Small Intestinal Bacteria Overgrowth (SIBO) is defined as excessive bacteria in the small intestine that leads to an array of uncomfortable symptoms, including gas, bloating, pain, and fatigue.

I want to discuss SIBO in depth so you can have a greater understanding of the disease, how it affects the body, what you can do to treat it, and how to best work with your doctor to find healing and support.

What Is Small Intestinal Bacteria Overgrowth (SIBO)?

While it is normal for bacteria to be present in your digestive tract, in SIBO patients, the level of bacteria has increased to irregular numbers.

If laid out on a table, you’d see that your small intestine is the longest part of your digestive system. This is where all the important nutrients get absorbed. If you have SIBO, however, due to the overwhelming amount of bacteria, your body will have a difficult time absorbing all the nutrients. Particularly, you’ll have a hard time digesting fat-soluble vitamins and iron. No matter how much healthy food you eat, poor nutrient absorption can lead to health issues and if you already have an unhealthy diet, a compromised small intestine will make things even more difficult. This can lead to various unpleasant symptoms, including bloating, gas, fatigue and pain (1, 2)

The most common symptoms of SIBO include:

Nausea
Bloating
Vomiting
Diarrhea
Malnutrition
Abdominal pain
Cramps
Weight loss
Weight gain
Joint pain
Fatigue
Rashes

Many of these symptoms are similar to the symptoms of IBS. It is important for physicians to rule out SIBO before giving an IBS diagnosis. (3)

Will I Have SIBO Forever?

SIBO is not a life sentence, but the most common treatment of antibiotics often causes a relapse. Your best bet is to start making serious dietary changes, avoiding problematic foods, replenishing your gut bacteria using a pro-biotic supplement, and restoring your digestive functions. If you stay consistent and patient, you can beat SIBO overtime.

What Causes SIBO?

SIBO may be caused by a number of underlying conditions, including aging, diabetes, chronic pancreatitis, diverticulosis, injury, fistula, a structural defect in the small intestine and scleroderma. Immune system disorders, Celiac disease, recent abdominal surgery, immune system disorders, immuno-suppressant medications and proton inhibitors may also increase your risk. (4, 5)

Since Celiac disease disturbs gut motility, causing possible compromised small intestine function, those with Celiac are at particular risk. Research has found that 66 percent of Celiac patients on a strict gluten-free diet tested positive for SIBO. Those who are undiagnosed and/or not following a proper gluten-free regiment are at an even higher risk. Participants in the study were treated with antibiotics, prescription medication and dietary changes. They all reported a reduction in their symptoms. (6)

Having a blind loop syndrome that causes food particles to bypass certain parts of your digestive tract can cause bacterial overgrowth in your small intestine as well. (7)

Since aging slows down your digestion, the risk of SIBO is also higher. 30 percent of older adults with a disability and 15 percent of all people over 61 suffer from SIBO compared to 6 percent of those under 60. (8)

Diabetes is another risk factor of many gastrointestinal disorders, including SIBO. Up to 43 percent of those with diabetes have SIBO as well. (9)

There are also some disorders that at first sight seems to have nothing to do with digestion are associated with SIBO. People with rosacea, a condition that causes rashes and redness on the face have high rates of SIBO. (10)

Am I At Risk?

Any of the conditions mentioned above can increase your risk of SIBO. In addition, etating an unhealthy diet of processed foods and processed sugar, any otherwise compromised digestion, low stomach acid, and/or frequent antibiotic use can also increase your risk.

If you believe that you are at risk or are experiencing certain symptoms of SIBO, talk to your healthcare professional. Remember, as with every other health condition, early detection, and proper diagnosis is crucial for correct treatment and proper recovery. In the meantime, follow a healthy diet and lifestyle with lots of whole foods and eliminating processed sugar and processed foods to reduce your risk of SIBO.

Complications of SIBO

One of the main complications of SIBO is malnutrition. Not being able to properly absorb essential nutrients, fats, carbohydrates and proteins can lead to significant deficiencies, including in B12, iron, calcium, vitamin A, K, E and D.

When SIBO is left untreated it can lead to some serious health complications, including (11, 12, 13, 14, 15):

Anemia
Fatigue
Memory Loss
Weakness
A decline in cognitive function
Confusion
Central nervous system issues
Hallucinations

Testing for SIBO

SIBO can be diagnosed with the help of a breath test. There is two type of breath tests: Lactulose and Glucose Breath Test. Since humans can’t digest lactulose, only bacteria can, the lactulose breath test can check for the possibility of overgrowth based on hydrogen and methane levels reflected in the results. Glucose, on the other hand, can be absorbed by both humans and bacteria. This happens within the first three feet of the small intestine. While the glucose test is somewhat more accurate, it can only test for the first 17 feet of the small intestine. The lactulose test is less accurate but can check up to the distal end of the small intestine. Since both tests have advantages and disadvantages, most doctors use both tests for proper diagnosis. Tests can be taken using a home kit or at a lab. (16, 17, 18)

