Oh SIBO. Aren't you just the party guest we wish would leave? SIBO is short for Small Intestinal Bacterial Overgrowth, and it is a pain to deal with. It can be the pesky bugger behind bloating, constipation, leaky gut and gas. It is also hard to approach as a practitioner because there are so many factors that affect it. From a physiological aspect it is caused by an imbalance in bacteria. Too many of the wrong kind of bacteria reside in small intestine that supposed to be in the large intestine wreak havoc. Gas, bloating, leaky gut and bowel movement issues can come from SIBO. What causes SIBO? It is a long list. Illness, stress, trauma, infections, autoimmune disease, alcohol, hormone imbalances, food allergies..all can contribute. Beyond what I list below, is a SIBO plan or protocol. I did not include a protocol here. Your practitioner should have a host of options for you to help with SIBO (and I am happy to help you too!). But often I only see about a 50% cure rate (that is my own anecdotal evidence) and even in cases of seeing excellent results, I see relapse rates higher than I am comfortable with. So, perhaps...consider these reasons I have listed if you are not improving on your SIBO protocol. I created this list because I saw "perfect performers" not healing. In the toughest cases, I have found the emotional/belief component is the leading force preventing healing. Did everyone hear that? Emotions, unresolved trauma and stress could be at the root of your SIBO. And that is the good news. The very thing that is preventing healing is the gateway to the healing. Illness is always our opportunity.
1. You have a co-infection
I consider SIBO to be a form of a co-infection. But you can have more than one co-infection at the same time. H. Pylori? EBV? Cytomegalovirus? All must be addressed. If you have parasites for instance and you try to solve SIBO, it probably will be slow going. The name of the game is to figure out which thing to tackle first and why.
Here are some links to labs I like that do co-infection testing
I love this graphic from ImmunoSciences Lab:
2. Your cortisol is dysregulated
If your cortisol is dysregulated, it is pretty much like saying "hey you have no gas in your gas tank." Why do a SIBO protocol when you are running on fumes? I suggest supporting the adrenals for a bit first and then tackling SIBO. Of course you won't get super far regulating your cortisol with SIBO, but I always say put gas in the gas tank first. You cannot deplete an already depleted person and expected good outcomes.
3. Your blood sugars are dysregulated
This can be related to cortisol quite a bit. But intermittent fasting can help, (please don't try that without a doctor helping you) and so can increasing your starchy carbs/fuel as well as liposomal curcumin and resveratrol. Micronutrient deficiencies can come into play here too. I see insulin resistant hypoglycemia all the time. There are many reasons for it, and once you know that you have it, it is easier to heal it.
4. You are not eating Low FODMAP at the right time during your SIBO protocol
If you eat low FODMAP when you are killing the SIBO bacteria, it can be counterproductive. You want the bacteria to be active and present so that the antibacterial protocol can work. I do not recommend starting Low FODMAP until you are done or almost done with your herbal or prescription antibiotics
5. You are eating resistant starch and have an autoimmune disease and SIBO
Resistant starch can contribute to certain autoimmune conditions. My book The Loving Diet will go into detail about this, so grab a copy next month 🙂 And here is the downside: most AIP 'treats' are made with foods that are high in resistant starch. Boo!
6. You are eating AIP foods that you shouldn't be
I cannot stress this enough. While doing elimination/challenge tests work, I prefer the quicker, less stressful route. Cyrex Labs Array 10 is the most up to date testing (in my opinion) to look at immune reactions via ELISA testing and I consider them to be an amazing option. I see so often those on AIP with odd reactions like ginger and lettuce. That means ginger and lettuce should be eliminated from your diet. Healing your immune system, and having a well functioning immune system is key to being ready to clear SIBO. You can go beyond the basic framework of AIP and individualize it. I am always about the quickest, easiest, most loving and logical path.
7. You have beliefs about safety and security in your life that are inflammatory and limiting
Most of these reside in our unconscious, so it is best to get help with them. But Ho'ponoponopono is a great resource for staring the ball rolling on this. When you have stressful or traumatic experiences in life (and we all do) then to make sense of them, we make up beliefs about life. For instance: "life is not fair." If nothing is done with that belief, then it becomes part of us (move into the unconscious) and will color how we live and decisions we make.. Forgiveness, gratitude and love are three very effective ways to clear held beliefs. Half of my professional work now is helping clients resolve beliefs that are not true through loving, and it can have profound impacts on physical health when we look at healing our life along with healing our bodies. I have found SIBO a wonderful gift in this regard. It is a wonderful opportunity to resolve what is not true in our lives.
8. Your Vagus Nerve is not doing its job due to physical and emotional trauma and stress
We know that low vagal tone affects motility in the gut. We also know that trauma can affect vagal tone (see the Polyvagal Theory). There are some straightforward physiological aspects of healing SIBO that help regulate vagal tone like probiotics. But, there are also a host of ways to increase vagal tone: yoga, diaphragm breathing, increasing Heart Rate Variability, gargling, singing, mindfulness, meditation, exercising and fixing leaky gut. Personally I think the vagus nerve will be emerging to be a big player in the mind-body movement as an interface between the physical and emotions.
9. Your Heart Rate Variability is causing sympathetic nervous system dominance
If you are sympathetic dominant, then it is a bit like you are in fight or flight too much, and more prone to the negative effects of stress and worry. Too much time in the sympathetic state will slow how quickly you heal. But, you can do your own version of biofeedback to balance the autonomic nervous system with Heart Rate Variability measurements. If you measure your HRV, you can track how well you are managing your sympathetic and parasympathetic nervous system. This is fantastic for knowing which days are best to exercise, train, meditate and relax. Very, very useful to healing the immune system, gut and SIBO.
10. Your autoimmune pathways are not being regulated
NF-kB is a protein complex that controls the transcription of DNA. It is a starting point of inflammation in response to cytokines from autoimmunity. Often with autoimmune disease, NF-kB is activated. But, when NF-kB is downregulated, immune pathways that include Th-1, Th-2, Th-3 and TH-17 are regulated as well. My favorite way to help regulate immune pathways is liposomal curcumin and resveratrol.