Small Intestine Bacterial Overgrowth (SIBO) in Lyme Disease

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SIBO in Lyme Disease

Small Intestine Bacterial Overgrowth (SIBO) in Lyme disease can make treatment difficult. In this condition, large intestine bacteria move into the large intestines. There, they cause

  • bloating and gas,
  • nausea,
  • constipation or diarrhea,
  • inflammation cytokines,
  • vitamin deficiencies like low Vitamin B12, and
  • a number of food intolerances.

Keep in mind, any condition that triggers more cytokines can make it look like the underlying Lyme disease is worse than what it is. As I explain in Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System most Lyme disease symptoms are caused by excess cytokines. So if SIBO triggers more cytokines, it will worsen a person’s Lyme disease symptoms.

In Lyme disease, SIBO can develop due to disruption of good stomach and intestinal function caused by the Lyme and the tick-borne coinfections, side effects of medicines, and disruption of good bacteria balance from using herbal and prescription antibiotics.

Successful treatment involves

  • restoring proper functioning of the intestines,
  • eating a healthy plant-based diet,
  • removing the large intestine bacteria from the small intestines, and
  • restoring good balance of bacteria and functioning of the intestines.

Make Sure It Is Not Yeast

SIBO and yeast overgrowth of the large intestines can look a lot alike. Both lead to an increase in inflammation cytokines - both often produce intestinal gassiness and bloating. Before I test for SIBO, I often treat yeast overgrowth first. For more information about diagnosing intestinal yeast overgrowth see A Silent Problem - Is It Yeast? Read Kills Yeast: A Brief Guide for information on how to treat intestinal yeast overgrowth.

Marty Ross MD Discusses SIBO Tests & Antibiotics

 
 
 
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Test for SIBO

There are two ways to test for SIBO. One is to have a culture of your small intestines. If too many bacteria grow, then a person has SIBO. An intestine specialist has to perform this test using a scope which is passed through the mouth into the intestines. Because of cost and comfort issues, this test is often not done.

The easiest way to test is called a SIBO Breath Test. It is not as exact as the test above. In the breath test a person swallows lactulose or glucose sugar water. Then, over a two or three hour time period you collect breath samples. If a person’s breath contains high amounts of hydrogen or methane, the test is positive. This test can be performed at home. In my practice, I use the test kit from Genova Diagnostics.

The downside to the SIBO Breath Test is it only finds up to 70 percent of people that have the illness. So you could have a negative test, but still have the condition. For this reason, the small intestine culture is much more accurate.

Diet for SIBO

The First Eight Weeks

During treatment, people with SIBO often get symptom relief, and start to restore normal gut function by eating a FODMAP diet over an 8 week period of time. FODMAP stands for

  • Fermentable
  • Oligosaccharides (like fructans and galacto-oligosaccharides (GOS))
  • Disaccharides (like lactose from cow's milk)
  • Monosaccharides (like excess fructose from fruit)
  • And
  • Polyols (like sorbitol, mannitol, maltitol, xylitol and isomalt)

These simple sugars are fermented by the small intestine bacteria producing the gas associated with this illness. Stopping these foods, can help starve these bacteria and decrease symptoms. For more information see the FODMAP food plan overview from the Institute for Functional Medicine or work with a nutritionist. You can also find various books on the internet.

After SIBO is Under Control

The FODMAP diet is not meant to be a permanent diet. It is hard to do for a long time. After SIBO is under control, then shift to a diet that is rich in plant-based foods. Such diets support healthy gut function and a balanced gut microbiome. These diets are also anti-inflammatory. I suggest either a “Mediteranean Style” diet or a paleo diet that emphasizes plants like The Best Brain, Inflammation, Pain, Energy, and Detox Diet Ever.

Herbal and Prescription Antibiotics

Hydrogen Producing SIBO

Hydrogen producing SIBO without methane is fairly easy to treat. For some just making the dietary changes above could be enough. But most will require antibiotics. In my practice I find the most success using the prescription antibiotic Rifaximin for two to four weeks. It stays in the intestines and is not absorbed into the blood. Studies show this works up to 70% of the time.

If this fails, or as an alternative, based on my clinical experience I suggest the herbal antibiotic compound called Biocidin. It includes various herbal medicines like oregano that may kill SIBO and restore balance. For more information see Biocidin: A Potent Antimicrobial & Biofilm Breaker. In my experience, Biocidin requires at least two months at the peak dose.  Be aware Biocidin can kill Lyme too, so it may cause a Herxheimer Reaction

Methane +/- Hydrogen Producing SIBO

Methane producing SIBO is much harder to treat. In my experience it takes one to two months of Rifaximin and Neomycin in combination while eating low FODMAP foods. Studies show these two antibiotics reduce symptoms and eradicate methane producing SIBO up to 80% of the time. Initially, I prescribe one month of these antibiotics. If one month does not work, then I may try an additional month.

