If you have any uncomfortable gut symptoms like bloating after eating, constipation, diarrhoea or cramping or have been diagnosed with Irritable Bowel Syndrome, then you may have SIBO.
In this article you will learn
- What SIBO is.
- Could my IBS or bloating actually be SIBO?
- How to get tested for SIBO and why this is vital.
- Why a diagnosis could be good news!
- Why everyone should have a tailored treatment plan.
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AUTHOR: Kirsten Donovan
Small Intestine Bacterial Overgrowth (SIBO)
Normally your small intestine is reasonably sterile and contains only limited numbers of bacteria. It is the site for absorption of most of your nutrients from food however it is not usually home to huge numbers of bacteria like those that reside further down in our large intestine. The condition; SIBO, is defined as an increased number of and/or abnormal type of bacteria in the small intestine.
The prevalence of SIBO can be much higher (but not limited to) older adults with rates of up to 50% in those over 75 years. Studies have shown that 56% of those with IBS are likely to have SIBO and prevalence is also high in those with coeliac disease, diverticulitis, gastroparesis, pancreatitis and cystic fibrosis. In my clinic, I have found that many people living high stress lifestyles have SIBO even without the concomitant conditions mentioned.
The types of bacteria that reside in your colon usually have roles such as fermenting carbohydrates into hydrogen gas or archea (these are not technically bacteria but another organism) that produce methane gas. So when these bacteria or archea migrate upwards to the small intestine, the result is usually uncomfortable symptoms such as:
- Abdominal bloating or cramping
- Combination of both constipation and diarrhoea
There are several variations of SIBO and you may have one or all of these
SIBO-C – the constipation dominant kind, usually caused by methane producing ‘archea’ (methane slows down transit through the intestine).
SIBO-D – the diarrhoea dominant kind which is often caused by dominance of the hydrogen producing bacteria.
SIBO-S – the hydrogen sulphide producing form of SIBO which is less common and will not show up on the typical SIBO breath test. The defining feature of this form is gas with a ‘rotton egg’ sulphur smell and this gas can cause damage to the intestinal lining.
Beyond the bloat
Aside from the persistent and uncomfortable symptoms of SIBO, there are other consequences of this overgrowth that can be serious and longstanding.
- Leaky Gut – Firstly, the endotoxins released by the bacteria cause damage to your small intestine wall – the site of much of your absorption. This may cause ‘leaky gut syndrome’ and result in food intolerances and an overzealous immune system.
Poor absorption means that you are not getting adequate vitamins and minerals to perform every function in your body and a lack of proper digestion of protein will not allow for rebuilding and repair of all muscle, hormones, neurotransmitters and structures.
- Deficiencies – The active bacteria in your small intestine may also consume all your nutrients from food before your body’s cells get a chance. This means that essential nutrients like B12, magnesium, iron and calcium and protein are all taken up by the bacteria leaving your own cells short.
Could my gut issues be due to SIBO?
20% of the population of the world is thought to have IBS or Irritable Bowel Syndrome, and for a large percentage of those with IBS, the root cause is SIBO. If you have been told that you have IBS and that there are no options, you have been mislead, as we are able to test for and treat SIBO with a lot of success.
If you have any of the following symptoms, you are at risk of having SIBO and should speak to your naturopath about having the correct testing done;
- Bloating within 1 hour after meals
- Chronic diarrhoea or chronic constipation or alternating constipation and diarrhoea
- Burping or reflux after meals
- Foul smelling gas
- Stomach gurgling and discomfort or cramping
Secondary symptoms due to the poor absorption and poor digestion often come along with the primary symptoms:
- Restless legs at night
- Joint pain
- Mood changes
- Multiple food sensitivities
- Respiratory symptoms such as asthma
- Acne or skin rashes
- Memory issues and foggy thinking
- Chronic iron and/or B12 deficiency
- Weight gain or loss
- Difficulty sleeping
How do I get tested?
Testing for SIBO is now available in New Zealand and is a simple breath test that is performed at home. It is important to choose the correct substrate as this can affect the results – different substrates test different areas of the small intestine.
There is a diet that you must follow for 24 hours prior to the test and although you must set aside a few hours to do the test, it is very straightforward.
Your naturopath can have the test kit sent out to you and guide you through the procedure.
Testing is crucial as treatment of each sub-type of SIBO is different and needs to be treated as such with different herbs and nutrients. It is also important to eliminate the possibility of SIBO as this condition is unlikely to self-resolve without some intervention with herbs or nutriceuticals.
Lastly a negative SIBO test result does not always mean you do not have SIBO. Depending on which substrate you have used, further testing may be required and in the case of SIBO-S this will not show up on your standard breath test. The Gold Standard in SIBO testing would be to use all 3 substrates. Be guided by your experienced practitioner here.
Treatment for SIBO
As SIBO comes in many variations, treatment varies and no one herb or supplement is likely to be adequate as full treatment. It has been shown however that herbal treatment is just as effective as treatment with antibiotics without such long lasting effects on the microbiome. Naturopathic treatment is based around reducing the overgrowth with diet, herbs and supplements but all the while treating root causes and considering the fact that bacteria often surround themselves in protective ‘bubbles’ called biofilms to keep them safe and hidden from the immune system.
Every SIBO patient may present with different symptoms so this needs to be taken into consideration and an individual programme tailored to your needs. It is also necessary to improve overall gut health so that these kind of imbalances do not reappear as soon as you eradicate the initial overgrowth.
In A Nutshell
SIBO is an underdiagnosed condition and poorly understood by many not trained to know what is occurring and underlying. The best way to know if you have SIBO is to get tested by your naturopath. If you have IBS or any uncomfortable gut symptoms, then consider that SIBO might be the cause.
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Hectman, Leah, Clinical Naturopathic Medicine, second edition, 2019, Elsevier, Australia.
Peralta, S., et al. (2009). Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: Experience with Rifaximin. World Journal of Gastroenterology : WJG, 15(21), 2628–2631
Chen et al; (2018) Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jan;53(1):27-36 - PubMed
Gandhi A, Shah A, Jones MP, Koloski N, Talley NJ, Morrison M, Holtmann (2021) Methane positive small intestinal bacterial overgrowth in inflammatory bowel disease and irritable bowel syndrome: A systematic review and meta-analysis. G.Gut Microbes. 2021 Jan-Dec;13(1):1933313.