In last week’s post, I talked about SIBO, or Small Intestinal Bacterial Overgrowth, explaining what it is and giving you a list of symptoms to look for. I also let you in on the debate raging over whether people with SIBO should be taking probiotics or not. Today we’re going to figure this probiotic thing out, plus look at some treatment options.
Treatment for SIBO…the Great Debate
The great debate over probiotics rages on, with some practitioners staunchly refusing to allow their patients to take probiotics while being treated for SIBO, and others vehemently insisting that patients must take probiotics as part of the SIBO treatment plan. Some even go so far as to say that SIBO cannot even be effectively treated without probiotics.
Why is there such a huge disagreement? And who’s right?
The answer to the first question is relatively easy. In my last post, Do You Have SIBO Symptoms, I pointed out that, in people with SIBO, it makes little difference whether the bacteria populating their small intestines is good or bad – the point is, they have too much, period. The small intestine was never meant to house an overabundance of any bacteria, even the healthy kinds.
So, if someone with SIBO is loading up on probiotics every day, they are making an already bad situation worse. Same goes for gorging on prebiotics, which provide wonderful nourishment for the good bacteria in the large intestine. But if you have SIBO, the last thing you want to do is nourish any bacteria in the small intestine. And you can’t do one without the other.
He Said-She Said in the Treatment for SIBO
Now here’s where the water gets murky. The health practitioners who are against any type of probiotics say no, you cannot nourish the healthy bacteria in the large intestine (good thing) without also nourishing the overabundance of bacteria in the small intestine (not-so-good thing).
But the ones who disagree usually do so with the interesting caveat – it depends on what kind of probiotics you take.
According to Dr. Amy Myers, the type of bacteria that is usually in the small intestine are lactobacillus and bifidobacterium. And most probiotic supplements contain these two amiable chaps. So, if your small intestine is already inhabited by a horde of these…well, you get the picture.
The solution? According to many pro-probiotic practitioners (try saying that five times, fast), the answer is soil-based probiotics, also affectionately known as SBOs, or soil-based organisms.
What are Soil-Based Probiotics, pray tell?
I can almost see the wheels turning: Wait, you’re thinking, they make probiotics with dirt in them? And there are doctors out there who want me to EAT these?
Let’s travel backward down the corridor of time to childhood. Remember making mud pies? Or for those of you who had access to a veggie garden, pulling a carrot out of the ground, dusting it off, and savoring its fresh, crunchy sweetness right there in the garden?
You ingested a lot of little microorganisms with that carrot (or whatever you ate), even if you thought you’d wiped the dirt off. Voila – SBOs, my friend. Even a few cherry tomatoes right off the vine instead of pulled from the dirt would have given you some.
But as Western civilization has become more urbanized and germaphobia has swept the U.S. at least, there are fewer and fewer home vegetable gardens, and it seems that even those of us who have those gardens have succumbed to germ hysteria.
Yes, guilty as charged – I have been known to soak my garden-fresh greens in a hydrogen peroxide and water solution to kill the germs. Never mind the fact that I was careful to rinse them well and then soak them in fresh water for a while before a final rinse so we didn’t get some kind of weird peroxide poisoning.
The point is, I killed the poor little SBOs! What was I thinking? And I won’t even tell you how I cleaned my turnips. That type of violence against innocent organisms is best kept to myself.
But the thing about these SBOs that makes them so special is their uncanny ability to remain in its seed-like spore structure, passing through the digestive system unhampered and unharmed by vicious mobs like bile salts, enzymes, and stomach acid. They’re smart enough to remain in this state until they reach their new home, the safe environment of the large intestine.
Which means of course, that they speed on through the small intestine without so much as a hat tip and a “howdy,” leaving shock and awe in the small intestinal microorganism community in their wake. And maybe a bit of peevishness as well.
Testing for SIBO
None of this means that that simply quaffing vast quantities of soil-based probiotics will eliminate SIBO. Resist the urge to open a tab and bring up Amazon, or for the more civic-minded, rush off to your nearest healthy brick-and-mortar retailer. At least for now.
