Top SIBO Mistakes and How to Avoid Them
Embarking on a journey to eradicate SIBO and heal a sensitive, damaged gut is a path that requires patience, persistence, and dedication. While it also involves lots of trial and error, every step you take brings you closer to renewed health and vitality. With our scientific and clinical understanding of SIBO continuing to grow, protocols and recommendations are constantly evolving and as with any gut condition, what works for one person doesn’t necessarily work for the next. This means a lot of SIBO sufferers are struggling to keep up with the most up-to-date and effective treatment approaches.
I’ve been there. Having experienced my own SIBO nightmare and now healing SIBO with my team and our incredible clients on a daily basis, I’ve made and seen almost every mistake under the sun. We’re all human, after all. But, if you are new to this journey, I want to help you learn from the experiences of those who’ve come before you and avoid some of the many pitfalls on the road ahead. So let’s get into it. Here are the most common SIBO healing mistakes I’ve encountered that I want to help you avoid while trying to eradicate SIBO and heal your gut.
1. Not knowing which type of SIBO you have.
Not all SIBO is created equal. And what we were calling ‘SIBO’ five years ago has already been divided up and reclassified. We are seeing this with the major differences identified between hydrogen, methane and hydrogen-sulfide dominant SIBO. We also have shiny new labels for them: SIBO (small intestinal bacterial overgrowth), IMO (intestinal methanogen overgrowth) and ISO (intestinal sulfide overproduction). But, there’s also; where in the small intestine is the overgrowth, what type of bacteria or archaea are overgrown, are there any autoimmune or structural elements to consider, as well as many other factors.
This is why testing is critical and why interpretation of test results, as well as a detailed health history by a skilled practitioner, is critical to developing an effective healing protocol. Using a one-size-fits-all protocol is very likely not going to work when it comes to this complex condition.
2. Overlooking other gut infections that may be present.
SIBO is often not alone in causing symptoms. Many of my clients’ lab results also reveal the existence of other serious gut infections. These can include parasites like Blastocystis hominis and Dientamoeba fragilis or bacterial infections like H. pylori or Citrobacter. And SIBO eradication is generally much less effective while these other gut infections are present. For this reason, I like to address gut infections before addressing overgrowths.
If you’ve only tested for SIBO and your protocols are no longer improving symptoms (and/or SIBO levels), it could be time to test for what else might be hiding in your GI tract that is blocking SIBO eradication, or causing symptoms of its own.
To learn more about Functional Lab Testing for gut infections an other root causes, you can read our blog: Functional Labs: IBS Testing for Root Causes
3. Not following a tailored diet approach.
There is no one best diet approach for SIBO. Each client needs a diet that is tailored to their test results, previous diet history, current lifestyle and healing protocol. Whether you subscribe to the ‘starve them’ or ‘feed them’ philosophy, both approaches require tailored planning before, during and after the antimicrobial phase of intervention.
The two main dietary mistakes that we see people make really often are:
1. They’ve read the research on feeding bacteria to improve antimicrobial effectiveness and interpret this to mean they should continue eating high FODMAP or high fermentable foods both during and after taking antimicrobials or antibiotics.
2. Adhering to strict SCD + Low FODMAP or BiPhasic Diet for too long after antimicrobials before retesting. If you can’t start to introduce small amounts of fermentable carbohydrates within two to three weeks of finishing antimicrobials, you protocol hasn’t been completely effective. You will likely need to retest, and develop a new protocol.
The goal is to tailor a diet to each individual that limits the most fermentable carbohydrates for the shortest time possible, while also incorporating as many fiber sources as tolerated to maintain microbiome diversity. It can be a delicate balance to get right.
4. Expecting one round of antibiotics or antimicrobials to be all you need.
SIBO is hard to eradicate. Relapse rates for both antimicrobials and antibiotics are as high as 45% within the first year in published studies. Expecting a single round to be all you need will likely set you up for disappointment, depending on the severity of your condition.
