Do you get bloated after most meals?
How about constipation that you can’t explain?—No matter how healthy you eat?
SIBO may be at play.
SIBO—Small Intestinal Bacterial Overgrowth—is a condition of the small intestine wherein there is an excessive overgrowth of bacteria.
In recent years, SIBO has gained more awareness, as many practitioners are realizing, what we once classified as “Candida” (yeast overgrowth) or an “unbalanced micro-biome” is actually often a little more complicated than once thought.
Although your gut is home to trillions of bacteria in certain locations of your digestive tract, if parts of your relatively sterile (clean) gut environment gets overpopulated with “bad” bacteria (il.e. think rotting food, undigested food, or toxins that are unable to cleanse through your body), then a problem isn’t far behind.
As bacterial overgrowth begins to builds up in both your large and small intestine bacteria, when the bacteria comes into contact with the food you eat, they produce methane—which can create abdominal discomfort, digestive difficulties and an uncomfortable bloated feeling.
Currently, there is no hard statistic of how many individuals are affected by SIBO, but since SIBO also often presents in a host of other conditions (listed below), estimates are in the millions.
Moreover, approximately 1 in 2 people with the condition don’t report experiencing GI (gut) symptoms at all (they have other symptoms)—which makes diagnosis of SIBO in many GI clinics UNCOMMON.
For example, in one study, 100 percent of fibromyalgia patients had SIBO, but only 50 percent of them had gut symptoms. In other words: SIBO patients (fibromyalgia) had muscle aches and pains and weakness that indicated SIBO—not the classic symptoms of bloating. http://ard.bmj.com/content/63/4/450.full
In addition, approximately 1 in 10 people have IBS—a severe case of diarrhea or constipation (or mixed). IBS is often linked directly to SIBO though—(and often times a reason why many IBS sufferers suffer with the condition for years, since SIBO is untreated).
SIBO Signs & Symptoms
Common signs and symptoms associated with SIBO include:
- Bloating after meals
- Diarrhea or loose stools (frequent)
- IBS (Constipation and diarrhea—mixed)
- Brittle nails and hair
- Dark circles under your eyes
- Low stomach acid (GERD, bloating, stomach upset when eating meat)
- Nutrient deficiencies
- Skin breakouts
- Fatigue throughout the day
- Blood sugar highs and lows
- Bad breath
- Brain fog
- Muscle pains or weakenss
Diagnosis of SIBO is not easy and not something your doctor can pick up on a blood test.
Breath testing is currently the primary testing mode of choice—consisting of a 2-3 hour test period, conducted at home, during which you breathe into a test kit at various periods in that time frame, then send it off to the lab where it is analyzed to see whether or not your methane levels spike during the test (indicating bacterial overgrowth).
More and more functional medicine practitioners and some GI doctors and nutritionists are offering the test if you want to confirm or rule out SIBO.
However, if many of the symptoms for SIBO sound like you, then often times approaching SIBO by treating yourself as if you had it is a second measure for assessing the disease.
If symptoms improve, then generally, SIBO was present—or at the very least a gut bacteria imbalance was present.
Initial treatment for SIBO typically involves a short-term targeted dose of anti-microbial supplements coupled with a real foods diet. Antimicrobials are herbal based supplements used along with probiotics and targeted nutrients to help reestablish a healthy gut microbiome.
While there is also a prescription medication called Rifaximin—that is also used to treat a “bad case” of IBS-D (IBS with diarrhea), it is often not warranted if one is consistent with sticking to their protocol.
I typically give a solid supplement protocol—built upon some top-of-the-line anti-microbials, probiotics, pre-biotics, and gut support aids—along with dietary interventions, a solid 60 days, then re-test the individual to see if symptoms have improved.
(Most often, they do).
The SIBO treatment diet is probably one of the biggest misconceptions amongst many practitioners and blogs you’ll read out there in cyberspace.
A lot of SIBO-sufferers are advised to go on a low-carb, ketogenic or low FODMAP diet during treatment in order to “starve” gut bacteria from common foods they love—even “real foods” like sweet potatoes, Brussels Sprouts, squashes, potatoes, garlic, onion, broccoli, cauliflower, asparagus, artichoke, mushrooms.
Many practitioners believe that low starch and low-FODMAP diets relieve symptoms and kill off bacteria by not feeding the bacteria.
However, when we nix carbs and starches altogether while treating SIBO, those bacteria go dormant.
Although this seems like a good thing (less symptoms and less active bacteria), it’s not a good thing when you are also trying to treat SIBO with Rifaximin or other antimicrobials (you’re trying to kill bacteria off).
Treatment may not work as well because the bacteria in a suppressed state are much more difficult to kill by the treatment protocol.
So what should a SIBO diet look like then?
Pretty simple: Real Food.
Cut Out the Crap: As you guessed it with most health and nutritional therapy approaches, food like processed foods, artificial sweeteners, sugar, hydrogenated vegetable oil (canola oil), conventional and refined grains, conventional meats and conventional dairy don’t help to create a healthy bacterial environment.
Add In: Build meals around a base of:
- 1-2 Healthy Fats (avocados, coconut oil, ghee, grass-fed butter, olive oil, avocado oil)
- Green Veggies
- Moderate amounts of starchy veggies (1-2 servings/day of sweet potato, butternut
- squash, spaghetti squash, plantains, carrots, beets)
- And, of course, lots of fresh filtered water throughout the day
Mindful Fruit Intake. Fruit consumption is recommended on a per-client basis. I often find many of my clients don’t feel well if they have SIBO and eat fruit—and many often are over consuming fruit (thinking of it as a “safe,” or low fat food and snack choice). While no food is inherently bad and a fruit ban is not forever, often times cutting back or cutting out fruit during treatment yields more positive results from a feel-good standpoint. If fruit is consumed, no more than 1-2 servings/day is recommended.
Intuitive Eating. Listen to your body and how certain foods make you feel—don’t force yourself to eat foods that trigger bloating or constipation (even if they are “healthy” foods), and keep consistent with your SIBO supplement protocol over the course of 30-60 days.
While there is speculation that SIBO is “stubborn” and easily comes back or is “hard to attack,” bacterial overgrowth can be won.
Consistency, along with follow-up “maintenance” care of proper digestive aids as needed (including a quality probiotic and potentially digestive enzymes), is where the race is won.
The bottom line?
You can feel good—like really good.