SIBO: Understanding Small Intestinal Bacterial Overgrowth
Are you experiencing bloating, gas, and digestive discomfort on a regular basis? You might be dealing with SIBO – a sneaky condition that affects millions of people worldwide. In this blog post, we'll dive into the world of Small Intestinal Bacterial Overgrowth (SIBO), uncover its symptoms, causes, and treatment options, and equip you with the tools you need to tackle this pesky condition head-on.
Let’s do this!
Overview of SIBO
SIBO stands for Small Intestinal Bacterial Overgrowth, which is a condition where there are too many bacteria in the small intestine (1). Normally, the small intestine only has a small amount of bacteria, but in SIBO, the bacterial population grows beyond normal limits, leading to various symptoms and health issues. This overgrowth can occur due to a number of factors, including underlying health conditions, such as Irritable Bowel Syndrome (IBS) or Crohn's disease, or due to issues with the digestive tract, such as a slow-moving or blocked small intestine (2).
If left untreated, SIBO can lead to malabsorption of important nutrients, including vitamins and minerals, and can cause inflammation and damage to the lining of the small intestine. Thus, it is important to identify and treat SIBO in order to prevent further complications and improve overall digestive health.
Types of SIBO
There are three types of SIBO, each of which is classified based on the type of bacteria that overgrows in the small intestine (3). The three types of SIBO are:
Hydrogen-dominant SIBO: In this type of SIBO, the overgrowth of bacteria in the small intestine produces high levels of hydrogen gas.
Methane-dominant SIBO: Methane-dominant SIBO is characterized by an overgrowth of bacteria that produce high levels of methane gas.
Hydrogen-sulfide SIBO: This type of SIBO is less common and is characterized by an overgrowth of bacteria that produce high levels of hydrogen sulfide gas.
It's worth noting that some people with SIBO may have a combination of two or more types of overgrown bacteria, which can complicate diagnosis and treatment.
Causes of SIBO
There are several factors that can contribute to the development of SIBO. Irritable bowel syndrome, intestinal motility disorders, and chronic pancreatitis account for 80-90% of SIBO cases (5). Other common causes include:
Structural abnormalities: Conditions that affect the structure of the digestive system, such as bowel strictures, obstructions or adhesions, can contribute to the development of SIBO (6).
Low stomach acid (hypochlorhydria): This is a condition in which there is a low level of stomach acid, which can lead to an overgrowth of bacteria in the small intestine (7). Contributors: H. Pylori infection, gastric bypass surgery, chronic use of antacids or proton pump inhibitors (PPI’s).
Medications: Certain medications, such as antibiotics, narcotics and acid suppressing drugs (antacids proton, PPIs) (8).
Underlying medical conditions: Certain medical conditions, such as inflammatory bowel disease, celiac disease, and pancreatitis, can also increase the risk of developing SIBO (9).
Slow intestinal motility: When intestinal motility is slow, food can linger in the digestive tract longer than normal, providing opportunities for bacteria to proliferate and cause SIBO. Contributors: nerve or muscle damage, medications, hormonal imbalances, and underlying medical conditions such as gastroparesis, hypothyroidism or diabetes. (10,11).
Risk Factors
There are several risk factors that can increase the likelihood of developing SIBO. Some of the most common risk factors include:
Gastrointestinal disorders: Certain gastrointestinal conditions, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease, can increase the risk of developing SIBO (12).
Abdominal surgery: Abdominal surgery can cause adhesions and other structural changes that can impact the normal movement of food through the digestive system (13).
Medications: Certain medications, such as proton pump inhibitors (PPIs), which are used to treat acid reflux, can increase the risk of SIBO by reducing the acidity of the stomach (14).
Age: SIBO is more common in older adults, likely due to age-related changes in the gastrointestinal system (i.e., reduced stomach acid and intestinal motility).
Impaired immune function: Conditions that impact the immune system, such as HIV/AIDS or autoimmune disorders.
