Unlocking the Power of Supplements for SIBO

By Dietitian Jill Place AKA The Good Gut Queen

Out of necessity … with so many people suffering from it these days … I’ve become a bit of an expert on supplements for SIBO. There are many other websites and doctors with great information too, including Dr. Siebecker, SIBO Survivor and SIBO SOS. And I AM an expert about supplements. Which I became so quite by accident.

Years ago, when I first became an RD, I was taken to a talk by Jeffrey Bland, one of the godfathers of Functional Medicine, by a chiropractor I was thinking of working with. The chiropractor is long gone … I can’t even remember his name.

But he and I sat in the bar and talked that night after the lecture. At the next table was Jeff … with a friend. His friend left … my friend left, and one of us asked to join the other.

Jeff and I sat in the bar for several hours talking Functional Medicine. I didn’t even know that was its name yet. But I DID know … even instinctively in those days … that what “modern medicine” was doing wasn’t helping some people. And that this may be an answer that I … as a Registered Dietitian … could participate in.

He Inspired Me …

Jeff’s onstage and our bar talks that night inspired me to go in a totally different direction with my budding practice. I was always in the front row at his subsequent talks. I became a CCN, a certification in Functional Medicine, helped start the Functional Medicine group of my association, wrote a supplement manual and in certain circles am called “famous”, a “visionary”, and a “trailblazer”.

Jeff and I have run into each other over the years many times. Last time he was receiving an award (he’s received many over the years).

I snuck up behind him and whispered, “Congratulations!”. He turned around and spontaneously hugged me.

I miss those hugs. But I DO understand how busy he is NOW! He once told me that he thought he was a failure. I tried to buoy him up … explained that things take time.

Now he’s a well-sought-after speaker. And Institute of Functional Medicine (IFM) courses now cost $20,000.

Which brings us … quite circuitously … to SIBO … and why it’s so important in not only Jeff’s concept of Functional Medicine. But to me … the Good Gut Queen.

What IS SIBO?

SIBO stands for Small Intestinal Bacterial Overgrowth. And, quite simply and obviously, it’s an overgrowth of bacteria within the small intestine.

And why am I so interested in it? Because one study says that 78% of Irritable Bowel Syndrome (IBS) sufferers (AKA Leaky Gut) may also have SIBO.

What causes SIBO? Well … that’s obvious too. Mainly bowel dysfunction (AKA diarrhea and/or constipation) and nutrient malabsorption (AKA Leaky Gut … if you want to know what causes THAT, read my article, What IS Leaky Gut?).

I was also shocked to know … from my research … that 10% of people who have severe food poisoning will develop post-infectious IBS(PI-IBS) AKA SIBO. A little over a year ago, I had just that. It put me in the hospital. And my symptoms have gotten worse and worse ever since. Lately, I even have the brain fog that’s one of the main symptoms of SIBO.

Other symptoms include:

bloating
gas
abdominal cramping
diarrhea and/or constipation,
poor nutrient absorption
weight loss or gain … and many more

Two Types of SIBO

There are two major types … hydrogen- and methane-dominant … gases that occur as a result of bacterial fermentation of food in the small intestine. Methane-dominant most often needs to be treated first with pharmaceutical antibiotics.

Commonly prescribed for SIBO are Neomycin, Metronidazole, and Rifaximin. A normal course is two weeks. So, obviously, you need to work with an open-minded doctor who’s willing to not only accept the SIBO diagnosis but treat it accordingly.

If you want to find out which type you have, Aerodiagnostics is my favorite test for that. I often order this through Rupa Health … a clearing house for labs. Book a free discovery call with me and we can talk about if it’s appropriate for you.

You have to pay out-of-pocket … unfortunately … for Functional testing … but most tests are discounted. Afterwards … if you have insurance … we can book a session so I can interpret it for you.

Even if you have Methane-dominant SIBO, the following treatment is suggested after medication. For the Hydrogen-dominant type, treatment can be solely:

Diet and Lifestyle
Natural anti-microbials
Adrenal and thyroid support
Digestive enzymes
Probiotics
Prokinetics (Motility Support)
Binders and Biofilm Busters

As a matter of fact, I’d suggest you start the diet right away … here are some guidelines …

Diet and Lifestyle

Many people use a low-FODMAP diet (there are many versions … here’s a gentle low FODMAP diet and seven days of menus and recipes for those who need to ease into diet changes) for SIBO. FODMAP is an acronym for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. And the theory is … the less fermented or potentially fermentable foods you eat … the more you’ll starve out what I call “The Bad Gut Guys”.

