What is SIBO?
SIBO stands for small intestinal bacterial overgrowth and occurs when normal bacteria that is typically found in the large intestine has migrated into the small intestine and overgrown. The small intestine is where your body absorbs nutrients from the foods you eat and is supposed to be a relatively clean environment housing 10,000 different strains of bacteria per ml of fluid, compared to the large intestine that has 100 billion bacteria per ml or fluid.
This overgrowth of bacteria poses a lot of problem in the digestive process. They impact our ability to properly digest carbohydrates and absorb fats, increase gut permeability (leaky gut), contribute to nutrient deficiencies and excrete acids that can create systemic symptoms in the body.
There are 3 types of gasses that are produced by SIBO bacteria:
Methane - typically associated with constipation as it slows down intestinal motility and can be related to infertility like PCOS, endometriosis, pelvic floor dysfunction and irregular periods
Hydrogen - Increases gut transit time and can cause a fluctuation between loose stool and bouts of constipation
Hydrogen Sulphide - This gas is produced when the hydrogen gas is converted into sulfide and the individual may produce sulfur smelling like gas as a result
Symptoms of SIBO
When there is bacterial overgrowth in the small intestine, particles of food that would normally be fermented by the bacteria in the large intestine are fermented in the small intestine, producing excessive quantities of hydrogen and/or methane gas which then leads to numerous symptoms
Over 75% of people that are diagnosed with IBS are found to have SIBO and although there symptoms appear to be similar there are certain distinctions between the two.
Symptoms that are associated with both IBS & SIBO include;
Bloating - typically in the lower/middle abdomen immediately or up to 2 hours after eating
Abdominal pain/cramping
Flatulence, belching
Constipation, diarrhea or a mixture of the two (this is dependent on the type of bacteria that is overgrown)
Symptoms that may point to SIBO being present;
Heartburn
Nausea
Histamine intolerance
Malabsorption: fat malabsorption, iron, vitamin D, vitamin K or B12 deficiency
Systemic bodily symptoms including headache, fatigue, joint/muscle pain and certain skin conditions (psoriasis, eczema)
Why does SIBO happen?
SIBO has an extremely high relapse rate after treatment that's why it’s so important to identify the root cause as to why the bacteria has overgrown in the first place.
Insufficient Migrating Motor Complex (MMC)
This is one of the main factors leading to the development of SIBO. Once your body has absorbed the nutrients from your food the MMC moves the left over waste and debris down into the large intestine to be eliminated. This process happens between meals and when you are fasting at night. It does this clean sweep to prevent bacteria from colonizing in the small intestines and happens every 90-120 minutes during periods of fasting. In a healthy person this happens 11 times per day but in individuals with SIBO this might only happen 3 times/day.
Low Stomach Acid
Stomach acid helps kill bacteria before they reach the small intestine. When acid levels are too low, due to factors like chronic use of proton pump inhibitors (PPIs) or aging, bacteria can survive and colonize the small intestine, leading to an overgrowth. Low acid also impairs the proper digestion of food, providing a nutrient-rich environment that fuels bacterial growth.
Ileocecal valve dysfunction
Your ileocecal valve plays a critical role in controlling the flow of contents between the small and large intestines. Normally, the ileocecal valve acts as a barrier, preventing bacteria from the colon from entering the small intestine. However, if this valve becomes weakened or dysfunctional due to structural issues, inflammation, or nerve impairments like stress the bacteria from the large intestine can backflow into the small intestine and disrupt the balance of the gut microbiome.
SIBO Treatments
The goal for treating SIBO is to eradicate the bacteria that has overgrow, eliminate their food source, repair any damage that may have been done to the GI tract and address the root cause of the overgrowth.
There are three ways to target bacterial overgrowth in the small intestine:
Antimicrobials
These herbal supplements are natural but powderful. They are designed to act primarily within the gut, minimizing systemic effects and reduce the risk of disrupting beneficial bacteria elsewhere in the body like some antibiotics may do.
Antibiotics
Rifaxamin is the most common antibiotic used in the treatment of SIBO because it works primarily within the gut, minimizing systemic side effects and sparing beneficial bacteria elsewhere in the body. Its broad antibacterial action is effective against hydrogen-producing bacteria, making it particularly useful for treating diarrhea-predominant SIBO.
Elemental Diet
The elemental diet is a beneficial approach for treating SIBO because it provides easily absorbed nutrients in their simplest form, which minimizes bacterial fermentation in the small intestine and effectively starves out bacterial overgrowth
The best form of treatment is selected based on the type and amount of the bacteria that is overgrown and the way to determine that is through functional testing
The Low FODMAP Diet
THIS IS NOT A FOREVER DIET. The low FODMAP diet is meant to be followed during the treatment of SIBO to starve the bacteria and discourage the return of overgrowth by cutting off their food source. Low FODMAP foods are foods that are easily digested early on in the digestive tract so that the bacteria do not have the opportunity to feed off them.
With SIBO having a high relapse rate the goal is to follow a low FODMAP diet for at least 3 month after the successful elimination or SIBO to prevent the bacteria from returning
Testing for SIBO
The most accurate way to determine if SIBO is present is to run a SIBO breath test. This test measures the levels of specific gases that the bacteria produce. The patient drinks a solution containing a sugar substrate which serves as food for bacteria in the small intestine. If there is an overgrowth, bacteria will ferment the sugar, producing measurable gases that are absorbed into the bloodstream and exhaled through the breath.
I always run a GI Map test first to get a complete picture of what's going on in the gut before determining if SIBO may be present and if testing is necessary. The GI Map is a functional stool test that provides insight into your guts bacteria levels (in the large intestine), parasitic infections, candida (yeast) overgrowth, pathogen, gut permeability and so much more! Although this test cannot confirm if SIBO is present there are certain markers that point to possible bacteria overgrowth in the small intestine alongside the persons symptoms. Running this test first is important because if pathogens like H.Pylori or parasites are present it is crucial to address these first or it will be difficult to target the SIBO bacteria.
Click here to learn more about how the GI Map test can be the key to helping you on your gut healing journey.
If you have SIBO or suspect that it may be causing your gut issues my SIBO mini protocol has everything you need from supplement, nutrition and lifestyle recommendations to start healing SIBO and beat your bloat for good!
Ready to finally get the answers to what’s causing your symptoms? Check out my GI Map Interpretation Package to take the first step towards healing your gut or go all in with my 1:1 Gut Healing Program and beat your bloat for good!
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