Alcohol and substance abuse: Heavy alcohol and substance abuse can damage the GI tract and impair normal digestive function.
Gender: Women are more likely to develop SIBO than men, with a female-to-male ratio of 2:1 (15).
Having one or more of these risk factors does not necessarily mean that someone will develop SIBO, but they may be more susceptible to the condition.
Symptoms of SIBO
SIBO can affect the way the body absorbs and processes food, leading to deficiencies in important nutrients, including vitamins and minerals (16).
Vitamins that can be affected by SIBO: Vitamin A, Vitamin D, Vitamin E, and Vitamin B12.
Minerals that can be affected by SIBO: iron, calcium, magnesium, and zinc.
These deficiencies can result in a range of symptoms, such as fatigue, weakness, and anemia. SIBO can also lead to inflammation and damage to the lining of the small intestine- increasing the risk of food sensitivities, allergies, and autoimmune disorders (17).
SIBO can be asymptomatic in some people, and the symptoms of SIBO can vary from person to person. Common symptoms include (18):
Abdominal pain or discomfort
Abdominal distention
Bloating
Diarrhea
Fatigue
Nausea
Constipation
In some cases, SIBO can also cause non-digestive symptoms, such as skin rashes, joint pain, brain fog, and mood changes.
Diagnosing SIBO
It is important to work with a healthcare professional to diagnose SIBO, as the symptoms of SIBO can be similar to those of other digestive disorders, such as IBS. In fact, up to 80% of people with irritable bowel syndrome (IBS) may have SIBO as an underlying cause (19).
During a SIBO diagnosis, a healthcare professional will typically start by taking a detailed medical history and performing a physical exam. They may also order blood tests to check for nutrient deficiencies and other underlying health issues. If SIBO is suspected, a breath test or other diagnostic test may be ordered to confirm the diagnosis.
There are several different methods used to diagnose SIBO, including breath tests, small intestine aspirate and culture, and lactulose breath testing (20).
Breath tests are the most commonly used method for diagnosing SIBO. During a breath test, a patient will be asked to drink a solution that contains a specific type of sugar, which is then metabolized by the bacteria in the small intestine. As the bacteria metabolize the sugar, they release gas, which can be measured using a breath analyzer. The presence of certain gasses can indicate the presence of SIBO.
The small intestine aspirate and culture test involves taking a sample of fluid from the small intestine and analyzing it for the presence of bacteria. This test can directly identify the bacteria present in the small intestine.
Treating SIBO
There are several different treatment options available for SIBO, including antibiotics, herbal supplements, and dietary changes.
Antibiotics
Antibiotics are commonly prescribed to treat SIBO, as they can help to kill off the overgrowth of bacteria in the small intestine. The most commonly used antibiotics for SIBO include rifaximin, neomycin, and metronidazole. These antibiotics are often given in combination, and are typically taken for a period of two to four weeks. It is important to note that antibiotics can have side effects and may also contribute to the development of antibiotic-resistant bacteria (21).
Herbal Supplements
Herbal supplements can also be used to treat SIBO, with some evidence suggesting that they may be just as effective as antibiotics (22). Common herbal supplements used for SIBO include oregano oil, berberine, and garlic. It is important to work with a trained healthcare professional when using herbal supplements, as they can interact with other medications, supplements, foods and alcohol, and may not be appropriate for everyone.
Dietary Changes
In addition to medication and herbal supplements, dietary changes play an important role in preventing the growth of new bacteria in the small intestine. The type of diet that works best for an individual with SIBO can vary based on the severity of symptoms, underlying health conditions, and food intolerances.
One dietary approach that has been shown to be effective in managing SIBO symptoms is the the low-FODMAP diet (23). This diet involves restricting certain types of carbohydrates that are poorly absorbed by the small intestine and can feed bacteria, leading to symptoms such as bloating, gas, and diarrhea. Examples of high-FODMAP foods include wheat, onion, garlic, and some fruits and vegetables.
