Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity (Dysbiosis) is a common finding in several disease states. The types of Dysbiosis are: 1- Loss of beneficial bacteria. 2- Overgrowth of potentially pathogenic bacteria. 3- Loss of overall bacterial diversity. 4- Overgrown in an area they’re not supposed to be in like the small intestine (SIBO). The overgrowth of microbes in the small intestine results in: 1- fermentation of food in the small intestine, producing hydrogen and other gases. 2- They can also degrade the thin mucus layer and come in contact with the gut barrier, causing inflammation and intestinal permeability (Leaky gut). 3- This can lead to a variety of unpleasant symptoms and consequences like food allergies , sensitivities and chronic inflammatory processes. 4- SIBO leads to both maldigestion and malabsorption as the bacteria interfere with normal enzymatic and metabolic activity of the small intestine. 5- Additionally, these bacteria are associated with increased serum endotoxin and bacterial compounds stimulating production of (pro)inflammatory cytokines. 6- Iron is typically absorbed in the duodenum and the jejunum and SIBO can interfere with this absorption resulting in microcytic anemia. 7- Vitamin B12 is absorbed in the ileum and patients with SIBO often have B12 malabsorbtion which leads to megaloblastic anemia and B12 deficiency. The best treatment for SIBO, like other forms of bacterial imbalance – or DYSBIOSIS is rehabilitating our microbiome.”

1. Dr. Fathi Neana, MD
Chief of Orthopaedics
Dr. Fakhry & Dr. A. Al-Garzaie Hospital
April, 06- 2019

3. Gut Microbiota for Health
World Summit March 23-24, 2019

4. Events 2019 location
Chicago Microbiome Conference Spring 2019 Chicago, IL
Reconstructing the Human Past – Using Ancient and Modern
Genomics
3/31/19 to 4/3/19 Heidelberg, Germany
Microbiota and gnotobiotic rodents (training course) 4/4/19 to 4/5/19 Milan, Italy
IGS Microbiome Analysis Workshop 4/8/19 to 4/11/19 Baltimore, MD
2nd International Translational and Regenerative Medicine
Conference
4/15/19 to 4/16/19 Valencia, Spain
5th Annual Translational Microbiome Conference 4/16/19 to 4/18/19 Boston, MA
6th Microbiome R&D and Business Collaboration Forum: Europe 5/20/19 to 5/22/19 Rotterdam, The Netherlands
Skin Microbiome & Cosmeceuticals Congress: Europe 5/20/19 to 5/22/19 Rotterdam, The Netherlands
Animal Microbiome Congress Europe 5/21/19 to 5/22/19 London, England
1st Microbiome Movement – Maternal & Infant Health Summit 5/22/19 to 5/24/19 Boston, MA
Microbiome Invest 2019 5/23/19 London, UK
Skin Microbiome Congress 5/29/19 to 5/30/19 Boston, MA
International Conference and Exhibition on Genomics and
Microbiomics
5/31/19 to 6/1/19 Barcelona, Spain
3rd Annual Microbiome Discovery and Development Congress 2019 6/11/19 to 6/12/19 Berlin, Germany
Conference on the Microbiome of the Built Environment 6/14/19 Houston, TX
13th International Conference on Clinical Gastroenterology &
HepatologyGut Microbiome
6/19/18 to 6/20/18 London, UK
Microbiome Movement – Drug Development Summit 6/26/19 to 6/28/19 Boston, MA
8th Congress of European Microbiologists – FEMS2019 7/7/19 to 7/11/19 Glasgow, Scotland
New Approaches and Concepts in Microbiology 7/10/19 to 7/13/19 Heidelberg, Germany
Kenneth Rainin Foundation 2019 Innovations Symposium 7/13/19 to 7/15/19 Honolulu, HI
CSHL Microbiome 7/18/19 to 7/21/19 Cold Spring Harbor, NY
The Gastrointestinal Tract XVIII Conference: Integrated Biology of the
GI Super-Organ
7/28/19 to 8/2/19 Steamboat Springs, CO
Microbiome Therapeutics US 9/10/19 to 9/11/19 Boston, MA
Microbiome Conferences 2019 9/20/19 to 9/21/19 London, England
Microbiological Monitoring of Rodents: Traditional and Innovative
Approaches (training course)
9/26/19 to 9/27/19 Milan, Italy
ICHM 2019 : 21st International Conference on Human Microbiome 9/26/19 to 9/27/19 San Francisco, CA
Microbiome R&D Summit 2019 10/17/19 to 10/18/19 Berlin, Germany
Microbiome R&D and Business Collaboration Forum: USA 10/29/19 to 10/30/19 San Diego, CA
Microbiome Movement – Gut-Brain Axis 2019 December 2019 Boston, MA

5. Microbiota - the forgotten organ
Diversity and Biodiversity
Like all healthy ecosystems,
Richness of microbiota species characterizes
the GI microbiome in healthy individuals.
Conversely, a loss in species diversity is a
common finding in several disease states.
Microbiota Biodiversity helps us:
1- Combat aggressions from other
microorganisms,
2- Maintaining the wholeness of the intestinal
mucosa.
3- Plays an important role in the immune
system,
4- Performing a barrier effect.
5- A healthy and balanced gut microbiota is
key to ensuring proper digestive functioning.

