SIBO: What it is and how to treat it for better digestive health

SIBO: What It Is and How to Treat It for Better Digestive Health

Small Intestinal Bacterial Overgrowth (SIBO) is a digestive condition that occurs when there is an abnormal increase of bacteria in the small intestine. This overgrowth disrupts normal digestion, leading to uncomfortable symptoms such as bloating, gas, abdominal pain, and altered bowel movements. Understanding the causes, symptoms, and effective treatments for SIBO is essential to managing and improving your gut health.

In this blog, we’ll explore everything you need to know about SIBO, including what it is, its symptoms, causes, and how you can treat it naturally or with medical interventions.

What Is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) occurs when there is an excess of bacteria in the small intestine. Under normal conditions, the small intestine has relatively few bacteria, while the majority of gut bacteria reside in the large intestine. However, in SIBO, these bacteria multiply and interfere with the digestion and absorption of nutrients, leading to a variety of uncomfortable symptoms.

SIBO can be categorized into two types based on the gases produced by the bacteria:

• Hydrogen-dominant SIBO: This is the most common type, where bacteria ferment carbohydrates, producing excess hydrogen gas.
• Methane-dominant SIBO: This type involves the production of methane, which is often associated with constipation and bloating.

Symptoms of SIBO

The symptoms of SIBO often overlap with other gastrointestinal conditions like Irritable Bowel Syndrome (IBS), making it challenging to diagnose. Common symptoms of SIBO include:

• Bloating and Abdominal Distention: This is the most common symptom of SIBO, caused by the fermentation of undigested food in the small intestine.
• Abdominal Pain and Cramping: This is often associated with bloating and excessive gas.
• Diarrhea or Constipation: SIBO can lead to alternating bowel habits, with diarrhea being common in hydrogen-dominant cases and constipation in methane-dominant cases.
• Excessive Gas, Burping, and Flatulence: Caused by the overgrowth of bacteria.
• Unexplained Weight Loss: Due to malabsorption of nutrients.
• Fatigue and Nausea: Chronic fatigue can result from nutrient deficiencies and impaired digestion.

If you're experiencing these symptoms, it could be a sign of SIBO. Seeking a proper diagnosis is crucial for effective treatment.

Causes of SIBO

SIBO occurs when normal digestive functions are disrupted, allowing bacteria to proliferate in the small intestine. Several factors can contribute to the development of SIBO, including:

1. Gut Motility Disorders: Slow movement of food through the intestines (as seen in gastroparesis or intestinal pseudo-obstruction) can lead to bacterial overgrowth.
2. Low Stomach Acid: Stomach acid helps prevent bacterial growth. A reduction in stomach acid (due to hypochlorhydria) can increase the risk of SIBO.
3. Structural Abnormalities: Conditions like Celiac disease, Crohn’s disease, or prior intestinal surgery can cause damage to the small intestine and promote bacterial overgrowth.
4. Weakened Immune System: A compromised immune system may fail to regulate bacterial populations in the gut, increasing the risk of SIBO.
5. Medications: Long-term use of antibiotics or proton pump inhibitors (PPIs) can disrupt the natural balance of bacteria in the gut, promoting the development of SIBO.

How to Diagnose SIBO

Diagnosing SIBO involves identifying abnormal bacterial overgrowth in the small intestine. The most common diagnostic methods include:

1. Breath Testing: The lactulose breath test or glucose breath test are the gold standards for diagnosing SIBO. These tests measure the production of gases like hydrogen and methane in response to an ingested sugar solution. High levels of these gases indicate bacterial fermentation in the small intestine.
2. Small Intestinal Aspirate and Culture: This is a more invasive diagnostic procedure in which a sample of small intestine fluid is aspirated using an endoscope and cultured to check for bacterial overgrowth.

Treatment for SIBO

Treating SIBO typically involves a combination of medical interventions, dietary changes, and supplements. The goal is to reduce bacterial overgrowth, manage symptoms, and address any underlying causes. Here are the most effective treatment options:

1. Antibiotics: The primary treatment for SIBO is the use of antibiotics to reduce bacterial overgrowth. Rifaximin is the most common antibiotic prescribed for hydrogen-dominant SIBO, while neomycin or metronidazole may be used for methane-dominant cases.
2. Dietary Modifications: Following a Low FODMAP diet or Specific Carbohydrate Diet (SCD) can help manage SIBO symptoms by limiting fermentable carbohydrates that feed bacteria in the small intestine. These diets have shown significant effectiveness in reducing bloating and improving overall digestion in SIBO patients.
3. Probiotics: Probiotics help to restore the natural balance of bacteria in the gut. Some strains, such as Saccharomyces boulardii and Lactobacillus, may help reduce bacterial overgrowth and improve digestion. However, the use of probiotics in SIBO treatment is still debated, and it’s important to consult a healthcare provider before starting.
4. Prokinetic Agents: To improve gut motility, doctors may prescribe prokinetic medications (like Low dose erythromycin or prucalopride) to help move food through the small intestine more effectively, preventing the buildup of bacteria.
5. Herbal Remedies: Some studies suggest that herbal antimicrobial agents such as oregano oil, berberine, and garlic can help reduce SIBO-related bacterial overgrowth. These can be used as a natural adjunct to antibiotic therapy or in cases of mild SIBO.

Conclusion

SIBO is a manageable condition that can significantly impact your digestive health. If you're dealing with symptoms like bloating, diarrhea, constipation, and fatigue, it’s important to seek a diagnosis and appropriate treatment. With the right combination of antibiotics, dietary changes, and possibly herbal remedies or probiotics, SIBO can be treated effectively.

Taking steps to address SIBO can help you restore gut health, improve digestion, and enhance your overall well-being. To book a consultation and receive a nutrition and lifestyle assessment and appropriate recommendation please visit www.ancavereen.com

References

• Pimentel, M., Chang, C., Chow, E., & et al. (2011). Methane production in the small intestine is associated with bloating, but not with symptoms of irritable bowel syndrome. Digestive Diseases and Sciences, 56(4), 928-934.
• Shin, A. (2017). Small Intestinal Bacterial Overgrowth (SIBO) and its connection to IBS. Journal of Clinical Gastroenterology, 51(2), 107-112.
• Fisher, B. R., & Sandler, R. S. (2010). The role of stomach acid in the pathogenesis of SIBO. American Journal of Gastroenterology, 105(9), 2200-2204.
• Hickson, M., Thomas, W., & Tredget, J. (2012). SIBO: Mechanisms and clinical management. Journal of Gastroenterology & Hepatology, 27(5), 810-819.
• Pimentel, M., Park, S., & Chow, E. (2000). Lactulose breath test as a diagnostic tool for small bowel bacterial overgrowth. Digestive Diseases and Sciences, 45(2), 312-317.
• Pimentel, M., Chang, C., & Chow, E. (2010). Rifaximin therapy for patients with irritable bowel syndrome without constipation. New England Journal of Medicine, 364(17), 1503-1512.
• Biesiekierski, J. R., Muir, J. G., & Gibson, P. R. (2011). The effect of a gluten-free diet on the symptoms of irritable bowel syndrome. Gastroenterology, 141(5), 1477-1485.
• Snydman, D. R. (2015). Probiotics and their role in small intestinal bacterial overgrowth. The Journal of Clinical Gastroenterology, 49(2), 120-128.
• Pimentel, M., Lembo, A., & Chey, W. D. (2018). Herbal therapy for small intestinal bacterial overgrowth. American Journal of Gastroenterology, 113(6), 981-990.