Tired. Bloated. In pain. Small intestinal bacterial overgrowth is not mere discomfort. While the large intestine is supposed to be microbe-rich, small intestine should contain relatively small numbers of microbes for optimal function. If you’re curious about the research behind small intestinal bacterial overgrowth, also known as SIBO, read our last article here. If you’ve been down that diagnostic road and find yourself dealing with SIBO, this is the article for you. From the outset, it’s important to note that there is little evidence to guide lifestyle interventions in SIBO. However, from a functional perspective, there are many approaches you can try that address the underlying physiology of the condition and support eradication of the overgrowth, alongside your prescribed antibiotic therapy. Ready to show your second brain some love? Here are some approaches that might be of interest. Mind Your Meal Times Your gut is an incredible machine. It uses its muscular design to sweep food through the machinery of digestion, absorption and excretion. However, you probably didn’t realize that the machine has a self-cleaning cycle called the migrating motor complex1. These rhythmic waves of contraction are designed to sweep away any digestive leftovers… and they are also thought to help control the growth of bacteria in the small intestine1. In order to optimize the migrating motor complex (MMC), you need to adequately space your meal times because these waves occur post absorption. While it varies between individuals, the migrating motor complex will occur typically 90 minutes post digestion and absorption. This is big news for a nation of constant snackers. If you are eating every 1-2 hours, you are less likely to access that self-cleaning cycle. A smarter approach? Do your best to space your eating opportunities four hours apart and try not to eat before bedtime. Mind Your Movement Learning about the migrating motor complex is a clue that motility – or that intrinsic muscular contraction that moves your gut – is an important underlying factor in SIBO. Often, use of pro-kinetics (pro-motility) medications are an important part of treatment alongside diet and meal timing. Pro-kinetics help encourage the normal movement of the gut so that overgrowth is less likely to occur. Speaking of movement, if you regularly suffer from constipation, addressing it is an important part of healing from SIBO. Drink plenty of water and exercise daily to encourage elimination. Dual antibiotic therapy to help eradicate the methane-producing bacteria associated with constipation may also be a strategy your physician chooses to help support regular elimination. Mind Your Fermentables At this stage in the research, many of the directives around what to eat in small intestinal bacterial overgrowth are driven by expert consensus. Kate Scarlata, an IBS/SIBO expert, recommends following a low FODMAP elimination during treatment and for at least four weeks post-antibiotic therapy. Mark Pimentel, MD, a leader in SIBO research at Cedars-Sinai, has also noted that bacteria are easier to eradicate via antibiotics when they are happy and growing. For this reason, he encourages small amounts of low fibre, FODMAP containing food such as white bread during the antibiotic phase of therapy. A low FODMAP, low sugar approach seems to be helpful when in combination with medication and other functional strategies. What are FODMAPs? They are carbohydrates (not fats or proteins) that tend to be mal-absorbed and readily fermented by gut bacteria. In irritable bowel syndrome and SIBO, eating them may lead to worsening symptoms. Want to learn more? Check out this article. Mind Your Microbes If microbes are to blame for your symptoms, could they also be the fix? One of the theoretical challenges with probiotics in SIBO is that the body is having difficulty moving bacteria through your system; however, with antibiotic therapy, there is always a risk of adverse side effects that probiotics are known to prevent. And we know that probiotic bacteria help to support a balanced community of microbes in the body. Bio-K+ brings support through not only an antibiotic therapy but through the post-antibiotic phase to support health and healing. While research is in early stages, there are indeed a few trials to suggest benefit2,3. When using Bio-K+ with an antibiotic, be sure to wait for two hours post-antibiotic to take your Bio-K+. Often, antibiotic therapy is three times a day, so it is most convenient to take one Bio-K+ 50 Billion capsule in between meals. Treating small intestinal bacterial overgrowth can be challenging, made no less challenging by the fact that awareness is still relatively low – and much more research needs to be done. However, by following an eating plan designed with microbes in mind, and tailoring your supplementation to optimize digestion, healing is possible. We highly recommend working with a dietitian experienced in gut health to help individualize a treatment plan to support your healing. Do you have more questions about SIBO, gut health or probiotics? Let us know in comments below! For more information on digestive health, join our community. Click here to find your Bio-K+ closest point of sale. Contact us or find us on Facebook and Instagram. References https://www.physiology.org/doi/abs/10.1152/ajpgi.00212.2015?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed https://www.ncbi.nlm.nih.gov/pubmed/25579140 https://www.ncbi.nlm.nih.gov/pubmed/27210778