6. Microbiota - the forgotten organ
How it affect our life

7. Dysbiosis is any perturbation of the normal microbiome content that could disrupt
the symbiotic relationship between the host and associated microbes,
a disruption that can result in diseases, such as inflammatory bowel disease and
other gastrointestinal (GI) disorders, including gastritis, peptic ulcer disease,
irritable bowel syndrome, and even gastric and colon cancer [3–6].
From: The Microbiota in Gastrointestinal Pathophysiology, 2017
DYSBIOSIS VS. SIBO
Microbial Imbalance Inside the Body
Types of Dysbiosis are:
1) Loss of beneficial bacteria
2) Overgrowth of potentially pathogenic bacteria
3) Loss of overall bacterial diversity
4) Overgrown in an area they’re not supposed to be in
It is not pathogenic bacteria (meaning, it is not an infection), but
is normal bacteria that has set up home in the wrong location:
the small intestine (SIBO)

10. Small intestinal bacterial overgrowth (SIBO)
is a type of dysbiosis where an overabundance of bacteria develops in
the small intestine
It is not pathogenic bacteria (meaning, it is not an infection), but
instead is normal bacteria that has set up home in the wrong location:
the small intestine
The small intestine typically has less than 104 organisms per
millilitre. Anything above this level is classically considered to be
SIBO (1).
This bacterial overgrowth can be a combination of both good
(progenic) and bad (pathogenic) microorganisms
What is SIBO?
Small Intestinal Microbiome:
The duodenum and proximal jejunum normally contain small numbers of bacteria, usually lactobacilli and enterococci, gram-positive
aerobes or facultative anaerobes. Coliforms may be transiently present (< 103 bacteria per mL) and anaerobic Bacteroides are not found in
the jejunum in healthy people (3).
The distal ileum is a transition zone between sparse populations of aerobic bacteria of the proximal small intestine and very dense
populations of anaerobic micro-organisms in the large bowel. Any imbalance or increase in the amount of bacteria in the jejunum and
ileum is considered SIBO (4)

11. Pathophysiology of SIBO
Several mechanisms help to maintain low microbial
numbers in a healthy small intestine:
•Antimicrobial peptides and immunoglobulins: secreted by
small intestinal epithelial cells
•Contractions of the smooth muscle: lining the walls of the gut,
which move the contents along the gastrointestinal tract to the
large intestine
•The acidity of chyme: (the mixture of food and stomach juices)
when it enters the small intestine
•The ileocecal valve: located between the small intestine and
large intestine, prevents backflow
A healthy large intestine
is home to trillions of microbes, collectively called the microbiota, that are crucially important to human health.
These microbes aid in digestion, outcompete pathogens, produce signaling molecules, stimulate the immune system,
and synthesize vitamins, among other important roles.1 To keep these microbes a safe distance away from the gut
wall, the epithelium secretes a thick layer of mucus.
The small intestine, on the other hand
harbors relatively few microbes. It is the primary site of nutrient absorption in humans and has a thinner mucus layer
to optimize absorption of nutrients.

12. Pathophysiology of SIBO
1- These microbes ferment food in the small intestine, producing hydrogen and other gases
2- They can also degrade the thin mucus layer and come in contact with the gut barrier, causing inflammation
and intestinal permeability (Leaky gut)
3- This can lead to a variety of unpleasant symptoms and consequences like food allergies , sensitivities and
chronic inflammatory processes
4- SIBO leads to both maldigestion and malabsorption as the bacteria interfere with normal enzymatic and
metabolic activity of the small intestine.
5- Additionally, these bacteria are associated with increased serum endotoxin and bacterial compounds
stimulating production of (pro)inflammatory cytokines
6- Iron is typically absorbed in the duodenum and the jejunum and SIBO can interfere with this absorption
resulting in microcytic anemia.
7- Vitamin B12 is absorbed in the ileum and patients with SIBO often have B12 malabsorbtion which leads to
megaloblastic anemia and B12 deficiency
When these mechanisms break down, abnormally large numbers of microbes bloom in
the small intestine and/or types of microbes normally found in the colon colonize the
small intestine. This is called Small Intestinal Bacterial Overgrowth, or SIBO.

15. SIBO symptoms and associated conditions

16. - The symptoms of SIBO are diverse in nature
- Not necessarily limited to the gut.
- 50% of patients with SIBO didn’t have gut symptoms,
- 100% of fibromyalgia patients had SIBO.2
Why Symptoms Can Range:
In addition to the absolute number of organisms
The type of microbial flora present plays an important role
Bacteria that metabolize bile salts to unconjugated or insoluble compounds may lead to fat
malabsorption or bile acid diarrhea.
Microorganisms that preferentially metabolize carbohydrates to short-chain fatty acids and gas
may produce bloating without diarrhea because the metabolic products can be absorbed.
Gram-negative coliforms, such as Klebsiella species, may produce toxins that damage the
mucosa, interfering with absorptive function and causing leaky gut syndrome.
SIBO symptoms and associated conditions

17. Here are just a few of the symptoms and conditions that are associated with SIBO.
1- IBS-like symptoms:
bloating, gas, abdominal pain or cramping; diarrhea, constipation, or both
2- GERD symptoms:
belching, acid reflux, halitosis
3- Intestinal permeability symptoms (Leaky gut):
food sensitivities, Food intolerances such as gluten, casein, lactose, fructose and more ,
headaches, skin conditions, joint pain, fatigue, asthma, anxiety, depression,
autoimmunity, brain fog
4- Malabsorption symptoms:
anemia, cognitive dysfunction, B12/iron , magnesium deficiency, weight loss, steatorrhea
(fatty stools))
5- Associated conditions:
IBS, IBD, GERD, acne, rosacea, eczema, chronic fatigue syndrome, fibromyalgia, gallstones,
gastroparesis, high cholesterol, liver cirrhosis, non-alcoholic fatty liver disease, obesity,
pancreatitis, rheumatoid arthritis, positive H. pylori breath test, and restless leg
syndrome, just to name a few.
It’s important to note that while the most common symptoms are those of IBS nature,
not every individual with SIBO will present with gut symptoms.
SIBO Symptoms and associated Conditions

