SIBO: what is it, and how do I know if I have it?
There may be something lurking within your gut, when and where you least expect it.
You’re probably already in tune with keeping the large intestine healthy, balanced and well- populated with good bacteria (got probiotics?).
But, what about the health of the small intestine that is located before it in the digestive tract?
The truth is, this is where the serious business of nutrient absorption happens before the waste products are sent through to the large intestine or bowel to be expelled.
As you can imagine, there’s quite a slippery slope that ensues when the flora in this critical stretch of digestive highway goes out of balance.
What is SIBO and what are the symptoms?
At its most basic level, SIBO or Small Intestinal Bacterial Overgrowth is when bacteria or other microorganisms, good or bad, grow out of control in the small intestine - an area that would normally have a low bacterial count, as compared to the large intestine.
Microorganisms setting up shop in this area (colonization) end up damaging the cells lining the small intestine. This is otherwise known as leaky gut or an increase in intestinal permeability.
This, in turn, impairs the digestive process and overall absorption of nutrients which exacerbate nutritional deficiencies, allow toxins, pathogens and undigested protein molecules to enter the bloodstream that then cause widespread inflammation, food sensitivities, autoimmune disorders, and other immune reactions.
The most common symptoms of SIBO are:
Malabsorption issues and malnutrition
Weight loss (or gain)
Nausea and/or vomiting
Abdominal bloating or distention
Abdominal pain or discomfort
Acid reflux or heartburn (GERD)
Excessive gas or belching
Constipation and/or diarrhea
Skin issues like rashes, acne, eczema and rosacea
Aches & pains, especially joint pain
As mentioned, one of the biggest concerns with SIBO is that essential nutrients, protein, carbohydrates and fats aren’t being properly absorbed, causing deficiencies of iron, vitamin B12, calcium and in the fat-soluble vitamins: A, D, E and K.
What causes SIBO?
According to experts, the causes are not clearly defined but contributing factors to being diagnosed with SIBO can include:
Metabolic disorders including diabetes
Injury to the bowel
Recent abdominal surgery
Celiac disease is also associated with an increased risk for developing SIBO, and can be of particular concern, as it disturbs gut motility leading to poor functioning of the small intestine.
Another common conditions associated with SIBO is Irritable Bowel Syndrome. As a matter fact, studies have found that SIBO occurs simultaneously in more than half of all cases of IBS.
It has even been reported that successful elimination of bacterial overgrowth in the small intestine resolves symptoms of IBS too.
The use of certain medications, including immuno-suppressant medications, and proton pump inhibitors (acid reflux medications) as well as heavy metal toxicity, low stomach acid, inflammatory diets, and yep, you guessed it, stress - are all thought to be contributors as well.
How can you test for SIBO?
It is typically diagnosed using a breath test in which the patient drinks a sugar-containing drink and exhaled gases are measured.
If there are too many bacteria, excess gases (hydrogen, methane or both) will be produced. It should be noted that the reliability of this test is considered less than ideal, but it’s one of the only methods available at this time.
What’s the treatment for it?
Most holistic health practitioners advise adhering strictly to the “SIBO diet” for at least 2 weeks - which may include any (or all) of the following protocols:
Herbal antibiotics, including oregano oil
A low FODMAP, GAPS and/or AIP diet; unfortunately, this includes avoiding garlic & onions
Stress management; yes, this can help heal your gut!
Repopulating the good bacteria using probiotics, and then feed with prebiotics
In more severe or persistent cases, a prescription antibiotic may be needed to get the overgrowth under control.
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World Journal of Gastroenterology: “Small Intestinal Bacterial Overgrowth Syndrome”
World Journal of Gastroenterology: “Irritable Bowel Syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype?”
Journal of Clinical Gastroenterology: “Gastrointestinal motility disturbances in celiac disease”