What is SIBO?
Small Intestine Bacterial Overgrowth (SIBO) is a chronic bacterial infection of the small intestine. Since these bacteria normally live in the gastrointestinal tract, SIBO occurs as a result of the bacteria colonizing in a place where they do not belong. When there is an abnormally high number of bacteria present in the small intestine, it can cause issues symptomatically as well as internally.
What are the common symptoms of SIBO?
There are countless symptoms associated with SIBO, but the most common symptom is abdominal bloating that worsens as the day goes on. In many cases, people will wake up with a fairly flat abdomen in the morning, which distends throughout the day and usually worsens after meals. Other common symptoms of SIBO include diarrhea, constipation, gas, belching, fatigue, low mood, and skin issues.
It can be challenging to figure out the cause of these symptoms because they are not directly correlated with specific types of food and can improve or worsen every few weeks throughout the course of the bacteria’s lifecycle. Some people will experience symptom relief for a period of time only to notice flare ups without making any dietary changes. This can be frustrating as the root cause is difficult to pinpoint.
Internally, large amounts of bacteria in the small intestine interfere with digestion and block the absorption of nutrients from the food that we eat. The bacteria take the nutrients from the food and use it for their own benefit, rather than the normal process of our cells using those nutrients. This can lead to low levels of vitamin B12 and iron, since the bacteria in the small intestine love to use those for a fuel source. They also use dietary fiber as a fuel source, so high fiber foods in the diet are used for their growth, as well. The high levels of bacteria in the small intestine also decrease fat absorption, which can lead to a decrease in one of our most important fat-soluble vitamins, vitamin D.
Intestinal permeability, commonly referred to as “leaky gut,” is also a side effect or symptom of SIBO, as the bacteria are associated with damage to the lining of the small intestine. When the GI lining is permeable, the tight junctions of that lining have loosened, so that toxins, bacteria and food particles can slip through the cracks and into our blood.
Gas created by the bacteria when they ferment the food we eat is a huge cause of belching, bloating, flatulence, abdominal discomfort and bowel changes. The bacteria also produce different acids and ammonia, which can cause neurological and cognitive issues, such as restless legs, brain fog, difficulty concentrating and poor memory.
How do you test for SIBO?
Lactulose breath testing for SIBO is the gold standard for diagnosis. The bacteria in the small intestine produce both hydrogen and methane gas, which is measured in the breath test. The day before taking the test is a preparation day with a limited diet consisting of mainly animal protein, followed by an overnight fast for 12 hours. The test is performed at home, at least one hour after waking, and takes 2 hours and 15 minutes to complete. Breath samples are collected every 15 minutes to assess the levels of both gases after a lactulose solution is ingested.
How do you treat SIBO?
Treatment for SIBO is a multi-faceted approach that allows for eradication of the bacteria along with changing the internal GI environment to avoid reinfection and regrowth. There are 5 pillars of SIBO treatment at Spark Health:
1. Anti-bacterial Treatment
Using either antibiotics or natural anti-microbials is the first step towards eliminating the overgrowth of bacteria in the small intestine. In order to begin the process of balancing the bacteria in the digestive system, we first must eradicate the bacteria that should not be present in the small intestine. This gives us a clean slate to start rebuilding a healthy GI environment down the road.
2. Diagnosis-Specific Diet
After completion of antibiotics, it is important to starve the remaining bacteria of their dietary fuel source, and not to allow new growth of bacteria to flourish. This is not a calorie, fat or carbohydrate restricted diet, but it removes all foods that the bacteria are able to ferment.
3. Internal GI Environment
Changing the environment of the digestive tract creates an inhospitable environment for unwanted bacteria to grow and allows beneficial bacteria to colonize in the right areas. This is accomplished with supplements for digestive enzyme support, stomach acid production, bile salts, dietary starch breakdown, biofilm disruption and GI lining support.
4. GI Motility and the Brain-Gut Connection
The muscles that comprise the digestive tract are involuntary, meaning that they need direction from the brain and nervous system to contract to propel contents downstream. Since we can’t voluntarily control those muscles, valves and sphincters, we need the proper nerve input to tell the GI tract how to mechanically function.
5. Nervous System and Stress Response
In order to have a healthy, happy gut, we need to make sure that our bodies are not caught in a constant state of fight or flight, also known as sympathetic upregulation. We need to be able to switch into parasympathetic mode, which allows for proper digestion. Stress management is a huge part of successful SIBO treatment.
This is a time-consuming and intensive process, but when done correctly under the guidance of an experienced doctor, the results are life-changing, and patients feel better long term.
Can SIBO come back?
Unfortunately, once someone has been treated for SIBO, there is a chance that it could come back. This can happen if:
1. Your original treatment for SIBO was ineffective
Antibiotics alone are sometimes not enough to kill the misplaced bacteria. Sometimes a combination of treatments, such as an antibiotic paired with a motility enhancing and or gut healing supplement will provide the best relief.
2. Your GI motility is low
If you have ever experienced chronic constipation, type I diabetes, celiac disease, Crohn’s disease, or hypothyroidism, your GI motility could be slower than average. If this is the case, you may need to take specific actions to improve GI motility before being treated again for SIBO.
3. You are not adhering to healthy lifestyle choices
If you decide to go back to being inactive and eating unhealthy foods, you could also experience a recurrence of SIBO.
When you do not move your body, a reduced amount of blood flows to the digestive tract. This, in turn, can slow GI motility. As a result, it will take longer for the small intestine to digest food, leaving plenty of time for bacteria to grow where it shouldn’t.
Eating too often can also affect a person’s chances for getting SIBO again. The migrating motor complex (MMC) is a recurring cycle that clears the food out of your stomach every 90 minutes once the stomach is empty. However, if you are continually snacking, the MMC does not have enough time to do its job and remove the excess food to keep the small intestine clear. This creates the perfect opportunity for SIBO to swoop in.
4. You had a case of food poisoning
There are many bacteria that can be responsible for causing food poisoning, including E. coli, Campylobacter jejuni, Shigella, and Salmonella. The one thing that all of these bacteria have in common is a substance known as cytolethal distending toxin (CDT), which has been shown to damage cells in the intestines. Therefore, if you have prior damage to the intestine, it can be easier to contract SIBO.
The best way to prevent SIBO recurrence is to continue to implement healthy diet and lifestyle choices that support healthy gut function and motility. And working with a team of naturopathic doctors is a great way to ensure that you have access to all the resources you need to achieve your goals.
If you are interested in learning more about optimal gut health and how to prevent and treat SIBO, please reach out to the Spark Health team. We take a collaborative approach to natural medicine, partnering with patients to help them achieve their unique health and wellness goals. Please call us at (858) 228-4188 or send us an email at firstname.lastname@example.org to schedule an appointment.
Spark Health naturopathic health clinic is located in Solana Beach, San Diego County, CA, and was founded in 2013.
Article written by Dr. Aliza Cicerone, NB, FABNO