By Dr. David Pollack

I’ve had countless new patients coming in this past year concerned with significant bloating and subpar bowel movements. Many of them tell me that their gastroenterologist tested them for SIBO. Wow! In many respects I couldn't be happier. I’ve been practicing for 15 years and the GI profession used to say SIBO was nonsense. Now, many of these patients have already been tested for it. But obviously, despite the test and identifying a culprit (SIBO), it's not resolving. That is not surprising to me. Let's explore why. 

Small Intestinal Bacterial Overgrowth (SIBO) is exactly as it sounds. There is too much of a symptom producing bacteria in the gut and hundreds—maybe even thousands—of different organisms could be responsible. The symptoms a person exhibits depend on which organism is involved and how severe the infection is—in addition to which foods might produce more responses.

Diagnosis traditionally involves a methane breath test. However, not all bacteria are methane producing so this test won’t detect at least 50 percent of organisms. Plus, just because there might be a methane producing organism, that doesn’t mean it’s responsible for causing the problems. Here is where I start to pivot from most so-called functional medicine practitioners out there. While the intention is good, very few people are getting better through the typical treatments. I’ve had many graduates of functional medicine programs and schools become my patients. Often the issue is severe bloating with a previous SIBO diagnosis. They have already tried antibiotics, extremely restrictive diets, and every natural microbial "killer" there is with minimal to no results. 

The antibiotic most used on the medical side is Xifaxin. This is an extremely powerful antibiotic, as SIBO is often unresponsive to most antibiotics. Most people have little to no improvement with it. While some may feel marginally to moderately better for a few weeks to months, the problem eventually returns. Often a second round of antibiotic therapy is prescribed by adding another really powerful antibiotic, neomycin. This offers slightly better short-term success and for weeks to months, patients are relieved about their results. Then SIBO comes back with a vengeance and often with new and worse symptoms including aches, rashes, nausea and many other non-digestive symptoms. A third round of antibiotics is often taken with virtually no relief.  Usually this is when people find me. They’re sick of being sick. They’re exhausted and almost in despair. Not only did their problems not resolve after many months to years of treatment, but they are also often worse and the symptoms can be quite scary. 

Why does this happen? There is an infection, why do antibiotics not work? I get asked this all the time. I believe the reasons are simple—SIBO is not really the cause of the problem. I know I just said the opposite of pretty much everyone out there. I believe in SIBO. It is real and it can be terrible. I just think it is the secondary issue not the primary one. While it might sound new and exciting on TikTok or Instagram, especially if you never heard of it before, it isn't really the cause. 

Let me explain the two major problems/concepts that stop this infection from healing. Firstly, if you happen to cut or scrape your finger, it generally heals all by itself. But sometimes it gets infected. When that happens, usually we apply some antibiotic ointment and eventually it heals.  But what if the wound didn't close? Would the infection resolve? It wouldn't. Until the wound closes, the infection will remain despite applying the antibiotic. This is what is happening in our bodies with gut infections. There is unresolved damage and then it gets infected. Attacking the infection only works if the wound is first healed. If you read Sun Tzu’s book The Art of War, the second problem will immediately make sense. It is difficult to impossible to defeat an enemy that is entrenched with a food supply. SIBO is happy hanging out in your gut—it’s the perfect environment offering a never-ending food supply. 

So how do we remove food from the invader? We can’t stop eating! But what we can do is digest our food. And then absorb it. This is the whole issue in a nutshell. If food is broken down and absorbed before it reaches the SIBO infection your body would have a chance to heal and resolve the infection. This is the gist of our process for helping people overcome SIBO and other similar infections such as candida (a fungal infection of the gut). 

Dr. David L. Pollack is the founder of Pollack Wellness Institute, located at 66 Commack Rd., #204, Commack, NY. For appointments or information, call 631-462-0801, email [email protected] or visit PollackWellness.com.