At Dignity Integrative, we've recently seen a number of patients seeking help for persistent gastrointestinal symptoms that haven't responded to conventional treatments.
Many of these cases point to Small Intestinal Bacterial Overgrowth (SIBO), a condition for which functional and integrative medicine doctors are increasingly a wise choice if you are seeking a more comprehensive, sustained approach that goes beyond just a course of antibiotics.
This guide will help you understand why you might need a SIBO specialist, what to expect from traditional and integrative approaches, and how to make informed decisions about your care. Wherever you are in your SIBO journey, it’s important to understand how to navigate the process of seeking effective care for SIBO-related symptoms.
Why Seek a SIBO Doctor?
People often begin their search for a SIBO doctor when they experience a constellation of gastrointestinal symptoms that don't respond to standard treatments. Common symptoms that may indicate SIBO include:
Bloating and abdominal distension
Excessive gas
Abdominal pain or discomfort
Diarrhea, constipation, or alternating between the two
Nausea
Fatigue
Nutrient deficiencies
Food sensitivities
Skin issues like rashes or acne
These symptoms can significantly impact quality of life and may persist despite dietary changes or over-the-counter remedies. If you've been diagnosed with irritable bowel syndrome (IBS) but treatments aren't working, SIBO could be the underlying cause.
Testing for SIBO
The primary tool used by most gastroenterologists to diagnose SIBO is the hydrogen breath test (HBT). This non-invasive test measures the levels of hydrogen and methane gases in the breath, which are produced by bacteria in the small intestine when they ferment ingested carbohydrates.
The type of gas detected determines which kind of SIBO you have.
There are three main types of breath tests commonly used for SIBO diagnosis:
Lactulose Breath Test (LBT): This test involves ingesting lactulose, a non-absorbable sugar, and measuring the gases produced as they pass through the intestines. It is particularly useful for detecting bacterial overgrowth in the distal small intestine, as lactulose is not absorbed and can reach the distal parts of the small intestine.
Glucose Breath Test (GBT): In this test, glucose is ingested, and breath samples are taken to measure gas production. Glucose is absorbed in the proximal small intestine, making this test more suitable for detecting overgrowth in the proximal regions. However, it may not detect distal overgrowth as effectively as the lactulose test.
Trio-Smart Breath Test: This is the first breath test capable of measuring hydrogen sulfide, alongside hydrogen and methane. It offers a more comprehensive view of the gases produced by intestinal bacteria and can help identify cases of SIBO that might be missed by traditional tests that do not measure hydrogen sulfide.
Breath testing will reveal whether your SIBO is hydrogen, methane, or hydrogen sulfide predominant. Methane predominant SIBO is now called Intestinal Methanogen Overgrowth (IMO). This is due to the fact that the methane producing organism (Methanobrevibacter smithii) is not actually a bacteria but something called archaea. These are ancient organisms distinct from bacteria and generally cause more complex gastrointestinal issues than SIBO.
Beyond breath testing, an integrative medicine approach to SIBO often involves more comprehensive diagnostics. A thorough comprehensive diagnostic stool analysis can offer valuable insights into your overall gut health, potentially identifying imbalances or pathogens contributing to your symptoms.
Depending on your specific situation and medical history, an integrative medicine doctor might recommend additional tests to rule out other conditions or pinpoint underlying causes. These could include a small bowel follow-through to check for structural issues, motility testing to assess your digestive system's functionality or tests for nutritional deficiencies.
By working with an integrative medicine physician, you're more likely to receive this kind of comprehensive testing, which can be crucial in developing an effective, personalized treatment plan. This holistic approach ensures that your care is tailored to your unique needs and addresses the root causes of your symptoms, not just their surface manifestations.
Traditional Gastroenterology Approach
When patients first seek help for persistent GI symptoms, they often consult a gastroenterologist.
The traditional approach to treating suspected SIBO typically involves:
Antibiotic treatment: The primary tool used by most gastroenterologists is a course of antibiotics, usually rifaximin. This approach aims to reduce the overgrowth of bacteria in the small intestine.
Initiation of a low FODMAP diet to reduce gas producing microbes. Duration of this is often not clearly defined.
Limited testing: Many traditional GI doctors will not perform comprehensive gut microbiome testing. They might rely on symptom assessment in combination with a breath test to diagnose SIBO.
Symptom management: Focus is often placed on managing individual symptoms rather than addressing the root cause of the bacterial overgrowth.
Follow-up care: After antibiotic treatment, follow-up care may be limited, with patients often left to manage recurring symptoms on their own.
