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Natural SIBO Treatment with Chinese Medicine & Acupuncture


Treating SIBO with Chinese Medicine Toronto

Our body is made to survive and heal. Chronic diseases only occur when our innate healing mechanism is interrupted. Small Intestine Bacterial Overgrowth (SIBO) is one of the perfect examples. The problem with SIBO is not just something wrong with the small intestine, as its misleading name suggests. SIBO is just the tip of the iceberg. a quantifiable focal point underlied by multiple system’s failure to maintain the normal integrity of our digestive system.

Treating SIBO, and more so preventing it from relapse, requires a comprehensive approach beyond just diet and antibiotics, that is capable of addressing multiple factors in a natural, cohesive manner. As an acupuncturist who also practices Chinese herbal medicine in Toronto, I use Chinese medicine with patients who are looking for alternative natural treatment and prevention for their SIBO. I find Chinese medicine has many advantages in addressing the complex SIBO condition with relatively simple and cohesive treatment protocol.

In this post, I will briefly talk about the pathology and mechanism of SIBO, and how Chinese medicine addresses this problem. For a more detailed analysis of SIBO from modern medical knowledge, you can refer to this article.


What is SIBO and 4 Symptoms You Need to Know.

Small intestinal bacterial overgrowth (SIBO) is defined as the presence of excess colonic bacteria in the small intestine (1) https://www.ncbi.nlm.nih.gov/books/NBK546634/

In SIBO patients, the overgrowth of bacteria produce too much hydrogen(H2) and/or methane(CH4) gas that cause discomfort such as excessive bloating. It also impairs the food absorption in the small intestine and leads to many secondary symptoms such as B12 and iron deficiency.

Here are 4 signs that are most common in SIBO:

  1. Excessive bloating that makes you very uncomfortable.
  2. Chronic unregulated bowel movement: diarrhea or constipation or yo-yo between both
  3. Reflux, burping, belching or foul smelling gas that is not only uncomfortable but embarrassing.
  4. Stomach gurgling, cramping or discomfort on a regular basis.

Secondary symptoms and health consequences of SIBO

If SIBO is left untreated, it can lead to many secondary health consequences and more serious complications. Malabsorption of protein, fat and vitamins can lead to malnutrition and vitamin deficiencies with its complications such as neurological disorders due to B12 deficiency.

There are a ray of conditions that are believed to be associated with SIBO: fatigue, brain fog, joint pain, restless leg, insomnia, acne, skin rash, food sensitivities and many inflammatory diseases in digestive and respiratory systems.

Causes and Risk Factors of SIBO

SIBO is infamously known for its stubbornness to kill. To treat and prevent SIBO successfully, first we need to understand the pathology, risk factors and causes. Since the bacteria overgrowth is at the tip of the SIBO iceberg, let’s take a deeper look at what is happening in the small intestine.

In a healthy individual, the concentration of bacteria in the small intestine never exceeds 1000 organisms/mL in contrast to 100,0000 organisms/mL in the large intestine. Below the tip of the iceberg, there are several mechanisms in our body that keep the number of bacteria in the small intestine in check:

  • GUT motility: the downward wave-like movement in GI tract that transport the food from one segment/organ to the next one.
  • Gastric acid keeps the small intestine acidic to inhibit the growth of bacteria.
  • Bile from the gallbladder helps break down the food and reduce the fermentation by the bacteria.
  • Number of immune cells in the small intestine that helps fight the bacteria.
  • Ileocecal valve: A one-way valve between the small and large intestine that stops the backflow of contents in the colon to small intestine.

Further down the iceberg, any disease, medications, medical procedure, lifestyle, diet that fail or disrupt any of the above mechanisms may contribute to SIBO. Here are some of the common risk factors:

    • Use of antacid drugs such as proton pump inhibitors: Reduce the acidity in the small intestine.
    • Use of opioids
    • Acute and chronic virtual infections:

The toxins released by the virus inhibit the downward movement of the GI tract.