20. •Low stomach acid
•Motility disorders
21% of T4 to T3 conversion
occurs in the gut

21. ✓ Irritable Bowel Syndrome (IBS) ✓ Acne rosacea
✓ Acid reflux ✓ Hyperthyroidism
✓ Coeliac disease ✓ Scleroderma
✓ Chronic Fatigue Syndrome ✓ Chronic Prostatitis
✓ Fibromyalgia ✓ Non-alcoholic Steatohepatitis (NASH)
✓ Chronic constipation ✓ Liver cirrhosis
✓ Inflammatory Bowel Disease (e.g. Crohn’s and
ulcerative colitis)
✓ Diverticulitis
✓ Restless leg syndrome ✓ Diabetes
Conditions associated with SIBO
One or more of the following condition means higher risk of SIBO

22. Risk factors associated with SIBO
Why is SIBO so prevalent?
Risk factors associated with SIBO:
•Low stomach acid
•Motility disorders
•Stress
•Multiple courses of antibiotics
•Alcohol consumption
•Oral contraceptive pills
•Proton pump inhibitor use
•Food poisoning
•Elderly
•Organ system dysfunction
•Prior bowel surgery
•Muscle/nerve damage to the gut from IBS,
IBD, celiac disease
•Modern processing of foods
•Carbohydrate dense Western diets

23. There are also medications that
influence or disrupt the microbiome,
such as
- Antibiotics,
- Acid-blocking drugs (PPIs)
- Steroids.
these medications for more than 2-3
weeks at a time, lead to some form
of SIBO.
Medications that Disrupt Gut Flora

24. Consuming a diet high in sugar and refined
carbohydrates is misaligned with the
environment that our gastrointestinal tract
evolved in:
“Whereas foods with living cells will have
their low carbohydrate density “locked in”
until their cell walls are breached by
digestive processes,
the chyme produced after consumption of
acellular flour and sugar-based foods is […]
suggested to have a higher carbohydrate
concentration than almost anything the
microbiota of the upper GI tract from mouth
to small bowel would have encountered
during our coevolution.”
(Spreadbury, 2012) 3
Processed foods and carbohydrate dense Western
diets

25. SIBO develops when the normal
homeostatic mechanisms that control
intestinal bacterial populations are
disrupted. There are several processes
that most commonly predispose to
bacterial overgrowth with the two
most common being diminished
stomach acid secretion and lack of
small intestine motility
1) Diminished Stomach Acid
2) Poor Gut Motility
3) Intestinal Neuropathy
4) Physical Obstructions
5) Diverticuli
Causes of SIBO

26. Migrating motor complex (MMC)
One of the most common 0f deficiency of
digestive motility
The MMC function is to clear the small intestine
of bacteria and any sort of indigestible food
residue.
The MMC only works when we are fasting. This
occurs when we are asleep or between meals.
It is for this reason that people with SIBO are
generally advised to eat every 4-5 hours and fast
for 12 hours overnight.
Risk factors that can lead to the migrating motor complex not working properly or there being a structural issue with the
small intestine, ultimately leading to SIBO. These include:
To much and frequent eating ( 1- delayed emptying 2- PH up to 4 – hypoacidity), ✓ Food poisoning✓ Surgical
intervention and operations to the abdomen. Eg. Appendectomy, C-section, etc.✓ Gastroenteritis✓ Endometriosis✓
Gastrointestinal infection✓ A dysfunctional ileocecal valve✓ Antibiotic use✓ Hypothyroidism✓ Acid blockers or proton
pump inhibitors (PPIs)✓ Stress✓ Pain medication✓ Diabetes✓ Initial poor colonisation of gut bacteria due to
cesarean birth and/or lack of breastfeeding

27. Migrating motor complex (MMC)
The rule of fasting

28. Migrating motor complex (MMC)
The rule of stress
Rest & digest
Parasympathetic
Blood volume 5 liters – Cap bed 100 L.

29. Acid suppression (Hypoacidity)
Normal Gastric PH 1 - 3 (1.3)
The normal pH of the human stomach ranges from 1
to 3, and usually sits right around 2
However, if you’ve eaten recently, the pH
increases by a point or two to roughly 4-5.
The primary function of gastric acid is to
1- Aid in digestion by activating pepsinogen into pepsin
– an enzyme that breaks down proteins – which, in
turn, helps to break the bonds linking amino acids.
2- The acidic environment inside the stomach prevents
infection and the growth of dangerous microorganisms.
low stomach acid are related to
1- Impaired digestion,
2- Increased susceptibility to infection,
3- Reduced absorption of nutrients from food.

30. Dysbiosis and SIBO
H. Pylori
Candida
Malnutrition

31. Different forms of SIBO
Based on the results of the breath test, there are three
primary forms of SIBO.
Hydrogen only:
overgrowth of bacteria in the small intestine ferment fibers.
Methane present:
about 45% of people with SIBO will also have elevated
methane on the breath test. particular, a group of archaea
called methanogens selectively feed on hydrogen.
Reflux , belching , constipation.7
Hydrogen sulfide present:
bacteria called sulfate-reducers feed on hydrogen
diarrhea-predominant IBS.5
Tests for SIBO

32. Treatment“The best treatment for SIBO,
like other forms of bacterial imbalance – or DYSBIOSIS
is rehabilitating our microbiome.”