SIBO is not an all or nothing condition. It’s about getting the levels of bacteria and archaea down to a point where they are no longer an ‘overgrowth’. So while you may still have SIBO after one round, your symptoms should be significantly improved after an effectively designed protocol. But, unless you retest, you may find your symptoms progressively build back up to their previous levels over the following months. This is because you stopped eradication work too soon.
Depending on the gas levels shown on testing, multiple rounds of antimicrobials are often necessary, especially if gas levels are 30-50ppm or higher.
5. Using a single antimicrobial at a time or repeating the same protocol.
This is most common among clients trying to treat themselves without the help of an exprienced SIBO practitioner. Specific antimicrobials and specific combinations are effective for certain types of overgrowths. We always use at least two different antimicrobial herbs at a time and don’t repeat the exact same products if subsequent rounds are required.
SIBO is very adaptable and can quickly develop resistance to repeated use of a single product. Studies show that protocol effectiveness drops after 30-45 days using the same combinations. As such, you want to rotate the products you use to keep the bugs guessing.
Just remember these two simple principles: ‘combine to kill’ and ‘rotate to avoid resistance’.
6. Not using probiotics effectively.
Probiotics can be an important part of a SIBO eradication protocol, but only if used correctly. Here’s a few points to keep in mind:
> Probiotics do not add to an overgrowth or make SIBO worse. Contrary to popular belief, most probiotics are transient and will not colonise your small intestine.
> That isn’t to say that specific strains don’t have beneficial effects on the way through. Some probiotic strains can stimulate the Migrating Motor Complex (MMC), decrease inflammation, lower gas levels, heal leaky gut and have antibacterial effects.
> It’s best to start probiotics when you start antimicrobial herbs, but only use helpful strains.
We use and recommend specific probiotic strains for most of our clients who are completing SIBO eradication work to help manage symptoms. What we use is tailored to the client and titrated in slowly to ensure effectiveness.
7. Not disrupting biofilms.
As many as 75% of bacterial, archaeal and fungal infections involve biofilms. Biofilms are the extracellular matrix that acts as a protective home for the infection to live in. This protective home makes the infection up to 1,000 times more resistant to antibiotic therapies and therefore, more difficult to kill. This is why a SIBO eradication protocol that does not include a biofilm disrupting agent is more likely to fail.
A comprehensive antimicrobial SIBO treatment protocol will generally include the use of a biofilm disrupting agent, like Biofilm Defense by Kirkman Labs or Interfase Plus by Klaire Labs (available on our Fullscript Dispensary).
8. Failing to address any underlying root causes for relapse.
SIBO is a much more complex condition than simply too much bacteria in a specific part of your intestine. By eradicating SIBO like other infections, many practitioners fail to address the underlying root causes and structural changes required to avoid repeated relapses from altered motility in the small intestine that allowed the bacteria or archaea to overgrow.
The two most common mistakes we see are:
> Not stimulating the migrating motor complex using a prokinetic for those with post-infectious SIBO.
> Not addressing adhesions for those with post-surgical SIBO.
9. Relying solely on information from blogs and support groups.
Eradicating SIBO effectively is actually a more complex process than most clients initially realize. Depending on the type, severity and cause of your SIBO, there can be functional, structural and autoimmune elements to consider. And with scientific and clinical understanding of the condition continuing to grow, best practice protocols and recommendations are constantly evolving.
And while many blogs (hopefully like ours) offer lots of wonderful free information and resources to help people, working with a practitioner can help you get results faster.
If you chose a practitioner who specializes in SIBO, not only will you be using the latest and most well researched approaches, you’ll also be by-passing a lot of the mistakes clients typically make when trying to treat themselves. Regularly refining your protocol recommendations depending on your reactions and results is another complex problem solving activity that a SIBO specialist will be able to work through with you, when you’re ready.
Next steps.
If you’re looking to work with a practitioner who specialises in SIBO, our team is currently accepting new clients - you can book an appointment using our online booking system. 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 test for and address the many root causes of SIBO, IBS symptoms and other GI conditions.
You can read our approach to natural SIBO treatment HERE and more FAQs about how we work HERE.