBO. 
  • Taking the wrong pre or probiotic can actually make the overgrowth worse.
  • You may have thyroid dysfunction, cortisol dysregulation, or other hormone imbalances preventing your SIBO from healing. 

Trying to go at it yourself by taking random supplements, antimicrobials, and following restrictive diets is like putting out a house fire with a spray bottle. It doesn’t sound very effective does it?

5. Ignoring lifestyle factors

In addition to trying to heal your own SIBO, treating your SIBO without adjusting any other lifestyle factors is like trying to fix a leaky pipe by slapping some tape on it. It might work for a little, maybe even hide that there was a problem, but in the end, the problem is still there and that tape will not hold up. 

The importance of stress and sleep:

woman in white bed with hands over face due to poor sleep
  • Chronic stress will absolutely prevent you from healing your SIBO. If cortisol and your HPA axis are out of whack and you are constantly in “fight or flight” mode, you don’t give your gut a chance to move into “rest and digest” mode, where it has a chance to heal. If your body is stressed (doesn’t even matter what kind!), it will downregulate digestion and upregulate other body processes as a protective mechanism because it senses that you are in danger.
  • This also ties into sleep habits. If you are not getting 6-8 hours of sleep a night, or are sleeping poorly, then the body will not have a chance to repair. Poor sleep habits will also affect cortisol regulation and your parasympathetic nervous system. You need to be able to switch from sympathetic mode (fight or flight) to parasympathetic mode (rest and digest) to support proper gut function.

Taking lifestyle factors into account, rather than just focusing on diet, is a significant part of healing from SIBO.


So what is the takeaway with healing SIBO?

SIBO is a challenging condition to tackle, so don’t try to do it on your own! With some proper testing, healthy lifestyle adjustments, and a positive outlook on your health you can crush your treatment plan and take one step closer to your healthiest, happiest you. 

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