Stop Fighting, Start Restorative Healing: A Functional Approach to SIBO

Chronic health problems precipitate out from a myriad of origins, but these can usually be loosely grouped gut microscopeinto three general categories: cumulative repair deficit, oxidative damage, and metabolic acidosis.

In order to tailor our therapeutic approaches, it is essential to look at the basic physiological aspects of health, with an eye toward restorative healing. The first step is to stop “chasing the label.” What I mean by that is, we need to stop fighting the diagnosis, and instead look for ways to start the healing process.

Consider small intestinal bacterial overgrowth (SIBO). This seems to be the new kid on the block when it comes to digestive system diagnoses. SIBO is defined as the presence of excessive commensal bacteria in the small intestine, and it manifests as symptoms including bloating, abdominal pain, constipation, diarrhea and/or nausea.

The causes of SIBO can include low stomach acid secretion, immune dysfunction, and decreased gastric motility among others, Treatments for this condition range from intensive courses of conventional antibiotic drugs to complex herbal protocols.

For many, the condition could also be called dysbiosis, or leaky gut, or irritable bowel syndrome (IBS). In fact, SIBO is thought to be involved in more than half of all IBS cases.

Whatever we choose to call it, the underlying pattern is the same, and the key to helping our patients feel better is to initiate restorative healing of the affected tissues. We need to shift physiology so that the internal environment no longer favors the overgrowth of hostile bacteria in the small intestine.

If we fail to do that, treatments aimed at eradicating the bugs will have little long-term efficacy. Here are five tips that help you tackle the SIBO/IBS/leaky gut issue.

Eat immune-tolerant, easy to digest, alkalinizing whole foods: Incorporate nourishing liquid foods like soups, broths and herbal teas, while slowly adding in fermented foods like sauerkraut and kimchi.

 Don’t forget the golden 5 bio-detox foods: Ginger Garlic Onions Brassica sprouts and Eggs (GGOBE) that naturally rid the digestive system of harmful toxins. Awareness of foods to which someone is sensitiveis very important, since people with food sensitivities and increased immune system dysfunction are more susceptible to having the wrong kind of microflora colonize their upper GI tracts.

Monitor GI transit time: This is easy to teach to patients. The test involves taking 6-12 capsules (1.5 – 3 grams) of high-quality activated charcoal with 8 ounces of water between meals, ideally after a bowel movement. Then, note the time at which the charcoal first shows up in a subsequent bowel movement. Dose the charcoal according to weight (< 150 lbs: 6 capsules; 150 – 200 lbs: 8 capsules; 200- 250 lbs: 10 capsules;> 250 lbs: 12 capsules).

I like to see transit times of 12-18 hours. Chances of SIBO increase many-fold when someone has impaired GI motility and digestive material doesn’t move through in a timely manner.

Stay well-hydrated: It is easy to check hydration status using a simple skin-pinch test. Gently pull up about 1/2 inch on the skin on the back of the wrist with the hand extended out (not flexed either up or down). If the skin maintains a little ‘tent’ i.e., stays pinched and then slowly goes back to normal (over 5-10 seconds) it is a sign that the person is moderately dehydrated. Skin turgor and elasticity are good indicators of overall hydration levels.

Most individuals with SIBO respond really well to high water intake as it helps to flush out bad bacteria from the system. I recommend a minimum of 8 ounces of water eight times per day.


Maintain a healthy morning urine pH: The stomach is really the only place where high acidity is a good thing. Low stomach acidity is problematic for many reasons, not least of which is that it promotes SIBO. So we want the gastric environment to be highly acidic. But in all other tissues, high acidity is a bad thing.

A healthy acid-alkaline balance is a requisite for optimum cellular function. The 1st morning urine pH provides a good assessment of overall systemic acid-alkaline balance. If this measure is in the 6.5 – 7.5 range, it is in the desired restorative zone. Proliferation of bad bacteria is minimized when people maintain acid-alkaline ratios falling into that restorative zone.

Measuring morning urine pH is easy to teach to patients. Visit for details.

Take prebiotics, probiotics and symbiotics: Contrary to common belief, having SIBO does not mean one must stop taking probiotics. Likewise, taking probiotics doesn’t mean that one is priming one’s self for development of SIBO.

That said, a correct balance of microflora is very important for restoring and healing the damaged small intestine. Strains like Lactobacillus plantarum, Lactobacillus acidophilus and Lactobacillus casei are all beneficial if they are live, ready to implant and robust. In general, I’m not a big fan of Saccharomyces boulardii in this context.

In addition, prebiotics (fiber) that aid in gut motility and probiotic implantation are really important for healing SIBO. These can be incorporated slowly and as needed.

Glutamine – an amino acid that is vital for the gut, when taken as a recycled compound with pyridoxal alpha-ketoglutarate (PAK) produces a symbiotic effect with pre- and probiotics, optimizing digestive function in many ways.

Above all, remember that like other aspects of overall health, restoring gut health is all about what we Eat, Drink, Think and Do!


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