TOBINintel · Condition

Gut Dysbiosis & SIBO

Dysbiosis means an unhealthy change in gut microbes. It is a research concept, and there is no validated lab test for it. Stool microbiome panels are not recommended for diagnosis. The parts that can be measured are small-intestinal bacterial overgrowth (SIBO) and gut inflammation. SIBO is shown by a lactulose or glucose breath test with a hydrogen rise of 20 ppm or more within 90 minutes, or methane of 10 ppm or more (North American Consensus 2017). Gut inflammation is shown by fecal calprotectin above about 50 µg/g, which calls for workup to exclude inflammatory bowel disease.

Key points

Bacteria are the subject here. Treat SIBO only when a breath test is positive. Probiotics and FMT are proven only for specific indications, such as recurrent C. difficile.
Test to discuss: Lactulose or glucose hydrogen/methane breath test
Test to discuss: Fecal calprotectin (exclude IBD)
Test to discuss: Celiac serology (tTG-IgA)
Test to discuss: B12, ferritin, vitamin D (malabsorption)
Test to discuss: Medication review: PPIs, opioids, antibiotics
25–35 g/day dietary fiber from varied plants
Avoid unnecessary antibiotics and long-term PPIs
Fermented foods as tolerated

Root-cause chain

Antibiotics, low-fiber diet → Loss of microbial diversityB

N · Randomized evidence · Fiber feeding trials raise short-chain-fatty-acid producers; antibiotics reduce diversity for months.

Reduced gut motility (diabetes, opioids, hypothyroidism) → SIBOB

B · Observational association · Impaired migrating motor complex lets bacteria accumulate in the small bowel.

Dysbiosis → Systemic low-grade inflammationC

I · Mechanistic plausibility · Endotoxin translocation raises inflammatory signalling; human causation remains unproven.

SIBO → Bloating, B12 and iron malabsorptionB

N · Observational association · Bacterial consumption of B12 and mucosal injury.

Protocols by lane

Evidence grade + regulatory status

Conventional: Rifaximin 550 mg three times daily for 14 days for breath-test-positive SIBOB

ACG 2020 SIBO guideline; also FDA-approved for IBS-D (TARGET trials).

Status: Off-label · Cautions: Recurrence is common; treat the underlying motility cause.

Functional: Low-FODMAP diet trial (2–6 weeks) then reintroductionB

Reduces bloating in IBS RCTs; reintroduction prevents long-term restriction.

Status: Lifestyle · Cautions: Use a dietitian; can reduce microbial diversity if kept long term.

Integrative: Increase dietary fiber diversity graduallyB

Raises short-chain-fatty-acid producers in feeding trials.

Status: Lifestyle · Cautions: Can worsen bloating at first, especially in SIBO.

Orthomolecular: Strain-specific probiotics only for evidence-backed indicationsC

AGA 2020 recommends probiotics only in clinical-trial settings for most GI conditions.

Status: Supplement · Cautions: Avoid in severely immunocompromised patients and central lines.

Traditional: Herbal antimicrobials (e.g. berberine-containing blends) for SIBOD

One retrospective study (Chedid 2014) suggested similar response to rifaximin.

Status: Supplement · Cautions: Berberine interacts with many drugs (CYP3A4, metformin); not for pregnancy.

Energy / Physical: No energy modality treats dysbiosisE

Listed for completeness only.

Status: Investigational · Cautions: Must not be presented as a treatment.

Monitoring

Symptom diary (bloating, stool form)
Repeat breath test only if symptoms recur
B12 and ferritin after treatment
TOBIN score change over time

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iDetection of an exposure does not establish that it caused a disease. This platform separates exposure, association, plausible mechanism, clinical evidence and demonstrated causation.