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How To Treat Sibo With Antibiotics

Natural Sibo Treatment: The Elemental Diet

Antibiotics for Treating SIBO

For most SIBO patients, the elemental diet is a last resort when other methods dont work. This diet involves drinking a specific medical solution for every meal over a two-week period. Its not fun, but its a relatively fast strategy that is effective at starving the bacteria for many patients while still giving them the nutrients they need to stay healthy.

The elemental diet mixture contains liquid nutrients that are commonly used in medical facilities to help heal the digestive systems of GI patients. These nutrients get absorbed quickly in the first part of the intestines, meaning that they never make it all the way to the small intestine areas where the unwanted bacteria in SIBO patients congregate.

Typically, the elemental diet will go on for two weeks, and the patient will retest on the 15th day. If someone is on the elemental diet, its not recommended to take antibiotics during the course of it.

You May Need Some Time For Inflammation To Settle Down

SIBO causes lots inflammation in your small intestine. It can take a hot second for that inflammation to calm down and our gut barrier to become strong again. You may have some lingering symptoms that are a result of this lingering high level of inflammation.

Probiotics and glutamine can be great tools to help reduce inflammation and intestinal permeability following antibiotic treatment for SIBO. Good bacteria are essential for strengthening the gut barrier and glutamine is the fuel source for the cells lining the gut.

Indirect Tests For Sibo

Breath tests

Breath tests are now widely used as an alternative to direct aspiration because they are noninvasive and less expensive. Breath tests that are commonly used include the 14C d-xylose breath test and hydrogen breath tests. The 14C d-xylose breath test depends on the capacity of the intestinal bacteria to release 14C CO2 which is absorbed and ultimately eliminated in the breath where it can be quantified. Radioactive 14C or the stable isotope 13C can be used to label 1 g of xylose. The sensitivity of 14C d-xylose test ranges from 14.3% to 95%, and specificity from 40% to 94% . However, it is not commonly performed in clinical practice because it is not widely available and has been largely replaced by hydrogen breath tests which are considered to be more accurate . In addition, disorders associated with impaired gastric emptying may lead to false negative results, while rapid intestinal emptying may lead to false-positive results due to early presentation of the test substrate in the colon.

Other tests

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How Long Should You Treat Sibo

Written by Dr. Michael Ruscio, DNM, DC on May 1, 2016

SIBO is a common cause of gas, bloating, constipation, and diarrhea. It can be treated with antibiotics, herbal antimicrobials, or a liquid elemental diet. The SIBO antibiotic is often given for two weeks. However, a recent study has shown this may not be the ideal approach for most patients and that ones SIBO lab values can help determine the ideal use.

Dr. Michael Ruscio: Hi, this is Dr. Ruscio. And if youre a patient thats been diagnosed with SIBOsmall intestinal bacterial overgrowthwhich can typically manifest as the symptoms of IBS, including but not limited to gas, bloating, and either constipation, diarrhea, or abdominal pain, then you may be wondering what the ideal treatment length is.

DrMR: Now, there are different treatment options. Two of the most used, I guess you could say, would be pharmaceutical antibiotics or herbal antimicrobials. And a recent study Trusted SourcePubMedGo to sourceactually gives us some very valuable information in guiding how long to use the antibiotic Rifaximin in the treatment of SIBO. And this was a study predominantly looking at those with SIBO that had an IBS-D or an IBS diarrheal type presentation.

Now, typically, a Rifaximin prescription is written for a two-week duration. So this is definitely quite a bit longer than is typically recommended. However, this is also a drug being used in a new application. So I still think we have much to learn.

Links & Resources

Constipation Methane Sibo Treatment: 2020 Guide

SIBO Herbal Treatment

Methane SIBO is its own special kind of overgrowth. It even might finally have its own name – Intestinal Methanogen Overgrowth . But for now, understanding how it differs from the more common hydrogen form of SIBO is critical to developing a treatment protocol that addresses its well established defences. From chronic constipation and fat-loss resistance, to interpreting test results and choosing interventions, constipation methane SIBO is an extremely complex GI condition and one that is particularly difficult to treat.