  • Food poisoning:
    Food poisoning is common among travel lovers, it is also a common risk factor for post infectious SIBO. A single gastroenteritis may increase the chances of developing IBS/SIBO six-fold,(link).
  • Inflammatory Bowel Diseases
    Although it is unclear if there is causal relationship, study has shown diseases like IBS, ulcerative colitis, Crohn’s disease and Celiac are particularly associated with SIBO.
  • Insulin-resistance/Diabetes
  • Hypothyroidism
  • Structural dysfunction cause by diseases and abdominal surgeries (C-section, hysterectomy, appendectomy etc)
  • Dysbiosis (microbiome imbalances)
    The balance in the microbiome is fundamental to GUT and immune health. The use of systemic antibiotics can upset and disrupt the balance of the microbiome by killing both bad and good bacteria. Babies were born via C-section, and those who are not being breastfed are at the high risk of microbiome imbalance (SIBO).
  • Migrating Motor Complex dysfunction
    Migrating Motor Complex (MMC) is the housekeeper in the GUT. Every once in a while (usually 90-240 minutes after the meal), MMC will contract the smooth muscles of the small intestine, in a wave-like manner toward the direction of the large intestine. MMC is responsible for the transport of the contents in the small intestine, including the undigested food and bacteria, to the large intestine. Many medications and infectious diseases can interrupt or even damage MMC.
  • Stress
    Last but not the least, our state of mind influences our autonomic nervous system that control our digestive functions. When we are under stress, our nervous system shuts down digestion for survival purposes, our body would not care about the bowel movement when there is a lion chasing after them. Chronic stress, either external or internal, can reduce the secretion of gastric acid and bile, slow down the GUT mobility, weaken the immune system, all of that predispose us to develop SIBO.

Holistic and natural SIBO solution for long-term success

SIBO is a chronic, complicated condition with a variety of risk factors/root causes. Killing the overgrowth alone is not enough, the root causes of SIBO have to be addressed for long term success. Therefore, a comprehensive and personalized protocol is necessary for successful SIBO treatment in short term symptom control and long term maintenance to avoid relapse.

Here are the four phases that are essential in any SIBO treatment protocol (including Chinese medicine) to address symptoms and prevent relapse.

Phase one: Control the overgrowth by natural antimicrobials

The first phase of SIBO treatment is to control the symptoms by removing the overgrowth. This phase can be done by using antibiotics with the risk of developing resistence and interrupting the healthy bacterial community in the GUT.

Chinese medicine has a long history of using antibacterial herbs to treat various bacterial, parasite, yeast and viral infections naturally and effectively. There are dozens of herbs that I use for antimicrobial purposes. For example, a formula called Huang lian jie du tang, is very effective to kill the bad bacteria in the digestive system. It has four herbs: huang lian, huang qin, huang bai, da huang. All of them have a wide range of antimicrobial activities. Because there are many kinds of bacteria that need to be killed, one herb can not cover all of them, but combining these four herbs can cover most if not all kinds of organisms in the small intestine.

I have an ongoing case of treating chronic eczema with Chinese medicine where I use “huang lian jie du tang” as part of the herbal treatment. This case is a perfect example of using ancient herbal formulas to address the connection between the digestion system and skin health.

Phase Two: Reduce the inflammation and gut sensitivity
GUT inflammation is not only present in SIBO, it is also the primary pathological process in IBS, Colitis, Crohn’s disease, Gastritis, Acid reflux, Leaky Gut syndrome and food intolerances. Using the herbs that have anti-inflammatory properties is a critical part of SIBO treatment to regulate and restore the digestive function. There are many excellent Chinese herbs that can get the job done such as huang qin, gan cao, lian qiao, zhi zi, mu dan pi, bai jiang cao, pu gong ying(dandelion root) to name a few.

Acupuncture is another natural and effective treatment in Chinese medicine for GUT inflammation. I have a recent case that helped a patient’s TMJ and IBS simultaneously. This case demonstrates that acupuncture as an effective anti-inflammatory medicine can be used in conjunction with Chinese herbal medicine to treat a variety of digestive conditions such as SIBO, especially the hydrogen type SIBO, because in hydrogen type of SIBO, diarrhea is more commonly present than constipation. Studies have shown that many SIBO cases are misdiagnosed with IBS. Due to the non-pathogen specific and holistic nature of Chinese medicine and acupuncture, Chinese medicine practitioners can significantly reduce the symptoms of SIBO and IBS.

