What Is SIBO?
SIBO stands for ‘small intestinal bacterial overgrowth’ and is when we have an overgrowth of bacteria in the small intestine. We should have far fewer bacteria in this area compared to the large intestine.
What Causes SIBO?
Dr. Jacobi, aka The SIBO Doctor, has done a great job of categorising causes of SIBO in to four categories:
- Poor motility: This can be caused by stress, poor thyroid health and can also be a result of a bout of food poisoning.
- Gastric deficits: This refers to things such as sub-optimal production of digestive enzymes, compromised bile health, and low stomach acid.
- Compromised flow: This can be caused by abdominal surgery.
- Medications: A common example being proton pump inhibitors.
What Are Symptoms of SIBO?
Symptoms can range widely, but some of the most common include:
- Bloating
- Abdominal pain
- Constipation
- Diarrhoea
- Belching
- Flatulence
- Fatigue
- Nutrient deficiencies
- Skin conditions
How Do you Test For SIBO?
Testing for SIBO is done via the hydrogen breath test. There are now home test kits available in the UK from Healthpath.
How Do You Treat SIBO?
The goals of treatment are threefold:
- Correct the underlying cause
- Provide nutritional support, if necessary
- Treat the overgrowth
(Dukowitcz, 2007)
So SIBO treatment needs to be personalised to achieve step 1, treating the underlying cause – this is going to be different person to person.
Nutrients that are frequently low include vitamin A and vitamin D – both these nutrients are important for a healthy mucosal immune system, the part of the immune system that lines the digestive tract. Other common deficiencies include zinc, magnesium, vitamin B12, and iron.
The main things that can be considered in regards to step 3, treating the actual overgrowth include:
- Probiotics
- Herbal antimicrobials such as oregano oil
- Prebiotics such as partially hydrolysed guar gum
- Antibiotics
The most important, and sometimes challenging part is understanding what the underlying cause might be. The health of the small intestine and gut has to be placed within the context of the whole body (and mind and spirit). This is why it has been stated
Therapy for SIBO must be complex (addressing all causes, symptoms and complications) and fully individualised (Kopacova, 2010).
I have seen chronic stress be the underlying cause, food poisoning, mycotoxins, high viral loads, head injuries, liver dysfunction, and hormonal imbalances all contribute.
For a more comprehensive blog on how to treat SIBO read my blog ‘SIBO: Natural Treatment Considerations‘.
Resources
Click here for my article on hydrogen sulfide.
Click here for my article on methane.
References
- Araujo et al., (2017) Impact of high-fat diet on the intestinal microbiota and small intestinal physiology before and after the onset of obesity., Biochimie. 2017 Oct;141:97-106.
- Enko et al., (2016) Refining small intestinal bacterial overgrowth diagnosis by means of carbohydrate specificity: a proof-of-concept study, Ther Adv Gastroenterol 2016, Vol. 9(3) 265–272
(ghoshal, 2011) How to Interpret Hydrogen Breath Tests, J Neurogastroenterol Motil, Vol. 17 No. 3 July, 2011 - Grace et al., (2013) Prevalence, Clinical Features, Current and Developing Diagnostic Tests, and Treatment, Aliment Pharmacol Ther. 2013;38(7):674-688
- Lin (2004) Small Intestinal Bacterial Overgrowth A Framework for Understanding Irritable Bowel Syndrome,
- Miller et al., (2012) Ileocecal valve dysfunction in small intestinal bacterial overgrowth: A pilot study World J Gastroenterol 2012; 18(46): 6801-6808
- Rana et al (2012) Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion. 2012;85(3):243-7
- Rezaie et al., 2017, Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus, Am J Gastroenterol. 2017 May; 112(5): 775–784
- Al-Shboul (2013) The Importance of Interstitial Cells of Cajal in the Gastrointestinal Tract, Saudi JGastroenterol.; 19(1): 3–15
- Allescher & Abdel-Aziz (2017) Mechanism of Action of STW 5 in Functional Dyspepsia and IBS: The Origin of Multi-Target, Dig Dis.;35 Suppl 1:18-24
- Banik et al., (2016) Hydrogen Sulphide in exhaled breath: a potential biomarker for small intestinal bacterial overgrowth in IBS, Journal Breath Research; 10(2): 02610
- Barrett (2017) How to institute the low-FODMAP diet, Journal of Gastroenterology and Hepatology; 32 (Suppl. 1): 8–10
- Begley et al., (2006) Bile Salt Hydrolase Activity in ProbioticsAppl. Environ. Microbiol., 72:3 1729-1738
Bested et al. (2013) Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part II – contemporary contextual research Gut Pathogens, 5:3 - Bonaz B, Sinniger V and Pellissier S (2017) The Vagus Nerve in the Neuro-Immune Axis: Implications in the Pathology of the Gastrointestinal Tract. Front. Immunol. 8:1452
- Borghini F, Donato G, Alvaro D, Picarelli A. New insights in IBS-like disorders: Pandora’s box has been opened; a review . Gastroenterol Hepatol Bed Bench 2017; 10(2): 79-89