Here is what we are going to cover in this post:> What is methane SIBO or IMO and the difference from hydrogen SIBO.> The methane SIBO and constipation connection.> Testing for methane SIBO and interpretation.> What diet to use for methane SIBO.> How is methane SIBO treated – the five different components.> Methane SIBO herbal treatment considerations.> Biofilms, prebiotics, probiotics, relapse prevention and lots more

As always, weve referenced peer-reviewed scientific journals where possible to illustrate the current research. Weve also relied on our own clinical experience at The Functional Gut Health Clinic working with hundreds of clients who have tested positive for methane SIBO.

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The Methane Sibo Constipation Connection

So, even though archaea help reduce the amount of hydrogen gas in our small intestine, the methane they produce can have its own negative effects. As with hydrogen in the small intestine, methane gas will also cause abdominal bloating, plus a much bigger problem it slows down transit time which leads to constipation.

Research has also shown that the higher the methane gas elevation, the more severe constipation becomes.

While you might think SIBO constipation is preferable to diarrhea, and symptomatically in the short-term you might be right, constipation caused by these methanogens can create a vicious cycle of SIBO that is harder to break than the traditional SIBO-D, diarrhea type. This was my issue, and the cause of lots of my healing struggles, so let me explain some more.

You see, methane slows transit time and causes constipation, and constipation allows more bacteria to grow, which causes more methane and more constipation and so on, and so forth. SIBO constipation is a difficult cycle to break without the right intervention.

What Happens If Sibo Is Left Untreated

Common symptoms of SIBO, including gas and bloating, abdominal pain and distension are uncomfortable enough. But left unmanaged, SIBO can cause more serious complications with long-term consequences. Malabsorption of fats, proteins and carbohydrates can lead to malnutrition and vitamin deficiencies. In particular, vitamin B12 deficiency can cause nervous system problems and anemia. Poor calcium absorption can lead to long-term osteoporosis or kidney stones.

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Work With Our Practitioners To Treat Methane Sibo Constipation

SIBO, and particularly the methane type, is an extremely complex condition. We really encourage you to not waste years taking the trial and error approach. Ask for accurate SIBO testing and treat using the most up-to-date science so you can get back to your vibrant and healthy life. We truly hope that the information in this post is helpful so when you commence your healing journey it is a real partnership between you and a practitioner that you trust to help guide you through the process.

Healing SIBO is a journey. If you are ready to begin yours, please head to the Work With Us page to learn more about how we work online with clients in many countries to treat methane dominant SIBO and other root causes of IBS symptoms.

How To Treat Methane Sibo

How to treat SIBO naturally ?

While weve previously written a separate blog on our approach to treating SIBO, here are the key things you need to consider when treating methane-dominant SIBO specifically. Basically, methanogens are tough critters to kill and you need to work with someone who specializes in SIBO and ideally this particular type of SIBO.

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Sibo: What To Do About It

SIBO has become a mainstream, recognized diagnosis over the past several years in both conventional and functional medicine. However, despite the prevalence of SIBO, current SIBO treatment strategies are sparse and not highly effective.

Conventional Treatment

In the conventional medical model, the typical prescription for SIBO entails:

Functional Medicine Treatment

A typical functional approach to SIBO includes:

  • Low FODMAP or SCD Diet
  • Antimicrobial herbs
  • Biofilm disruptors

Although both approaches have proven to work in the short term , reoccurrence of SIBO is also highly common.

Why does SIBO return!?

Herbal Alternatives To Antibiotics Can Be Very Effective

Need another reason to choose herbal remedies over antibiotics for SIBO? How about the fact that herbs may be more effective in treating SIBO than prescription antibiotics! Now, bear in mind that there have been really few studies on pharmaceutical antibiotics for SIBO. There have been even fewer for herbal treatments for SIBO. In fact, there are only two studies to date which look at how herbal alternatives can treat SIBO. And one of these studies was on just one person!5

However, the lack of research doesnt mean that herbal alternatives to antibiotics arent a good solution. In the larger study, which was published in the journal Global Advances in Health and Medicine6, the results are pretty impressive. They took 104 people who had been diagnosed with SIBO through lactulose breath testing. Of these, 37 of the patients were treated with herbal alternatives to antibiotics and the remaining were given Rifaximin.

