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Why Antibiotics May Not Be The Best Approach For Small Intestinal Bacterial Overgrowth (SIBO)

Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an excessive growth of bacteria in the small intestine. It can lead to various digestive symptoms such as bloating, gas, abdominal pain, and altered bowel movements. While antibiotics are often used as a treatment approach for IBS and SIBO, they may not be the best long-term solution. One of the main reasons is the high relapse rate associated with antibiotic treatment for SIBO.(*)

While antibiotics can initially reduce the bacterial overgrowth, they also disrupt the balance of beneficial bacteria in the gut, potentially creating an environment for the bacteria to regrow and cause a relapse of symptoms. This happens because antibiotics not only target the harmful bacteria, but also the beneficial ones that are crucial for maintaining a healthy gut. Consequently, the use of antibiotics alone may not provide a sustainable resolution for SIBO, and alternative approaches that focus on restoring gut health and addressing the underlying causes of bacterial overgrowth are often recommended. You may be wodering about the antibiotic Rifaxmin and its relapse rate.

Rifaximin and SIBO

The high relapse rate associated with the use of Rifaximin, a commonly prescribed antibiotic for SIBO treatment, can be attributed to several factors.(*) Firstly, while Rifaximin is effective in reducing bacterial overgrowth, it primarily targets and eliminates only certain types of bacteria in the small intestine. This selective action may not completely eradicate all the bacterial species involved in SIBO, leaving behind a potential reservoir for regrowth and recurrence of symptoms. Additionally, Rifaximin has a relatively short duration of action, meaning that its effects may not be long-lasting, allowing the bacteria to bounce back after the treatment period ends. This also explains the high reinfection rate when patients rely on rifaximin alone.

Furthermore, SIBO is often a multifactorial condition with underlying root causes, such as impaired motility, immune dysfunction, or structural abnormalities. Addressing these underlying factors is crucial for long-term resolution. Antibiotics alone may not be sufficient to tackle these underlying issues, and without addressing them, the overgrowth may persist, leading to relapse.

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Hey folks Dr Hagmeyer here !
One of the common problems seen with people who have digestive problems (bloating, belching, gas, diarrhea, skin conditions, fatigue, Rosacea, Fibroymyalgia, acne, depression) is something known as SIBO or small intestinal bacterial overgrowth.

I have personally worked with hundreds of patients with SIBO and including myself have been treated successfully and we did it naturally.

But the purpose of today’s video, is to share with you some of the common problems and pitfalls, and really share with you my perspective of where I see many people going wrong and making an infection that could be easy to treat… very difficult.

There are 5 major points I want to discuss with you today Regarding SIBO

#1 Why many people are getting re infected- Many people are put on antibiotics and then within 6-12 months that Infection is back- It reminds me of the merry go round that happens with kids who receive antibiotics for ear infections
#2 Why antibiotics are not always the best treatment approach for some people,
#3 The different kinds of breath tests that are out there, and some of the causes behind why testing comes back negative, yet you have many symptoms that you do have an infection.

#4- Herbal therapy and SIBO

Finally, I will share with you what I call the BIG picture in treating SIBO and why treatment needs to be tailored and customized to the individual (another words) don’t follow some Joe Schmos 30 days to eradicating SIBO program that has littered the internet.

You can learn more about Natural Treatments for SIBO Here

For those of you just tuning in, SIBO, or small intestinal bacterial overgrowth, continues to be one of the most common associations of IBS (Irritable Bowel Syndrome) and IBS-like symptoms, these are all you typical symptoms that include bloating, abdominal pain, diarrhea, constipation and gas.

SIBO just like the name implies is a bacterial infection in the small intestines. Here’s the problem— Normally you shouldn’t see the kinds of bacteria in the small intestines that you see in the large intestines.

But with SIBO, the bacteria in the large intestines migrate up into the small intestines where they don’t belong. This can happen for a number of reasons and I have discussed this in other videos, but when it happens, It creates a huge problems that can extends far beyond bloating, gas, diarrhea or constipation.

If you take a brief look at this chart, you will quickly see that SIBO is often be associated with many other conditions or it or could be a contributing CAUSE of these conditions.