But I prefer my The Heal Your Gut Diet. As it’s much simpler. And you can even go as slow as you want with my FOUR-STEP PLAN. But I’d suggest, if you want this GONE, that you dive right in with a strict program … and see how you feel in two weeks (but you SHOULD continue ikt for 4 to 6 … and possibly switch to the more severe plan) … a short time for perhaps big wins …

LIFESTYLE

Meanwhile, let’s talk lifestyle. A lot of my treatment in the past few years when I’m working with clients has been about stress management.

Because, if you read my article, 4 Ways Stress Causes Leaky Gut, you’ll see that stress is just as lethal for leaky gut (and SIBO) as bad diet and other poor lifestyle choices. And one way that you can cope with stress is my Micro-Mindfuls … snippets of sequential mindfulness.

I made these so you could chill out a few minutes every day (or string a bunch of them together for a longer practice) just by turning on a video and listening to my voice. You can access them all by CLICKING HERE.

Other lifestyle changes include daily exercise (mix up breathing-and-flexibility things like yoga and Qigong (Tai Chi) with aerobic-and-muscle training like hiking, running, and weights) and daily socialization. I live alone, but I make sure I have meaningful connections with friends and family often.

So … YOUR DIET AND LIFESTYLE ACTION PLAN STARTS WITH …

Low FODMAP diet for two weeks or longer (or follow the instructions for the first two weeks in the Heal Your Gut Diet) and continue the Heal Your Gut Diet for at least 1-2 months before moving on to possibly add back foods that you initially cut out of your diet
Some sort of stress management, daily exercise, and/or socialization.

SUPPLEMENTS

It would be great if you could balance you gut with just diet. But many can’t get rid of SIBO without some healing supplements.

Here are my choices. These recommendations will all be available as “Jill’s Stompin’ SIBO Supplements” on my Fullscript Supplement Apothecary.

I would recommend, however, that you consult with an expert like me before beginning any supplement program. Because,one of the aspects of Functional Medicine (I’ve been an advocate and practitioner since I met Jeff) is that everyone is individual. And needs to be treated individually.

Meanwhile, here are my supplement picks broken down by type. And check out my Fullscript SPECIFIC recommendations for brands …

Thyroid Support

So, what does SIBO have to do with the thyroid? Gut health and thyroid health are connected. Having thyroid issues such as hypothyroidism can actually cause SIBO. Your thyroid not performing the way that it should could slow down all metabolic processes including yourdigestion.

Also, thyroid issues CAN cause constipation … which can lead to an overgrowth of harmful bacteria. A 2017 study has found that those with constipation-predominant SIBO (SIBO-C) also had thyroid panels with characteristics of hypothyroidism compared to the control group. Not only that, but many people who suffer from hypothyroidism also have lower levels of stomach acid so when we do not have enough it can be easy for the pathogenic bacteria in the gut to grow.

SIBO can ALSO lead to hypothyroidism. A 2017 study found that hypothyroidism and T4 therapy were linked to a 2.6 and 3.0 times higher risk of SIBO. Since about 21 percent of T4 to T3 conversion occurs in the gut, problems can occur when you do not have optimal gut flora. When your gut is dealing with an overgrowth of harmful bacteria this can cause issues with the T4 to T3 conversion which can then lead to hypothyroidism.

So … chicken or the egg … SIBO can lead to hypothyroidism but hypothyroidism can also lead to bacterial overgrowth. A 2007 study found that 54 percent of participants with hypothyroidism also had SIBO. That’s why it’s so important to support the thyroid (AND the adrenals … because these glands DO work together).

Adrenal Support

Any supplement program should begin with adrenal support. Because people with SIBO and IBS often feel tired, stressed, and depressed. And changing things in your body can cause even more stress and exhaustion.

To help these symptoms … and support proper thyroid function … herbs for the adrenals … glands that are located atop your kidneys, can go a long way to stimulate better mood, vitality, and digestion.

Digestive Enzymes

Digestive enzymes help break down foods quickly so that less fermentation and, therefore, less gas and overgrowth can occur. A broad-spectrum enzyme (and sometimes a stronger pancreatic enzyme) is best. Take with meals to assure good digestion.

Betaine HCL

I cringe when I see TV ads for antacids!!! Because usually we don’t make ENOUGH hydrochloric acid in the stomach … not too much. You just get heartburn because you’re either eating too much food or gut-challenging foods (check out the Heart Attack Grill in Vegas). The Betaine … with the digestive enzymes … helps food pass through the gut faster … cau7ing less ferment for the SIBO to feed on.

Antimicrobials

Herbal antibiotics may be as effective and pharmaceuticals for SIBO WITHOUT the bad side effects. And many don’t do away with “The Good Gut Guys” like medicinals, which will kill most of the bacteria … good AND bad … in your gut.

Also, constant use of antibiotics in meats has made us antibiotic-resistant. So many types may not even be effective.

