Gut Health Testing and Treatment: What's the Deal with Breath Tests and "Herbal Antibiotics"?
Plus: Does this SIBO protocol really lead to weight loss?
It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.
This week’s question is about small intestinal bacterial overgrowth, or SIBO. The first part of my answer is available to everyone, and paid subscribers can read the whole thing. There’s no audio version this time, but please let me know if you miss it!
First, I’d like to say thank you so much for the work you do. Your books have really helped me in my journey toward a healthier relationship with food.
I recently went to a nurse practitioner at a functional medicine clinic. My family doctor works there part time, so I felt I could trust the clinic. However, after an hour-long conversation, she basically said I have SIBO. However, she said that I would need to take an expensive test to find out for sure and determine what kind of SIBO I had. She explained that my digestive symptoms (previously diagnosed as IBS) were likely SIBO and that with treatment of either antibiotics or a series of herbal supplements (sold at the clinic) I could be cured and likely lose weight.
Is this legit or diet culture woo-woo? She lost me at “continuous glucose monitor,” but when I looked up SIBO later, I saw that there’s so much info out there that makes me wonder if it’s something I should explore.
FYI: my answers here are for educational and informational purposes only, aren’t a substitute for medical or mental-health advice, and don’t constitute a provider-patient relationship.
Thanks so much for this question, and I’m sorry you’re dealing with these symptoms. As someone with IBS myself, I definitely understand the search for explanations and relief.
I can also see why your alarm bells are going off after this encounter with the nurse practitioner! I’m noticing a lot of red flags, too. I’ll share what they are and explain why I think it’s worth seeking a second opinion outside the functional-medicine field.
First, though, let’s talk about what the science really says about SIBO, digestive symptoms, and IBS.
As I reported in another piece last year, SIBO is a condition in which bacteria in the small intestine increase above normal levels. There are always going to be some bacteria in the small intestine, but not many; the main bacterial colonies live in the large intestine, where microbes feed on food waste and help break it down, releasing gas in the process. When gas-forming bacteria back up into the small intestine, they can cause bloating, pain, diarrhea, and other symptoms, including (in more extreme cases) malabsorption and malnutrition.
Why do people get SIBO? When the condition was initially discovered in the late 19th century, it was thought to be caused by (presumably rare) congenital anatomical differences; later, researchers discovered it could also be brought about by intestinal surgery or disease. Today, the causes are thought to include slow digestion, low levels of stomach acid, GI surgery, and problems with the valve that’s supposed to separate the small and large intestines. One 2018 study even found that probiotics may be linked to SIBO—a finding that’s been controversial, especially among researchers with ties to probiotic manufacturers.
In fact, there’s a lot about this condition that’s controversial, and much that remains unknown. SIBO has become a buzzword in wellness culture, where in some circles it’s being blamed for all kinds of digestive woes, despite a lack of sound science. Perhaps most frustratingly, there’s no standardized way of diagnosing SIBO, so misdiagnoses are likely—and many of the proposed treatments for it are hit-and-miss, if not entirely ineffective.
Like the gut health field in general, SIBO is poorly understood and often overhyped—making it ripe for exploitation by the diet and wellness industries.