What is SIBO and how can you overcome it?

What is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) is an excessive amount of bacteria in the digestive system, specifically in the small intestine. The symptoms of SIBO closely resemble those of IBS and therefore are often mistaken for IBS. As mentioned in my irritable bowel syndrome article, SIBO may in fact be the cause of your symptoms. It is estimated that up to 60% of IBS cases are actually caused by SIBO.

Bacteria are meant to transit through the small intestine, not set up house there. Trouble arises when the movement, or peristalsis, of the small intestines is compromised, making the perfectly healthy bacteria proliferate there instead of being moved downwards towards the colon where it is meant to be.


Symptoms

As previously mentioned, SIBO symptoms closely resemble those of Irritable Bowel Syndrome and can in fact be the cause of IBS. Here are a few common symptoms of SIBO:

• Abdominal pain
• Bloating
• Cramping
• Excessive flatulence
• Diarrhea
• Constipation
• Nausea
• Nutritional deficiency
• Fat malabsorption
• Weight loss
• Fatigue
• Rash
• Joint pain
• Asthma
• Skin conditions, such as acne, eczema, rosacea

Testing

SIBO testing has taken many forms including stool tests and urine tests. The most practical and to this day most accurate test doctors have found is the lactulose breath test.

SIBO test kits can be done in the comfort of your own home and are fairly easy to perform. After a 24 hour period of eating a specific diet which removes all fermentable carbohydrates and other harder to digest foods, patients spend a 12 hour period fasting overnight. Before even brushing their teeth, they breathe into a bag to catch a baseline reading of gasses, either hydrogen or methane, then a solution of lactulose is ingested. This solution is made of a fermentable carbohydrate that feeds bacteria. So if there is an overgrowth of bacteria in the small intestine, the bacteria will feed off of this solution and produce gasses that can be detected by the breath test. Over the next 3 hours, patients' breath samples are taken every 3 hours. Sibo is suspected when values are above 20 ppm for hydrogen and 12 ppm for methane or a combined value of 15 ppm for both hydrogen and methane.


Causes

Low stomach acid: Our stomach acid acts as the first line of defense against normal everyday life bacteria. When stomach acid levels are low, it can allow abnormally large amounts to survive past the stomach and into the intestinal tract leading to dysbiosis, IBS & SIBO.

Antibiotic use: While occasional antibiotic use can be essential, antibiotics have the ability to kill the good as well as the bad bacteria in our system. When protective bacteria gets killed in large numbers, it sets the stage for an imbalance in the gut microbiome after antibiotic treatment and can potentially lead to SIBO.

Proton-Pump Inhibitors & H2 Blockers: This type of medication decreases our levels of natural stomach acid, leading to bacterial overgrowth. PPI’s and H2 Blockers can contribute to the development of SIBO.

Motility disorders: The Migrating Motor Complex (MMC) is the system that propels the content from the stomach, down through the small intestines and into the colon. This “housecleaning” effect only occurs in between meals (around 90 minutes after eating). If the MMC becomes sluggish, bacterial overgrowth ensues.

Stress: When we are in a state of heightened stress, the parasympathetic nervous system shuts down. This results in the slowing of digestive mechanisms such as transit time, nutrient absorption, enzymes production and stomach acid production, all necessary components to keep our digestive and overall bodies healthy. Stress becomes an important contributor to SIBO.

Other causes of SIBO:

• Structural abnormalities of the GI tract
• Abdominal or GI surgery
• Immune deficiencies

Who is at greater risk of developing SIBO

IBS sufferers

Those with Celiac Disease

Those who suffer from chronic diarrhea

IBD sufferers


Treatment

Dietary

There are a myriad of SIBO diets out there. Which diet will be right for you will depend on your symptoms as well as your current dietary habits.

The Low-FODMAP diet
This is probably the most well known diet for addressing IBS and SIBO.

“FODMAPs” is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. It requires restricting certain fermentable carbohydrates in your diet which can be found in foods like garlic, onions, asparagus and beans. Studies have shown that a low FODMAP diet can improve symptoms in about 60% to 70% of IBS sufferers, which can in turn show great results for SIBO sufferers as well. The low FODMAP should not be followed for an indefinite amount of time as it is very restrictive and can modify the intestinal microbiome with its lack of fiber. It remains a great tool to reduce symptoms and proliferation post SIBO treatment.


The SCD or Specific Carbohydrate Diet

This diet has traditionally been used to treat Ulcerative Colitis, Crohn’s and Celiac disease. It restricts certain carbohydrates which are thought to feed the pathogenic bacteria in the gut and cause inflammation in the body. By restricting complex carbohydrates, you are essentially starving out the overgrowth in the intestinal tract. It can be daunting to take on as it removes rice, all grains including wheat, corn, oats and rice, sugar, potatoes, sweet potatoes and high lactose foods. It is even more restrictive than the low FODMAP diet and has the potential of helping those who still experience symptoms on a low FODMAP diet.


The SIBO Specific Diet

The SIBO specific food guide diet was created by Dr. Allison Siebecker. It combines the low FODMAP and SCD diets. It has a color-coded system of legal, moderate and illegal items ranging from green, to yellow, to orange then red. The SIBO specific guide gives recommended portion sizes for each food. As with the low FODMAP and SCD diets, it is not meant to be followed on a long-term basis but can be a very useful diet to implement post-SIBO treatment in order to starve out any remaining overgrowth and avoid relapse.


The Cedars-Sinai diet (Low Fermentation Diet)

This diet was first developed by Dr. Mark Pimentel of Cedars Sinai Hospital. Also known as the low-fermentation diet, it restricts the consumption of fermentable carbohydrates while allowing easily digested starches and sugars. It is slightly easier to follow for some patients as it is less restrictive than the low FODMAP, SCD and SIBO-Specific diets. One important component of the diet is the spacing of meals and limiting late-night snacking. It allows for easily digested carbohydrates such as rice, potatoes and sweet potatoes.


Lifestyle

Stress management and good sleep hygiene is very important when addressing SIBO. While dietary and supplemental or medical intervention is important when tackling this disorder, patients should not ignore the psychological factors that can either exacerbate or assist in the remission of SIBO.


Supplements and medication

Working with your doctor or naturopath is essential when addressing this challenging health issue. Most doctors will recommend a round of specific antibiotics in order to eradicate the bacterial overgrowth while naturopaths often recommend antimicrobials as a course of treatment. Both treatments can be highly effective. Make sure to speak to your DR or ND in order to make a decision regarding the best course of action for you.