Gas? Bloating? Generally “dodgy” digestion? Or does Food create digestive problems?
What is SIBO?
Small intestinal bacterial overgrowth (SIBO) occurs when the bacteria in the gut get out of balance, in the wrong place, and/or too abundant. These bacteria can be normal mouth bacteria setting up camp in the first part of the intestines or large intestinal bacteria back-washing into the far end of the small intestine. Either of these scenarios can cause a range of problems, including pain, gas, bloating, constipation, diarrhoea and reflux as well as contributing to symptoms outside the gut.
In the past issues that were perceived to be something “not right” with gut bacteria was (usually incorrectly) diagnosed as “candida overgrowth”, and more recently it’s been referred to as “dysbiosis”. For people with a bacterial overgrowth in the small intestine, an anti-candida diet may improve some of the symptoms because sugars are eliminated (bacteria love sugar). This is not only difficult to follow, but the continued consumption of fermentable carbohydrates means bacteria can still flourish.
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, but may not be).
2. Bloating (usually worse after food, or more noticeable at the end of the day)
4. Abdominal pain or cramping
5. Constipation (may alternate with 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. Deficiencies of vitamins or minerals, such as vitamin B12 or iron
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.
Organic Acids (Metabolic Profile) Test
This functional medicine test gives levels of by-products of small intestinal yeast or bacteria that are excreted into the urine. If your intestine is hosting a yeast or bacterial overgrowth, excessive amounts of these by-products will appear in your urine, indicating their presence – of course we won’t know if it is small or large intestine. This test is much easier for as it requires a single urine specimen after a 48 hour period of avoiding certain foods. It is somewhat expensive but has the advantage of providing information related to a range of other bodily processes. For a sample report, click here.
Comprehensive Stool Test
This is a functional medicine laboratory test that analyses the flora of the large intestines. The result will also reveal any parasites, yeasts and opportunistic species of bacteria and some test options include a range of markers of digestive processes, inflammation and so on as well. These tests all involve sending stool samples to Australia. One such test is Genova GI Effects (sample report). Thereafter flora-only versions, which are less costly, may be adequate. We also sometimes recommend Nutripath’s Comprehensive Digestive Stool Analysis (CDSA) or Bioscreen Medical’s top-rated stool culture test. Please contact us to order any of these tests – we may need to see you first to guide you as to the most indicated test for your particular case..
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 of your digestive dysfunction might be. For example, it might be advisable to order lactose and fructose intolerance testing as soon as SiBO has been ruled out or treated.
How is SIBO Treated?
Clinical studies have shown improvement in IBS patients who are treated for 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 in the USA 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 the bacteria that cause SIBO. Some of our clients choose this type of treatment. However, Rifaximin is a very expensive drug (around $1000/course) and is not funded in New Zealand. 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 antibiotics, 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 or out-compete the overgrown bacteria
- Restore the normal gut flora/defenses.
- Repair the damage!
A diet low in carbohydrates and free of refined flours, sugars and alcohol is important, but we do not recommend anyone undertake dietary restrictions without guidance. Many people find that a low FODMAP diet can reduce symptoms, but this diet is intended for short-term use only and is not recommended to be done without proper supervision.