Small Intestinal Bacterial Overgrowth, or “SIBO” is defined as the presence of excessive bacteria in the small intestine. It develops when the normal homeostatic mechanisms that control small intestinal bacterial populations are disrupted.
SIBO is characterized by a wide variety of non-specified signs and symptoms, and often times individuals may not even “feel” small intestinal bacterial overgrowth in their gut. Common symptoms include:
- IBS (interchanging loose stools and hard stools)
- Skin problems
- Hallostasis (bad breath, despite brushing teeth)
- Muscle ache/weakness/pain
- Brain fog
- Nutrient deficiencies or “off” blood work markers
Other not-so-known symptoms of gut dysfunction include:
- Autoimmune conditions
- Adrenal distress
- Mood swings
- Anxiety and depression (brain gut connection)
- Hormonal Imbalances
- Thyroid imbalances
- Difficult focusing
- Low energy
- Blood sugar imbalances
WHAT CAUSES SIBO?
There are 3 primary causes of SIBO:
1. Low Stomach Acid Secretion
If stomach acid is low, it suppresses the growth of ingested bacteria.
2. Sluggish Digestion
Poor gut motility (movement and digestion) of the small and/or large intestine encourages the overgrowth of bacteria since food is left to ferment for longer than it should and is unable to be broken down. Disruption of the migrating motor complex also compromises digestion in the gut, which normally has a cleansing action and prevents the overgrowth of bacteria.
3. Disrupted Gut Microbiome
Last, but not least, imbalanced gut bacteria (“dysbiosis”) in the colon leads to overgrowth of bacteria in the small intestine. Additionally, it is well-established that antibiotic use can lead to disrupted gut bacteria, and in turn result in small intestinal bacterial overgrowth.
HOW DOES MY GUT MICROBIOME GET “DISRUPTED?”
An increase in “bad” bacteria in the small intestine is most often a result from an overgrowth of bacteria further down the line—in the colon.
When our large intestine gets backed up with things like:
- Undigested food particles
- Foreign chemicals and substances (from artificial sweeteners to soy, sugar, phytates and lectins in grains)
- An overload of waste
- Reduced stomach acid (preventing proper digestion throughout the rest of the system)
- Structural damage on the protective valve of the large intestine (intended to keep food from refluxing back into the small intestine)
… This sets the stage for bacterial overgrowth.
Other triggers that may increase your probability of SIBO include:
- Not chewing our food enough
- Eating on the go/in a hurry
- Lacking digestive enzymes
- Eating gut-irritating foods that are difficult to break down
- Not drinking enough water
- Not eating enough fat in our diet
- Lack of fiber (especially cooked veggies) in our diet
- Intake of sugary foods and sweets
- Medications & oral birth control
- Antibiotic use history
- Formula-fed and C-section birth
- Toxic hygiene products, cleaning products and other environmental toxins
HOW DO I KNOW IF I HAVE SIBO?
There are two primary modes of testing for SIBO:
1. Lab Endoscopy
2. Breath Test
The Breath Test
Due to the costly and invasive nature of endoscopy testing, the SIBO breath test is the most commonly used test in functional medicine settings. It’s important to note that while urine, stool and blood markers can be helpful in further assessing the presentation of small intestinal bacterial overgrowth, none of these markers can confirm a SIBO diagnosis alone.
Breath testing is based on the premise that bacteria in the intestines metabolize carbohydrates like lactulose, glucose, sucrose, or xylose and produce gases like hydrogen and methane, which can be measured in the breath.
That said, there are certain types of SIBO that can go undetected or diagnoses–namely hydrogen sulfide based SIBO, and it can effectively be treated with a safe botanical, herbal protocol without official testing confirmation if signs and symptoms suggest small intestinal bacterial overgrowth is present. The result? If the individual does in fact have small intestinal bacterial overgrowth, generally, the symptoms and condition improves tremendously after following a small intestinal bacterial overgrowth protocol for approximately 30-90 days. If the individual did not have small intestinal bacterial overgrowth, they generally will feel the same after the protocol and further testing is recommended.
Work with a healthcare practitioner familiar in SIBO to assess your condition together.
HOW DO I TREAT SIBO?
If SIBO is suspected or detected, a 30-90 day antimicrobial protocol is initially recommended through supplements or specific prescription antibiotics. It is in conjunction with a real-food diet and essential lifestyle changes. Re-testing at the end of your small intestinal bacterial overgrowth treatment can help confirm if SIBO treatment was beneficial. Also, it will tell you if a longer or more aggressive approach to SIBO is necessary. Work with your healthcare provider to determine continuing recommendations.