What is SIBO?
SIBO is when there is an abnormally large amount of bacteria in the small intestine and the type of bacteria present there resembles the bacteria normally found in the large intestine.
Bacteria is littered throughout the entire gastrointestinal tract. Only a very small amount live in the small intestine in comparison to the large intestine (colon). The type of bacteria found in the small bowel are different to what's found in the colon.
What is the small intestine responsible for?
- digestion of food and absorption of nutrients;
- contains lymphoid cells which help regulate immune system function and prevent infection;
- houses beneficial bacteria that produce many nutrients such as short chain fatty acids (SCFA), vitamin K and folate;
- this beneficial bacteria protects against invasion from harmful bacteria and yeast after we eat or drink;
- this bacteria also maintains healthy muscular contractions in the small intestine which allow the passage of food and contents into the large intestine.
Small intestinal bacterial overgrowth (SIBO) is more common than we think. Up to 15% of people, free of symptoms have it and up to 80% of those with irritable bowel syndrome (IBS) are thought to have it.
How can SIBO affect us?
- SIBO can harm the structure and function of the small intestine;
- Damages cells that line the small bowel (mucosa) and reduce digestion of food and absorption of nutrients;
- Leads to leaky gut - mucosal damage weakens intestinal cell walls allowing undigested food and protein to pass through causing immune reactions. These immune reactions result in inflammation, allergies, sensitivities and autoimmunity;
- Causes nutritional deficiencies - especially of B12, protein and fat soluble vitamins A, D and E because bacteria like to gobble these up before our cells do;
- Burdens our detox pathways - bacteria produce ammonia that require detoxification.
Common symptoms and signs
- Abdominal pain
- Chronic diarrhoea (often seen in those with “Hydrogen gas”)
- Constipation (often seen with those “Methane gas”)
- Excess gas
- B12 deficiency
- Increasing food reactions
- Vitamin deficiencies
- Chronic fatigue and weakness
- Weight loss in severe cases
- Restless legs
- Gluten intolerance but not feeling better off gluten
- Anxiety and stress
What causes SIBO?
To understand what causes SIBO, first we must understand how our body prevents it. Generally speaking SIBO may occur if more than one of these protective functions are compromised; the acidic environment of the small intestine (acid inhibits growth of bacteria), muscular bowel activity, antibodies in the intestinal fluid and function of the valve that allows movement of contents into the large intestine and prevents return of it back into the small bowel.
- Low stomach acid
- Stomach or small intestinal dysmotility (dysfunction of the muscular contractions, the migrating motor complex MMC that move contents through to the colon)
- Irritable bowel syndrome
- Inflammatory bowel disorders such as Celiac and Crohn's disease
- Bowel surgery - that causes scarring and adhesions which affect the small intestine
- Long standing or poorly controlled diabetes
- A diet rich in simple carbohydrates
- Recurrent antibiotic use
- Medications - proton pump inhibitors, morphine, other opiates, narcotics. Maybe calcium channel blockers and beta agonists
- Post infectious - previous history of food poisoning
- Organ dysfunction - cirrhosis of the liver, pancreatitis, kidney failure, celiac disease
- Caesarian birth, no breast feeding
- Alcohol - alcohol damages intestinal walls and can cause leaky gut. It can also reduce muscular contractions in the small bowel and feed harmful bacteria, stimulating their growth.
Bold indicates the most common causes
SIBO is a complex condition and is NOT contagious. It is also generally a secondary condition.
How is SIBO diagnosed?
- Hydrogen/Methane breath testing is the most common method of testing. I use SIBOtest. If you would like to get tested I can help you choose the appropriate test for you.
- A stool test does not diagnose SIBO however certain signs in someone's poop test along with symptoms can strongly suggest the presence of SIBO such as disruption to short chain fatty acids, pancreatic enzyme production or faecal fat.
The three key principles of treatment are:
- address the cause;
- nutritional support;
- treat the overgrowth.
