Medical vs Natural Approaches

IBS and SIBO are the most common digestive complaints seen in medical offices. Medical treatments for Irritable Bowel Syndrome (IBS) focus on relieving symptoms like pain, diarrhea, and constipation, as no cure exists. Key treatments include fiber supplements, laxatives, antispasmodics, antibiotics like rifaximin, serotonin modulators (alosetron, lubiprostone), and low-dose antidepressants. Diet modifications, such as the low FODMAP diet, and therapies like cognitive-behavioral therapy are also used.

SIBO can be diagnosed with a simple breath test. Since the symptoms overlap with IBS, sometimes it is good to make the distinction. Doctors treat SIBO (Small Intestinal Bacterial Overgrowth) primarily with targeted antibiotics, such as Rifaximin, to reduce excess bacteria in the small intestine. Treatments often include nutritional support to correct vitamin deficiencies, a low-FODMAP diet to manage symptoms, and addressing underlying causes like motility issues or structural abnormalities.

FODMAP Diet

This seems to be the go-to treatment for IBS and SIBO. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are short-chain carbohydrates (sugars) that the small intestine absorbs poorly, leading to rapid fermentation by gut bacteria and water retention in the bowel. Many find it a difficult diet to stick to. Also, it is meant to be temporary. FODMAPs are in fruits and vegetables and are not to be avoided indefinitely.

Killing Undesirable Flora

Since the growth of inappropriate flora is the cause of SIBO and the likely cause of IBS, killing undesirable bacteria is a good strategy. Simply starving them with the FODMAP diet is not terribly efficient. Natural substances, unlike antibiotic drugs, tend to disrupt the microbiome much less.

  • Saccharomyces Boulardii has been used to treat inflammatory bowel disease and other intestinal infections [1,2]. It is a microbe that will crowd out all other microbes in the GI tract and disappear when supplementation is discontinued.
  • Olive Leaf not only kills bacteria, but supports the immune system [3,4].
  • Berberine will not only kill undesirable bacteria, but it will also support normal bowel bacteria and reduce intestinal inflammation. It has also been used to treat colitis [5-8].
  • Emulsified Organic Oregano Oil is one of the most powerful natural substances that kill undesirable bacteria [9-12].

First, Try It Gently

Dr. Harry Eidenier came up with this “pattern” for dealing with SIBO and IBS. It is a two-step procedure repeated three times.

  1. First, give natural antimicrobials for two weeks. You can give Berberine (500 mg. 3x/day). It is an antimicrobial that tends to leave the “good” bacteria alone.
  2. Second, give Saccharomyces boulardii (1, 2x/day) for two weeks. It will “crowd out” undesirable bacteria.
  3. Repeat steps 1 & 2 a total of three times. Finish by taking a probiotic for another six weeks.

This usually works. Finish by giving probiotics for six weeks. It will get rid of some of the undesirable bacteria and leave much of the healthy flora intact. Dr. Eidenier generally has patients take the Olive Leaf and Oregano Extracts in step one. If results are less than perfect, you can try adding the Oregano and Olive Leaf Extracts in step one.

The Microbiome Is an Ecosystem

Ideally, you want balance in your microbiome. Taking steps to kill some of the flora is an extraordinary measure, but it is a viable strategy when symptoms are severe enough. Dr. Eidenier has enjoyed a lot of success with this approach. Taking steps to restore balance will improve results:

  • Treat the GI tract from North to South: This simply means ensuring that there is adequate HCl in the stomach, biliary stasis (if present) is being addressed, and pancreatic enzyme (if needed) are being taken with meals).
  • Polyphenols, carotenoids, and fiber: Polyphenols and carotenoids are powerful antioxidants that give fresh produce its color. They help reduce inflammation and ensure the gut lining is healthy. Healthy bacteria feed on vegetable fiber. Juicing is a great way to get polyphenols and carotenoids (juice vegetables, not fruit). Eating the leftover fiber (with salt, pepper, oil and vinegar) is a great way to grow health bacteria.
  • Can’t tolerate a lot of vegetables? If the GI lining is very inflamed, vegetable fiber can cause irritation (even if you need the fiber). Taking soluble fiber, like citrus pectin, can be helpful here. You should still be able to drink the vegetable juice. If certain FODMAPs bother you, don’t juice those vegetables.

YOUR DIET CAN HELP WITH IRRITABLE BOWEL SYNDROME AND SIBO

Diet has been used to get SIBO and IBS under control. The FODMAP diet is most commonly used by the medical profession. The FODMAP Diet is difficult to follow. It is complicated, and not everyone with SIBO or IBS responds to it. The idea is to starve the problem bacteria. Since you don’t know which bacteria are present, it is hit and miss.