What you need to do right now is finish reading this, then either:
- Call your doctor (if you have one who believes SIBO exists) or,
- Find a decent holistic doctor (if your regular doc gives you eye-rolls over testing for SIBO); then,
- Get tested for SIBO
- Follow Doc’s recommended treatment plan
- Extra Credit: Research and learn all you can about this nefarious hooligan (SIBO, not your doctor! Well, maybe your doctor, too.)
Before you treat SIBO, you must find out if you even have it. Here’s how that rolls.
SIBO Testing, One, Two, Three
- The Breath Test
This is the Numero Uno, preeminent, most revered, gold standard test for SIBO (according to many, but not all practitioners).
It is also a pain in the behind. But’s probably worth it because it is the most accurate and has the added bonus of telling you and your doctor whether the gas produced by the SIBO gang is mostly methane or hydrogen.
Before you start picturing tiny creatures in your small intestine either farting and giggling like a bunch of preteens at a sleepover, or gleefully rubbing their filthy hands together and snickering while creating a miniature nuclear bomb, read on.
To do this test, you’ll fast for 12 hours, then breathe into a little balloon-type thing, which will establish a baseline. Then you drink the small amount of sugar concoction that comes with the test. This feeds the bacteria and gets them more excited than a pack of rabid hyenas on the trail of an injured rabbit.
After this, you’ll repeat your balloon-blowing (puffing a bit of air into a tube connected to a piece of plastic that looks like something you’d use for cake decorating) every 15 minutes for two to three hours, depending on which test your doctor ordered.
Once that’s done and the lab has analyzed it – don’t be in a hurry because it could take weeks to get your results – you’ll learn whether the majority of the gas produced by the critters is of the methane or hydrogen variety, making it easier for Doc to design a treatment plan. Both types of gas are present, but usually one is dominant over the other. It can be a nearly equal mix, however.
- The comprehensive Stool Test
I know. Gross. But you think it’s bad for you? Imagine being that poor sucker in the lab who drew the short straw and now has to handle your poop. Eew.
But suppose you go this route and your test results show that you have high levels of good bacteria. Yay, me! you cheer to yourself. No. Not good. This means that you probably have SIBO. The nice thing about this nasty test is, if you have other gut issues besides SIBO, such as parasites or candid, this test will reveal it. Knowledge is power, people.
- The Urine Test
Also known as the organix dysbiosis test. If there is a yeast or bacterial overgrowth problem in your small intestine, there will be by-products of this present in your urine. This is obviously the quickest and easiest test, if not the cleanest — and don’t quote me on this — but I’m willing to bet it’s the cheapest, too. The drawback here is the fact that it cannot distinguish between methane and hydrogen-producing bacteria.
Time for SIBO Treatment
As one might suspect, curing SIBO is not as simple as popping a few pills. Like most things that are worthwhile, it takes determination and perseverance, but it can be done.
The first thing most doctors have their patients do is starve the bacteria. Goodbye sugar, alcohol, and carbs — yes, even complex carbs like legumes, whole grains, most fruit, and starchy veggies. Hello healthy fats, protein, and low-starch veggies. Your doc may even let you eat a little low-carb fruit.
Sounds keto-ish to me!
The second tip of this three-pronged approach is to chase down the bacteria that aren’t yet dying from starvation and swoop in for the kill, using either safe for you, but deadly for them, herbs or antibiotics.
Wait, antibiotics? Isn’t that counterintuitive?
It would seem that way, but Xifaxin and Neomycin actually do very little harm to your gut microbiome.
And of course, what we discussed earlier, once the medication has done its work, many practitioners will want to start restoring the good bacteria in your large intestine with good old soil-based probiotics.
Don’t Give Up!
There is hope for conquering SIBO once and for all. Find a knowledgeable doctor who is willing to test you and administer the SIBO treatment that you want, whether that’s herbs, essential oils, or antibiotics. Be willing to do your part by temporarily eliminating sugar and starch from your diet, and you’ll soon be on your way to better gut health and tremendous relief.