I will say this from the start, if there is a medication out there that will help a patient fix SIBO and the daily, often debilitating symptoms that they are experiencing, I am first in line. I also want people to recover – long term. Though I have seen xifaxan and the combination of xifaxan and neomycin work for some people, it seems like these are successful at knocking down SIBO long term for only a very small percentage of people.
Prior to meeting with a new SIBO patient I spend around 45 minutes combing through all the labs, intake paperwork and health history timeline in preparation for our intake session. It is extremely common for me to see a new patient who has undergone four and five, or more rounds of antibiotics, trying to knock out SIBO.
During the intake session, I get to hear firsthand, the experience that the patient has had with each of these successive rounds of antibiotics. There are two patterns that I see with patients.
The first pattern that I see is that they go on an antibiotic and they don’t feel much better. So, the doctor tries again with another prescription – maybe the same antibiotic, a higher dose, they’ll recommend that they take it longer (I’ve seen people prescribed Xifaxan for a full month), or they may now recommend a combination of antibiotics or another antibiotic altogether. This goes on and on with multiple rounds. Unfortunately the patient doesn’t respond well to the treatment.
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I realize that the goal is to treat SIBO with an antibiotic and knock it down so the patient can recover from this, yet, there are so many people that are not responding well to this line of treatment… and in the end, all of these rounds of antibiotics are going to make it harder for a person to recover the balance in their gut.
I have seen emails and letters from GI docs to their patients stating that they have done everything they can and they don’t have another form of treatment to offer. I have seen another stating that they recommend monthly xifaxan and erythromycin for life – they recommend A MONTHLY ANTIOBIOTIC.
The second pattern that I see is this – they go on an antibiotic and they finally feel good. Their symptoms seem to resolve quickly and they feel better for the length of time that they take the antibiotic.
Then, often within two-four weeks, the symptoms begin to slowly creep back in. This happens slowly. At first, the symptoms are a little unsettling, but compared to what they were experiencing prior to treatment, they are still in a very good place.
A little time will go by and now the symptoms fully return and they are ready to do another round of antibiotics. The doctor, thinking that the initial treatment didn’t work, may prescribe the same antibiotic, a higher dose, recommend that they take it longer, or they may now recommend a combination of antibiotics or another antibiotic altogether.
This time, during the antibiotic treatment, they don’t feel as much recovery and they often feel fatigued during treatment. After treatment, they still see some symptoms. And, with each successive treatment, symptoms begin to worsen over time and these symptoms become harder to recover.
SIBO is a symptom of an extreme imbalance in the gut. Treating SIBO with an antibiotic is like having a bomb go off in you digestive tract. Any semblance of balance that the commensal flora was holding onto with their fingernails has just been upturned.
Additionally, treating SIBO with antibiotics will also do nothing to address fungal imbalances in the gut. You don’t usually hear a lot about this – but two large studies have shown that, of the over 100+ subjects in each study, around 2/3 of the subjects reporting classic SIBO symptoms had SIFO (small intestinal fungal overgrowth) which was identified with a duodenal aspirate, where fluid was taken at the very proximal, or near, part of the small intestine; right on the other side of the stomach. This is the part of the intestinal tract that should house the least amount of flora and be free of yeast.
Treating SIBO with an antibiotic, or multiple rounds of antibiotics, will clear the way for a fungal imbalance to take hold in the digestive tract.
This is why I prefer to address SIBO with herbs that are both antimicrobial and antifungal. Once SIBO is knocked down, and your symptoms have recovered, this simply marks the first phase of treatment.
Steps still need to be taken to address the underlying factors that set the stage for SIBO in the first place. If each of these items is not addressed, SIBO will likely reoccur and then you are back to square one: you need to support digestion at every step, heal the gut lining, repair the damage SIBO has caused, systematically rebalance the gut flora, address mucosal immune dysfunction, and address gut motility. Once these have all been addressed, then you can begin to expand from a LOW fermentable SIBO eating plan and begin to test out known trigger foods.
Healing SIBO takes time, but it can be done!!
Angela Pifer, SIBO Guru
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