Herbal antimicrobials are shown to be equally effective as rifaximin in managing SIBO. An herbal antibiotic protocol for managing SIBO involves dosing two herbs or formulas together for six weeks before reassessment. Dosing more than two single herbs simultaneously does not usually provide additional benefits and can be more expensive for the patient. As with prescription antibiotics, multiple courses of herbal antibiotics may be required for complete SIBO management.

The following herbs are most commonly utilized to manage SIBO:

Berberine: 1,500-4,500 mg daily, split into three doses
Oregano: 150-300 mg daily, divided between 2-3 doses
Neem: 600 mg three times daily

Combination herbal formulas … like Biocidin … can be an alternative to dosing single herbs. I sometimes prefer them as this treatment entails a lot of supplements … so taking one pill or one pump (for the liposomal variety) can ease up on the protocol. Or you can switch between the blends and two individual if the treatment becomes prolonged. Also … Biocidin has a built-in biofilm buster (see below) so less pills there too.

Prokinetics

Lack of motility (delay of passage of waste through the gut AKA constipation) is one of the causes of SIBO. And one of its more painful, upsetting symptoms.

Therefore, it’s important to include a “motility activator” (an actual supplement) in your supplement regime. You can do this after or with antimicrobials depending upon how severe your lack of motility is.

Binders and Biofilm Busters

I can’t find these type of supplements in ANY treatment protocol for SIBO. But I always include them because they’re vital in making sure you kill offending bacteria. And bind them so that they can be removed safely from the body without bad side affects.

Binders, like activated charcoal, fulvic acid, and humic acid, trap dead bacteria, parasites, and other toxins and remove them from the body. They are vital in treatment as what is known as “die-off” can make you even sicker. Then you won’t know if what’s you’re doing is effective or not.

Also, I only recommend that you take these AWAY from food and other supplements as binders, especially activated charcoal, bind EVERTHING. And take only for a short period of time … with the antimicrobials.

Biofilm busters are also important at that time. Because bacteria build what can only be described as “angry birds structures” (“Angry Birds” is an online game where you use some “birds” to destroy structures in which other “birds” are hiding). In other words, they construct scaffolds to keep them safe from the onslaught of antibiotics and herbals.

So … in order to get to the bacteria in the first place … you need to take a complex mixture of enzymes, peptidases (protein-specific enzymes) and EDTA. There are … at this writing (fortunately) … no pharmaceutical drugs for biofilms. And the supplements can be very strong for some. But … like everything else in this protocol … you can start slow and build up to a normal dose … even just taking part of the capsule if necessary. And Biocidin has a built-in biofilm buster.

YOUR SUPPLEMENT ACTION PLAN STARTS WITH …

Begin digestive enzymes and Betaine HCL (both in SIBOzyme) at each meal … start slowly adding one supplement at a time to see if there’s a reaction (do this with all supplements in this protocol).
Add adrenal and thyroid support herbals.
Begin antimicrobials (either separate supplements or blend) and binders.
In other words, you’re doing a health self-experiment to see if diet, lifestyle, and supplement changes can improve your symptoms. If not, it may be a good thing to schedule a ONE + ONE package (an in-depth initial and one follow-up virtually) with me to see what’s not working.
Whether you see me or continue treatment with the following supplements, keep going with the diet by all means. Some people take more time to improve than others.

Probiotics

Many, many research studies have confirmed probiotics … different strains of “Good Gut Guys” … friendly bacteria to repopulate the gut … as a crucial cornerstone of treatment for IBS and SIBO. That’s probably why you hear about them everywhere!

Many probiotics sold today are general strain combinations that supposedly help with gut health. But there are specific strains (there are hundreds … and many haven’t even been discovered yet) that help with IBS and SIBO. They are, according to sibosurvivor,com:

Saccharomyces Cerevisiae Boulardii (mostly helps with diarrhea)- studied in SIBO and SBS
Bifidobacterium lactis HN019- studied to help slow transit time
Lactobacillus reuteri (DSM 17938)- studied to help methane and constipation
Lactobacillus plantarum 299v- studied to help IBS

I also like soil-based probiotics, and often recommend a rotation of the above with blends of them. But I don’t start probiotics for two to four weeks or longer after I begin the SIBO protocol below.

FINAL SUPPLEMENT ACTION STEPS INCLUDE:

Begin antimicrobials, thyroid and adrenal support, binders, and prokinetics (if constipation is a problem) continue for 1 to 2 months
Afterwards begin probiotics and continue with the basic plan, including the your diet of choice and supplements suggested in your initial supplement action plan.
If this is ALL too complicate for you, you take a stab at it and none of this works, or you still don’t feel 100% (or even before to figure this all out) book a FREE “Let’s Talk HEALTH” session with me by CLICKING THE BUTTON BELOW.

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