Phase Three: Address the root causes
As I mentioned before, there are several factors underlie the development of SIBO and cause overgrowth of the bacteria in the small intestine.

Structural changes in the digestive tract can significantly impair the movement of bacteria from the small intestine to the colon. Tissue adhesions, obstructions, diverticuli(non-draining pockets in the small intestine), ileocecal valve impairment can impact the normal bacterial transportation. Chinese medicine alone may not be able to reverse the structural damages, but it certainly can reduce the negative impacts and symptoms from these issues through its holistic modalities.

Functional impairment is much more common than structural ones in SIBO cases, major factors are:

  • Dysmotility of the GI tract
  • Lack of bile and enzyme production
  • Reducing gastric acid from anti-acid medication such as proton pump inhibitors(PPI).
  • Immune deficiency.
  • Use of certain medications that can impair the GI tract motility such as opioids and anticholinergics.

Both herbal medicine and acupuncture can regulate the function of digestive organs and glands. TCM practitioners will look into the individual history, various signs and symptoms, and use Chinese medicine assessment methods: pulse, tongue, abdominal palpation, to identify the major imbalances and dysfunctions that underlie SIBO.

For the patients who are using the drugs that contribute to the development of SIBO such as pain and acid reflux, Chinese medicine can be used as an alternative treatment for those conditions therefore to reduce the underlying factors of SIBO.

Migrating Motor Complex dysfunction(MMC)

MMC is a collection of autonomic wave-like impulses that move the contents in the GI tract from stomach to colon. An impaired MMC (dysmotility) can have many serious health consequences. MMC is responsible to transport the undigested food and debris from small to large intestine, and prevent the colonic organisms from moving back to the small intestine. Impaired MMC or GI motility in general is the most common underlying factor in SIBO patients.

Thousands of years ago, Chinese medicine physicians recognized the importance of GI motility in digestive health. They thinks “胃气以降为和”, meaning “normal wei qi(digestive energy) should be descending”. If the “wei qi” doesn’t descend, diseases can occur as consequences, not only digestive issues such as bloating, indigestion, constipation but also headaches and mental and cognitive symptoms. Therefore many herbs and acupuncture treatments have been developed to address those problems.

Current treatment protocol for SIBO suggests starting prokinetic regim to regulate MMC after the overgrowth got under control. However, in Chinese medicine, because the flexibility and multi-targeting nature of herbal formula and acupuncture allow TCM practitioners to combine different treatments within one course cohesively. And it makes more sense this way, because if the impaired MMC is where the problem started, why don’t we address it from the beginning?

Immune deficiency

Chinese medicine also thinks the “wei qi” (digestive function) is the foundation of our immune health. Which is perfectly aligned with the current scientific discoveries of a tight relationship between the immune function and microbiota environment in the digestive system. Chinese herbs and acupuncture can help patients to rebuild their immune health to balance the bacteria environment within the digestive system.

Phase Four: Long term maintenance and prevention
Because there are so many internal and external factors that can cause SIBO to come back. In this study, a relapse rate of about 50% was reported at 9 months after eradication.https://www.ncbi.nlm.nih.gov/pubmed/18802998

The maintenance should last at least 6 – 18 months with a comprehensive approach including diet, stress management, and continuing prokinetic treatment for motility to minimize the chance of relapse.

Other Pathogens
Mold, yeast, parasites and SIFO can also contribute to digestive symptoms. If you keep experiencing symptoms, you should look for testing these possibilities and solutions.
Stress Management
Stress can interfere with our health in many ways, it can misregulate our autonomic nervous system function, weaken the immune system, cause inflammations, disturb the hormones that regulate digestive functions. For severe SIBO cases, a stress reduction regime should be part of SIBO maintenance plan. Exercise, good sleep, Sun, healthy hobbies, vacation, acupuncture and bodywork all can help you keep the stress level in the bay.
Food sensitivity
Some people have a very sensitive stomach that reacts to too many types of food. That creates an elevated inflammation in the body that is counterproductive to SIBO treatment. Acupuncture is a great way to reduce food sensitivity. Read my case of “Kill two birds with one needle” and “Treat HIstamine Intolerance with Chinese Herbs” cases I use Chinese medicine to reduce the food sensitivity.