If this fails, or as an alternative, based on my clinical experience I suggest the herbal antibiotic compound called Biocidin. It includes various herbal medicines like oregano that may kill SIBO and restore balance. For more information see Biocidin: A Potent Antimicrobial & Biofilm Breaker. In my experience, Biocidin requires at least two months at the peak dose. Be aware Biocidin can kill Lyme too, so it may cause a Herxheimer Reaction.

Antibiotic Dosing

  • Rifaximin 550 mg 1 pill 2 times a day
  • Neomycin 500 mg 1 pill 2 times a day
  • Biocidin Liquid. Start at 2 drops on the tongue 3 times a day and increase every other day by 1 drop per dose till you reach 10 drops 3 times a day. If you develop a Herxheimer die-off reaction, do not increase until it passes. Take without food by taking more than 30 minutes before food and more than 2 hours after food.
  • Biocidin Capsules. Start at 1 capsule 2 times a day and after 2 days increase to 1 capsule 3 times a day. Every 2 days add 1 capsule till you take 2 capsules 3 times a day. If you develop a Herxheimer die-off reaction, do not increase until it passes. Take without food by taking more than 30 minutes before food and more than 2 hours after food.

Probiotics

Restoring healthy gut function requires probiotics. However, for some with SIBO, probiotics can make the situation worse, until the bacteria are under control.

While a person is on SIBO herbal or prescription antibiotics, I recommend taking a soil-based spore forming probiotic which does not contain any prebiotic fiber. A prebiotic is a substance that supports the bacteria in a probiotic supplement. The prebiotics found in many probiotics can cause more gas and bloating. Corebiotic Sensitive by Researched Nutritionals is a spore forming probiotic with no prebiotic fiber. Generally, most of my patients with SIBO can tolerate this. I suggest giving it a try, but if it makes things worse, then stop it.

Once treatment is complete for active SIBO, to keep it from coming back, probiotics should be used. These can include ones with prebiotics and can include both spore forming ones and human bacteria based ones. For more information about these different types of probiotics read Probiotics in Lyme Treatment. Here are the probiotics I recommend to my patients.

  • Corebiotic by Researched Nutritionals 2 to 4 pills 1 time a day. This product is a soil-based spore-forming probiotic that includes strains of Bacillus scientifically proven to support intestinal health. Consider using Corebiotic Sensitive, which does not include prebiotic fiber, if Corebiotic causes gassiness. Another spore-forming probiotic to consider is Proflora R by Bio-botanical Research.

AND/OR

  • HMF Forte by Genestra 2 to 4 pills 1 time a day. This product includes Lactobacillus and Bifidobacterium strains scientifically shown to support intestinal health.

Disclaimer

The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.

References

View Citations

  1. Avelar Rodriguez D, Ryan PM, Toro Monjaraz EM, Ramirez Mayans JA, Quigley EM. Small Intestinal Bacterial Overgrowth in Children: A State-Of-The-Art Review. Front Pediatr. 2019;7:363. Published 2019 Sep 4. doi:10.3389/fped.2019.00363 (View
  2. Chedid V, Dhalla S, Clarke JO, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014;3(3):16-24. doi:10.7453/gahmj.2014.019 (View)
  3. Gatta L, Scarpignato C. Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth. Aliment Pharmacol Ther. 2017;45(5):604-616. doi:10.1111/apt.13928 (View)
  4. Lewis D. SIBO: Herbal Therapy is an Effective Treatment for Small Intestinal Bacterial Overgrowth (SIBO). A Clinical Research Update. YouTube. https://www.youtube.com/watch?v=ur3Q-FYmuh0. Accessed July 26, 2020.
  5. Low K, Hwang L, Hua J, Zhu A, Morales W, Pimentel M. A combination of rifaximin and neomycin is most effective in treating irritable bowel syndrome patients with methane on lactulose breath test. J Clin Gastroenterol. 2010;44(8):547-550. doi:10.1097/MCG.0b013e3181c64c90 (View
  6. Mullin GE. Treatment options for GERD and SIBO. Oral presentation at: The Institute for Functional Medicine Gastrointestinal Module; Oct, 2019; Scottsdale, AZ.
  7. Rezaie A, Buresi M, Lembo A, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017;112(5):775-784. doi:10.1038/ajg.2017.46 (View)
  8. Wang XJ, Camilleri M. Personalized medicine in functional gastrointestinal disorders: Understanding pathogenesis to increase diagnostic and treatment efficacy. World J Gastroenterol. 2019;25(10):1185-1196. doi:10.3748/wjg.v25.i10.1185 (View)

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About the Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State where he has treated thousands of Lyme disease patients in his Seattle practice. 

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS) and The Institute for Functional Medicine.

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