Methods For Treating SIBO

Antibiotics

Using antibiotics, such as rifaximin and neomycin is usually the first step of the treatment to combat unwanted bacteria in the small intestine. These antibiotics only work in the small intestine without spreading elsewhere. They show a 91% success rate killing bacteria. In order to avoid relapse, however, you have to deal with underlying issues and make appropriate lifestyle and dietary changes. (19)

Probiotics

Probiotics can help to create a healthy bacteria balance in the body. Lactobacillus was specifically shown to reduce hydrogen levels in a breath test. Probiotics can support other methods of treatment and can allow the body to remain healthy. Besides taking high-quality probiotics, it is important to eat probiotic-rich fermented foods, such as sauerkraut, kimchi, yogurt, kefir, coconut milk and kombucha. (20, 21, 22)

Herbal Supplements

Research shows that certain herbs in capsules and tinctures can be as effective as antibiotics and can support an antibiotic regimen or be used when antibiotics don’t seem to be effective. Herbal supplements, such as lemon balm, garlic, berberline, oregano oil, wormwood oil, Indian barberry oil, neem and Chinese skullcap show promise to treat SIBO effectively. It is important to use the most therapeutic formula and correct dosage for your specific needs to see results. Work with a qualified healthcare practitioner before taking any type of herbs. Most functional doctors recommend a combination of antibiotics and natural supplements. (23, 24)

Vitamin and Mineral Supplements

Since SIBO can result in serious vitamin deficits, taking various supplements, in particularly B12, D, K, iron, and zinc can be helpful. Digestive enzymes may also help your recovery. Talk to your healthcare provider if taking supplements is right for you.

Follow a SIBO-Supportive Diet

Following a SIBO-supportive diet shows high success rates in treatment and overall health maintenance. There are a variety of SIBO-supportive diets you can choose from to rebalance your body. Most diets focus on removing some, if not all, carbohydrates, sweeteners, processed sugars, and processed foods. They also cherish eating lots of plant foods with a focus on healthy animal products. Work with a healthcare practitioner to choose the right meal plan for you.

The Specific Carbohydrate Diet is a more lenient version of the Paleo Diet that allows legumes and certain dairy but eliminates starchy vegetables and sweeteners. The focus is on animal protein, ripe fruits, non-starchy vegetables, leafy greens, and seeds. (25)

The Gut and Psychology Syndrome Diet (GAPS) focuses on non-dairy fermented food, organ meat, bone broth and healthy fats. (26)

The Low FODMAP diet stands for fermentable oligosaccharides, disaccharides, monosaccharide and polyols, focuses on the elimination of fermentable sugars that can feed bad bacteria, such as dried fruits, sweeteners, and many carbohydrates. The Low FODMAP Diet starts as an elimination diet for 2 to 6 weeks, then moves into a maintenance phase allowing more foods but still following a strict guide. (27)

The SIBO Specific Foods Guide is the most restrictive when it comes to carbohydrates, but also seems to be somewhat more successful than the other three mentioned. (28)

Frequently Asked Questions About SIBO

Q. Will SIBO ever go away?

A. With patience, perseverance and a change in diet, SIBO can be treated. Treatment involves restoring digestive function, eliminating excess bacteria, avoiding certain foods, and replenishing your gut with beneficial bacteria. Realistically, recovery can take several months or even a year.

Q. Will SIBO kill me?

A. No, but a compromised digestion can lead to more serious health conditions down the road.

Q. When was SIBO discovered?

A. Though the symptoms of SIBO have been known for a while, SIBO is a relatively new diagnosis.

Q. Can SIBO cause acid reflux?

A. Yes, SIBO can lead to worsening of all kinds of digestive discomfort, including acid reflux.

Q. Why does SIBO cause fatigue?

A. Yes, bacteria overgrowth and imbalance in your body can lead to fatigue.

Q. Are SIBO and candida the same thing?

A. No, SIBO is a bacteria overgrowth while candida is yeast overgrowth in your body.

Q. Where is the pain from SIBO?

A. SIBO can cause pain and discomfort associated with its symptoms, including abdominal pain and cramps.

Q. How can I gain weight with SIBO?

A. Yes, SIBO can lead to changes in weight, including weight gain and weight loss. Weight loss is more common than weight gain.

Conclusion

If you think you might have SIBO, I suggest scheduling an appointment with your healthcare professional.

You will create the best results in your life and health goals if you commit to being your own #HealthHero. This means that you are committed to your well-being and will do what it takes to live a life of health and vitality. When you feel your best, you can make the most impact in the lives of those you love and in the community you live in.

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References:

Partha Nandi MD, FACP

`Partha Nandi MD, FACP`

What Is Small Intestinal Bacteria Overgrowth (SIBO)?