SIBO (Small Intestine Bacterial Overgrowth) is a very common digestive disorder that produces a variety of gastrointestinal symptoms. Those with SIBO are often first diagnosed with IBS (Irritable Bowel Syndrome), which shares much of the same symptoms as SIBO. In addition, there are other symptoms associated with this disorder that are not related to the digestive system. SIBO has multiple underlying causes and is linked with other chronic diseases. As such, SIBO is the end result of other health conditions. It is what can happen when chronic health issues go unaddressed.
Treatment usually follows a foundational protocol that is then added to depending on the unique cause of a persons’ SIBO. There are several supportive nutrients that can be included in SIBO treatment. Bone broth is one such food item that supports health in many ways including digestive health and gut healing. The benefits of bone broth and how it can help heal SIBO is discussed in part 2 of our SIBO blog. Be sure to check it out since conventional bone broth contains ingredients that make SIBO symptoms worse. Our part 2 blog describes ways to get the right kind of bone broth.
So, what exactly is SIBO and what symptoms should I be aware of? Let’s dive in to find out!
What Is SIBO And How Is It Diagnosed?
One of the most common chronic symptoms that millions of Americans struggle with are digestive symptoms. This ranges from bloating, gas, diarrhea, constipation, or just general abdominal pain. These symptoms are identified in a number of digestive disorders to varying degrees. Let’s discuss one such disorder, called SIBO (Small Intestine Bacterial Overgrowth).
SIBO is when certain species of our gut bacteria migrate to and populate our small intestine (where they don’t belong). Gut bacteria is normally found in our large intestine, but when they travel to our small intestine they can cause several unpleasant digestive symptoms. More than that, the misplaced gut bacteria disrupt the normal functioning of our small intestine, namely nutrient absorption. This can lead to deficiencies in several nutrients.
You may have heard it said that anything that affects the gut affects the rest of the body. Our digestive system is integrally connected with every other body system. For this reason, SIBO is linked to other health conditions. These include rosacea, psoriasis, fibromyalgia, chronic fatigue syndrome, hypothyroidism, rheumatoid arthritis, other digestive disorders, and many more. These health conditions either predispose people to SIBO, are caused by SIBO, or are co-existing conditions. If you are struggling with a chronic disease, it would be wise to get tested for SIBO and any other gut abnormalities.
SIBO is diagnosed using a breath test after fasting for 12 hours and then drinking a sugary solution (lactulose). Breath samples are collected throughout the day using a take-home kit and then analyzed for the presence of hydrogen and methane gases. These gases are produced by the overgrowth bacteria as they ferment the lactulose drink. People are diagnosed as having methane-dominant SIBO or hydrogen-dominant SIBO. Some can have a mixture of both gases, while others can have hydrogen-sulfide SIBO.
What Causes SIBO?
SIBO can be caused by a number of factors. Most people actually have several factors compounded at once. It’s important to learn what has caused your SIBO so that your treatment can be modified to address and reverse the cause.
Low Stomach Acid
A common cause of SIBO is low stomach acid. Low stomach acid can result from taking antacids or PPI medications, having chronic stress, having a bacterial infection called H. Pylori, or from eating inflammatory foods. Interestingly, an H. Pylori infection can result from relying on heartburn medication for several years. Both of these combined raise the risk of developing SIBO.
Low Bile and Digestive Enzymes
Another cause of SIBO is low production of bile and digestive enzymes. Bile acids help balance our gut bacteria and prevent overgrowth. Digestive enzymes digest carbs, proteins, and fats. If we aren’t digesting carbohydrates appropriately, they can feed our gut bacteria, causing them to overgrow. Having low stomach acid leads to low bile and enzyme production, putting us at increased risk for SIBO.
Impaired Gut Motility
Some people have slow or impaired gut motility (gut contractions). This means their digestive tract does not physically move food through the body in an efficient way. Food, and the natural bacteria on our food, will stagnate in our gut if it is not able to move through our system. If these aren’t cleared from our gut in a timely manner, bacteria can settle where it doesn’t belong and cause SIBO. Our gut motility can be impaired by hypothyroidism, proton pump inhibitors (PPI’s), diabetes, or even other digestive disorders such as celiac or IBD (inflammatory bowel disease).
