In our practice, we see a lot of patients that are struggling with chronic digestive symptoms. They complain of symptoms ranging from indigestion to bloating and constipation.
Recently, a condition called SIBO (Small Intestinal Bacterial Overgrowth) has been popping up more and more. SIBO is a condition in which not just one type of bacteria has overgrown, like a candida infection, but a widespread overgrowth of bacteria in the small intestine.
The types of symptoms you will notice with SIBO are as follows:
What causes SIBO?
According to the literature, “the most important contributors for the development of SIBO in ascending order are immunosuppression, impairment of intestinal clearance and levothyroxine use, but they do not sufficiently explain its emergence.” (1)
Your gut flora, or normal gut bacteria, has a very delicate ecological balance. It plays a huge role in digestion and absorption of essential nutrients like vitamin K and folic acid. It also acts as part of your immune system by creating a barrier from the outside world (ie the foods and liquids you ingest). Anything that disrupts the ecology of your gut flora can lead to SIBO. In our practice we tend to find the following causes of SIBO; many times a combination of the following:
- A history of several rounds of antibiotics.
- High stress levels.
- Insufficient production of stomach acid. Your food is not broken down properly before it passes into your small intestine, which can also slow your intestinal motility or rate of transit.
- Poor bile production. Bile helps to not only break down the fats we ingest so we can absorb fat soluble nutrients like Vitamin A, D, E and K, but also help to alkalize the very acidic contents of your stomach. Without this buffer, the pH balance of your gut can be altered. Bile also provides glutathione, the body’s most powerful antioxidant and detoxifier, to the small intestine.
- Chronic constipation can lead to SIBO. As the colon gets backed up, the ileocecal valve, which is the valve separating your small intestine from your large intestine, can cause reflux of bacteria into the small intestine, culturing it with harmful bacteria.
- Chronic consumption of food sensitivities will cause an inflammatory response in the intestines that can also lead to SIBO.
- A condition commonly found in conjunction with SIBO is Non-Alcoholic Fatty Liver Disease (NAFLD). This is a condition in which fatty deposits infiltrate the liver and make it sluggish. It is hard to say which condition comes first, but does explain the commonly seen poor bile production/sluggish gallbladder. (2)
How do I get diagnosed?
The most commonly used and least invasive test for SIBO is a breath test. The test measures the amount of hydrogen and methane gas produced by the bacteria in the small intestine. You can ask your primary care physician to order this test for you. (3) (4)
Another way you can test this out for yourself, or in the meantime, is to try a low FODMAP diet and monitor your symptoms. You will typically notice a moderate decrease in your symptoms within a few days to weeks depending on the severity of your condition.
How can I fix it?
The Low FODMAP diet is the most commonly used diet to help eradicate symptoms of SIBO, and IBS for that matter. With SIBO, eating seemingly healthy foods with high amounts of certain carbohydrates: lactose, polyols, fructose, and fructans/GOS will actually feed the overgrown bacteria and cause gas and bloating. For this we use a low FODMAP diet. Foods like cruciferous vegetables (cabbage, broccoli, cauliflower), some fruits, many grains, and dairy products contain these types of carbohydrates and should be avoided. Typically if followed for 3 months (sometimes longer) in addition to either herbs or antibiotics, SIBO can be treated effectively.
In our office we use a combination of all natural, pharmaceutical grade (meaning as strong as, not synthetic) herbal supplements to combat the overgrowth of bacteria. The supplements we use are natural antibacterials that can be used in lieu of rifaximin. One study found that herbal remedies were as effective (if not more) as antibiotics. In addition the herbs were able to relieve the individuals in which rifaximin failed, and resulted in fewer side-effects. (5)
There is some evidence that probiotics can help with symptoms of SIBO, but we find in practice that this can be a mixed bag. (6)