Management of Small Intestinal Bacterial Overgrowth, (SIBO) Through Dietary and Nutritional Intervention

Abstract

Introduction: Small intestinal bacterial overgrowth (SIBO) is a dysbiosis of the normal intestinal flora. An increase in the number of organisms present in the small intestine can cause symptoms such as abdominal discomfort, bloating, flatulence, cramps, constipation and/or diarrhea. Changes in epithelial cells due to inflammation, including the blunting of the villi and other less visibly apparent damage to the brush border, can also occur, thus decreasing the nutritional status in SIBO patients. Specifically, fat maldigestion and malabsorption can lead to deficiencies in fat-soluble vitamins A, D and E. Other vitamin and mineral deficiencies can result from SIBO, including vitamin B12, thiamine, nicotinamide and iron. Unfortunately, repeated antibiotic doses may help sustain these deficiencies by altering the host microbiota, continually effecting patient health over time. This can result in antibiotic associated diarrhea or potential antibiotic resistance. Therefore, nutritional therapies that may delay the need for recurrent antibiotic use should be a part of the management of patients who develop SIBO. Methods: Literature reviewing SIBO treatment options is summarized and how oral administration of Serum-derived Bovine Immunoglobulin/Protein Isolate (SBI) may have similar activity via the known mechanism of action is discussed. Results: Dietary changes and nutritional intervention has been shown to modify the microbiota in both healthy patients and in those with gastrointestinal disorders. This has been also been documented for the use of the FODMAP diet, probiotics, and SBI. Given the findings reported by Salem and Roberts (2014) that dietary manipulation through the FODOMAP diet and probiotics may play a fundamental role in the treatment of SIBO and by Weinstock and Jasion (2014) that SBI can help manage SIBO in patients refractory to conventional and rifaximin therapy, the use of SBI for the dietary management of SIBO patient may also be appropriate. SBI has already been shown to bind to proinflammatory microbial components and prevent bacterial translocation (Detzel et al., 2015). Conclusion: When managing SIBO physicians should consider dietary approaches that help replace potential deficiencies in vitamins and minerals. The use of distinctive proteins sources such as SBI which binds to microbial components of bacterial overgrowth in the small intestine should be considered. A detailed study of SBI use in patients with SIBO is warranted.