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  • Writer's pictureMary Shackelton, MPH, ND


In the past several years there has been an explosion of health-related data specifically related to gut function. We have a relatively new diagnosis called SIBO (small intestinal bacterial overgrowth) which can account for many GI issues such as bloating, gas, pain, constipation, diarrhea and more. What many people diagnosed with this condition find is that even though they embark on a new diet to treat this disorder, a handful of herbs to treat this disordered bacteria, and even a few weeks on an anti- biotic, two thirds of people remain symptomatic, frustrated, and searching for more treatment.

What could be the biggest issue with treating SIBO is that there is an upstream cause for this condition. Often people who have SIBO have had:

1. Food poisoning

2. Lots of antibiotics throughout their life

3. Challenges with eating a variety of food

4. Low stomach acid

5. High exposure to medications that negatively affect the microbiome. Until now these felt like sufficient explanations for a stubborn journey in treating gut dysfunction. But there is more.

I will admit, this is one of the most difficult things to eradicate, I often hope that my patients with a positive SIBO test are in the 1/3 of patients who respond to treatment. However, hope is not a strategy.

With continued frustration in treating SIBO, I have had greater successes looking upstream to the causes and treat those. Perhaps someone has:

With continued frustration in treating SIBO, I have had greater successes looking upstream to the causes and treat those. Perhaps someone has:

1. Vagus nerve dysfunction from trauma originating many years ago- cranial nerve 10 which greatly impacts digestion among other bodily functions.

2. Damage to the way the gut moves food through the intestines- also call the Migratory Motor Complex (MMC).

3. Changes in the terrain of the stomach- specifically the pH of the stomach. If this is too low it can cause many issues down stream.

4. Structural issues in the GI tract

5. Challenges with detoxification through liver and gallbladder

6. Hormone deficiencies

7. Immune dysfunction.

If we are honest with ourselves as providers, treating SIBO has fallen into the pitfalls of many other approaches to treating patients. Treating symptoms. If we look at all of the “perhaps: issues above, we can see that setting the groundwork for healing the gut requires that we look at the whole person, not just their GI system. Thanks to the work of Steven Wright, PhD who has poured his life into finding solutions for difficult gut problems, and thanks to a recent conversation with him, it is apparent that the upstream causes are critical to treat before someone can heal their gut.

Examples of this are:

Healing trauma, supporting immune function and detox so the terrain is able to respond to treatment, facilitating detoxification and improving the simple act of chewing and digestion with digestive support is where we start for several weeks before we even begin to think about using antibacterials to “kill” the dysbiosis in the gut. Taking one giant step upstream and investing 4-6 weeks in treating the terrain will yield better results in long term gut improvement.

If you find yourself a frustrated SIBO patient who falls into the above category of “no treatment works” I would suggest looking at the upstream issues, approaching with simplicity the treatment of the terrain before taking on treating bacterial overgrowth in the gut.

Let us know how we can help! Here is a great podcast about how to look at SIBO with a different perspective:

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