Small Intestine Bacterial Overgrowth (SIBO) in Lyme Disease

Updated: 3/28/23

SIBO in Lyme Disease

Small intestinal bacterial overgrowth (SIBO) in Lyme disease may make treatment difficult. In this condition, large intestine bacteria move into the small intestines. There, they cause

• bloating and gas,
• nausea,
• constipation or diarrhea,
• inflammation cytokines,
• vitamin deficiencies like low Vitamin B12, and
• several 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 (Chapter 31), 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 develops 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 & Prevents Yeast: A Brief Guide.

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 intestinal test above, however. 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 eight-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 (ifm.org) 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 and 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 “Mediterranean Style” diet or a paleo diet that emphasizes plants. See 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 2-4 weeks. It stays in the intestines and is not absorbed into the blood. Studies show this works up to 70 percent 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 a combination of Rifaximin and neomycin 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 the combination of Rifaximin and neomycin 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 Doses

• 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 until 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, meaning at least 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 until 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, meaning at least 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 increase the bloating and cramping 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.

Once treatment is complete for active SIBO, probiotics should be used to keep it from coming back. 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 Probiotic Strategies in Lyme Disease. Here are the probiotics I recommend to my patients.

• Corebiotic by Researched Nutritionals 2-4 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. If Corebiotic causes gassiness, consider using Corebiotic Sensitive, which does not include prebiotic fiber. Another spore-forming probiotic to consider is Proflora R by Bio-botanical Research.

AND/OR

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

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