Do you have SIBO? Small intestinal bacterial overgrowth

Have you ever eaten something and within a few hours realised that your stomach is so bloated that you can’t button your trousers? Or perhaps you are just one of those “gassy” folk, and wonder why your digestion is always somewhat dodgy (or embarrassing).
It’s not uncommon for my clients to tell me that they wake up with a flat belly and by the end of the day they look six months pregnant.
If this sounds like you, it won’t surprise you to learn that gas production in those with Small Intestinal Bacterial Overgrowth (SIBO) is about 100 x higher than in people without it.
Even if you haven’t experienced abdominal swelling to such an extreme, any amount of bloating is not normal; it’s actually a sign of intestinal dysfunction. If you’re having gas and/or bloating regularly, you could have food sensitivities and/or a gut infection, such as SIBO.  Or you might have an inability to digest common sugars such as fructose and lactose, resulting in very similar symptoms.

What is SIBO?

Small intestinal bacterial overgrowth (SIBO) occurs when the bacteria in the gut get out of balance and overgrow. This can be due to such things as normal mouth bacteria residing in the first part of the intestines or large intestinal bacterial back-tracking into the far end of the small intestine.  This can cause a number of different problems, including pain, gas, bloating, constipation, diarrhoea and reflux as well as a range of symptoms outside the gut.  In the past this was referred to as dysbiosis, and for many years it has been (incorrectly) diagnosing as “Candida overgrowth”.  For those with SIBO, an anti-candida diet may improve some of the symptoms through the elimination of sugars, but due to the continued consumption of fermentable carbohydrates, the problem does not resolve.  An anti-candida diet is more likely to benefit someone with proximal SIBO (upper small intestine) than someone with distal SIBO (lower small intestine).

How do we get too much of some bacteria over others?

SIBO can manifest in several different ways, and often occurs in those who have had antibiotics or other drugs that disrupt the normal gut environment, such as opiate painkillers and anti-acid drugs.  It can also be triggered by diets that are high in sugar, alcohol and refined carbohydrates. Certain strains of bacteria feed on refined carbohydrates and break them down, creating gas and causing bloating.
Some types of bacteria can break down bile salts before your body has a chance to use them. Bile salts are crucial for the breakdown of fats; without them, the end result is fat malabsorption and pale diarrhoea.

Bacteria can also produce toxins that damage the lining of the small intestine. This prevents your body from absorbing the nutrients you need, resulting in malabsorption and/or leaky gut syndrome (intestinal hyperpermeability).
Ultimately you will have an abnormal fermentation (bacteria feeding on carbohydrates) in your gut.

10 Signs that you Might have SIBO

1. Gas (may be smelly).
2. Bloating (usually worse after food)
3. Diarrhoea
4. Abdominal pain or cramping
5. Constipation (much less common than diarrhoea)
6. Diagnosis of irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)
7. Food intolerances such as gluten, casein, lactose, fructose and more
8. Chronic illnesses such as fibromyalgia, chronic fatigue syndrome, diabetes, neuromuscular disorders and autoimmune diseases.
9. Vitamin B12 or iron deficiency or deficiencies of other vitamins and minerals
10. Fat malabsorption

What other Conditions are Associated with SIBO?

A fermenting gut may result in a number problems. The gasses produced by the bacteria get absorbed into the bloodstream and may contribute to a wide array of symptoms, including fatigue, “brain fog”, arthritis, scleroderma, urticaria, dementia, venous ulcers, chronic cystitis, asthma, immune suppression, tinnitus, psoriasis and other skin problems such as eczema and rosacea.

Another theory for these problems is the triggering of an immune response to fermenting microbes that spill over from the gut into the blood stream to drive allergic/inflammatory reactions in other parts of the body.

How Can I Test for SIBO?

Hydrogen-Methane Breath Test
This is currently the gold standard.  It involves a preparatory diet for one day and an overnight fast (12 hours).  Then a breath sample is collected by breathing into a collection bag to provide a baseline sample.  You then take a precise amount of a particular type of sugar, and collect further breath samples every 20 minutes for 3 further hours. The breath samples that you collect are analysed using a Quintron BreathTracker which measures the amount of hydrogen, methane and carbon dioxide in your breath.  The changes over the 3-hour test aid in diagnosis of SIBO.
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Organic Acids (Metabolic Profile) Test
This functional medicine test analyses by-products of small intestinal yeast or bacteria that are excreted into the urine. If your small intestine is hosting a yeast or bacterial overgrowth, these byproducts will appear in your urine, indicating their presence. This test is much easier for patients and requires a single urine specimen. It is somewhat expensive but has the advantage of providing information related to a range of other bodily processes.
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Comprehensive Stool Test
This is also a functional medicine laboratory test that analyses the flora of the large intestines. If all the good bacteria are elevated, SIBO is suspected.  The result will also reveal any parasites, yeasts and opportunistic species of bacteria.  These tests involve sending stool samples to Australia.  Our preferred test initially is the Genova GI Effects (sample report).  Thereafter flora-only versions, which are less costly, may be adequate.  Please contact us to order this test

Thorough Health History
By gathering information about your health history and symptoms, it is sometimes possible to make a judgement as to what the cause might be.  There are also other ways of testing lactose and fructose intolerance.

How is SIBO Treated?

Clinical studies have shown improvement in subsets of IBS patients who have bacterial overgrowth.  Naturally, those suffering from these symptoms should see their health care practitioner or contact our office for a comprehensive evaluation. In some cases, testing is not necessary.
The standard treatment for SIBO is an antibiotic called rifaximin. Because this drug is not well absorbed throughout the body, it mostly stays in the gut and is very effective against SIBO. Some of our clients choose this type of treatment.  However, Rifaximin is not funded in New Zealand, and research has revealed that response rates using botanical treatments are about the same as using antibiotics. Furthermore, relapse rates tend to be higher in those who choose antibiotic treatment.  If using antibiotcs, following our guidelines is important to get the gut in good shape again and minimise the risk of reinfection.  Contact us to book an appointment (90 mins)

It is important to be aware that those who are susceptible to SIBO may be prone to recurrence. Management of SIBO is very individual, however we follow the following principles:

  • Increase stomach hydrochloric acid (HCl) and digestive enzymes.  These are your normal gut defenses against bacteria
  • Break up biofilm.  This is a mucous layer in the intestine that harbours bacterial  In the normal gut this is useful to protect your good bacteria, but is counter-productive in a SIBO gut.
  • Eradicate the overgrown bacteria
  • Restore the normal gut flora/defenses.

A diet low in carbohydrates and free of refined flours, sugars and alcohol is important. We may recommend that you follow a special diet, low in fermentable carbohydrates until your condition has cleared.

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