Dr Hagmeyer SIBO slide
This is an important point to understand when considering treatment and why it is important to look at the entire clinical picture… Not just the infection component of the gut but all the things that can affect the motility and health of the GI tract. This is the Who, What, Where, When and most importantly the Why.

I want you to Consider this. If you have ever gone to the local home depot, or hardware store and looked for garden hoses, Most of the time those garden hoses come in 25 foot segments.
Well imagine all of that hose sitting in your abdomen.

Within your digestive system- there is a rhythmic, recurring cycling complex that occurs in the stomach and small intestines that happens between meals.

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This Cycling complex has been named the Migrating motor complex or myo-electric motor complex or MMC for short.

This MMC is essential for a number of Reasons

#1 MMC triggers peristalsis and this is how your body propels the food you eat… through the digestive system from the stomach a
#2 It also decreases the bacterial buildup in the beginning parts of the small intestines. And that’s huge! This is why you might here this as the “cleansing waves

I like to think of it as the street sweepers that come out at night when all the hustle and bustle of eating is over. The cycle of the motility occurs between meals or in fasting states and its the grumbling sound you hear

Its also the reason why people who have SIBO generally feel better when they don’t eat- remember that when the MMC is the most active. If the MMC complex shuts down, the street sweepers are not keeping the intestines clean.

70% of people who have SIBO, experience a disruption of MMC rhythm. When the second and third phase of the MMC is reduced, bacteria remain in the small intestine instead of being pushed forward into the large intestine.

These bacteria adhere and set up home in the small intestines and this can causes food sensitivities, leaky gut, and Inflammation.

Last week I had three patients all with your typical IBS symptoms of bloating, gas, constipation, but beyond testing them for SIBO which they all had- every single patient also had early signs of Crohns or Ulcerative Colitis- That was detected with through antibody testing. This is why you need to work with a doctor who is not going to just stop the investigation at SIBO.

A Low FODMAP diet is the Basic Starting Point

If you are not familiar with a FODMAP diet and the foods you need to avoid visit my website and you can download a list of foods to avoid. Sometimes depending on the individual, you might need to avoid many things that historically are good for gut restoration. Things like probiotics, prebiotics, kefir, and even Bone Broth and fermented foods. Some times these foods can also create a histamine response. When it comes to Bone Broth- Bone broth made from cartilage bones such as knuckle bones are rated high on the FODMAP and therefore, suggested to be avoided. However, Bone Broth made from marrow bones and meaty bones are ok.

So back to the Migrating Motor Complex– this MMC can be affected by many things. Remember we want to focus on motility! And the causes behind why motility is compromised not just killing the infection.

So what does SIBO or low MMC activity have to do with Thyroid disease or even adrenal problems or even too much estrogen as in the case with girls on oral contraceptives, woman who are in menopause or perimenopause (where women favor a more estrogen dominant state?)

The answer is EVERYTHING!

Hypothyroidism affects the entire gastrointestinal system and causes hypomotility- ask any person with Thyroid disease and you will find that the majority of them suffer with IBS- and predominantly the constipation kind.

SIBO and Thyroid connection Dr Hagmeyer

Hypothyroidism slow down gastric emptying, it can compromise (HCL) production, if you think about the importance of acid in the stomach- HCL also sterilize the contents of the foods prior to entering the small intestines and so if you don’t focus on improving digestion, then pathogens and invaders that you just ate, can now populate the intestines as well, Low Thyroid function delays gastric emptying, and ultimately slow down the migrating motor complex. So can you see why OPTIMAL Thyroid function is critical to addressing SIBO.

Even if you have been told that you’re Thyroid levels are normal… they are probably not optimal.
I encourage you to visit my website and look at what represents optimal levels of thyroid functions vs what is the statistical norm.

Chronic stress can also affect Migrating Motor Complex and be a contributing factor in the development of SIBO.

When you think stress. Think adrenal glands. If your body is locked in a fight or flight response, digestion shuts down because the immediate need is burning fuel for energy. Here again people who have IBS are often chronically fatigued. Why? Because they are in a chronic prolonged stress state.

Physiologically, when your body is under chronic stress, you produce less saliva, less digestive enzymes, and less stomach acid and here again peristalsis slows down.

Stress and cortisol fluctuations will inhibit the sweeping motion of the Migrating Motor Complex in between meals leading to Bacterial overgrowth. This is one more reason why stress levels needs to be addressed when addressing any digestive symptom and condition. Again this is why you need to look at the BIG picture.

