Functional Medicine Approach to SIBO

Small intestinal bacterial overgrowth, or SIBO, is a common condition in which bacteria that is supposed to be in the lower gastrointestinal tract moves into the small intestine.  Symptoms include bloating, nausea, diarrhea, and sometimes weight loss and malnutrition caused by inflammation in the digestive system and malabsorption of nutrients. SIBO is commonly confused with irritable bowel syndrome (IBS), yet patients who are given multiple medications for IBS often find little relief.

Dr. Elizabeth Boham, medical director of The Ultrawellness Center in Lenox, Massachusetts, and Dr. George Papanicolaou, a doctor at the center, discussed the symptoms and treatment of SIBO using a functional medicine approach in an episode of the center’s Getting to the Root podcast.

Overuse of antibiotics and extended use of proton-pump inhibitors (acid blockers) could be causing an increased incidence of SIBO, according to Dr. Boham. “Food gets digested in the wrong areas so we don’t get the absorption we need.” Nutritional biomarkers show low protein status, low iron and other minerals. These can lead to a cascade of other symptoms, including depression and anxiety.

“When your gut’s not working well, that’s going to affect other systems, and other systems that aren’t working well are going to affect your gut,” says Dr. Papanicolaou.  He stresses the importance of understanding the connection between the gut and the immune system. Whatever goes into the gut can have a direct impact on the immune system. Leaky gut, whereby proteins and toxins get into the system, cause inflammation which can affect the brain and the joints.

“When your gut’s not working well, that’s going to affect other systems.”

“We’re looking for that underlying, root cause,“ says Dr. Papanicolaou. Low motility—how foods move through the digestive system—can be a contributing factor to SIBO.  Diabetes and Lyme disease are both possible causes of motility problems.  Stress can also significantly impact motility.

The breath test is recommended as a starting point for treatment. The test measures hydrogen and methane levels, which will inform the treatment protocol. Options for treatment include antibiotics, herbal antibacterials, or a shift in diet to starve the bacteria in the small intestine. To address stress, The Ultrawellness Center’s recommendations include meditation. “This can be beneficial in dialing down stress and anxiety.”

“Let’s open Pandora’s Box, let that out and let’s find ways to deal with it in a healthy way,” says Dr. Papanicolaou, who says many of his most difficult cases have turned the corner this way.

For some patients, he says, “We shift their diet and maybe use a herbal regimen and we can rebalance their microbiota pretty quickly and they feel better right away.”