What Do We Really Know About Treating SIBO

This morning I got to thinking about some of my favorite papers of the past, and decided to pick one to write about today.

In the spring of 2010, around the same time I saw Dr. Jeremy Nicholson present his findings – that the urine of children on the autism spectrum contains metabolites different from their typical peers, confirming the existence of an altered bacterial microbiome[i] – I read a paper[ii] in the journal, Nutrition, that also rocked my world.  (I mentioned this once before, in one of my SCD posts.) It confirmed that everything I was doing as a nutritionist for my clients with the symptoms of SIBO (small intestine bacterial overgrowth) and/or IBS (and actually, IBD as well), everything I had done for my own son, everything I had observed and learned to be effective, was spot on. Science had finally caught up with me.

The paper pointed out that the available laboratory testing for SIBO is inadequate and unreliable. (This is still the case, 8 years later, by the way.)  Therefore, the best way to determine its presence is to treat for it and if the person gets better, that’s what they had.

What then did these authors suggest as therapeutic approaches?  “In light of the potential mechanisms by which SIBO might cause symptoms, therapeutic approaches theoretically include reducing the bacterial load and/or changing the functional properties of the microbiota.”

1. Firstly, there are antibiotics. In the most severe cases, I often found myself recommending patients consult with their physicians about the potential use of these medications.

2. Secondly, probably the single best treatment is the removal of foods in the diet that contain fermentable substrates: sugars that are poorly broken down and absorbed.  They specifically mention FODMAPs and elemental diets, but in my personal experience, as I have written before, the Specific Carbohydrate Diet (SCD) is by far the most effective.  I remember only too well, back in 2003, I had started Alex on SCD and was watching our own little miracle take place.  I met another mother whose son with autism was the same age, had the same history of IBD, and who used the same gastroenterologist.  Completely coincidentally, the same month that she had chosen to go along with his suggestion of the elemental diet, I had ignored him, and started Alex on SCD.  When she and I met 4 months later, with Alex having the first formed stools of his life, her son was still screaming with profound abdominal pain.  After we talked, she switched to SCD and her son made extraordinary improvement.  (In fact, she was only too happy to share her story in my book on SCD, We Band of Mothers:  Autism, My Son, and The Specific Carbohydrate Diet. (Please note for anyone interested in the book:  it is available on Amazon.  All proceeds go to the Autism Research Institute.)

3. Finally, there are prebiotics and probiotics to improve the quality of the gut bacteria.

Everything we’ve learned since – for example, all the recent work on the importance of prebiotics in the diet – continues to support the above as the best treatment options available at this time.

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[i] Yap, IKS, Angley, M, Veselkov, KA,  Holmes, E, London, JC, Nicholson, JK. Urinary metabolic phenytyping differentiates children with autism, fromtheir unaffected siblings and age-matched controls.  Journal of Proteome Research.  2010. 4;9(6):2996-3004.

[ii] Gibson PR, Barrett JS, The concept of small intestinal bacterial overgrowth in relation to functional gastrointestinal disorders. Nutrition (2010), doi:10.1016/j.nut.2010.01.005