33. Treatment
Risk factors associated with SIBO
• Low stomach acid
• Motility disorders
• Stress
• Multiple courses of antibiotics
• Alcohol consumption
• Oral contraceptive pills
• Proton pump inhibitor use
•F ood poisoning
• Elderly
• Organ system dysfunction
• Prior bowel surgery
• Muscle/nerve damage to the gut
from IBS, IBD, celiac disease
• Modern processing of foods
• Carbohydrate dense Western diets

34. Treatment of SIBO
Intermittent fasting
People with SIBO are generally advised to do
intermittent fasting where they only consume
foods between a 6-8 hour eating window each
day
1- Treatment of Deficiency of digestive
motility (Migrating motor complex MMC)
2- The fasting helps to starve down the
bacteria and reduce their count.
3- It also helps enhance the healing process
and the restoration of the gut lining.
4- The gastric PH

35. Animals will abstain from eating solid food when
they are injured or ill. They instinctively know
that eating adds to the burden when all of the
bodies resources need to be devoted to healing
(rather than digestion).
The human body also has this same instinct, for
it is common for most people to stop eating
when illness strikes (anorexia).
Many humans think of food as comfort and
sustenance and believe that when sick, they need
to eat to keep up their strength; when actually the
reverse is true.
Healing begins in the gut and fasting is beneficial
because it rests the body’s systems.
Why animals fast when feeling ill ?
Animals instinctively know that fasting from solid food intensifies and accelerates the
healing process.
Help your dog stay hydrated by providing plenty of fluids in the form of fresh water, coconut
water and bone broth
Jun 27, 2017

36. How to acidify the stomach:
H. pylori infection a course of antibiotics can be prescribed
Underlying medical condition or medications as PPIs
HCl supplement (betaine hydrochloride), in conjunction with an
enzyme (pepsin)
Unfrequent eating to lower the PH (fasting)
Chew your food thoroughly. A simple but overlooked tip
Limit processed foods. ...
Eat fermented vegetables. ...
Drink apple cider vinegar. ...
Eat ginger.
Mar 7, 2018
Treatment of SIBO
Treatment for Hypochlorhydria

37. Treatment of SIBO
De-stress

38. Treatment of SIBO
Antibiotics vs. Natural antimicrobial
Natural Antimicrobials:
Like antibiotics, herbal antimicrobials seek to address the bacterial
overgrowth.
One multi-center study found that herbal therapies are at least as
effective as rifaximin, with similar response rates and safety profiles.14
Herbal therapy is a good first-line treatment, since herbal
antimicrobials can also correct other dysbiosis issues, such as fungal
overgrowth, parasites, and overgrowth of pathogenic bacteria in the
colon.
These can also be ordered without a physician.
Antibiotics:
Rifaximin is the antibiotic of choice for most cases of SIBO, though a combination of rifaximin and
neomycin may be used if a positive result for methane in the breath test.
Both rifaximin and neomycin are poorly absorbed, they remain in the intestine and do not have
systemic side effects.
Rifaximin also works via a different mechanism , does not result in antibiotic resistance.8
*Important note ?: restrictive diets such as GAPS or low FODMAP are not recommended during antibiotic or
antimicrobial treatment, since microbes may transition into a dormant state when food is not available and will be
less susceptible to treatment. In fact, feeding the microbes may significantly increase the efficacy of antibiotic
treatment.13

39. ?

40. Uses of Silver in Medicine
Silver ions act as a catalyst by absorbing oxygen, which kills
bacteria by interfering with their respiration
This antibiotic property, along with its non-toxicity, has given silver an
essential role in medicine for thousands of years.
Before widespread use of antibiotics,
Silver foil was wrapped around wounds to help them heal,
Colloidal silver and silver-protein complexes were ingested or applied topically
to fight illness.
Silver has also been used in eye drops and in
dental hygiene to cure and prevent infection.
While silver is not toxic, repeat intake of small amounts of silver over
time can result in argyria. In people with this condition, silver builds
up in body tissue, giving it a gray-blue appearance when exposed to
the sun. In addition, the ingestion of large amounts of silver can
have negative effects on the body.
For these reasons, medical doctors discourage the use of colloidal
silver, discounting claims by some that colloidal silver is a cure-all
dietary supplement.
Today,
the presence of antibiotic-resistant superbugs increases the demand for silver
in hospitals.
Small amounts of silver can coat hospital surfaces and medical equipment to
prevent the spread of pathogens.
Silver in surgical equipment, wound dressings, and ointments protects wounds
from infection.
Silver sulfadiazine is especially useful for burn victims because it kills bacteria
while also allowing the skin to regrow.
Silver ion treatments can heal bone infections and allow regeneration of
damaged tissue.
ٍ‫ة‬َ‫ي‬ِ‫ن‬‫آ‬ِ‫ب‬ ‫م‬ِ‫ْه‬‫ي‬َ‫ل‬َ‫ع‬ ُ‫اف‬َ‫ط‬ُ‫ي‬َ‫و‬ٍ‫ة‬َّ‫ض‬ِ‫ف‬ ‫ن‬ِ‫م‬ْ‫ك‬َ‫أ‬َ‫و‬‫ا‬َ‫ير‬ ِ‫ار‬َ‫و‬َ‫ق‬ ْ‫ت‬َ‫ن‬‫َا‬‫ك‬ ٍ‫ب‬‫ا‬َ‫و‬
(15)َ‫ير‬ ِ‫ار‬َ‫و‬َ‫ق‬ٍ‫ة‬َّ‫ض‬ِ‫ف‬ ‫ن‬ِ‫م‬‫ا‬ً‫ِير‬‫د‬ْ‫ق‬َ‫ت‬ ‫ا‬َ‫ه‬‫و‬ُ‫َّر‬‫د‬َ‫ق‬(16)
‫سور‬‫ة‬‫االنسان‬
15. And amongst them will be passed round
vessels of silver and goblets of crystal,
16. Crystal-clear, made of silver: they will determine
the measure thereof (according to their wishes).
Sura Al-Insaan
Silver is used in ointments: Some ointments take
advantage of silver's antibacterial qualities to
protect wounds against infection. Image copyright
iStockphoto / cglade.
‫قال‬ ‫أنه‬ ‫والسالم‬ ‫الصالة‬ ‫عليه‬ ‫هللا‬ ‫رسول‬ ‫عن‬ ‫ثبت‬:‫آنية‬ ‫في‬ ‫تشربوا‬ ‫ال‬
‫فإنها‬ ،‫صحافها‬ ‫في‬ ‫تأكلوا‬ ‫وال‬ ،‫والفضة‬ ‫الذهب‬‫في‬ ‫ولكم‬ ،‫الدنيا‬ ‫في‬ ‫لهم‬
‫اآلخرة‬
‫صحته‬ ‫على‬ ‫متفق‬
A catalyst is something that helps chemical processes happen. The most
commoncatalyst is heat, but sometimes a catalyst is a substance that facilitates the
process without undergoing any transformation itself.

