Managing SIBO Through Dietary Interventions

By KARA FITZGERALD, ND, IFMCP, and Lara Zakaria, RPh, MSc, CNS, CDN, IFMCP

SIBO Basics

Awareness of small intestinal bacterial overgrowth (SIBO) has increased in recent years, in part as relatively common risk factors have become more widely recognized. For instance, low stomach acid (including from PPI use), pancreatic insufficiency, irritable bowel syndrome (IBS) and Crohn’s, celiac diagnosis, and diabetes all raise the risk of SIBO.¹

Despite its prevalence, SIBO can be challenging to diagnose. SIBO sufferers often describe a range of agonizing gastrointestinal (GI) symptoms, including:²

• Abdominal distension
• Flatulence
• Cramping
• Diarrhea
• Constipation

Non-GI symptoms attributed to SIBO include systemic symptoms like brain fog, headaches, fatigue, skin conditions, and joint pain.^3-5

Interventions focus on the primary pathophysiology, which includes dysbiosis, altered GI motility, hypochlorhydria, reduced production of digestive enzymes, osmotic pressure, fermentation, and nutrient depletion due to malabsorption and maldigestion along with altered local and/or systemic immunity and intestinal permeability.^2,6-7

The mainstay of SIBO treatment is antimicrobial therapy (prescriptive and herbal),^2,5 although one study suggests recurrence of infection may be common.⁸ Additionally, used solo, antibiotics are insufficient for addressing the full spectrum of underlying pathologies.^6,10