Do you have pain, gas, or bloating after meals? Is this problem worse when you have more carbs with your meals? These are the hallmark symptoms of SIBO, small intestinal bacterial overgrowth.
I’m seeing this issue more and more in my practice yet many people still do not know what it is. I had a conversation recently with a woman who said “oh yes I’ve heard of SIBO and I have all the symptoms but I dismissed it as another “fad diagnosis”, like candida overgrowth”. After we both had a brief chuckle I went on to explain to her exactly what SIBO is, what it does, and it’s underlying causes. By the end of our conversation she changed her tune to “wow. That makes so much sense now that you put it that way. I do think it is something I should address now!”.
First of all, what is SIBO?
SIBO is an overgrowth of bacteria in the small intestines. It is not even necessarily pathogenic, or “bad” bacteria, it’s just simply where it doesn’t belong. We all have and NEED bacteria in our large intestines. If you’re not sure why you can read my post on probiotics here to help gain a better understanding of what exactly these bacteria do in our large intestines and why they’re so important.
The problem arises when the bacteria that should be living in and doing their jobs in the large intestines end up in the small intestines. Our bodies were not designed to house bacteria there and when foods enters, these bacteria begin to ferment the food, causing bloating, gas, and other issues. Besides the obvious discomfort that comes with these symptoms, the more insidious problem is the malabsorption issues that arise when SIBO goes untreated and can lead to malnutrition as well as serious damage to the intestinal lining.
Some other common symptoms with SIBO are diarrhea or constipation, depending on which type of bacteria you have; food sensitivities from damaged GI tract; fatigue, anxiety, depression, and brain fog from inflammatory cytokines being released; nausea from slow stomach emptying; anemia from low ferritin and iron due to malabsorption; acne, interstitial cystitis and MORE!.
What causes SIBO?
This is an incredibly complex topic, as there are many possible underlying causes and many layers to each cause. I’ll briefly hit on a few highlights here, but please know there are more layers to this story-enough to fill an entire book rather than a blog post. 😉
1. Faulty illeocecal valve. This valve is between your large and small intestines. It is supposed to open to allow food to flow from your small to your large intestines and then it is supposed to promptly close. Sometimes the valve gets stuck wide open and allows a back flow affect from the large to the small (wrong direction!!), other times it just doesn’t close all the way causing a slow leak of bacteria in the wrong direction.
2. Delayed migrating motor complex. The migrating motor complex, or the MMC, is often called the “housekeeper wave” and moves things along in the right direction (the right direction being out of the small intestines and into the large!). When the MMC is slow it doesn’t push the food along as it should and instead it sits and ferments in the small intestines, further feeding the bacteria that shoujldn’t be there, and causing gas, bloating and pain.
3. Food poisoning such as E.coli, Shigella, C. Diff, can all cause a release of bacterial toxins which through molecular mimicry create an auto antibody to vinculin which can cause small intestinal nerve damage, thus decreasing the migrating motor complex.
4. Low Hcl, or hydrochloric acid. Hydrochloric acid kills incoming bacteria that is constantly entering in through our mouths and noses. If HcL is low (which is VERY common these days, especially if you’ve been on a PPI) it wont be able to kill the bacteria and they can then set up shop in your small intestines where they don’t belong.
5. Structural issues. Partial obstructions like adhesions and compression or a non draining pocket like small intestinal diverticula or blind loop syndrome will allow the bacteria to set up shop and hide in their little areas.
How do you treat SIBO?
Of course this is even more complex than what causes it and it MUST be customized to the individual. Do not fall for a one size fits all approach. Treating your SIBO properly must take into account what the underlying cause is for YOU. As you can imagine treating a patient suffering from SIBO stemming mainly from adhesions with hydrochloric acid will not help them in the slightest.
1. Antibiotics are crucial to kill the bacteria. It does not need to be a pharmaceutical and you can use herbs effectively but if you are going to use an antibiotic I highly recommend one that is not systemic so that it only stays in your small intestines and works there rather than taking one that kills everything everywhere. Your treatment protocol will be different depending on whether it is hydrogen dominant bacteria, methane dominant, or a combined type
2. Prokinetics are CRUCIAL as well. This is the step I see most often missed by Drs until I educate my clients on their importance so they are empowered to demand this important element from their Drs. Some options are low dose erithromycin, low dose naltrexone, or a variety of herbal pro kinetics like ginger, which won’t be as strong but can work for some. The reason you need prokinetitic is that they stimulate the MMC. If you don’t have a strong MMC to move the food through, you will just wind up right where you started, with food where it shouldn’t be staying, feeding bacteria that shouldn’t be there.
3. Elemental diet. This is quite the gold standard for treating many forms of SIBO. It’s not easy (it consists of drinking a chalky liquid substance ONLY for a few weeks with no food) but it works incredibly well. It works by starving off the bacteria while simultaneously nourishing the host (you!) with predigested nutrients.
4. SIBO specific diets. For many people this will be a lifelong endeavor. It will need to be more strict in the beginning but can begin to open up once you begin to heal more fully. Some options are the low FODMAP diet, SCD diet, GAPS or C-SD. Again it is important to be treated like the individual you are and fully customize your diet to what works for YOU and YOUR microbes, and YOUR underlying causes.
5. Once you’ve treated SIBO some good prevention methods to keep it from coming back are body work like visceral manipulation, craniosacral and massage. Another important aspect is meal spacing (a minimum of 4 hours should be used to allow MMC to do it’s job between meals).
Where to turn for more help
Allison Siebecker is a leader in the field of SIBO research and education. Here website is a wealth of information. I was lucky enough to attend a conference where she was the keynote speaker and have been able to use all the amazing knowledge I gleamed from her to help countless clients of mine to date.
SIBO Summit is an intense action packed wealth of information. For a few hundred dollars you can own the entire series and watch hours and hours (and hours) of experts in the field speak about SIBO. I personally watched SIBO Summit 1 AND 2 and can certainly say they are worth the time and effort.
Me! If you’re feeling overwhelmed by all the info out there and want someone to guide you through this process step by step reach out and we’ll set up a free health history to see if we’d be a good fit! You can read more about my services here.