42. Treatment of SIBO
The four R’s (4 R’s)
1. Remove: get rid of things that negatively affect the GI tract such as inflammatory foods, infections and gastric
irritants like alcohol, caffeine or drugs. Inflammatory foods such as gluten, dairy, corn, soy, peanuts, sugar and
sometimes eggs can lead to food sensitivities.
I recommend a Low FODMAPS Elimination Diet and IgG food sensitivity testing to determine if any foods are a problem
for you. Infections can be from parasites, yeast or bacteria. A comprehensive stool analysis is key to determining the
levels of good bacteria as well as any infections that may be present.
Removing the infections may require treatment with antimicrobial herbs or various medications.
2. Replace: Replace the good. Add back in the essential ingredients for proper digestion and absorption that may
have been depleted by diet, drugs (such as antacid medications), diseases or aging. This includes digestive enzymes,
hydrochloric acid and bile acids that are required for proper digestion.
3. Reinoculate: Restoring beneficial bacteria to reestablish a healthy balance of good bacteria is critical. This may be
accomplished by taking a probiotic supplement that contains beneficial bacteria such as bifidobacteria and lactobacillus
species. In some cases, individuals with SIBO and gut problems do not do well with lactobacillus species and that is
when I focus on spore forming soil based organisms.
I recommend anywhere from 30 -100 billion units a day. Also, taking a prebiotic (food for the good bacteria)
supplement or consuming foods high in soluble fiber such as beets, carrots, leeks, radishes, jicama, onions, garlic and
artichoke is important.
4. Repair: Providing the nutrients necessary to help the gut repair itself is essential. One of my favorite supplements
is L-glutamine, an amino acid that helps to rejuvenate the gut wall lining. Other key nutrients include zinc, omega-3 fish
oils, anti-oxidants and herbs such as deglycyrrhizinated licorice (DGL) and aloe vera.
No matter what your health digestive health issue is, the 4R program is the best place to start in order to get you and
your digestive system healthy. I have witnessed dramatic reversals of chronic and inflammatory illnesses in a very short
period of time by utilizing this simple approach.

44. Treatment of SIBO
SIBO Diets
Low-FODMAP diet
Eexcellent choice for short-term therapeutic relief.
FODMAPs stands for Fermentable Oligosaccharides, Disaccharides,
Monosaccharides, and Polyols.
These are specific types of carbohydrates that are highly fermentable
and stimulate the growth of microbes.
In controlled studies, a low FODMAP has been shown to reduce
symptoms in 76 percent of patients compared to 54 percent of
patients given standard dietary advice.15
Low FODMAP doesn’t necessarily eradicate the bacteria. may be
detrimental to the colonic gut microbiota in the long-term.
Most FODMAPs are Prebiotics,
meaning that they selectively feed and promote the growth of
beneficial bacteria in the large intestine. Cutting all FODMAPs may
starve microbes in the small intestine, but it also starves beneficial
bacteria in the colon. It also may alter colonic pH and interfere with
proper vitamin absorption.
For these reasons, not recommend ed for more than 2-3 months. It
should only be used as short-term symptom relief and should not be
used in place of antimicrobial or antibiotic treatment.

45. Low FODMAPS Diet
For individuals with SIBO, it is
adviseable to begin on a low FODMAP
elimination diet for 30 days.
FODMAPS is an acronym for
Fermentable Oligo, Di- and
Monosaccharides and Polyols.
These are all types of sugar based
carbohydrates that are found in
certain foods and are challenging on
the bowel (28).
These sugars include glucose, fructose,
galactans, polyols and lactose among
others.
These can be problematic because
they fuel the growth of the bacteria in
the small intestine which aggravates
the pre-existing overgrowth syndrome
(29). Here is the list of the foods in
these categories.

