April 11, 2023

SIBO Is Sneaky. Let’s Look at Who Might Have It

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This month we’re taking all things SIBO — small intestinal bacterial overgrowth. SIBO is Irritable Bowel Syndrome’s sneaky cousin. Many people who suffer with IBS also have this overgrowth of bacteria lurking in their small intestine.

Last week we had an overview of SIBO. This week we’re going to dig in and talk about the causes of SIBO.

Why is bacteria good for your large intestine and bad for your small intestine?

Your microbiome — the colony of bacteria that lives in your large intestine — does wonders for your health. It boosts your immune system, helps out your digestion, and supports your mood and brain health.

Your large intestine is the perfect spot for the growth and survival of bacteria because it has a stable pH, which allows for a wide range of bacterial species to thrive. And by the time what’s left of your dinner reaches the large intestine, you’ve already extracted most of the nutrients you need from it. And what’s left makes great food for the healthy bacteria that live there. Plus, the large intestine has a generous mucosal layer that protects your tissues and helps keep things in balance.

But when bacteria migrate to the small intestine and multiply, it doesn’t work out so well. The small intestine — which is normally relatively low in bacteria — isn’t equipped to handle a large population. First off, the bacteria may compete with your body for nutrients. And when it grows there, it produces gasses and other byproducts that can cause bloating, belly pain, and diarrhea.

Because the small intestine isn’t coated with thick mucus like the large intestine, SIBO can damage the lining of the small intestine, leading to inflammation and other digestive problems. And since the bacteria is competing with your intestines for the absorbable nutrients, SIBO can cause nutrient deficiencies and other health problems.

What are the causes of SIBO?

Like most complex health conditions, there isn’t one single cause for SIBO. It’s not like you get exposed to SIBO like you would a cold. An overgrowth of bacteria in your small intestine can come from a variety of factors. Generally, it means that something is out of balance in your digestive system.

But if you have SIBO, it’s a good idea to work with a practitioner who has the experience to figure out what caused your individual case of SIBO. This way you can address the underlying issue and not only stop the overgrowth, but prevent it from happening again.

Here are a few potential causes of SIBO your practitioner may consider:

Small intestine pH levels

Remember high school chemistry class? You probably learned about the pH scale that measures whether a substance is an acid or a base. A lower pH means that something is more acidic, and a higher pH means it’s more alkaline.

Your body cares a lot about pH, especially when it comes to digestion. The small intestine is a relatively low pH environment. And this helps keep bacteria from taking hold and colonizing the area. But if the pH of the small intestine is too high, it’s easier for bacteria to grow.

Your small intestine pH levels can be thrown off by disruptions in your digestion. If you have low levels of stomach acid or your food moves too slowly through your intestines, bacteria can take hold. Certain medications, chronic stress, or underlying medical conditions can also cause your pH to become more alkaline, creating an environment that can lead to SIBO.

Physical Abnormalities

It’s possible that you’re more susceptible to SIBO because of the way your small intestine is shaped. A narrowing of the small intestine can slow down transit time, allowing bacteria to grow. Or scar tissue from surgery or inflammation can change the anatomy of the small intestine and slow down transit time as well.

Inefficient Muscle Movement

If the muscles in your small intestine are not working efficiently, sometimes it takes your food too long to move through to your large intestine. And anything that slows down this transit time can create an environment ripe for bacterial growth. Sometimes this is an immune system problem.

Immune System Issues

Your immune system is constantly working to maintain a bacterial balance in your body. Some bacteria are beneficial, while some aren’t. You want good bacteria in your large intestine, but you probably would rather avoid the bacteria that causes strep throat or a gut imbalance.

If your immune system is having trouble maintaining a healthy population of beneficial bacteria while suppressing the growth of harmful bacteria, then SIBO can develop.

If you have any of these conditions, you could have SIBO too:

Viral gastroenteritis — better known as a stomach bug

We’ve all had it: fever, vomiting, diarrhea. It’s not fun. Usually a common stomach bug only lasts 24 hours or so. But sometimes the after effects can last much longer. A stomach bug can throw off the balance of good and bad bacteria in your large intestine. And if this happens, the bad bacteria is more likely to work its way up into the small intestine and cause SIBO.

