Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is short for Small Intestinal Bacterial Overgrowth. What a mouthful- we’ll just stick to the acronym for the rest of this article! Although not a new disease, SIBO has become more widely recognized within the past decade. Why is this? You’ve probably heard of IBS (Irritable Bowel Syndrome). Well, a study by Mark Pimentel, a leading gastroenterology researcher, found that 78% of his study participants with IBS were positive for SIBO¹. What’s more, some common IBS treatments such as increasing fiber intake can actually worsen SIBO symptoms!
So What Exactly is SIBO
SIBO occurs when bacteria that are normal and happy in the large intestine grow in the small intestine. These bacteria do wonderful things for you–when they’re in the right location. If you think about the small intestine, just as the name implies, it has less width than the large intestine. Bacteria take the food you eat and release gases, which is fine in a large space. But when that space is smaller, those gases don’t have anywhere to go and cause symptoms such as bloating and abdominal pain.
Common SIBO Symptoms
- Bloating after meals
- Abdominal pain
- Diarrhea, constipation, or alternating between the two
- Excessive gas
- Skin issues such as eczema
- Brain fog/fatigue
- Joint pain
- Food sensitivities
- Iron and B12 deficiency
As you can see, symptoms of SIBO don’t just reside in the gut. We see people with a wide variety and combination of these symptoms.
What Causes SIBO?
Your body is smart and has multiple safeguards in place to prevent SIBO from occurring. When one or more of these safeguards fails, SIBO can occur. One of the most common causes of SIBO is a bout of food poisoning. So why doesn’t everyone who has had food poisoning have SIBO? In the majority of people, food poisoning occurs and the immune system mounts an attack on the bacteria that are responsible. Once those bacteria are killed, this attack stops. In a small portion of the population, the immune system continues to attack. It wrongly believes that a part of the small intestine called the Migrating Motor Complex (MMC) is related to the bacteria that caused food poisoning. Our immune system attacks the MMC, thinking it is fighting off invaders! The MMC is one of our safeguards against SIBO. It creates a sweeping motion in the small intestine to move food and bacteria into the large intestine. If it isn’t able to do its job, SIBO can occur. Another common cause of SIBO is adhesions from abdominal surgery (such as appendectomy, gallbladder removal, and hernia repair). These create obstructions that impair the movement of food and bacteria through the small intestine. Other contributors to SIBO:
- Low stomach acid- this is one of our first lines of defense against bacteria in our food. Proton pump inhibitors used for Reflux/GERD lead to low stomach acid.
- Chronic opioid and antibiotic use
- Chronic stress- when our bodies are always in “fight or flight” mode, resources aren’t devoted to the GI Tract. During the time of hunters and gatherers, if we needed to run from a tiger we didn’t need proper GI function! Now, our bodies can’t tell if stress is from a tiger or our jobs, and continues to react in the same way.
How Do We Test for SIBO?
We have the Quintron breath test machine right in our office, so no need to ship test tubes off to external labs or wait for months on end! Test kits can be picked up on the day of your appointment and returned directly back to us as soon as you have completed them. If SIBO may be causing your symptoms, we will run a Lactulose Breath Test (LBT). This consists of a 24-hour diet prep period, followed by consumption of lactulose. Bacteria in the small intestine create methane and hydrogen gases from lactulose, which are then released from your lungs. You will blow into test tubes every 20 minutes for 3 hours so that we can see the lactulose traveling from the small intestine into the large intestine based on the gases. Pretty interesting, right?
There are three main types of SIBO treatment: conventional antibiotics, herbal antibiotics, and the elemental diet. We will work with you to create a treatment plan that fits your personal needs and diagnosis. During the treatment, we will also utilize dietary changes to complement our approach. We know that SIBO can be a chronic condition in about two-thirds of people and will work with you to prevent relapse. This is what sets us apart from many conventional practices. We know that simply killing the bacteria is just a single part of SIBO treatment. We spend much more time with each patient to get to know each person’s individual history and work to find the root cause of this illness. After SIBO is treated we provide continued support for a healthier, SIBO-less life! If you think you might have SIBO, give us a call so we can help. Our trained professionals know how important gut health is, so please don’t be embarrassed to tell us about your gastrointestinal symptoms. We’re ready to discuss your individualized treatment needs.
References: ¹Pimentel, M., Chow, E. J., & Lin, H. C. (2000). Eradication of Small intestinal bacterial overgrowth reduces symptoms of Irritable Bowel syndrome. The American Journal of Gastroenterology, (12), 3503.