46. The risks of following a low FODMAPs diet on the long-term
Getting caught on the diet for too long:
Low FODMAPS designed to be followed strictly for 4-6 weeks
maximum
Body start to miss out too many valuable food components
(vitamins, minerals, anti-oxidants, fibre, prebiotics etc.)
the negative impacts on a long-term can outweigh the positives.
Dysbiosis in the large intestine: restricting our prebiotic (FODMAP)
foods leads to the reduction in specific types of gut bacteria,
including Bifidobacteria1
If you starve your gut bacteria, they could start harming
you. colonic bacteria. When there’s not enough fermentable fibre
to go around, the more our mucus is relied on for their fuel
Not getting the correct guidance from an experienced practitioner
can impact your results:
Promotes food related anxiety and stress. restrictive diet can
trigger stress
Low nutrient intake: risk of missing out on some of the key
nutrients like calcium

47. Dr. Natasha’s Story With Her Own Son: The Early
Years
My Son
By Natasha Campbell-McBride, M.D.
This inspiring story was written in February 2003
before Dr. Natasha had completed her book ‘Gut and
Psychology Syndrome’.
Dr. Campbell-McBride, a neurologist who also holds
a Master’s degree in nutrition(one son was born in
the autumn of 1992 and was later diagnosed with
autism).
I went back to university and took a master of
sciences degree in human nutrition
I hope that our story can be an inspiration for
parents of autistic children.
Never give up on your child, and your child will
reward you!
Treatment of SIBO
SIBO Diets
GAPS Diet
(Gut and Psychology Syndrome (GAP Syndrome
or GAPS))
The Gut and Psychology Syndrome (GAPS) Diet was
designed by UK practitioner Dr. Natasha Campbell
McBride and is loosely based on the Specific
Carbohydrate Diet (SCD). GAPS focuses on
removing all potentially inflammatory and
fermentable carbohydrates (including but not
limited to FODMAPs), healing and sealing the gut
barrier, and restoring healthy digestive function
and microbiota.
GAPS is an extreme diet and is not recommended
as a first course of treatment for most patients
with SIBO, but may be worth considering in
patients with severe neurological and/or
gastrointestinal issues. The therapeutic bone broth
that is considered a staple of the GAPS diet should
also be a staple in any SIBO treatment or
prevention protocol.
Breast milk full cream

49. GAPS Diet Approach:
GAPS diet stands for Gut and Psychology
Syndrome developed by Dr Natasha
Campbell-McBride. Dr Campbell was one of
the first to recognize that when the body has
a dysbiotic state and resulting leaky
gut syndrome it creates an inflammatory
process that affects all regions of the body
(30).
In particular, the brain is extremely
susceptible to this inflammatory stress and it
appears to light up regions of the deep limbic
system, basal ganglia and anterior cingulate
gyrus of the brain that are associated with
depression, anxiety and obsessive compulsive
disorders
The GAPS Nutrition plan helps to repair leaky
gut syndrome by providing supportive
nutrients and reinnoculating the gut with
healthy probiotic enriched foods.
This process helps to heal IBS and improve
symptoms of anxiety, obsessive compulsive
disorder, ADHD, Autism and depression.
There are a number of foods that you need to
continue to avoid on this plan. All grains,
processed sugars, high-starch foods,
processed foods, and non-organic meats and
dairy should still be avoided. Your system is
still healing from SIBO, and repairing your
digestive tract and getting your body back in
balance are the priorities.

50. GAPS Diet – Important Guidelines
•Drink one cup of bone broth with each meal.
•Use coconut oil or grass-fed ghee for cooking.
•Only eat low-glycemic fruit (berries, lemons/limes,
granny smith apples & grapefruit)
•Never eat fruit with meat of any type
•Introduce probiotic-rich foods slowly (sauerkraut,
kimchii, coconut water kefir, etc.)
•Don’t eat pasteurized dairy (including yogurt);
consume only fermented raw dairy as tolerated.
•Include one tablespoon fermented vegetable juice
with each meal. (Sauerkraut juice is readily available.)
•Incorporate organic coconut oil,
• grass-fed ghee and coconut butter whenever
possible during this stage.
These are all rich in medium-chain triglycerides
which are easy on the digestive system and help
support the health of the gut lining and blood brain
barrier.

51. Treatment of SIBO
SIBO Diets
Elemental Diet
An elemental diet is another extreme approach that seeks to
starve the bacteria by replacing all meals for two weeks with an
elemental formula of powdered nutrients in pre-digested, easily
absorbed form.
There are several disadvantages to this method, including not
being able to eat solid food for 2-3 weeks, unintended weight loss,
and the unpleasant taste of the formula.
Like the low FODMAP diet, it will also effectively starve the
bacteria in your colon. However, it has a surprising 80-84% success
rate in eradicating SIBO, and is safe and well-tolerated.
Because of its extremity, the elemental diet should only be used
as a last resort if other SIBO treatments have failed.
If you go this route, I recommend a homemade formula.
Commercially available elemental formulas are expensive and
incredibly high in carbohydrates, sugar, and artificial ingredients.
An elemental diet is a diet that proposes
the ingestion, or in more severe cases use
of a gastric feeding tube or
intravenousfeeding, of liquid nutrients in
an easily assimilated form. It is usually
composed of amino acids, fats, sugars,
vitamins, and minerals.

