SIBO stands for Small Intestine Bacterial Overgrowth. SIBO is thought to account for somewhere between 50 - 80% of IBS cases, but is commonly misunderstood or unheard of.
What is SIBO?
The large intestine is a rich and diverse microbiome of beneficial bacteria. Whilst they are contained in the large intestine, they help us by creating short-chained fatty acids that are needed all over the body. They keep the PH of the gut at the right level and help our digestion function optimally. They even create certain vitamins and nutrients out of our waste.
These bacteria are essential, but occasionally, they can creep out of the large intestine and enter the small intestine. When they are in the wrong location, they can cause a great deal of digestive discomfort. There`s lots of reasons why they get displaced from the large intestine into the small intestine. The ileocecal valve that keeps the two separate may be a little loose, or it might be that a person may not have enough stomach acid and they are entering through the mouth and making their way down to the small intestine because the stomach acid isn`t doing its job. Some peoples movement of the bowel is a little slow, so waste gets pushed along a little slower. Stress can also be a causative factor, especially if a person is living in a sympathetic nervous system state over a prolonged period of time.
There are certain medical conditions that increase the likelihood of getting SIBO, including:
Hypothyroidism, Parkinsons, Liver cirrhosis, Diverticulitis, Small intestine structural abnormalities, Coeliac disease, Diabetes,Pernicious anaemia, pancreatitis, Fistulas or injury.
Diet and lifestyle can also be a cause, especially for those who suffer from alcoholism. Ageing also increases the chance of SIBO
What are the symptoms of SIBO?
The bacteria in our gut help us digest our food by fermenting our waste. When this happens in the colon, it is perfectly fine. When these bacteria creep out of their original home and enter the small intestine, the fermentation causes a great deal of gas. This causes trapped wind, digestive pain, cramping and changes in bowel habits.
Here are some common symptoms of SIBO
Gas - belching and flatulence
Abdominal pain - discomfort and camps
Constipation or Diarrhoea or a mixture of both
Muscle and joint pain
Skin problems - eczema or rashes
Mood disturbances - depression, anxiety
Neurological symptoms - Autism, ADHD
Some people with SIBO will encounter:
And dark circles under the eyes
Aches and pains during the afternoons
How do I know if I have SIBO?
If you are nodding your head to most of the symptoms above, it is important to find out if you have SIBO. There is a very simple laboratory test that can be done to find out if you have SIBO. It`s called a SIBO breath test. The bacteria create hydrogen and methane as a bi-product of their fermentation. If the bacteria are in the correct place, then these bi-products won`t normally cause such a problem and wouldn`t be detectable in your breath as much. If they are in the small intestine, these gases can be measured in your breath in larger quantities. The test involves following a special diet two days before the test, then drinking a glucose solution. After drinking the solution you simply breathe into a sample kit at regular intervals over a two to three hour period. This is then sent off to the laboratory and analysed. Excess levels of these gases indicate that you may be affected by SIBO.
What can I do about SIBO?
It`s important to get SIBO under control. The longer it stays in the small intestine, the more chance you have of developing Leaky gut because SIBO can damage the intestine lining. (see my other article on leaky gut). If this happens, you can develop intolerances to certain foods. Sibo also implicate the digestion of nutrients, especially iron, B12 and fat soluble vitamins. If the problem persists a person can develop malnutrition. The naturopathic approach to supporting SIBO involves a combination of dietary changes and herbal antimicrobial supplements to support its elimination. The herbs used have been studied and found to be as effective as three rounds of antibiotics, without causing the harm to the microbiome that antibiotics cause.
The goal of the SIBO diet is to lower inflammation in the intestines and repair the intestine lining, whilst ridding the small intestine of the bacteria that shouldn`t be there.
You will need to eat smaller quantities at meal times to start with. Eating smaller meals allows the body to digest food more quickly and efficiently. Meals can be spread out over 5 - 6 smaller servings rather than 3 larger ones. It`s also really important not to rush whilst eating. You should thoroughly chew every bite.
Bacteria use carbohydrates as their source of primary fuel, so a low carbohydrate diet is essential whilst trying to balance SIBO. As is a low sugar and low caffeine/alcohol diet. Dairy foods also should be removed whilst supporting SIBO.
You will be given information about the SIBO diet to follow.
It`s important to make sure that you are well hydrated and drink an adequate amount of water each day. Please read my other article about water in the learning section.
You should also consider the stresses that you have in your life. Balancing your stress levels is vital for overcoming SIBO. Schedule in self care time each day, even if it`s just half an hour sitting outside with the sun on your face. Yoga, Tai Chi and relaxation techniques are all very effective.
If the problem persists after cutting out the carbohydrates and sugars, it may be necessary to follow a low FODMAP diet for a little while.