A Low Carbohydrate Diet May for a Short Time May Help SIBO

It is easier and more effective to simply limit carbohydrates. Sugar and undigested complex carbohydrates feed bacteria and yeast. Also, many SIBO patients also have insulin insensitivity. If you are overweight, eat only 40 grams of carbohydrate per day. If weight is not an issue, 80 grams of carbohydrate is allowed. To give perspective, there are seven grams of carbohydrate in a cup of green beans and 27 grams of carbohydrate in a banana. If you eat vegetables and not a lot of fruit, it is easy to keep to this discipline. You do not have to eat like this forever. Usually, you only have to follow the program strictly for eight weeks.

Starchy foods, like potatoes, contain 37 grams of carbohydrate, and are to be avoided. There are other problems with complex carbohydrates, like potatoes. If they are not properly digested (and they often are not in people with digestive problems), they feed bacteria.

Avoid Complex Carbohydrates (For a Time)

We will be utilizing the principles of Elaine Gottschall and the Specific Carbohydrate Diet. Her book, Ending the Vicious Cycle. It presents a reasonable mechanism for at least some cases of Crohn’s disease and ulcerative colitis. Many practitioners have found that this approach helps with other digestive issues, like IBS, SIBO, GERD etc. The mechanism that leads to digestive problems that Gottschall suggests is as follows.

Incomplete digestion –> Growth of improper GI flora –> Irritation of the SI mucosa –> Decreased enzyme production in the SI (disaccharidases)–>Incomplete digestion –> More improper flora, etc.

Elaine Gottschall’s diet is almost identical to the Paleo diet, which we are recommending in addition to the carbohydrate restriction.  Simply stated, avoid starches (wheat, rice, potatoes, corn, beans, etc), dairy, and refined sugar. There is a modified version that avoids many other inflammatory foods and is high in polyphenols and carotenoids, the Roadmap to Health (edited for IBD sufferers). One of the most important things the Roadmap to Health does is reduce inflammation.

Final Thought:

There are many ways to approach IBS and SIBO in natural healthcare. This is just one method that has been used successfully in the past. Other approaches can work as well, and individual responses will vary.

 References:

  1. Immunopharmacol Immunotoxicol. 2018 Dec;40(6):465-475 Review of Saccharomyces boulardii as a treatment option in IBD
  2. World J Gastroenterol. 2019 May 14;25(18):2188-2203 Diversity of Saccharomyces boulardii CNCM I-745 mechanisms of action against intestinal infections
  3. Antioxidants (Basel). 2017 May 17;6(2):34 A Study of the Protective Properties of Iraqi Olive Leaves against Oxidation and Pathogenic Bacteria in Food Applications
  4. Endocr Metab Immune Disord Drug Targets 2018;18(1):85-93 Olive Leaf Extracts Act as Modulators of the Human Immune Response
  5. Biomed Pharmacother. 2019 Oct;118:109131 Effects of berberine and metformin on intestinal inflammation and gut microbiome composition in db/db mice
  6. Appl Microbiol Biotechnol. 2020 Feb;104(4):1737-1749 Berberine ameliorates colonic damage accompanied with the modulation of dysfunctional bacteria and functions in ulcerative colitis rats
  7. Acta Pharmacol Toxicol (Copenh) 1952;8(1):71-8 Toxicity of alkaloids to certain bacteria. II. Berberine, physostigmine, and sanguinarine
  8. Front Pharmacol. 2018 May 31;9:571 Berberine Regulates Treg/Th17 Balance to Treat Ulcerative Colitis Through Modulating the Gut Microbiota in the Colon
  9. Pak J Pharm Sci. 2009 Oct;22(4):421-4 Antibacterial activity of oregano (Origanum vulgare Linn.) against gram positive bacteria
  10. Food Microbiol. 2015 May;47:69-73 Application of an oregano oil nanoemulsion to the control of foodborne bacteria on fresh lettuce
  11. Curr Pharm Des. 2019;25(16):1809-1816 Essential Oil and Ethanol Extract of Oregano (Origanum vulgare L.) from Armenian Flora as a Natural Source of Terpenes, Flavonoids and other Phytochemicals with Antiradical, Antioxidant, Metal Chelating, Tyrosinase Inhibitory and Antibacterial Activity
  12. Pak J Pharm Sci. 2009 Oct;22(4):421-4 Antibacterial activity of oregano (Origanum vulgare Linn.) against gram positive bacteria