52. ٍ‫د‬‫ُو‬‫ض‬‫ن‬َّ‫م‬ ٍ‫ح‬ْ‫ل‬َ‫ط‬ َ‫و‬(29)-‫الواقعة‬ ‫سورة‬
Bananas: The Miracle Fruit
DYSBIOSIS
Unripe bananas special type of
PREBIOTIC
Good source of resistant starch
Great potential in the treatment of metabolic,
digestive, and inflammatory disorders.
SIBO
Ripened bananas affordable whole foods
ELEMENTAL DIET
Naturally pre-digested and so absorption is
enhanced
Great potential in the treatment of IBD or IBS

54. Probiotic supplementation has demonstrated to
improve gut barrier strength and integrity, to
reduce pathogenic bacteria levels, modulate the
immune system and reduce inflammation
throughout the body.
Probiotic supplementation is a key part in the full
restoration from SIBO and has been shown to be
superior to antibiotics in the treatment of SIBO
(31, 32).
Lactobacillus plantarum, lactobacillus acidophilus,
lactobacillus casei have all demonstrated
effectiveness in the treatment and management of
SIBO. Conversely lactobacillus fermentum and
saccharomyces boulardii have been found to be
ineffective (33).
Both lactobacillus plantarum and lactobacillus
rhamnosus have been shown to be effective in
suppressing abnormal gas producing organisms in
bacterial overgrowth syndrome. High
quality probiotics taken in uncomplicated cases of
SIBO can usually result in the individual becoming
symptom free (34). Probiotic therapy may need to
be taken continuously to prevent the return of
overgrowth of gas producing bacteria (35).
Treatment of SIBO
Probiotic Treatment

55. Soil Based Organisms:
For most of the history of mankind, we lived in close
contact with the Earth. The majority of our diet
consisted of foods and water that had soil clinging to
it. This soil was not an inert substance but was a
dynamic mineral rich, probiotic infused source of
electrochemical energy.
The unique soil based probiotics bacillus subtilis and
bacillus coagulans were some of the key components
that gave the soil its powerful nutritional benefits. This
bacterium is called a human soil organism (HSO) and
has an extraordinary ability to survive harsh
environments.
B subtilis and coagulans are fully resistant to bile salts and can handle the harsh stomach acid environment which
allows it to get into the digestive system and colonize. It has beneficial effects in the digestive system
(36, 37, 38). Research has revealed that supplemental B subtilis and coagulans improve symptoms of irritable bowel
syndrome (39).
B subtilis and coagulans are able to suppress the growth of harmful pathogens, strengthens the mucosal biofilm and
enhance the growth of other good probiotic strains such as lactobacillus species in the gut microflora (40, 41).
Many individuals with SIBO struggle with any lactobacillus strains of bacteria and need soil based, sporm forming
bacteria of the Bacillus strain. Clinically, I will use Hista Response, which is a low dose B Coagulans with
hyperimmunized IgY to reduce gut inflammation and improve immune function.
Later on, I will often add in SBO Probiotics with my SIBO clients as they begin to feel better and then I will often
switch to a lactobacillus and bifidobacterium rich probiotic.

56. Strategies to prevent and/or beat SIBO. You should always consult with your physician before
stopping or changing medications or taking on new health strategies.
1. Bone Broth Fast:
Do a 3-7 Day bone broth (grass-fed beef, chicken or fish bones are the best but you can do vegetable
broth as well) fast to cleanse the gut and starve out the bacteria while providing nutrients such as
proline and glycine that are necessary for the gut membrane to heal.
You can have herbal teas and organic coffee with coconut oil and ghee along with the bone broth on
this fast.
2. Low FODMAPS Diet:
After completing the bone broth fast (even if you can only do 1 day or 24 hours) begin following the
Low-FODMAPS diet plan here for 14 days
3. GAPS Diet:
After finishing the 14 days on the low FODMAPS plan, move into a low-FODMAP GAPS diet here for
the next 14 days where you begin to add back some fermented foods and beverages.
4. Slow Reintroduction:
Add higher FODMAP group foods back into your system slowly. Take one food (such as avocado) and
add it back for 3 days and see if you notice more gas, cramping and other digestive issues. If so,
eliminate that food, go back on GAPS-FODMAP diet for 2-3 days and then try another food higher
FODMAP food (onion).
Treatment of SIBO
Summary

57. 5. Hydration:
It is especially important to focus on hydration and electrolytes during this period. Aim to drink a
minimum of half your body weight in ounces of water. Most individuals with SIBO respond really well to
high amounts of water as it helps to flush out bad bacteria from the system.
I will often tailor programs to help individuals with SIBO super-hydrate their systems with great
success. It is also adviseable to use good pink salts such as Himalayan sea salt adding in 1/4 tsp per 8oz
of water to help mineralize the body.
before a meal to improve digestion function.
6. Use Organic Acids:
Individuals with SIBO typically respond well to small amounts of organic acids such as apple cider vinegar
and lemon juice. Add these to your water or herbal teas. Proper ratios would be 1-2 tbsp of ACV per
8oz of water or 1/4 – 1/2 lemon per 8oz of water.
These acids help to kill off bacteria and improve the production of digestive juices such as hydrochloric
acid, bile and pancreatic enzymes. Drink them between meals and
7. Intermittent Fasting:
I have my SIBO clients do intermittent fasting where they only consume foods between a 6-8 hour eating
window each day. The fasting window helps to starve down the bacteria and reduce their count. It also
helps enhance the healing process and the restoration of the gut lining. Read this article for more
information in Int Fasting.
8. Liquid Nutrition:
I recommend consuming protein shakes with berries and coconut milk or raw, grass-fed milk (if tolerable)
and a high quality protein powder. I am also a big fan of soups, stews, bone broth, green juices, herbal
tea and coffee with coconut oil and grass-fed ghee. Also doing some coconut water kefir and sauerkraut
or kimchii juice early in the GAPS is a great idea.
Liquid nutrition is easy on the digestive system and reduces stress on the stomach, liver, gallbladder,
pancreas and intestines. This enhances the healing process of the body.

