Have you heard about “SIBO?” If not, let me introduce you…
SIBO stands for small intestine bacterial overgrowth and it’s responsible for many common conditions that conventional medicine has no solid answers for. An ever-growing number of ailments such as chronic fatigue syndrome, fibromyalgia, autoimmune conditions, irritable bowel disease, leaky gut, and multiple food sensitivities are frequently the result of SIBO. These disorders are not being managed effectively in our current “sick care” system because the underlying cause (often SIBO) is not being addressed.
The small intestine is where most of our nutrients are absorbed and, unlike the large intestine, is considered to be relatively sterile. That means, under normal circumstances, there are only a few bacteria present in the small bowel. Occasionally, however, healthy bacteria from the large intestine can make their way into the small intestine, or the few bacteria normally present in the small intestine can multiply out of control. These abnormal conditions give rise to SIBO—defined as an increase in the number of bacteria, and/or changes in the types of bacteria present in the small bowel.
Our small intestine has many important functions including digestion, nutrient absorption, immunity, and brain health. It is also home to friendly bacteria (probiotics) that are an essential part of our overall health. These bacteria synthesize several important nutrients including folic acid, vitamin K, and butyric acid (known to improve metabolism and protect against inflammation and insulin resistance), and aid in the absorption of many other nutrients. Another important job of these healthy microorganisms is to limit the growth of the unfriendly or pathogenic bacteria, yeast, and parasites.
When in balance, these bacteria keep our intestines running smoothly. But when the good guys get overrun by the bad guys, our health can suffer. SIBO has been shown to damage the integrity of the intestinal lining, leading to increased intestinal permeability, or “leaky gut syndrome.” This increased permeability allows large protein complexes to escape the intestines and find their way into the bloodstream. Substances like undigested food particles, bad bacteria, intestinal toxins, and protein complexes such as gluten pass through the “leaky” intestine into the bloodstream activating the immune system. The body’s natural response to these foreign invaders is to trigger inflammation and immune reactions resulting in allergies, food reactions, muscle and joint pain, autoimmunity and depression.
Additionally, pathogenic bacteria are known to rob our body of key nutrients, leading to vitamin, mineral, and amino acid deficiencies. Because these bad bacteria are not normally present in the intestines in significant amounts, they can’t interfere with absorption. However, as their numbers increase, they selfishly absorb nutrients for their own needs leaving less available for us. Besides eating our food, pathogenic microorganisms have been found to excrete toxic byproducts that can congest the liver, irritate joints, and affect hormone balance.
Do you have small intestinal bacterial overgrowth? Find out what the most common signs and symptoms are.
10 Most Common Symptoms of SIBO
- Gas
- Bloating
- Diarrhea
- Abdominal pain or cramping
- Chronic fatigue not relieved with rest
- Diagnosis of irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)
- Food intolerances such as gluten, casein, lactose, FODMAPs, or others
- Chronic illnesses such as fibromyalgia, diabetes, restless leg syndrome, arthritis, and autoimmune diseases
- B12 deficiency, as well other nutrient deficiencies
- Fat malabsorption
What Causes SIBO?
SIBO can develop as a result of multiple imbalances. The valve that divides the small intestine from the large intestine, called the ileocecal valve, can become dysfunctional and allow bacteria from the large intestine to migrate into the small intestine. The enzymes that digest and sterilize food can become low, and some foods and beverages can feed the unwanted organisms. For a more in-depth review of conditions that can lead to SIBO see this article.
8 Potential Causes of SIBO
- Low stomach acid
- Ileocecal valve syndrome
- Celiac disease (gluten allergy)
- Alcohol consumption
- Excessive consumption of refined sugars and processed carbohydrates
- Birth control pill
- Frequent use of antibiotics
- Chronic stress (adrenal fatigue syndrome)
Do you Have SIBO?
Unfortunately, SIBO is under-diagnosed and not well understood by the majority of healthcare practitioners. This can be extremely frustrating for patients with this condition. The standard tests used by most doctors to evaluate the digestive tract will not detect SIBO. Colonoscopies, endoscopies, ultrasounds, blood tests, etc., will all be negative and may leave one feeling discouraged or crazy. I see this frequently in my practice. A patient suffering with digestive issues goes to see their primary doctor or a specialist and all the tests are normal. The doctor discounts the patient or may blame the symptoms on stress, hormone imbalance, depression, or just getting older.
How to Test For SIBO
Fortunately, there are several reliable methods to test for SIBO.
History and Exam: As a functional medicine practitioner, listening to the patient and performing a kinesiological exam will often reveal that SIBO is present. This is the fastest and easiest method of testing.
Breath Test: This is the gold standard. The overgrowth of bacteria causing SIBO give off hydrogen and methane gases (which are what cause the bloating) and these gases can be detected in one’s breath. There are labs that offer test kits that detect the presence of these gases.
Organix Dysbiosis Test: This test measures the urine for byproducts of yeast and bacteria. Normally, these byproducts are not found in the urine, and when present, predict SIBO or yeast overgrowth.
How to treat SIBO
Once it’s been established that SIBO is present, the next step is to treat it. The standard treatment for SIBO is an antibiotic called Rifaximin. Rifaximin works well because it’s not absorbed into the body. Instead, it stays in the gut and kills only the local bacteria it comes in contact with. This limits many of the harsh side effects that are common with general antibiotic use. A recent study has found that herbal therapy is just as effective as Rifaximin for treating SIBO with even less side effects. I’ve found that a low carbohydrate or “lean and green” diet with a combination of herbs for 30 days works extremely well in most instances.
Additionally, manual correction of the iliocecal valve by a trained chiropractor or kinesiologist can be very helpful, both to lessen the acute symptoms and in the longterm recovery of SIBO.
For reasons we don’t fully understand yet, SIBO often recurs in some susceptible patients. I highly advise recovering patients to adopt a long-term, gut restoration mindset. This includes continuing to follow a relatively low carb, ancestral diet, including fermented foods and resistant starch, limiting stress and stimulants (coffee and alcohol), and adopting a restorative exercise plan (yoga, tai chi, energizing hikes, or progressive relaxation exercises).
Now I’d like to hear from you. Have you had SIBO? What has helped you recover?
