The current treatment for a SIBO is an antibiotic called Rifaximin. Some other antibiotics used are metronidazole and neomycin. People usually have to go on multiple rounds, and this can lead to a barren gut. As all bacterial populations diminish, the mucosal layer starts to lose its integrity. Think of it as a field with no grass in the rain, the dirt starts to wash away. Sometimes a person will also be prescribed a pro-kinetic drug to help with motility. These usually consist of drugs that stop the reuptake of neurotransmitters not being made or utilized correctly such as serotonin. Unfortunately, the recurrence rate of this route is over 90%, as the underlying issues mentioned above are not addressed.
Diet and SIBO
As far as eating for a SIBO, there is a lot of variation from different sources. Ideally, a diet should be customized for an individual based on food sensitivities, co-infections, and digestive chemistry. To get started on a diet, a general rule of thumb is no:
- high fructose fruits
- fructan containing vegetables
- natural or artificial sweeteners
- gums and fibers
- protein shakes with gums
However, the longer a person goes without foods the harder it is to reintroduce them and have the immune system tolerate them. This is the concept of oral tolerance. When working with a patient, a large goal we have is for them to be able to eat foods that used to cause symptoms and they are okay with reintroducing them. This shows that we have “fixed the gut” instead of just avoiding foods.