Celiac disease

Celiac disease is an autoimmune disorder that’s triggered by gluten — a protein found in wheat, barley, and rye. Over time, exposure to gluten can damage the lining of the small intestine, reducing the number of digestive enzymes and disrupting the normal digestive processes. And you guessed it, this damage creates an environment that can lead to SIBO.

Crohn’s disease

People with Crohn’s disease are susceptible to SIBO because of the chronic inflammation that occurs in the small intestine. This inflammation can damage the lining of the small intestine and disrupt digestion, creating an environment where bacteria can thrive. Crohn’s disease can also slow down your transit time. And antibiotic use to manage Crohn’s disease can disrupt the microbiome, leading to more bad bacteria.

Hypochlorhydria — low levels of stomach acid

Stomach acid is a vital component to digestion. If your levels are low (and for many people they are), it can affect both the pH of your small intestine and how well your food is digested before it gets there. It’s important that the food in your stomach is broken down and that the pH is low enough to keep everything working smoothly.

Irritable Bowel Syndrome (IBS)

When you think of IBS, you’re probably concerned about your large intestine. But in reality, this issue affects your entire digestive system. IBS can impact both your immune function and your transit time.

In fact, most people who have IBS also have SIBO. Studies have shown that the number is probably somewhere in the 80% range. And I’ve seen that play out in my practice as well. I almost always test my IBS patients for SIBO. We’ll dig deeper into the IBS/SIBO connection next week.

But wait, there’s more…

Yes, there are more risk factors for SIBO. Like I mentioned, SIBO is complex. And any complex illness also tends to have complex causes. So if you know (or suspect) that any of the following are a problem for you, it’s a good idea to talk with your practitioner about the possibility that you also have SIBO:

😬 Gastroparesis

😬 Nerve damage

😬 Cirrhosis

😬 Portal hypertension

😬 Certain gastric bypass procedures

😬 Surgeries that cause strictures or adhesions

😬 Diabetes

😬 Systemic Sclerosis (scleroderma)

😬 HIV

😬 Parkinson’s disease

😬 Hypothyroidism

What do I do if I think I have SIBO?

If you have one of the above conditions or risk factors for SIBO, it’s a good idea to reach out to a good practitioner who can test you for it. Your regular doctor may not know much about SIBO. And sadly, many gastroenterologists are uniformed too.

But that’s why I’m here! Your doctor doesn’t necessarily have the time or the knowledge to help you with complex digestive issues like IBS or SIBO. But I do. If you’d like to find out more, click the button below.

References

https://my.clevelandclinic.org/health/diseases/21820-small-intestinal-bacterial-overgrowth-sibo

https://www.healthline.com/health/sibo

https://www.medicalnewstoday.com/articles/324475

https://www.mayoclinic.org/diseases-conditions/small-intestinal-bacterial-overgrowth/symptoms-causes/syc-20370168