While this approach can be effective for some patients, others may find their symptoms return or persist, leading them to seek alternative options.
Underlying Causes of SIBO
Integrative or functional medicine doctors offer a more comprehensive approach to treating SIBO, whose causes generally fall into four categories, courtesy of THE SIBO DOCTOR:
Motility: includes autoimmune (IBS/MMC damage), traumatic brain injury, hypothyroidism, chronic infections, diabetes, mold/CIRS, dysautonomia, and scleroderma.
Outflow/Impaired Flow: ileocecal valve dysfunction, EDS, endometriosis, and abdominal surgery/adhesions.
Digestive Deficits/Impaired Digestion: Microbiome dysfunction, chronic stress, secretory lgA deficiency, deficiency in pancreatic or brush border enzymes, poor bile flow, and low stomach acid.
Medications: Opiates/narcotics, antispasmodics, proton pump inhibitors, tricyclic antidepressants
The Integrative Medicine Approach to SIBO
Here's why patients might consider a more integrative approach to SIBO treatment:
Root cause analysis: Integrative doctors aim to identify and address the underlying causes of SIBO, which may include motility issues, structural problems, or immune dysfunction.
Comprehensive testing: Beyond the standard breath test, integrative doctors use more extensive gut microbiome testing to get a complete picture of your digestive health.
Personalized treatment plans: Treatment is tailored to the individual, often combining conventional methods with natural approaches. The 4R gut healing approach is standard.
Dietary interventions: Specific food plans, such as the low FODMAP diet or elemental diet, may be prescribed to starve out the overgrown bacteria and promote healing.
Supplements and herbs: Natural antimicrobials, probiotics, and supplements to support gut healing are often incorporated into treatment plans.
Lifestyle modifications: Stress management, sleep optimization, and exercise recommendations are typically part of the integrative approach.
Long-term support: Integrative doctors often provide ongoing support, often by partnering with an experienced nutritionist, to prevent recurrence and maintain gut health.
Should You Treat SIBO Yourself?
While it's certainly possible to find information about SIBO treatments online, working with an integrative medicine physician offers several significant advantages. First and foremost, proper testing is crucial to confirm SIBO and identify the specific type you have, ensuring an accurate diagnosis. An integrative doctor can then create a treatment plan tailored to your unique situation, taking into account factors like your medical history, lifestyle, and test results.
Professional oversight allows for ongoing monitoring of your progress and adjustment of your treatment plan as needed. This is particularly important because while self-treatment may provide temporary relief, it often fails to address the root causes of SIBO, leaving you vulnerable to recurrence. A skilled practitioner can help identify and address these underlying issues, setting you up for long-term success.
Safety is another critical factor to consider. Some natural treatments for SIBO can interact with medications or be contraindicated for certain health conditions. A doctor can ensure your treatment is both safe and effective, taking into account your overall health picture. This comprehensive approach is especially valuable because SIBO often coexists with other health issues. An integrative medicine doctor can address your overall health, not just your gut symptoms, providing a holistic path to wellness that goes beyond simply managing SIBO.
Finding the Right SIBO Doctor
When seeking a SIBO specialist, consider the following:
Look for a doctor with specific experience in treating SIBO. This could be an integrative medicine physician, a functional medicine practitioner, or a naturopathic doctor with a focus on digestive health. (Dignity Integrative offers free, 15-minute consults for patients in Maryland and communities surrounding Washington D.C., including Rockville, Germantown, Gaithersburg, Bethesda, and Olney.)
Check their credentials and read patient reviews to gauge their expertise and approach.
Ensure they offer comprehensive testing, including breath tests and microbiome analysis.
Look for a doctor who takes a holistic approach, considering diet, lifestyle, and potential underlying causes of SIBO.
Choose a practitioner who is willing to work with you long-term to prevent recurrence and optimize your overall health.
Final thoughts
Finding the right doctor to treat your SIBO is an important step in reclaiming your digestive health and overall well-being. While traditional gastroenterology can offer important insights and treatments, an integrative medicine approach provides a more comprehensive, personalized path to healing.
By combining the best of conventional and natural therapies, addressing root causes, and providing ongoing support, integrative medicine offers SIBO sufferers hope for long-lasting relief and improved quality of life. Remember, your journey to digestive health is unique, and working with a knowledgeable, experienced SIBO specialist can make all the difference in your recovery.
Looking for a SIBO doctor? Dignity Integrative offers functional and integrative medicine services in-person in Maryland and communities surrounding Washington D.C., including Rockville, Germantown, Gaithersburg, Bethesda, and Olney. Contact us today for a free 15-minute consultation.
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