In addition to following a low-FODMAP diet, individuals with SIBO may also benefit from eliminating dairy, gluten, and other potential allergens, as well as increasing their intake of water, probiotics, digestive enzymes, and fiber-rich foods (which can help promote the growth of beneficial bacteria in the gut) (24).
A note of caution: The low-FODMAP diet is very restrictive. It is highly recommended that individuals following a low-FODMAP diet do so on a short term basis, and under the supervision of a trained nutrition professional. Long-term use and improper application of the low-FODMAP diet may result in gaps in nutrition and adverse health outcomes. Other major dietary changes as described above should also be done under the guidance of a trained nutrition professional to ensure safety, efficacy and appropriateness to an individual's unique circumstances.
Lifestyle Changes
Lifestyle changes can also be an important part of treating and managing SIBO.
Stress management: Chronic stress can disrupt gut function. Managing stress through activities such as meditation, yoga, or counseling can help to reduce stress levels and promote gut health (25).
Regular exercise: Regular physical activity can help to improve gut motility. Aim to engage in moderate-intensity exercise for at least 30 minutes per day (26).
Adequate sleep: Lack of sleep can disrupt gut function. Aim to get 7-9 hours of sleep per night to support overall health and well-being (27).
Avoid alcohol and smoking: Alcohol and smoking can both disrupt gut function. Limiting or avoiding these substances can be helpful in managing SIBO symptoms (28).
Preventing SIBO Recurrence
SIBO recurrence is a common problem that can be frustrating for individuals who have already undergone treatment. In some cases, SIBO can come back even after successful treatment due to underlying medical conditions or lifestyle factors. Here are some ways to prevent SIBO recurrence:
Address underlying medical conditions: Conditions such as hypothyroidism, diabetes, and scleroderma can contribute to SIBO recurrence if they are not managed appropriately.
Avoid poor dietary choices: Eating a diet high in sugar, refined carbohydrates, and processed foods can contribute to gut dysbiosis and SIBO recurrence. Check out my monthly meal plan subscription to help keep you on track with healthy eating.
Limit use of antibiotics: While antibiotics can be effective in treating SIBO, overuse may lead to antibiotic resistance and recurrence of the condition (29). Consider exploring alternative treatments.
Poor gut motility: Slow gut motility can increase the risk of SIBO recurrence. Taking prokinetics, engaging in regular physical activity and eating certain foods (i.e., fiber-rich foods, ferments) can help to improve gut motility and prevent SIBO recurrence.
Practice good oral hygiene: Poor oral hygiene practices can increase the risk of bacterial overgrowth in the mouth (and possibly the gut) (30). Brushing teeth twice a day, flossing daily, and using an alcohol-free mouthwash can help reduce the number of harmful bacteria in the mouth.
Final Thoughts
SIBO can be a chronic digestive disorder characterized by an overgrowth of bacteria in the small intestine. It is challenging to diagnose, but with proper treatment and prevention it can be managed effectively. While dietary and lifestyle changes can be helpful, it's important to seek professional help for proper diagnosis.
Dietary changes such as following a low-FODMAP diet, consuming probiotics and fiber-rich foods, and avoiding gluten can help in the treatment and management of SIBO symptoms. Additional steps to prevent recurrence of SIBO include staying hydrated, treating underlying conditions, and managing stress.
Managing SIBO is a journey, and it may take some time to find the right treatment plan that works for you. But with patience, persistence, and professional help, you can manage SIBO and enjoy a healthy gut and a happy life!
If you are struggling with SIBO, I can help! With specialized knowledge of gut health and digestive disorders, I can work with you to develop a personalized nutrition and lifestyle plan that is tailored to your specific needs and preferences. Don't let SIBO hold you back any longer - schedule a consultation with me today and start your journey to better digestive health! I look forward to hearing from you 🙂