58. 9. Fermented Foods:
Begin slowly adding in fermented veggies such as organic and live sauerkraut, kimchii, natural pickles,
coconut water kefir and coconut yogurt. Consuming a few tbsps throughout the day and especially with
any larger meals is especially helpful.
10. Oil Pulling:
Doing oil pulling with coconut oil and a drop of essential oils is especially helpful. This process reduces
the microbial load on the body and improves immunity. Read this article on oil pulling here
11. Get Moving and Regular Sunlight:
Moving on a regular basis, especially light intensity movement such as walking helps reduce
inflammation in the body and improve bowel transit time. Getting regular sun exposure enhances the
healing process through the assimilation of biophotons into the skin.
Additionally, sun exposure provides vitamin D3 which we want to optimize in order to heal effectively.
12. Improve Your Gut Motility:
Improving bowel movement frequency and consistency is a key detoxification concept. Read
this article for steps and strategies to improve bowel motility.
13. Digestive Support Pack:
If you have mild symptoms of SIBO, I would recommend using our basic digestive health support
pack here
14. Utilize an Advanced SIBO Support Supplement Program:
If you have moderate-severe SIBO than I would recommend using an advanced SIBO support
supplement program and strongly considering working with a natural practitioner who is trained in
helping people overcome SIBO naturally.

59. Treatment of SIBO
Prevention of SIBO recurrence
Despite treatment, recurrence of SIBO develops in almost half of patients. This is because SIBO itself is a “symptom” of underlying causes. If
these underlying causes are not addressed, bacteria can regrow within as little as two weeks of finishing antibiotics or antimicrobials.
The three major mechanisms that seem to contribute most to SIBO are impaired motility, poor gastric acid secretion, and colonic microbial
dysbiosis. There are several risk factors that I discussed earlier that you want to be sure to address as well.
With these in mind, here are six key steps to preventing SIBO recurrence:
•Eat a lower carbohydrate diet: Avoid large amounts of carbohydrates and eliminate refined carbohydrates entirely from your diet.
Replace them with non-starchy vegetables. This will significantly reduce the chance of overgrowth recurring.
•Use prokinetic agents: In many cases, SIBO relapses because eradicating the bacteria does not correct deficiency of the migrating
motor complex (MMC). The MMC is responsible for moving bacteria down into the large intestine every 90 to 120 minutes during periods of
fasting at night and between meals, clearing them from the small intestine. Many conditions, such as diabetes mellitus and scleroderma, can
affect the muscles in the gut and impair MMC function. Therefore, prevention should include motility agents such as the herbal formulation
Iberogast or the prokinetic drug Low Dose Naltrexone, particularly in cases of SIBO with constipation.
•Restore stomach acid: Restoring the acidity of chyme entering the small intestine is crucial for inhibiting bacterial overgrowth. This can
be accomplished using betaine HCl supplements. You should also check for nutrient deficiencies, as zinc, iodine, potassium, sodium, and
chloride are required for gastric acid production.
•Try intermittent fasting: Fasting stimulates the MMC and sends “housekeeping” waves through the small intestine, sweeping food or
bacteria into the large intestine. Constant eating or snacking, on the other hand, results in the constant presence of food in the small intestine –
the perfect environment for SIBO.
•Avoid alcohol consumption and use of medications that promote SIBO: Alcohol, proton pump inhibitors, and oral
contraceptives have all been associated with an increased risk of SIBO.
•Support a healthy gut microbiota: Dysbiosis in the colon can disrupt gut motility and is therefore a predisposing factor to SIBO. Consuming
plenty of fermented foods, prebiotic fibers, and taking a probiotic of soil-based organisms can help to reseed a healthy microbiota after
eradication therapy.

60. Action Steps
Functional Medicine Approach
Dr. Becky Campbell - January 20, 2019
1- Removing FODMAPS from the diet
2- Instead I stick with a diet high in foods
like
Eggs
Grass-fed beef
Grass-fed lamb
Free-range chicken & turkey
Wild caught fish
Cucumbers
Lettuce
Carrots
Bananas
Oranges
Blueberries
Coconut oil
Avocado oil
Sprouted nut butters
Dietary and lifestyle changes
1- Intermittent fasting
(Migrating motor complex MMC - PH)
2- Acidify the stomach
Do not overeat. No snacks between meals
3- De-stress
4- Avoid alcohol and drugs as PPI
5- Natural antimicrobial
6- SIBO Diets short term
Eliminate sugar, gluten, refined carbs and
fresh diary
7- Supplement with a soil based probiotic ?
8- Take digestive enzymes when needed

61. 14 Strategies to Beat SIBO Naturally
By DR. JOCKERS
comments54shares1.7K
Dr. Jockers
Dr. David Jockers is a doctor of natural medicine,
functional nutritionist and corrective care chiropractor.
He currently owns and operates Exodus Health Center in
Kennesaw, Georgia. He has developed 6 revolutionary
online programs with thousands of parti
All about SIBO: Small Intestinal Bacterial Overgrowth
By Lucy Mailing|January 10th, 2018
Lucy Mailing
MD/PhD student in Nutritional Sciences, Founder &
Writer at NGmedicine.com
The SIBO and the Thyroid Connection: Dr. Becky
Campbell
https://drbeckycampbell.com/the-sibo-and-the-thyroid-
connection/
Jan 20, 2019
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Resources
•Axe. Do You Have SIBO Symptoms? Here is ALL You Need to Know.
•Amy Myers. The SIBO and Hypothyroidism Connection.
•Axe. What are FODMAPS? The Key to Heal IBS?