Dr Hagmeyer Stress and SIBO

Now… On a side note, about 4-5 years ago, I had tested for (+) SIBO. I had treated myself with various antimicrobials, biofilm disruptors, ezymes etc and I was unable to really address and get rid of my digestive problems until I began looking at the entire clinical picture. And my own experience with this is why my approach is very different than a lot of doctors out there. Without testing myself, I would have never know what was happening in my own body.

Hormones and Stress Dr Hagmeyer

One of the very first thing you want to do if you have any of the conditions you see listed here or if you have been diagnosed with IBS or any other GI disorder is work with a doctor you like and GET TESTED.

I can’t stress this enough!

While no test is perfect, and many doctors will say that you don’t need to test for SIBO. I completely disagree. Can there be instances when a test comes back negative and a person is truly positive you better believe it- But…If you follow the things we are going to talk about later in this video and read some of the resources I have posted for you on my website, You will see that you can increase the outcome of an accurate test… if you follow those recommendations.

Recently a new patient came to me after getting herself tested for SIBO.
The test came back negative but upon questioning on the preparation for the test- She did everything wrong- so we retested her an it came back positive.

So lets get into Testing.

When you suspect SIBO the best test currently is something called a breath test. Some Breath tests detect H.pylori, Some tests detect fructose malabsorption and some tests identify a lactose intolerance. Either way the standard for SIBO testing is a Breath test.

If your not familiar with these tests, what happens is that the person will drink a solution of glucose or lactulose and a sampling of their breath is taken every 15-30 minutes.

When I run this test on my patients I always order both the hydrogen and methane. Some doctors only run hydrogen and don’t measure methane, I like to look at both. That’s my preference.

SO How Do you Prevent a false Positive SIBO test and increase the accuracy of the test

There are many potential reasons a person might have a test that says they are negative.
SO let me give you 7 reasons you might not get an accurate reading. You can always go back to my website and learn the others but these are the most common according to the labs that offer the testing.

1. Delayed gastric emptying
2. Patients with chronic pancreatitis- just had that happen with a patient last week.
3. Celiac disease
4. If a person was taking antacids or any other medication that can alter the PH of gut. H2 antagonists, proton pump inhibitors.
5. If you were recently on antibiotics-
6. Not following a low FODMAP diet 24-48 hours prior to testing
7. Diarrhea- rapid transit time

In bringing this video to a close, a couple of points I want to stress.

#1 Focus on the Big Picture- In order to address the root cause behind SIBO- We need to look at other potential contributing factors that compromise MMC- Disbiosis, Low stomach acid, Inflammation, Thyroid hormones, Adrenal stress hormones, Synthetic Hormones such as those found in Birth control pills, a malfunctioning ileo-cecal valve (the valve between your colon and small intestines)?
#2 It is important that you work with a doctor who understand SIBO and its connection. If you don’t, you are going to bounce from one doctor to the next, spending a lot of money and still not getting anywhere.
#3 Be Realistic! Depending on what’s happening within your body- you are going to heal differently than another person who has SIBO. So don’t compare yourself to someone else.

I hope you found value with today’s video! I hope you have a better understanding of some of the connections SIBO has with other parts of your body and If this video was helpful, share it with your friends and family. You can get better- Just find a doctor who you feel you connect with and who will partner with you in this quest for optimal health! Till Next Time

Our Personal SIBO Recovery Program Is A Great place To Start

SIBO Dr HagmeyerThe Personal SIBO Recovery Program is a Natural Treatment for bloating, gas, constipation Diarrhea and other GI related problems. Our office utilizes nutritional supplements, Dietary modifications, Hormone and endocrine support formula, and lifestyle guidance.

To Schedule a Free 15 minute Phone Consult to see if this program is right for you Fill out our online questionnaire.

If you’re ready to get started and schedule an appointment take a moment and fill out our contact us form and in the comment box let us know what time of the day works best to contact you. One of our New Patient Coordinators will contact you with the next available new patient opening within 24-48 hours.

Out of State or Out of the Country and Still have questions? Email us. Dr Hagmeyer offers a Remote Recovery Program, where all testings can be done locally.

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