SIBO: What is it & How to Treat it
This week we’re talking you through a specific digestive issue; SIBO. In this post you will find the symptoms associated with the condition, the potential causes, how one diagnoses this condition and some of the treatment options available from a naturopathic perspective. As usual, please do not take this as medical advice. If you think you may have this condition it is important to have a personalised 1:1 consult to determine this. We also use functional testing establish if this is what’s going on - discussed further in this journal post.
Overview:
Small intestinal bacterial overgrowth (SIBO) is a common problem, experienced by many. As the name suggests SIBO is characterised by an abnormally increased amount of bacteria within the small intestines; which is the section of your digestive tract that absorbs most of your nutrients and also connects the stomach to the large intestines. The presence of symptoms (discussed in the section below) are also usually present.
Symptoms:
The symptoms of SIBO are some-what general and not specific to this issue ( if you've seen any of my gut health posts over on Instagram these symptoms may be familiar ! ) Someone with SIBO may be experiencing diarrhoea, flatulence, pain of the abdomen, belching, distension, bloating, and indigestion. Other symptoms include 'brain fog'
SIBO can also be the underlying cause of other issues, such as chronic diarrhoea, malabsorption of nutrients, unwanted weight loss, even osteoporosis and more serve conditions if left untreated. It can also result in 'leaky gut', which is a condition where your intestinal wall is damaged (in this case due to the bad bacteria) and allows proteins to leak out into the blood stream, causing an array of issues such as immune responses, inflammation and even auto immune conditions being triggered.
SIBO can also be the underlying cause of other issues, such as chronic diarrhoea, malabsorption of nutrients, unwanted weight loss,
even osteoporosis and more serve conditions if left untreated. It can also result in leaky gut, which is a condition where your intestinal wall is damaged (in this case due to the gases that hydrogen and methane producing bacteria create during abnormal fermentation in the small intestine) and allows proteins to leak out into the blood stream, causing an array of issues such as immune responses, inflammation and even auto immune conditions being triggered. This can lead to multiple food sensitivities, FODMAP sensitivities and high histamine (think anxiety, hives, nasal congestion, headaches etc). SIBO also compromises overall digestive function and impairs the breakdown of food in the small intestine.
Causes:
There are a number of potential causes in the development of small intestinal bacterial overgrowth - like any condition, the cause may also be multifactorial. Listed below are some of the common risk factors:
Poor upper intestinal function (dismotility of the small intestines )
Low stomach acid or hypochlorhydria from the use of antacid medications.
Antibiotic use, which if left without proper re supplementation of probiotics leave the intestines more susceptible to bad bacteria forming.
Coeliac disease / gluten intolerance that has been left untreated
Diverticulitis (pouches develop in the intestines which can cause food to become trapped, inflammation etc)
Metabolic disorders (diabets)
Traumatic brain injuries (car accident, concussions from sport, falling on coccyx etc) can contribute to dysmotility.
Diagnosis:
To test specifically for the bad bacteria in the intestines there are two non invasive tests that can be used. The first is simply a hydrogen and methane breath test, which involves the client drinking a sugar solution and blowing into a device at intervals. The results indicate if you have SIBO because the bad bacteria produce these gases as they break down foods. You may have predominantly hydrogen producing bacteria, methane producing bacteria, hydrogen sulphide producing bacteria or a combination of these. It is also important to recognise that there may be other pathogens such as parasites, candida, worms also contributing to your poor gut health in the colon so further testing may be needed.
The other non invasive test that can be done is called a GI MAP (gastrointestinal microbial assay plus) which is stool test and indicates if there are parasites or bacteria within your stool through DNA. It can also show the general function of your intestines, as well as the composition of the bacteria within your stool - which can help your practitioner further decide the right treatment protocol.
Other tests that can be done and may be helpful include vitamin and mineral testing through blood sample (to see if there are any deficiencies that may have arisen due to the SIBO) - this test is not to diagnose SIBO itself, but rather to look at the bigger picture of your health and again will influence the direction your treatment plan will take.
When it comes to testing, you will generally receive a referral letter to take to your GP, unless you are visiting an integrative and multi modality clinic in which there is a nurse or general practitioner available.
Treatment:
The treatment for SIBO will depend on the cause that is specific to you (remember that list at the start ?). Generally speaking though, the bad bacteria will still need to be eradicated in some way eradicated through specific SIBO antimicrobials and prevented/balanced out with good bacteria. Protocols for this include 'weed feed and seed' - this really means "weeding" the bad bacteria out, and in naturopathic medicine this can be done through antimicrobial herbs specific to hydrogen/methane/hydrogen sulphide bacteria; and 'starving' these bacteria by removing foods from the diet that are fermentable by them ( going on a FODMAPS diet for a short period of time while ). Once the bad bacteria are removed, good bacteria are to be re introduced, and the diet will again include these fermentable foods in order to feed the good bacteria that are now in place (this may take some time and the foods may be slowly re introduced while the bacteria inoculate properly).
In naturopathic philosophy the whole person is looked at no matter what the condition is. The treatment plan you would receive will likely include also some stress relieving herbs, and lifestyle practices that will help with easing stress and even toning your vagus nerve if this is needed.
SIBO treatment can take time, often at least a few months. However we place an importance on prevention/relapse of SIBO as this can be quite common if underlying causes are not addressed long term.
That is all for todays post ! Hope you enjoyed reading a little about small intestinal bacterial overgrowth, found this information useful or learnt something new. If you would like to get in touch with our naturopaths to help you with SIBO or other digestive issues, please click here to book an appointment.
