SIBO Summit 2016 Review – Dr Allison Siebecker (part 1)

SIBO Summit 2016 Review - Part 1

Australia's first SIBO conference, the SIBO Summit, kicked off in Melbourne on Saturday 8 October 2016, followed by Sydney on 10 October 2016.  The Healthy Gut was proud to be a platinum sponsor and co-organiser of the event.  Dr. Allison Siebecker, arguably the Queen of SIBO, flew in from the US to speak at this event and delivered an excellent presentation on the causes and risk factors of Small Intestinal Bacterial Overgrowth, treatment options, diet types and much more.   Read on to see our founder Rebecca Coomes' key take-aways from her presentation.

The full video of Dr. Allison Siebecker presenting at the SIBO Summit along with her slides and notes are available to purchase.  This article is a summary of her presentation but we highly recommend watching the full video for the complete learnings.  You can order the presentation here.

This is the first part of a 2 part article on Dr. Siebecker's presentation. Click here to see Part 2.

Rebecca Coomes the healthy gut with Dr Allison Siebecker the Queen of SIBO

Rebecca Coomes with Dr. Allison Siebecker at the SIBO Summit

In this article, you will learn:

  • The common causes of SIBO (hint: there aren't many)
  • The things that put you at risk of developing SIBO (hint: there are lots)
  • The treatment options for hydrogen and methane dominant SIBO

 

60% of all Irritable Bowel Syndrome cases are actually caused by SIBO.

The common causes of SIBO

We are constantly exposed to bacteria. The body has several mechanisms in place to prevent bacterial overgrowth in the small intestine, including hydrochloric acid, bile, enzymes and our immune system to kill or stop bacteria which has entered via the nose and mouth; the ileocecal valve to prevent backflow from the large intestine and the migrating motor complex (MMC) which sweeps food and bacteria through the small intestine and prevents it from staying in the wrong place.

Something has to go wrong in the body for SIBO to occur. It is not normal to have an overgrowth of bacteria in the small intestine.  The bacteria compete for our food and put pressure on our system.  If you have SIBO, your digestive system has stopped working properly to allow it to develop.

It might surprise to you discover that there are only a few causes of SIBO.  The agreed causes are:

  • A deficient Migrating Motor Complex (MMC) where the MMC does not operate effectively to push the matter through the small intestine into the large intestine
  • Structural alterations e.g. from injury, surgery, disease such as partial obstruction from adhesions, structure tumour, compression, non-draining pockets
  • Immune deficiency disease e.g. where the bacteria is not killed or removed by the immune system

 

The Migrating Motor Complex is believed to be the biggest prevention against SIBO.  It occurs in the small intestine every 90 minutes between meals and at night.  Eating turns it off, which is why it is recommended to space out your meals while treating SIBO.  It is recommended that you space your meals out every 4-5 hours and fast for 12 hours overnight (eg. Breakfast at 7am, lunch at 1pm, dinner at 7pm and no food again until breakfast the following day at 7am, with no snacking in-between meals).

If you would like to see a video of the MMC in operation, click here and watch video #13.

Other causes may include (but are debated for their accuracy in actually causing SIBO, and may instead just be a risk factor):

  • Deficient hydrochloric acid
  • The ileocecal valve not working properly
  • Insufficient bile and enzyme production

 

SIBO is not pathogenic.  It is not caused by bacteria that are an infection to the body, such as salmonella. Instead, SIBO is caused by normal gut bacteria that are living in the wrong place, causing havoc. The small intestine should have low levels of bacteria in it.

 

SIBO risk factors

There are many risk factors that can contribute to one of the underlying causes of SIBO.  These include:

  • Deficiency to the MMC
  • Infections.  (eg. Food poisoning,  C. difficile infection, appendicitis, etc)
  • Drugs (eg. antibiotics, opiates, etc)
  • Lifestyle (eg. stress, sleep, etc)
  • Obstruction
  • Diseases (eg.Frank Immunodeficiency Disease, diabetes, hypothyroid, HIV, endometriosis, cancer, IBD, T cell deficiency, etc)
  • Surgery
  • Injury

We have developed a handy guide on SIBO causes and risk factors which you can see here.

Rebecca Coomes at SIBO Summit 2016 with Handout Covering Infographic

SIBO symptoms

SIBO symptoms are caused by the gases created by the bacteria in the small intestine.  They produce hydrogen, methane and/or hydrogen sulfide.  The bacteria can also damage the small intestine, impacting the digestive process and absorbability.  The most common symptoms are:

  • Bloating
  • Pain
  • Altered bowel movements (eg. Constipation, diarrhoea, both)
  • Belching and flatulence
  • Nausea
  • Heart burn

Methane gas has been shown to slow the motility of the small intestine by 70%.

How do you test for sibo?

There are currently three testing options for SIBO:

  1. Aspirate via endoscopy. Invasive and needs to be done in-clinic.
  2. Breath test. 3-hour lactulose or glucose breath test. Effective and easily administered. Can be done in-clinic or at home.
  3. Blood test. IBSChek Test where SIBO is caused by food poisoning (only available in the US).