The results?

46% of the patients who took herbal alternatives to antibiotics had a negative breath test upon follow-up, compared to just 34% of the Rifaximin users. The researchers concluded that herbal therapies are at least as effective as Rifaximin for resolution of SIBO.

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Herbs Dont Cause Antibiotic Resistance

In 1929, Alexander Fleming discovered penicillin and changed modern medicine completely. Doctors were convinced that antibiotics would cure all bacterial diseases. In 1963, the Australian physician and Nobel Prize winner Sir Macfarlane Burnet even said that by the end of the 20th century humanity would see the virtual elimination of infectious disease as a significant factor in societal life. In 1970, the Surgeon General William Stewart said that antibiotics would soon close the book on infectious diseases.

They couldnt have been more wrong!

What they didnt realize was that bacteria are capable of adapting to antibiotics and becoming resistant to them. This is a VERY serious problem, and one which shouldnt be taken lightly. Thanks to antibiotic resistance, diseases which were once treatable such as tuberculosis are often now fatal. We may soon see the reemergence of diseases like typhoid, diphtheria, and many others.1

Keep in mind that antibiotics are often ineffective in treating SIBO. Even when the first round of antibiotics works, the SIBO often comes back after just a short time. As researchers point out in an article in Gastroenterology2, SIBO patients often require multiple rounds or continuous courses of antibiotic therapy. To prevent resistance, they recommend rotating antibiotic regimens to prevent resistance.

Why Working With A Qualified Care Team Is Extra Important When It Comes To Sibo

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Treating SIBO and avoiding a recurrence takes real commitment, and going it alone can be incredibly overwhelming . Thats why enlisting the help of a care team, like the clinicians at Parsley Health, can be smarteveryone wants to do it alone, but because proper treatment for SIBO can be so individualized, its great to have not only an expert opinion, but a sounding board for what makes sense and what doesnt, says Dr. Steinberg.

Parsley Health clinicians can test for the different types of SIBO and treat accordingly with the appropriate antibiotics, herbal antimicrobials, or a combination of both. Theyll also walk you through a maintenance phase with appropriate supplements to support gut health and motility, and look for underlying conditions that may prime you for recurrent SIBO. All Parsley Health members also work with a health coach, who can help to personalize dietary recommendations and hold you accountable for lifestyle changes that can help prevent recurrence.

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Low Fodmap Diet And Sibo

FODMAPs are a type of fermentable carb common in the foods we eat.

They act as necessary food for our gut bacteria, but can cause severe digestive problems in sensitive people.

The process of identifying and removing problem FODMAPs from the diet is known as a low FODMAP diet, and is clinically proven to treat IBS .

SIBO shares almost all the same symptoms as IBS. In fact, studies show that between 30-85% of patients with IBS also have SIBO .

Due to this strong overlap, researchers suspect a low FODMAP diet may be beneficial for SIBO patients too, as it would starve the problem bacteria in the small intestine.

Unfortunately, there has not been much research in this area and the current evidence is not clear.

It seems the low FODMAP diet is incredibly helpful when starting off, but requires a bit more flexibility for SIBO when reintroducing fermentable carbs.

Just make sure not to start a low FODMAP diet until you have finished your course of antibiotics. The bad bacteria need to be active for the antibiotics to work.

Theres also limited research on the long-term effects of a low FODMAP diet. Following such a strict regimen for a long period of time may lead to detrimental effects on the bacteria in the large intestine.

Summary: A low FODMAP diet may help initially by starving the problem bacteria in the small intestine. But studies have not yet confirmed it as a reliable SIBO treatment.

Important Notes About Herbal Antibiotic Alternatives For Sibo

Whether you are taking herbal remedy or pharmaceutical antibiotics for SIBO, you should wait 14 days after finishing a round before retesting. This is critical for the accuracy of test! However, dont wait more than 16 days to retest you want to retest before regrowth of bacteria has time to occur. After finishing with herbal or pharmaceutical antibiotics, you will want to take a prokinetic agent . You can start with the prokinetic immediately after antibiotics, even before youve retested.

