SIBO (small intestinal bacterial overgrowth) is a disorder that seems to be increasing in frequency with each passing year. Whether this is because physicians are getting better at identifying and diagnosing SIBO or because the disease is becoming more prevalent is yet to be known. The symptoms of SIBO (gas, bloating, indigestion, diarrhea and/or constipation) are often misdiagnosed by doctors as IBS.
While SIBO generally responds very well to antibiotic or herbal antimicrobial treatment, experts estimate that between 45%-65% of patients who are treated for SIBO will have at least one relapse. In my practice, I see many patients who have had three or more relapses in their life.
So why does this happen? Why do the bugs keep coming back? When we compare SIBO with other bacterial infections, it does seem strange that simply wiping the bugs out with an appropriate antibiotic wouldn’t fully address the issue. But what is different about SIBO is these bugs are opportunistic. This means that there is something about the host’s (YOUR) system that is weak. This weakness allows bacteria to flourish, often over and over again after treatment. The key to eradicating these pesky bugs for good is identifying and correcting all underlying weaknesses in the system.
While every patient is unique, here is my top ten list of common problems that should be evaluated for and treated in order to keep SIBO from relapsing:
- Underlying food intolerances
- Digestive enzyme and/or hydrochloric acid deficiency
- Chronic use of antacid medications
- Hypothyroidism
- Slow intestinal transit time
- Celiac disease
- Diabetes
- Gastroparesis
- Immune system suppression
- Reoccurring usage of antibiotics
On average, I find that most patients have 1-3 of these underlying issues. While correcting these imbalances may take longer than a two-week antibiotic treatment, the long-term outcomes for patients who follow a comprehensive protocol are dramatically improved.
Dr. Katie Nuckolls is a naturopathic physician and owner of Thrive GI: Natural Digestive Medicine in Vancouver, Washington. She currently sees patients that live in Washington and Oregon using a combination of telemedicine and in-office visits. For more information, visit our contact page or schedule a free 15-minute consultation online.