Dr. Siebecker recommends starting with the breath test because 60% of SIBO is caused by IBS and it is easy to administer.  She also advised that it is important to correctly diagnose SIBO through testing before treatment commences, as there are many other conditions and diseases which can present with similar symptoms.

It is estimated that two thirds of SIBO cases are chronic cases and can't be cured quickly.

SIBO treatment options

Dr. Siebecker discussed the three layers to her treatment approach with SIBO.

  1. Symptom relief. Address the symptoms and look to provide relief through diet and lifestyle modifications and supplements.
  2. Treatment. Treat the bacterial overgrowth through antibiotics, herbs or the Elemental Diet.
  3. Underlying cause. Address the underlying cause (if possible) to prevent future relapse.

"SIBO is often a secondary disease, and unless the underlying problem is addressed and well controlled, the chance of recurrence remains high. However, in the majority of cases, elimination of the underlying cause is not possible.” Pimentel, Rao, Rezaie ‘16

Unfortunately, relapse rates are high.  Commonly, people relapse within 2 months, 2 weeks or 2 days.  Knowing that you will possibly relapse at the time of diagnosis can be disheartening, however being aware that this is a chronic condition can support you psychologically in the knowledge that it is not your fault that you haven't beaten it the first time around.

It is not expected that all of your symptoms will disappear with SIBO treatment.  A reduction of 80% to 90% of symptoms is standard and believed to be a successful treatment.  The challenge for patients is the expectation that 100% of their symptoms will disappear, especially after antibiotic use.  We often believe that antibiotics will fix everything, and this is not always the case with SIBO.

SIBO is commonly treated with antibiotics for a course of treatment lasting 2 weeks per treatment.  There are currently three antibiotics which are used for SIBO:

  1. Rifaximin. Can be used for all types of SIBO.
  2. Neomycin. Can be used for methane dominant SIBO.
  3. Metronidazole. Can be used for methane dominant SIBO.

SIBO can also be treated with herbs, which include:

  1. Berberine. Can be used for all types of SIBO and is the herbal equivalent of rifaximin.
  2. Oregano. Can be used for all types of SIBO.
  3. Neem. Can be used for all types of SIBO.
  4. Allicin. Can be used for methane dominant SIBO.

A round of herbs takes longer, lasting 4 weeks per treatment.  Dr. Siebecker discussed the importance of only using two herbs at a time to prevent against herbal antibiotic resistance and sensitivities.

 

Antibiotics and herbs tend to bring gas down 30 parts per million per treatment. It is extremely unlikely to bring very high numbers down in only one treatment.

 

The Elemental Diet is the third treatment option for SIBO.  It is a liquid diet made up of predigested nutrients which replace food for two to three weeks.  During this time, no solid food is eaten.  It works by starving the bacteria but feeding the person, and is believed to be as effective as antibiotics with an 80%-85% success rate.

The elemental diet can reduce severe gas numbers in one two week course, which is why it is often used for more challenging cases.  Dr. Siebecker noted that antibiotics and herbs should not be used at the same time as the elemental diet as the bacteria are hibernating and thus they would be ineffective.

This is the first part of a 2 part article on Dr. Siebecker's presentation. Click here to see Part 2.

The full video of Dr. Allison Siebecker presenting at the SIBO Summit along with her slides and notes are available to purchase.  This article is a summary of her presentation but we highly recommend watching the full video for the complete learnings.  You can order the presentation here.

Dr. Siebecker's website is full of informative and useful information relating to SIBO.  To read more about her work, head to www.siboinfo.com.

 

11 thoughts on “SIBO Summit 2016 Review – Dr Allison Siebecker (part 1)”

  1. Tania Maree Glover

    What do you do when the combination of berberine and allicin is churning your stomach to pieces causing violent vomiting and anxiety

  2. I understood that allison was a treatment for methane dominant SIBO. However, my doctor wants to put me on Rifaximin and allison (after I’ve done 6 weeks of herbal antibiotics). Does this seem to make sense?

    1. Allicin is often used for methane dominant SIBO, but some practitioners do use it for hydrogen dominant SIBO as well. Rifaximin is used for all types of SIBO.

  3. Thank you for the summary Rebecca! It is encouraging to read what has been learned about SIBO and to have so much additional help with treatment. In good health, Danita

  4. Thank you for the information! After years of struggling with IBS, I was diagnosed with methane dominant SIBO. I worked with an FDN and after an 8 week treatment period it wasn’t gone and my motility was not improved even with adding a prokinetic and I was following the restrictive diet of SCD and low FODMAP “the green column.” However, my symptoms were greatly reduced. I understand this is a process and may be a lifelong journey. Over use of antibiotics for chronic ear infections helped to cause this for me. I’ll be following your blog as I continue down this path to good gut health.

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