I took:

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Which Herbal Antibiotic Alternatives Can Treat Sibo

Unfortunately, there hasnt been much research into herbal alternatives to antibiotics, and even less research about herbal treatments specifically for SIBO .

Disclaimer: Remember, none of these herbal treatments have been approved by the FDA for SIBO. While there is some evidence that these substances may have medicinal benefits against infections, it does not necessarily mean that they will work for you. Always talk to your doctor before taking any supplements for treating SIBO.

You May Have Cortisol Dysregulation From High Levels Of Physical Or Emotional Stress

Antibiotics for SIBO? There is a better way!

Chronic stress will prevent you from healing from SIBO and will exacerbate symptoms. Stress comes in many forms. It can be emotional like feeling pressure at work or feeling stuck in a toxic relationship. Or stress can be physical such as undereating or over exercising. Both physical and emotional stressors will raise cortisol levels, which can wreak havoc on the gut.

As I mentioned above, high cortisol levels will reduce MMC activity, digestive enzyme release, stomach acid release and immune function in the gut. To make matters worse, high cortisol will also increase intestinal permeability. Basically, stress shuts down digestion.

Some stress is unavoidable. Raising your stress tolerance to emotional stressors by employing stress management techniques into your daily routine can help you with unavoidable stressors that are often positive like starting a new job or having a baby.

Physical stressors can be a little bit harder to pinpoint, but are very common in SIBO patients. Undereating due to restrictive diets is a HUGE physical stressor that I see all the time in SIBO clients. It is easy to unintentional under eat when you are restricting so many foods.

Lack of sleep, sunshine and physical affection are other really common physical stressors in the SIBO world.

Wrangling stress is not always easy, but it is imperative for good gut health.

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Sibo Treatment Step : Food Reintroduction And Fiber

After going through each of the previous steps that have been scientifically proven to treat SIBO, the hope is that by this stage the patient has experienced some level of symptomatic relief. By this point in the SIBO treatment regimen, patients can begin to gradually introduce a wider variety of foods and fiber into their diet.

After being on a more restricted diet for an extensive period of time, it is important to make this a slow and easy transition. To do this, it is recommended to begin with small amounts of new foods and monitor major symptom reactions you experience for re-introduced foods. If you do not experience any negative side effects with new foods, that is a step in the right direction.

However, experiencing minor symptoms is not something to overly concern yourself with either. When so many foods have been eliminated from your diet for an extensive period of time, it is natural for your body to react in some way to various different foods.

At this stage, patients can also begin to incorporate very small amounts of fiber into their diets to test its effects. The goal at this stage is to promote a healthy balance of microorganisms in your GI tract. By slowly introducing small amounts of these food products, it provides patients with the ability to accurately monitor their progress and potential dietary limitations.

The following fiber products have been widely used in IBS studies, and may be useful to try in small amounts:

Food Re-introduction Action Steps:

Xifaxan For Sibo And Ibs

While there are a few different antibiotics usually prescribed to treat SIBO and IBS, the most common antibiotic is Xifaxan .

Xifaxan is a non-systemically absorbed rifamycin with antimicrobial activity against gram-positive and gram-negative aerobic and anaerobic organisms.1

Xifaxan is used to treat travelers diarrhea, hepatic encephalopathy, IBS/SIBO, and a few other bowel infections.2

The main difference between Xifaxan and other SIBO antibiotics is that it is very minimally absorbed throughout the body and works specifically in the gastrointestinal tract.

This means that you are less likely to have toxic or systemic side effects compared to other antibiotics.

Also, the solubility of the drug increases 100-fold in the presence of bile acids , meaning that its antimicrobial effect is much greater in the small bowel than in the colon.3

More so, Xifaxan decreases mucosal inflammation, which is likely another reason it helps IBS patients. 4 Because of these properties, Xifaxan is a top antibiotic chosen for SIBO treatment.

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