What is the best diet for SIBO?

Diet doesn’t cause SIBO but it is a trigger. The bacteria that produce hydrogen gas thrive on fermented fibres from the food you eat. A Paleo diet with food on Low FODMAP(link to page) is a generally good start. Keep in mind that diet alone is not going to cure SIBO. In fact, being on an elimination diet for too long can have a negative effect on digestive health in the long term. Starving the bad bacteria also starves the good ones, which is critical to maintain digestive and immune health. In addition, starving them for too long may make them more resistant to the treatment.

Final Dietary Tip from Chinese Medicine for SIBO
Cooked, Ripened and Soup
Chinese medicine usually encourages eat cooked and ripped food. Not only does the cooking process reduce the burden for our GUT to break down the chemical bondings, it also reduces the concentration of some irritating chemicals in the food (which is the natural survival mechanism of any species). So well cooked meals and fully ripened fruit are highly recommended. Chinese love soup, even if you have the most sensible stomach in the world, mixing different nutritional food with spices you like and slowly boiling them down, then just drink the fluid with all the nutrients in. This traditional way of cooking is repackaged to another name called “the elemental diet”. In China, we just call it “The diet for the sick”.

Why Chinese Medicine for SIBO?

Chinese medicine is definitely not the only medicine that can help SIBO. But It has its own advantages in treating a variety of chronic diseases. Please keep in mind that the five advantages that I list here can apply to most of conditions that Chinese medicine can help, not only specific to SIBO,

5 Benefits of using Chinese herbal medicine for SIBO

There are many advantages of using Chinese herbal medicine in terms of efficacy, side-effects, and cost-efficiency.

1) Combine to ensure the efficacy
Many herbs are known for its antibacterial activities. What’s good about herbs compared to antibiotics is herbs have a wider range of antimicrobial effects than antibiotics. When using multiple herbs in the formulated form, this advantage is even more significant especially because there are many different kinds of bacteria that can cause SIBO symptoms, and there is no one herb that can kill them all by itself. Using herbal formula can increase the range of microorganisms that can be affected by.

2) Diverse to avoid resistance
Bacteria are small but also very smart, they can develop resistance to certain antibacterial chemicals quickly. Because of the much diverse components(can be in hundreds) in a combined herbal formula, it will takes much longer for bacteria to figure out how to survive from them.

3) All-in-one to optimize cost-efficiency
The number of natural products on the current supplement market is almost countless. A standard natural regime for any sort of health issues contains at least several separate products, that means you will need a good size medicine cabinet for it. Chinese herbalists usually mix their own formulas from their own or third-party herbal dispensary(I have my own dispensary that has over hundreds of herbs), which makes it possible to put out a complex herbal formula that can have at least the similar therapeutic effect as the multiple supplements approach. Patients will enjoy the ease of carrying just one bottle of herbs and taking them with peace in mind.

4) Personal to ensure accuracy
Chinese medicine it has its own diagnostic methods such as tongue, pulse and abdominal examinations, while embracing modern medicine’s knowledge in diagnosis and treatment. We have a more detailed diagnostic system to differentiate the subtleness of the personal difference under the same western diagnosis. For example, two patients with same constipation symptoms, Kampo(the japanese herbal school that I practice) practitioners will palpate the patient’s abdomen to feel for the fullness, hardness, tension and locations of the discomforts. The differences in above metrics will be reflected in the formula in terms of the types and dosages of herbs selected. Make it possible to create a treatment tailored to the subtle individual differences to ensure a accurate and effective outcome.

5) Dynamic and Holistic: More bang for your bucks
Last but not the least. You get more bangs for the bucks! As I mentioned above, because Chinese medicine practitioners have much more freedom and flexible to adjust their treatment, not only we can make a customized treatment for specific conditions such as SIBO, but also we can combined other treatment together, such as insomnia, skin issues, hormonal issues, with very minimal extra financial and time cost in comparison to multiple visits to different specialists.

Case: Manage chronic SIBO with Kampo(herbs)

If you are suffering from SIBO, or suspect you may have SIBO, contact us to set up a consultation to discuss if Chinese medicine can help you.

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