I have been following the evidence, data and recommendations for SIBO for many years. The most updated information is from the conferences I purchase. The GI MD’s I work with, of which there are many, do not generally test for SIBO. They rarely use Rifaxamin and do not use SIBO as a diagnosis when they refer patients to me. I often suspect from their history and symptoms that SIBO is present.
My questions involve patients with constipation, any or all of the following: infrequent bowel movements, incomplete evacuation and or hard stools. I also see many patients with obstructive constipation which is often misdiagnosed as IBS (alternating diarrhea and constipation). I have found it critical for patients to explain their symptoms since they often state they are constipated when in fact they have gas, or skip a day here or there.
I always start my evaluation with basic dietary evaluations: do they eat regularly scheduled meals, are they animal rather than plant dominant, do they make time to go to the bathroom, fiber and fluid intake, etc.
CONSTIPATION MODALITIES I often use include but are not limited to”
FOOD BATHROOM BEHAVIORS
Flax – Uncle Sam’s
I start with as simple and basic as possible. A food and symptom (including bowel movement record) is maintained. About 70% of my patients’ bowel movements normalize within a month.
The problem, which is why I opened this discussion, is those who do not improve. I assume (which may or may not be correct) they have IBS-C caused by methane. There seems to be 2 dietary schools: Naturopaths who recommend the” Bi-Phasic diet” or “The SIBO diet” and Drs. Pimentel and Salt who use the “Low Fermentation Diet/SIBO Diet.
Clearly addressing the methanogen problem is not simple. Additional recommendations I’ve seen include a prokinetic (e.g. Iberogast), FODMAP, meal spacing to address MMR.
What are you recommending for these patients?
What are your outcomes?
What are your conclusions?