I’ve Been Diagnosed with SIBO, Now What?
POV: You’ve just finished your appointment with your doctor or naturopath and have been diagnosed with something called SIBO.
What the heck is that??
The first thing you do when you get home is open up your laptop and start Googling SIBO.
Small Intestinal Bacterial Overgrowth- never heard of it.
You feel relieved that after months or years of constant bloating, cramping in your stomach, issues digesting FODMAP foods and running to the washroom (or not being able to go at all!), you finally have a diagnosis that can explain all the uncomfortable and frustrating symptoms you’ve been experiencing.
But all the information and options your practitioner provided you is overwhelming, scary, and isolating and you may be left wondering what to do next. These thoughts and emotions are all valid and it’s important to take time to digest everything and think things through.
This is exactly how I felt. I didn’t know who to turn to for advice or what to do next.
My naturopath briefly told me what SIBO was and gave me a handout on supplements to take to get rid of the bacteria but I had so many more questions I wanted answered before starting.
At the time all the info on the internet was in scientific jargon that I wasn’t able to read (I had just started nutrition school at that time). All the books I looked at all had different diets with foods allowed on some but not the other and there didn’t seem to be one clear path of how to tackle this.
My goal in writing this is to provide a simple to understand guide for others recently diagnosed with SIBO who aren’t quite sure what to do next.
Killing SIBO Bacteria
In order to overcome SIBO, there are 2 main steps that must happen.
You need to kill off the bacteria by taking antibiotics or herbal antimicrobials: You have two options here which can be done with either your doctor or naturopath. 1 round of antibiotics generally take 2 weeks while herbal antimicrobials generally take 4-6 weeks.
You can take an antibiotic called Refaxamin, which can be prescribed by your doctor or gastroenterologist, which is taken for 7-14 days. The other alternative is seeing a naturopath or functional medicine practitioner who will prescribe herbal supplements like oregano, berberine, allicin (garlic) based on the type of bacteria present from your breath test. It is very normal for someone with higher level of SIBO bacteria to need multiple rounds of antibiotics or antimicrobials.
You need to follow a SIBO elimination diet: The purpose of the diet is to starve the bacteria while it’s being killed. If you feed the bacteria while on antibiotics or antimicrobials, the bacteria population grows which makes it more difficult to eliminate. It also reduces your symptoms of bloating, gas, diarrhea, pain etc. and makes your life much more enjoyable while going through a SIBO protocol.
Overcoming SIBO involves killing the bacteria as well as a concurrent diet that starves bacteria
SIBO Nutrition
The nutritional component, especially the food reintroduction is often overlooked and not included in many protocols or is lacking structure on how exactly to re-introduce foods back in. However, this part is critical!
When you go on an elimination diet, your body adapts and gets used to the limited intake of highly fermentable carbohydrates. If you went back to eating a roasted veggie buddha bowl the day after you complete the diet, helloooo bloating, cramping and gas!
It’s important to re-introduce foods slowly and gradually which likely isn’t on your handout of foods to avoid on the SIBO diet.
Think about feeding a baby it’s first foods. A mother generally starts with a smaller amounts of easy to digest food and pays attention to how the baby responds or feels before increasing the amounts. Your tummy will also feel it’s best when you start with small amounts of cooked carbohydrate rich foods and then slowly work your way up to larger amounts with more raw carbohydrate foods that your body can handle without overwhelming your digestive system.
Once you’re able to eat FODMAP containing foods again, the third step to a successful SIBO protocol involves working on rebuilding your microbiome.
The state of your gut health (the intricate balance between good and bad bacteria) plays a critical role in metabolism, protection from pathogens like bacteria, viruses or parasites, immune system and mental health. The killing phase often times negatively impacts the levels of good bacteria in your gut as well.
The best way to establish balance and regrow good bacteria is through diet. This involved incorporating a variety of both prebiotic and probiotic foods daily. Think of your gut like a garden. At the early stages right after killing is completed, you plant the seeds and feed it daily so overtime the garden grows and flourishes so you can eat all your favourite foods again without symptoms.
SIBO Relapse Strategy
It’s also important to work with a practitioner who is trained in managing SIBO and can identify and correct the underlying causes of why you got SIBO in the first place. This is where many of the conventional practitioners fail, which is one of the main contributors to why SIBO relapse rates are so high.
If all you’re doing is killing the bacteria without changing anything else, the chances of it coming back are pretty high. The underlying causes of SIBO can fall into 4 main categories:
Impaired motility (autoimmune conditions, poor vagal tone, hypothyroidism, chronic infections, other illnesses that impact digestion)
Impaired digestion (chronic stress, poor bile flow, low stomach acid)
Impaired flow through the intestines(previous surgery/adhesions, endometriosis, ileocecal valve dysfunction)
Medications (PPI’s, anti-depressants, antispasmodics, opiates/narcotics)
In my practice, I assess my client’s underlying causes and incorporate them into the 3 month recovery plan so that once the bacteria is gone, the enviornment that led them to get SIBO in the first place has been changed to significantly reduce relapse.
Another key piece to avoiding relapse in the long term is understanding which of your eating habits may have contributed to you getting SIBO in the first place.
Eating habits?? That’s right, think scarfing your lunch down at your desk in 5 minutes as you rush to your next meeting or in the car as you drive your kids to their sports practice.
The way we eat in our fast paced, modern society creates stress on our digestive system and over time may contribute to digestive imbalances which can develop into conditions like leaky gut, SIBO, GERD, or candida.
This is something I work with every client on, whether they have SIBO or not! Each session we look at various eating habits so over time your body is re-trained to positively support digestion again.
Get Rid of your SIBO for GOOD
So this leaves you with 2 main decisions: what route you want to take to kill bacteria and finding an experienced SIBO practitioner who can provide nutritional support throughout the elimination and re-introductory phase.
If you still feel like you have unanswered questions, I’d be happy to chat! You can book a free discovery call below and I’d be happy to provide direction or clarification for you.
Has this left you wondering which foods are you allowed to eat during the diet and what foods do you start introducing first and in what amounts?
…or how do you know what eating habits are contributing to stress on your digestive system?
All of this is covered in detail in The SIBO Turnaround Method. Click below to learn more about the program.
🚨 Before You Go!
Don’t forget to reward yourself with this totally free e-book that will help you understand why you haven’t been able to overcome SIBO for good! It’s free and you can access it right away by clicking here
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By Krista Znebel, Holistic Nutritionist, R.H.N.
Jan. 23, 2024