SIBO stands for “Small Intestinal Bacterial Overgrowth,” which means bacterial overgrowth in the small intestine. In a healthy system, a higher concentration of intestinal bacteria lives in the colon than in the small intestine. In SIBO, bacteria from the colon invade the small intestine and interfere with food digestion that occurs in the small intestine via digestive enzymes.
SIBO: Invisible Cause of Digestive Problems
In SIBO, the food in the small intestine is consumed by bacteria causing fermentation. A byproduct of the bacteria’s digestion is methane and/or hydrogen gas. Among other things, these gases cause bloating, flatulence, cramps, diarrhea, burping and constipation.
The other side effect of SIBO is further disruption of food digestion in the small intestine resulting in nutrients not being absorbed. When the bacteria digest the food in the small intestine, it means they absorb many of the nutrients, leading to malabsorption (poor absorption) of monosaccharides, amino acids, vitamins (especially B12 and folic acid) and minerals (especially magnesium, iron and calcium).
Side effects of poor nutrient absorption can include fatigue, hormonal imbalance and restless legs. SIBO generates toxins, which burden the lymphatic system, the immune system and our own detoxification system.
Unfortunately, SIBO goes largely undiagnosed, which can lead to years of problems in the small intestine. People may develop intolerances to certain foods such as gluten, lactose or fructose as the digestive quality of the small intestine decreases.
SIBO Treating: Dual Approach to Recovery and Balance
SIBO is a major cause of irritable bowel syndrome (PDS). It is difficult to treat other digestive problems if SIBO remains present, and the longer it is present the more problems it can cause.
A dual approach is often taken as treatment; starvation of the bacteria and active treatment. The important thing seems to be to stop feeding the bacteria. This means dilating the foods that the bacteria like to eat such as sugars, carbohydrates and starches. The bacteria can live for several months without food, so a diet that avoids these substances is recommended.
In addition to starving them, it is important to reduce their numbers by killing them. This can be done by treatment with herbal antimicrobials, antibiotics or both. When both approaches are taken (starving and killing), good results are often achieved. It is also important to address stress levels, poor sleep and exercise, as these can affect recovery. Once the bacteria are gone, it is important to reintroduce the good bacteria to help heal the gut and fight future battles against the bad guys.
It is important to understand why the body developed SIBO. Just as bloating can be a symptom of SIBO, SIBO is a symptom of an underlying imbalance that allowed bacteria to migrate and multiply in the small intestine.
What is the underlying cause of SIBO?
It is important to see what the underlying cause is. This bacterial overgrowth can occur when bacteria travel from part of the colon to the small intestine or when natural bacteria in the small intestine multiply too much.
People can develop SIBO due to the following factors:
– disturbed or delayed intestinal peristalsis
– deficiency of stomach acid, bile acid, use of inflammatory or antacids. (Stomach acid kills bacteria)
– physical abnormalities of the small intestine
– weakened immune system
"SIBO: Recognize the symptoms and discover the road to recovery"
What are the signs and symptoms of SIBO?
The signs and symptoms of SIBO are similar to those of other digestive disorders such as PDS. SIBO directly affects the gut and causes uncomfortable digestive problems and symptoms such as: gas and bloating, diarrhea, abdominal pain or cramps, constipation, alternating constipation and diarrhea, heartburn or reflux, food hypersensitivity (including gluten, dairy, lactose, fructose, FODMAP). But also oily and often floating/sticky stools, nausea, headaches/migraines, fatigue, skin rashes, joint complaints, moods (depression, anxiety), concentration disorders, craving for fast sugars and carbohydrates, bad breath.
What are the risk factors?
People with certain medical conditions are more likely to have SIBO. Doctors consider SIBO a possible complication of the following conditions: cirrhosis, Crohn’s disease, celiac disease, hypothyroidism, HIV, Diabetes, PDS, scleroderma, fibromyalgia. Other risk factors for SIBO include: long-term use of proton pump inhibitors, which are drugs that reduce stomach acid production, bowel surgery, having recently taken a course of antibiotics, alcohol.
How is SIBO determined?
Unfortunately, there is no perfect test. The small intestine is a difficult place to reach. Endoscopy reaches only into the upper part and colonoscopy reaches only into the end part. The middle part, which is very long, is difficult to access. Stool tests mainly reflect the colon.
Fortunately, there is a non-invasive test that is widely used in SIBO research; the hydrogen and methane breath test.
How can SIBO be treated?
Currently, SIBO can be treated through three options: antibiotics, plant-based antibiotics and diet.
Antibiotics:
Antibiotics are often a preferred treatment option by both gastroenterologists and patients because they attempt to attack bacterial overgrowth quickly. Rifaximin and Neomycin are the most commonly prescribed antibiotics for SIBO because they are almost completely nonabsorbable and remain in the small intestine. This means they have localized action and do not cause systemic-or widespread-side effects.
Herbs:
Herbal antibiotics also attempt to directly attack excess bacteria by reducing the number of bacteria in the small intestine. Herbs are often the first choice of alternative therapists, naturopathic healers and integrative physicians. Herbs take longer to take effect. Studies have shown that herbal therapies are as effective as Rifaximin and have a similar response rate and safety profile. Some of the most commonly used herbs include allicin, oregano, berberine and neem. Like all treatments, the appropriate herbal protocol must be determined for each individual patient.
Diet:
All dietary treatments strive to reduce food sources for the bacteria. They try to feed the person but starve the bacteria. The diet developed by Dr. Siebecker, a specialist in SIBO, has a significant impact on our gut bacteria population. Bacteria eat mainly carbohydrates, so all recommended diets reduce carbohydrates to try to reduce the bacteria and especially the gas they produce, by limiting their food supply. The only carbohydrates that bacteria do not eat much of are insoluble fiber. The established SIBO treatment diets are advised and supervised by natural dietitians. This diet includes:
- Avoid foods for which a hypersensitivity has been tested.
- Beware of heavy food combinations and cooking techniques that aggravate digestion.
- Avoidance of exorphins (if demonstrated)
- Avoid bile-disrupting foods (frying, deep-frying) and add foods that regulate bile flow.
In addition to the treatment protocol, a patient’s diet is important in supporting recovery from SIBO. It is currently believed that diet alone cannot cure SIBO, and instead is used to support treatment and provide relief from digestive symptoms. A restricted diet is designed to be used only briefly.
It is important to reintroduce a wide range of foods and fermentable fibers as they nourish the broader gut microbiome. In addition, it is necessary to understand why the body developed SIBO in the first place. Just as bloating can be a symptom of SIBO, SIBO is a symptom of an underlying condition that allows the bacteria in the small intestine to migrate and multiply. The underlying cause must be understood and addressed to achieve permanent recovery from SIBO.
In my practice, I always look at the big picture: gut function, stress load, hormones, nutrition and lifestyle.
Want to get started concretely with a nutrition approach at SIBO? If so, it may be helpful to review this overview by Dr. Nirala Jacobi. bi-phasicdite protocol
Think of it as temporary support within a broader recovery plan. If you would like to be personally guided in this, so that nutrition does not limit but rather supports your recovery process, I would be happy to look into this with you. Warm regards, Dafna