Hello everyone!

Hope you're having a good week! This week we send out an overview of SIBO (not a Star Wars robot!). It's usually hard to treat but we have protocols that can work and diet modifications are crucial. If you have been diagnosed with SIBO or suspect you are suffering from it, reach out right away! If not you can always leave a review on Google! since we can never have enough of these. If you missed previous newsletter you can click below to visit the archive. And as usual this is not medical advice, you should always work with a board certified medical provider!

Small Intestinal Bacterial Overgrowth (SIBO) 

Small intestinal bacterial overgrowth (SIBO) is a chronic intestinal disorder characterized by excessive amounts of bacteria in the small intestine, exceeding 105–106 organisms/mL. Bacterial overgrowth in SIBO may contribute to increased intestinal permeability and inflammation. 

Signs, symptoms, and complications 

Symptoms of SIBO, which may vary between individuals, are non-specific and often overlap with a number of other associated disorders, making it difficult to recognize or diagnose. SIBO typically presents with fatigue, weakness, and a number of gastrointestinal symptoms, such as abdominal pain, abdominal distension, bloating, flatulence, and chronic diarrhea. SIBO may also result in malabsorption of micro- and macronutrients, certain nutrient deficiencies, and other complications. 

Complications and extraintestinal manifestations of SIBO may include: 

● Anemia
● Arthralgias
● Chronic prostatitis
● Hypoproteinemia/hypoalbuminemia
●  Interstitial cystitis
● Neuropathies
● Osteoporosis
● Restless legs syndrome ● Rosacea
● Steatorrhea
● Weight loss 

Causes & Risk Factors 

The development of SIBO can be attributed to a disruption in the homeostatic mechanisms that regulate the intestinal microbiota. Inadequate gastric secretion (hypochlorhydria) and small intestine dysmotility (impairment in mobility) are the two most common factors that predispose individuals to bacterial overgrowth. Other factors that have individual’s susceptibility to SIBO include: 

  • Age, resulting in increased risk in the elderly population
  • Anatomic alterations or abnormalities of the GI tract, such as diverticula, strictures, fistulas, surgical loupes, and gastric or ileocecal valve resection
  • Vagotomy, surgery that affects or removes part of the Vagus nerve
  • Impairment of systemic and local immunity, immunodeficiency states
  • Motility disorders, such as small intestine dysmotility, Celiac disease, and gastroparesis
  • Irritable bowel syndrome (IBS)
  • Certain metabolic conditions, such as diabetes (enteropathy) and hypochlorhydria
  • Dysfunction of certain organs, such as cirrhosis, renal failure, pancreatitis, scleroderma, and Crohn's disease
  • Certain medications, such as antibiotics, proton pump inhibitors, and antimotility agents
  • Alcoholism 

Intake of FODMAPs, fiber, prebiotics, and probiotics have also been shown to alter the intestinal microbiota and may, therefore, increase the risk of developing SIBO or exacerbate its symptoms. 

Addressing SIBO 
SIBO treatment typically involves: 

1. Identifying any underlying causes
2. Treating the bacterial overgrowth
with antibiotics or antimicrobial herbs, such as oil of oregano, wormwood, Coptis root, thyme, red thyme, field horsetail, olive leaf, and berberine extracts.
3. Correcting nutrient deficiencies common in cases of SIBO, such as deficiencies in calcium, magnesium, vitamin B12, and fat-soluble vitamins A, D, E, and K.
4. Preventing recurrence 

Diet and SIBO 

In cases of SIBO, carbohydrates, such as fructose, lactose, and fermentable oligo-, di-, monosaccharides and polyols (FODMAPs), may be fermented by bacteria in the small intestine leading to increased digestive symptoms, such as abdominal pain, bloating, and flatulence. 

Some individuals may experience improvements in bacterial overgrowth and associated symptoms by following a carbohydrate-restricting diet, such as the elemental diet, the low-FODMAP diet, the Specific Carbohydrate Diet (SCD), and the Gut and Psychology Syndrome (GAPS) diet. 

Low-FODMAP Diet 

The low-FODMAP diet is a dietary intervention that restricts foods containing highly Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. These short-chain carbohydrates and polyols are poorly absorbed in the digestive tract and reach the colon, where they are fermented by bacteria, a process that may result in certain gastrointestinal symptoms. Limiting dietary intake of FODMAPs may lower intestinal water content as well as reduce fermentation and gas production in the colon. While FODMAPs are always poorly digested, healthy individuals may not experience any adverse gastrointestinal symptoms. 

Health Benefits of the low-FODMAP Diet 

Managing symptoms in certain conditions,including: 

  • Celiac disease (CD) 
  • Healthy athletes who experience gastrointestinal issues during training 
  • Inflammatory bowel disease (IBD) 
  • Irritable bowel syndrome (IBS) 
  • Non-celiac gluten sensitivity

Low-FODMAP diet apps 


TCM patterns that are often associated with SIBO are

  • Spleen Qi Deficiency
  • Stomach Heat
  • Liver Qi Stagnation
  • Liver/Spleen Disharmony with Heat, or Liver Attacking the Spleen
  • Those patterns can also me intermingled with Stomach Yin deficiency and 

In TCM, herbal formulas are the first lines of action supported by acupuncture to relieve discomfort right away.

  • Spleen Qi Deficiency: Si Jun Zi TangShen Ling Bai Zhu San, Bu Zhong Yi Qi Tang
  • Stomach Heat: Qing Wei San
  • Liver Qi StagnationChai Hu Shu Gan San, Yue Ju Wan, Xiao Yao Wan
  • Liver/Spleen Disharmony with Heat (or Liver attacking the Spleen): Jia Wei Xiao Yao Wan,  Xiao Chai Hu Tang modified, Bu Zhong Yi Qi Tang modified 

As far as other more functional medicine treatments are concerned we have:

  • Priority One’s SIBO Rebuild, SIBO Zyme, SIBO-MMC etc.
  • APEX Energetics Clear Vite and Gur Repair protocols
  • Probiotics

Again, everyone presents differently and this email is not medical advice! Work with a healthcare provider! (me!)

Herbal formulas are ideally modified according to the patient's unique profile of disease. GI patterns are complex and it is not uncommon to rotate 2-3 formulas as symptoms improve and change over the course of treatment. It is EXTREMELY important that any supplementation is supported by compliance and the recommended dietary adjustments (low FODMAP DIET)

Be Safe and Be Well!

Sources: Fullscript, Grass Roots Functional Medicine, TCM books, Medical News Today, PubMed

Dr Arno Kroner

2001 South Barrington Suite 220
West LA CA 90025
Copyright © 2022 dr arno kroner, All rights reserved.

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