Small Intestinal Bacterial Overgrowth (SIBO)

What is SIBO?

SIBO is a digestive disorder that results from bacteria residing within the small intestine. While it is healthy for the colon to have high numbers of microbes this is not true of the small intestine. The small intestine has mechanisms to discourage the growth of bacteria such as stomach acid, bile, digestive enzymes and consistent smooth muscle contractions (MMC) that sweep contents further along. Sometimes these protective mechanisms fail and this allows bacteria to grow in numbers that create problems such as SIBO.

 

What are the symptoms of SIBO?

Symptoms vary from person to person but may include some or all of the following:

  • Bloating
  • Bowel movements can be loose, diarrhea or constipation depending on the prominent bacterial species
  • Excessive gas
  • Nausea
  • Abdominal pain
  • Indigestion/GERD/heartburn
  • Skin issues (rosacea, acne)

Interestingly some studies suggest that 80% of people with IBS may in fact have SIBO.

Common causes of SIBO

As discussed above there are protective mechanisms in place to avoid bacteria from growing in large numbers within the small intestine. Any disruption to the basic digestive processes can disrupt this unique balance.

  • Concussions or TBI
  • Poor gut motility (slow movement through gastrointestinal tract)
  • Low stomach acid (this can include longterm PPI use) and/or poor fat digestion
  • Food poisoning or other infections
  • Structural or surgical

 

How do you diagnose SIBO?

Typically a breath test is used to diganose SIBO. At my naturopathic office in Hamilton we usually drop ship the test kit to your house to be completed at home.

A preparatory diet (24 hrs) is outlined in the test kit provided. The diet eliminates foods that fuel the bacteria prior to testing. The morning of the breath test you consume a solution (glucose or lactulose) that feed the bacteria. You proceed to collect breath samples at specific intervals for 3 hours. Once the test is completed you send the results back to the lab by mail. Hydrogen and methane gas levels are analyzed and the results are reported in a chart and graph for you to view with your practitioner. Elevated levels of methane and/or hydrogen gas indicate positive SIBO.

Glucose breath test: has high test specificity, which means it is less likely to cause false positives and you can be more confident in a positive result truly capturing SIBO. The down side to this test is that it sometimes misses SIBO cases that are further along the small intestine as glucose is rapidly absorbed. If we suspect that SIBO is further down the small intestine we would select a lactulose breath test.

 

What does treatment of SIBO look like?

Pharmaceutical and/or herbal antimicrobials are selected to kill off bacterial overgrowths. It is equally important to consider the cause of  overgrowths and implement preventative strategies following successful eradication.

Next steps? It is recommended to start with an initial visit. An initial visit allows us to get a detailed digestive health history to decide upon whether testing is indicated, understand underlying cause(s) of presenting concern(s) and pursue individualized treatment based on history, symptoms and/or testing results.

 

Disclaimer: Always consult a health care provider before starting any treatments. This post is not meant to substitute medical advice.