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This month we’re talking about all things SIBO — small intestinal bacterial overgrowth. Specifically, I want to answer the SIBO FAQs I hear about this underdiagnosed condition that can cause all sorts of unpleasant digestive symptoms from diarrhea to bloating and more. Last week we covered SIBO basics FAQs — what it is, what causes it, and how it’s diagnosed. So if you’re not familiar with SIBO that would be a good place to start. But if you’re struggling with SIBO, what you probably care about most is how to treat SIBO. So those are the FAQs we’re covering today. Let’s dive in… Can SIBO be treated? The short answer is yes. Once you have a SIBO diagnosis — usually from a non-invasive breath test — SIBO can be addressed at its source. However, the treatment depends on the underlying cause and severity of the condition. What are the treatment options for SIBO? Antibiotics are often used to clear out the bacterial overgrowth, but it's important to address any underlying factors that may have led to the overgrowth in the first place. But antibiotics will reduce the amount of bacteria in your small intestine — and also your symptoms. But antibiotics aren’t without a downside. Yes, they kill the excess bacteria that’s causing you problems. But they also kill the good bacteria that lives in your large intestine — where it belongs. Fortunately, there are other options. Some naturally-minded practitioners (like me), use options like herbal antibiotics that have fewer side effects. And don’t let the word “herbal'' fool you into thinking they won’t work. Herbal antibiotics have proven to be at least as effective as the antibiotic rifaximin. Can diet help with SIBO? Yes! Emphatically, yes. In fact, dietary adjustments are one of your most powerful weapons against this bacterial overgrowth. The bacteria that are partying in your small intestine are living things. That means they need food to survive. So a combination of medication and bacteria starvation will help you get rid of SIBO more quickly than medication alone. So your treatment plan should include some dietary adjustments. Some people do really well on the low FODMAP diet. Or your practitioner may recommend a SIBO specific diet like one of these: 💡 SIBO Specific Diet by Dr. Allison Siebecker This diet — also called the Specific Carbohydrate Diet (SCD) — involves avoiding certain carbohydrates that feed bacteria in the small intestine, in addition to limiting FODMAPs. Foods are color-coded as green (legal), yellow (limited), or red (avoided) to help navigate the restrictions. 💡 SIBO Bi-Phasic diet by Dr. Nirala Jacobi This diet combines the low FODMAP diet with the SCD, but is divided into two phases. The first phase involves eliminating all fermentable starches for up to 6 weeks — starving the bacteria in the small intestine. In the second phase, a few starchy foods are reintroduced to feed the beneficial bacteria in the large intestine. 💡 The low histamine diet This diet can be helpful for those with SIBO who are showing signs of histamine intolerance. This is when your body has trouble breaking down histamines — chemicals involved in the immune system. You foods with high histamine levels like fermented foods, tomatoes, eggplant, and spinach, while prioritizing fresh, unprocessed foods with low histamine levels. This diet may reduce symptoms like headaches, skin irritation, and diarrhea. 💡 Elemental diet This is the most restrictive SIBO diet and involves two weeks of liquid-only nutrition. Your nutritional drink will contain pre-digested nutrients. The idea is that you can quickly absorb the nutrients before they have a chance to feed the bacteria in your small intestine. The diet has an 80-84% success rate according to clinical trials. While effective, it can be challenging, expensive, and not typically covered by insurance. 💡 Cut out sugar and processed sweets If you want to keep things simple, this can be an effective approach that’s easier to navigate. For many SIBO patients, avoiding processed sugars and alcohol is a great way to go. Processed sugars also include artificial sweeteners like aspartame, saccharin, and sorbitol. You won’t be missing out on any nutrients that your body needs. So this type of diet can be useful even after you’ve resolved your SIBO symptoms. How long does it take to treat SIBO? There’s not a clear one-size-fits-all answer for this one. It depends on what caused your SIBO in the first place and how severe it is. Typically, people on a SIBO treatment feel better within 4 weeks. If you take antibiotics, you’ll probably be on medication for about 2 weeks. But full recovery takes longer and requires both dietary changes and dealing with those underlying issues. What is the success rate of SIBO treatment? The success rate for treating SIBO is high. Some figures put the eradication rate at over 70%. The key is keeping it from coming back. Will SIBO come back? I hate to be the bearer of bad news… But yes, SIBO often comes back. In fact, according to recent studies, about 44% of people with SIBO will have a recurrence of symptoms within 9 months of their initial treatment. But… It doesn’t have to be that way. Medication — herbal or pharmaceutical — can treat the symptoms of SIBO and tame the bacterial overgrowth. But you need to remember that something caused your SIBO in the first place. There was some underlying condition that made your small intestine vulnerable to this overgrowth. And unless you address that issue, your SIBO is likely to return. That’s why it’s so important to work with a practitioner who can address the root cause of your problems, instead of just reducing the symptoms. Remember, symptoms are your body’s way of telling you that something is wrong — out of balance. And if you really want to keep your symptoms from coming back, you need to do something about the imbalance that enabled the bacterial overgrowth to get started. This could include addressing any nutrient deficiencies, food intolerances, or gastrointestinal motility issues (how quickly your food moves through your digestive system). Additionally, a dietary plan designed for SIBO recovery and probiotics may also be used to support the gut during and after treatment. It's important to work with a healthcare professional to develop a treatment plan that's right for you. How do I figure out the right SIBO treatment for me? If you suspect that you have SIBO, the first step is to consult a practitioner who specializes in digestive issues (like me). They will evaluate your symptoms and medical history and may recommend a SIBO test. Once you have a diagnosis, your practitioner will work with you to develop a treatment plan that’s customized for your body’s unique needs. In the meantime, there are steps you can take to alleviate your symptoms. I’ve created a guide with helpful resources for managing IBS and SIBO. Click the link below to get your free copy. And if you’re ready for a customized treatment plan, you can schedule a consultation here. Yes, SIBO is a challenging condition. But it is treatable and you can take control of your health.

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