SIBO, small intestinal bacterial overgrowth, is everywhere.
I didn’t used to think so. In fact, in my Undoctored book, I stated that SIBO was uncommon. Yes, the majority of people have some degree of dysbiosis, i.e., disruption of the microbial species inhabiting the colon due to antibiotic exposure, herbicides/pesticides, food additives, numerous prescription drugs, etc. But trillions of unhealthy microbes that have proliferated unchecked, then ascended up the 24-feet of ileum, jejunum, duodenum, and stomach? Surely that is uncommon—at least, that’s what I thought until I began talking about the AIRE device that measures breath hydrogen (H2) gas that “maps” out where in the human gastrointestinal (GI) tract that microbes are living. Although a similar H2 breath test has been around for a number of years, performed in a clinic or lab and ordered by the doctor, most practicing physicians are unaware of the value of this test and rarely, if ever, use it. The AIRE device brings the convenience of H2-breath testing into the comfort of your kitchen or living room.
As more and more people obtained the device and began testing, it became clear that SIBO is everywhere. Yes, the people who follow my conversations may do so because they have health concerns and results may therefore be skewed towards abnormal values. But people who tested negative were clearly the exception. So we cannot make any firm predictions about the prevalence of SIBO, but it is clear that it is far from rare. Even better, people testing positive who then tackled their SIBO experienced health benefits: weight loss plateaus broken, blood sugar and HbA1c dropped, residual abdominal symptoms receded, skin rashes disappeared, etc.
If you test positive, or if you don’t test but have what I call “telltale signs” of SIBO such as fat malabsorption (fat droplets in the toilet), food intolerances (histamine, legumes, fructose, FODMAPs, nightshades, etc.), or health conditions virtually synonymous with SIBO such as restless leg syndrome, irritable bowel syndrome, or fibromyalgia, how do you eradicate this condition? You have choices that include conventional antibiotics such as xifaxin that your doctor can prescribe, or herbal antibiotics, two of which have some clinical evidence for efficacy (Candibactin AR/BR and FC Cidal with Dysbiocide).
What about probiotics? If you took a commercial probiotic, will it get rid of SIBO? No, it is unlikely that an off-the-shelf probiotic kills off the out-of-control species of SIBO. This should come as no surprise, as commercial probiotics are not crafted for this purpose. Instead, the current crop of commercial probiotics are, for the most part, haphazard concoctions of species assembled with no rhyme or reason. A number of factors that should (and likely will in future) be incorporated into an effective probiotic include inclusion of keystone species, “consortia” or “guilds” of species that “collaborate,” and listing strains, not just species. If you took a commercial probiotic, even one that costs a lot of money, it might reduce symptoms associated with SIBO such as bloating or reduce the number of diarrheal bowel movements, but you will more than likely be left with 30-feet of unhealthy over-proliferated microbes in your GI tract—SIBO persists. You will continue to test positive for H2 on breath testing.
So let’s therefore ask different questions. Let’s ask what would happen if, rather than a haphazard collection of species, we chose species/strains that:
- Colonize the upper GI tract—that, after all, is where SIBO occurs.
- Produce bacteriocins—these are natural antibiotics produced by selected microbes effective in killing or suppressing the species of SIBO such as Klebsiella, E. coli, or Streptococcus.
Could a properly curated collection of microbes then be fermented to high counts by using prolonged fermentation (as I do with my L reuteri yogurt to obtain around 250-260 billion counts, or CFUs, per 1/2-cup serving), then consumed to eradicate SIBO species? I chose three species:
- Lactobacillus gasseri BNR 17 that colonizes the small intestine and produces up to 7 bacteriocins, a virtual bacteriocin powerhouse
- Lactobacillus reuteri DSM 17938 and ATCC PTA 6475 that also colonize the small intestine and produce up to four bacteriocins, including the powerful reuterin. (L reuteri is such an effective antibacterial that a microbiologist with 40 years experience told me that they sometimes clean their bacterial production vats with this microbe. I was skeptical and checked with my friend, Raul Cano, PhD, also with 40 years of academic microbiology experience–yup, he confirmed: L reuteri can clean vats of unhealthy microbes.)
- Bacillus coagulans GBI-30,6086 that produces a bacteriocin. It does not colonize the upper GI tract but has been shown to substantially reduce the symptoms of irritable bowel syndrome that is virtually synonymous with SIBO.
We co-ferment for 36 hours, then consume 1/2-cup per day for 4 weeks. I didn’t know what to expect at first but, so far, this mixture has performed way beyond my expectations. Of around 30 people who have tried “SIBO Yogurt,” 90% have normalized breath H2 and obtained relief from SIBO symptoms. Given that the best in conventional healthcare is rifaximin with a track record of effectiveness of around 50%, if the 90% with the SIBO Yogurt holds up, that would be spectacular. The experience is preliminary and anecdotal, but promising.
If the treatment for some condition is invasive or extreme like, say, frontal lobotomy or total colectomy (colon removal), you want to be damned sure of the diagnosis and treatment. But what if the potential treatment is benign, a fermented yogurt-like food? Well, then the bar is much lower. I’m now suggesting to people that they give the SIBO Yogurt a try before trying anything else.
If you would like to give the SIBO Yogurt a try, you will find the full recipe, where to source the microbes, and fermentation details in the Super Gut book. And be sure to come back and report what your experience has been.
Here is my Defiant Health podcast discussion of this topic.