Common treatments include
- Antibiotics a course of antibiotics is often prescribed and at times cycled to prevent tolerance. Such as Rifaximin and Neomycin;
- Herbal antimicrobials - one study has shown that natural antimicrobials were more effective than antibiotic treatment. About 57% of those who did not get results with Rifaximin treatment got better results with herbal antimicrobials;
- Diet - a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) or the Bi -Phasic diet is generally prescribed. More on diet below;
- Nutritional support - to correct and support weight loss and vitamin and mineral deficiencies such as B12, vitamin A, D and E;
- Prokinetics to improve muscular contraction - given if abnormalities of SI motility exist;
- Probiotic therapy - may help to reduce symptoms. Note - this is a hotly debated topic. Some believe probiotic therapy is best suited to after antimicrobial treatment, however others use probiotics during.
What do I eat when on SIBO treatment?
There are a few SIBO diets that are commonly used. They include low FODMAP, SIBO BI-Phasic diet, SIBO specific food guide and specific carbohydrate diet. You may also need to be on a histamine restricted, low salicylate and low sulphur diet.
FODMAP foods are fermentable carbohydrates that feed the good bacteria in the large intestine. While the above diets reduce symptoms and make you more comfortable by starving off bacteria in the small intestine, it does not get rid of the overgrowth alone.
These diets are not designed for long term use as they can reduce the overall bacteria diversity in the large intestine along with reduce the production of short chain fatty acids (SCFA), such as butyrate. Butyrate is essential for good health as it decreases inflammation in the colon, improves gut transit time, resulting in regular bowel movements and helps prevent the development of leaky gut.
I personally use the SIBO BI-Phasic diet developed by Dr Nirala Jacobi prior to and during treatment. However will always adjust these guidelines to suit my patient.
Dietary treatment is highly personal because everyone responds differently. It's best to work with a health practitioner who is familiar with SIBO as they can guide you through treatment integration.
Other dietary and lifestyle considerations are to make sure that quality protein is consumed with every meal and that stress is minimised so that the immune system is not weakened while you detox and repair.
Unfortunately SIBO can take some time to treat with a recurrence rate of almost 45% within a year of treatment. This just highlights that correcting the cause and drivers of SIBO is as important as treating the overgrowth and that more than one round of treatment may be needed to clear it.
There is still a lot to discover about treatment of SIBO so no doubt the current protocol will continue to change as new discoveries are made. In the meantime I suggest you get some support from a naturopath or GP if you suspect SIBO so that your treatment plan can be tailored and monitored to suit your individual needs.
I would love to hear of your experience with this so please feel free to leave a comment below.
Have SIBO and need help with creating delish recipes? Order your copy of the SIBO Family Favourites Cookbook today. It is jam packed with delicious SIBO-friendly recipes that the whole family will love. Recipes are gluten-free, dairy-free (or dairy-free alternative), refined sugar-free, soy-free, grain-free (except some rice and quinoa) low FODMAP options, easy to make, affordable and most importantly, delicious.
Note – this cookbook is specific for those undergoing SIBO treatment with a qualified Health practitioner.
If you suspect you have SIBO, get in contact. I can help.
I love treating SIBO. Most importantly I love when an individual can reclaim the quality of their life. Below is a testimonial from a SIBO patient of mine, a very happy bride to be...You may resonate with her journey.
"I came to Lynda after struggling with SIBO and not finding any practitioners that were able to either acknowledge its existence or treat it effectively. My symptoms included constipation, bloating as well as perioral dermatitis (an acne like rash on the face around the mouth/nose) and considering I am getting married in December I wanted none of that!
It was obvious immediately that Lynda is incredibly knowledgeable about all things gut, digestion and elimination and she was able to implement strategies (both supplementation as well as gentle lifestyle changes) to help me manage my symptoms. Her enthusiasm and genuine concern for for my well-being made her wonderful to work with. As of writing I can confidently say that my SIBO (and all those nasty symptoms) is gone but the techniques I have learnt from Lynda will stick with me for life. I cannot recommend her highly enough. Lynda, thank you!" Charmaine
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