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SIBO and Vivonex Plus Alternatives

 

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4/26/2011

Question:

I have Small Intestinal Baterial Overgrowth (SIBO), a form of IBS. A leading doctor in the field has recommended an elemental diet using Vivonex Plus for 2 weeks to kill the intestinal bacteria. This product is very expensive. I have searched for other less expensive products, but have not been able to locate a good alternative. The supplement needs to be lactose free, gluten-free and low residue; in other words, easily digestible. Could you make a recommendation?

From,

Lorraine

Answer:

Hi Lorraine. To start, here’s a brief introduction to small intestinal bacterial overgrowth (SIBO):

The small intestine is the section of the gastrointestinal tract that connects the stomach with the colon (the large intestine). The main purpose of the small intestine is to digest and absorb food into the body.

Most people have between 300 -500 different species of bacteria in their gastrointestinal tracts. Most of these bacteria are in the middle and the last part of the small intestine and also in the colon. The upper part of the small intestine and the stomach are generally too acidic and have too many muscular contractions for most bacteria to survive1.

SIBO, also known as small bowel bacterial overgrowth (SBBO), refers to a condition in which abnormally large numbers of bacteria are present in the small intestine. This overgrowth of bacteria and other organisms competes with your body for the digestion of nutrients, such as vitamins (especially Vitamin B-12). There is also malabsorption of sugars and carbohydrates, which are then passed to the colon where greater amounts of gas are produced, causing bloating, abdominal discomfort and loose stool. The lactulose or glucose breath tests are the standard tests for SIBO1.

To overcome these complications, you may be recommended to take appropriate antibiotics. One treatment option is to take a course of antibiotics, sometimes followed by probiotics for a period of time determined by your doctor and/or your dietitian based on your symptom relief. While the antibiotics help in killing the bad bacteria, the probiotics are “friendly,” live bacteria that will replenish the intestine’s good bacteria2. The most common types of probiotics are lactobacilli and bifidobacteria. Certain organic yogurts contain a variety of healthy living bacterial species, as well.

You may find that a consult with a dietitian is useful to review a balanced, healthy diet that corrects nutrient deficiencies (particularly Vitamin B-12) and limits foods that are commonly poorly digested, such as FODMAPS (fermentable carbohydrates)3,4. FODMAPs, which are good sources of food for bad bacteria, include sweeteners, such as corn syrup (fructose), sugar alcohols (such as sorbitol, mannitol, etc), products sweetened with fruit juice (which can contain fructose)3, lactose (the natural sugar in dairy products), and many others.

A dietitian can also recommend foods that are easily digested so that the body can absorb most of the nutrients before being a good fuel source for the bad bacteria. A diet that has modest amounts of fiber (rather than high fiber which may make symptoms worse) and adequate fluid is generally recommended3. Encouraging spacing meals several hours apart will allow time for the cleaning-waves in the small intestine to get rid of food by-products, bacteria and waste, which can only happen when a person is not eating3,4.

As you can see, there are many dietary recommendations that can help with SIBO, and you are encouraged to visit a dietitian who will take your medical history into account when making your individualized meal plan.

According to Nestlé Nutrition, there is not another clinically comparable, less expensive alternative to their Vivonex Plus formula within their product line. However, I recommend contacting the Nestlé Health Care Nutrition Patient Assistance Program. Nestle provides medical nutrition products at no charge to eligible individuals who cannot afford their products, and Vivonex Plus is one of the eligible products. The application must be submitted by a healthcare provider. You can contact them at (847) 808-5300 for more details.  

Per the clinical representative from Abbott Nutrition, a comparable product to Nestle’s Vivonex Plus is their Vital HN product. More information on this formula can be found at www.abbottnutrition.com. Abbott also has a patient assistance program.

Sincerely,

Melinda Dennis, MS, RD, LDN

Article written with assistance from Aparna Kohli, Nutritionist, Beth Israel Deaconess Medical Center, Boston, MA.

References:

  • Leffler, D. Small Intestinal Bacterial Overgrowth. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free. Dennis M, Leffler D, eds. AGA Press. Bethesda, MD, 2010.
  • Small Intestinal Bacterial Overgrowth. MedicineNet.com. http://medicinenet.com/script/main/art.asp?articlekey=55091. Accessed April 13, 2011.
  • Diet for IBS and SIBO. Specialists in Gastroenterology. www.gidoctor.net/diet-ibs-sibo.php. Accessed April 13, 2011.
  • Scarlata K. Small intestinal bacterial overgrowth- what to do when unwelcome microbes invade. Today’s Dietitian, April 2011,13(4):46.

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