Heavy Antibiotic Use
Ironically, SIBO can also be caused by the overuse of antibiotics. These medications kill off all bacteria, both helpful and harmful. In such a harsh environment, only the strongest bacteria survive. Oftentimes the strongest bacteria is the harmful type. Without the helpful bacteria to keep it in check, harmful bacteria are allowed to thrive and overgrow, causing SIBO. Another risk of taking antibiotics is that your gut bacteria may adapt to them and be unaffected by them. This is called antibiotic resistance and makes it even more difficult to treat SIBO and any other bacterial infection.
Other Causes of SIBO
There are other causes of SIBO including autoimmune conditions, gut dysbiosis, food poisoning, chronic stress, and leaky gut syndrome. Anybody who has a history of these SIBO causes should be treated appropriately in order to prevent SIBO from developing.
Symptoms of SIBO
Symptoms associated with SIBO can mirror the symptoms of other digestive disorders such as IBS. In fact, having IBS is a common precursor for developing SIBO, with about 60% of IBS patients also having bacterial overgrowth.
Common SIBO symptoms are bloating, gas, diarrhea, and constipation. A more complete list of SIBO signs and symptoms is below:
Leaky Gut Syndrome
Pain from bowel movements
Feeling of fullness
Malnutrition and nutrient deficiencies
Not every person with SIBO will have each of these symptoms. In fact, SIBO affects each person differently and at different levels of severity. One person may have mild stomach cramping while another person may have debilitating cramps that take them out of work. Depending on the severity of symptoms, those with SIBO can have a lowered quality of life.
SIBO Treatment and Die-Off Symptoms
It was said earlier that SIBO is the end result of other health conditions. Thus, simply treating SIBO does not address these underlying conditions which allow SIBO to thrive. The root cause needs to be treated as well, to prevent SIBO from recurring. In this way, there are two parts to treatment: treating SIBO itself and treating the underlying cause. Each person’s underlying cause will be different, making each SIBO treatment unique.
Treatment for SIBO itself involves taking antimicrobial supplements that target and kill bacterial overgrowth. Many people also need to take a specific antibiotic, called Rifaximin, which works in the same way as the supplements.
Other than prescription antibiotics and supplements, those with SIBO should adhere to a low FODMAP diet for several weeks. This diet avoids certain carbohydrates that feed the overgrowth of bacteria. Avoiding these foods essentially starves them out and prevents them from growing. “FODMAP” is an acronym where each letter stands for a different type of carbohydrate that can be bothersome for those with SIBO. This is why a “low” FODMAP diet is ideal during the treatment process.
One round of SIBO treatment can be quite effective for people but some may require multiple rounds of treatment before the overgrowth is eradicated. If the underlying cause of SIBO is also treated, the odds of total eradication increase dramatically.
During SIBO treatment, many people experience a unique set of symptoms for a short time. The supplements, antibiotic medication, and specialized diet all act to eliminate harmful bacteria and bring the overgrowth back into balance. As harmful bacteria die, they release toxins into your body. These toxins cause a reaction, called a Herxheimer reaction, or die-off symptoms. These don’t occur in everyone though, and they usually are short-lived. Symptoms of die-off include flu-like symptoms, muscle or joint pain, irritability, fatigue, and digestive symptoms (most commonly bloating). If people experience die-off symptoms, they often take certain supplements, as needed, that act as detox binders. These binders attach to the bacterial toxins and escort them out of the body, reducing symptoms.
We’ve seen how SIBO can develop and how it’s related to multiple other chronic health conditions. SIBO symptoms vary among people and range in severity. There are several factors that can cause SIBO and it’s important to identify the cause to help guide treatment. Treatment involves a standard approach along with specific supports unique to each person. Sometimes SIBO treatment can cause die-off symptoms that are usually short-term. In part 2 of our blog, we’ll discuss one of the ways to support gut health for those with SIBO. Check out part 2 here!