SIBO: The common gut condition you haven't heard about

Have you heard of small intestinal bacterial overgrowth, aka, SIBO? It's a form of dysbiosis, in which an overgrowth of bacteria in the small intestine can lead to an array of uncomfortable symptoms in  the short term, including excessive gas, bloating, diarrhea and/or constipation, and more serious consequences if left untreated. But isn't bacteria in the gut a good thing? It is- when it remains in the colon, or large intestine, where the majority of gut bacteria should reside. But when bacteria from the colon move into the small intestine and begin to grow there, leading to uncomfortable symptoms, that is SIBO. 

Risk factors include low stomach acid, long-term use of proton-pump inhibitors (PPIs), irritable bowel syndrome (IBS), poor pancreatic function, Crohn's disease, liver disease, Celiac disease, diabetes, obesity, and older age. Those with SIBO share the same cluster of symptoms: severe bloating/abdominal distension, excessive gas, cramping, diarrhea, and /or constipation. Non-GI symptoms may include brain fog, headaches, fatigue, joint pain, and skin conditions, especially if SIBO is left untreated. Long-term symptoms may also include malabsorption of important nutrients, including vitamin B12 and fat-soluble vitamins like vitamin D, which can lead to malnutrition and vitamin deficiencies.

Our guts have several built-in mechanisms to prevent bacterial overgrowth-gastric acid and bile secretion, digestive enzymes, a healthy intestinal mucosal layer, and normal intestinal motility all play a role in preventing excessive colonization of the small intestine by bacteria, but if any one of these is compromised, you can become susceptible to developing SIBO. To add insult to injury, SIBO can significantly interfere with these processes and functions, so if you are already starting with an unhealthy gut, SIBO only compounds the problem. It can also leads to increased intestinal permeability (aka, leaky gut) and certain strains of bacteria can produce toxic substances that can increase inflammation not only in the gut, but throughout the body. 

How do we test for SIBO?

The least invasive test to diagnose SIBO is a breath test that measures levels of hydrogen and methane. These gases are produced by bacteria that live in our guts and an increase in levels of either of them can indicate an overgrowth of bacteria in the small intestine specifically. 

How do we treat SIBO?


1. Reduce

The first  step in treatment is to eliminate the problematic bacteria in the small intestine-this is commonly done via prescription or herbal antimicrobial treatment. Because long-term treatment with antibiotics can lead to further dysbiosis, diarrhea, and possibly an increased resistance to antibiotics in general, more people are opting for herbal antimicrobial blends, which have been shown to be as effective as the antibiotic rifaximin, commonly used to treat SIBO. Along with antimicrobial treatment, a short-term elimination diet is recommended to remove the foods that promote the growth of bacteria.

2. Restore

As you work to eliminate bacterial overgrowth, it is also important to work to restore your gut to good health to prevent SIBO from recurring. Nourish your gut with healing foods like bone broth, MCT oil, and ghee; these foods contain compounds that actively help heal the gut lining.

Digestive enzymes and betaine HCL (hydrochloric acid) improve digestion and restore normal gastric acidity, which helps you to better digest food and absorb nutrients while creating an environment inhospitable to bacteria. Apple cider vinegar taken before meals can also support healthy stomach acid production. The amino acid L-glutamine is one of the best known for healing the lining of the small intestine- the cells of the small intestine use L-glutamine as fuel to create optimal health in the intestinal lining, improving digestion and absorption of nutrients. 

3. Repopulate

It is generally advised to avoid probiotics while you reduce bacteria in the small intestine. However, one probiotic in particular- S. boulardii- is the exception. Wait until you have cleared bacteria from the small intestine before you repopulate the colon. Once you are in the clear to do that, probiotics will provide the healthy bacteria you need in the colon to promote overall gut health.

Finally, because SIBO can lead to nutrient malabsorption and thus sub-optimal levels of certain nutrients, it's a good idea to take a quality multivitamin supplement (with special attention to vitamin B12 and fat-soluble vitamins such as vitamin D).