SIBO - the #1 treatable cause of ibs
IBS is not a life sentence.
There is always a root cause, and up to 70% of cases it's SIBO - small intestine bacterial overgrowth.
The good news is, SIBO is treatable!
But it's not a DIY project - treatment is complex and must be personalized in order to achieve complete remission.
But let's back up a minute and discuss your gut bacteria - the microbiome.
The gut microbiome is an ecosystem of bacteria, yeasts, parasites and viruses that live in your gut (and actually, all throughout your body!)
These bacteria do many things for us including:
digestion
immune support and balance
keeping gut lining healthy
preventing infections
producing vitamins
Your gut is a delicate ecosystem - it doesn't take much to throw your microbiome out of balance.
It's normal, and even healthy to have some "bad" bacteria such as E. coli, but the good bacteria also have to be there to keep them in check.
Healthy bacteria need fibre as food, so low fibre diets and diets high in processed foods cause microbiome imbalances called dysbiosis.
As we'll dive into later in the post, there are many other causes of dysbiosis, as well.
Dysbiosis doesn't just mean too much "bad" bacteria, it can also refer to too little good bacteria, or even too much good bacteria, in the wrong place.
Most of your gut microbes live in your large intestine and colon.
Your small intestine, in comparison has very little bacteria, it's designed that way for proper digestion and absorption.
When you have too much bacteria in your small intestine, you have SIBO - small intestine bacterial overgrowth.
For optimal digestion your small intestine needs to be healthy, free of inflammation and be producing digestive enzymes. This is also where bile is released from your gallbladder to help digest fats.
How your body keeps YOUR gut bacteria under control
Your body is designed to keep bacteria from growing in your small intestine.
Stomach acid and bile
Both your stomach acid and bile from your gallbladder are bacteriostatic (antibacterial), which means they keep bacteria levels under control.
The Migrating Motor Complex
Another important aspect of your upper gut is the MMC - migrating motor complex.
You can think of the MMC as a street sweeper - a cleansing wave like contraction that goes through your small intestine between meals to help clean up and heal. This can be damaged by many things including viruses, food poisoning, toxins from bad bacteria, concussions or any damage to the central nervous system, including trauma.
But imbalances can develop and contribute to SIBO when:
low stomach acid: stress or antacid medications
chronic constipation
use of antibiotics
poor diet: high in carbs and sugar and low in fibre and fruits and vegetables
abdominal surgeries
autoimmune diseases
damage to the MMC
Symptoms of SIBO include:
heartburn/GERD/acid reflux
silent reflux
belching after meals
reacting to many foods
bloating and indigestion
feeling full quickly
bowel movement issues (constipation or diarrhea)
brain fog
mental health issues (especially if treatment resistant to medications)
weight loss
skin issues: eczema, dryness, acne
You're at high risk for SIBO if:
you've used antibiotics often
you've been on an antacid medication
you've had food poisoning
you have chronic constipation
you have a poor diet high in carbs and processed foods and low in fibre
you have adrenal fatigue (burnout)/chronic stress
Why is SIBO an issue?
triggers digestive symptoms: gas, belching, acid reflux/heartburn
prevents optimal absorption: results in nutrient deficiencies
causes chronic inflammation: this can lead to developing other illnesses including autoimmune conditions (Crohn's), liver or gallbladder issues or pancreatic issues.
How is SIBO diagnosed?
To test for SIBO we use a breath test.
There are three types of SIBO, which are categorized based on the gasses the bacteria produce.
We determine the type from a breath test - you drink a sugar solution and blow into tubes at timed intervals.
The lab measures the gasses produced, which indicates which of the 3 types of SIBO you have.
The three types:
hydrogen dominant: tend to experience diarrhea
methane dominant: tend to experience constipation
hydrogen sulfide dominant
I often use the GI MAP microbiome stool test in my practice.
While this isn't the ideal test for SIBO, it does give me a good indication of whether SIBO might be present based on the types of bacterial overgrowth.
My clients sometimes prefer not to do testing, in which case, we do a trial run of the 4R protocol (see below) based on their symptoms and my clinical judgement.
How is SIBO treated?
Treatment for SIBO really depends on the root cause.
If you're working with a doctor, they may prescribe specific antibiotics including Rifaximin.
While antibiotics can be helpful, many people with SIBO don't experience full remission when using antibiotic treatment alone.
When you work with a functional practitioner such as a nutritionist or naturopath we work to not only kill off the bacteria in your small intestine, but also address the root causes of what caused the SIBO in the first place.
SIBO treatment is complex as we need to determine the root cause(s) in order to adequately restore a healthy small intestine.
Causes of SIBO include:
food poisoning
damage to the migrating motor complex (MMC): concussion, illness (viral, bacterial infections)
overuse of probiotics
use of antibiotics
low stomach acid
low bile production/output from gallbladder
chronic constipation
poor diet
medications
concussion
Typical treatment follows the 4R Protocol and includes:
Remove
bacterial overgrowth: with broad spectrum antibacterial supplements
inflammatory foods: processed foods, food sensitivities, excess sugar
gut irritants: medications (especially painkillers) and alcohol
Replace
nutrient deficiencies: common deficiencies include B12, calcium, vitamin D, iron and magnesium
stomach acid: most people with SIBO are low in stomach acid, which can be supplemented
digestive enzymes
Repair
motility: MMC and peristalsis
gut lining and "leaky gut"
functioning of liver and gallbladder: ensure optimal bile flow
Restore
bowel function: must be having a solid, easy to pass bowel movement at least once per day
balance to microbiome: promote the growth of healthy bacteria (probiotics). It's important to note that simply taking a probiotic isn't enough - most do not stay in your gut longer than 14 days. We use fibre to encourage the growth of your own healthy gut bacteria
What type of diet is best for SIBO?
SIBO diets are used the early stages of the 4R treatment protocol in order to both relieve symptoms such as gas and bloating, and to starve the bacteria we are killing.
For SIBO, I typically recommend a modified, temporary low FODMAP and low histamine diet. This is best done under the guidance of a trained professional, as these diets are not intended for long term use, and can result in multiple nutrient deficiencies.
Low FODMAP diet
FODMAPs are fermentable carbs that your gut bacteria ferment, which can cause gas, bloating, pain and indigestion.
I use the low FODMAP diet temporarily while we do the 4R protocol in order to relieve symptoms but also starve the bacteria we are trying to kill.
High FODMAP foods include wheat, dairy, beans and lentils, and certain fruits and vegetables including broccoli, asparagus, garlic and onion, cabbage, apples and bananas.
Low histamine diet
Many people with SIBO or gut dysbiosis in general have histamine intolerance and/or chronic allergies.
You may find you react to high histamine foods such as anything that is fermented, aged or cured.
This includes smoked meats, aged cheeses, kombucha, alcohol, dried fruits and leftovers.
Histamine intolerance develops with gut bacteria imbalance as you likely are not producing enough of the enzyme DAO that breaks down histamine.
While we do need some histamine in the body, excess histamine buildup results in food sensitivities and allergy like symptoms.
This can often be managed by a temporary low histamine diet while we heal the root cause; the the gut bacteria imbalance or SIBO.
Autoimmune Protocol Diet (AIP)
Some people may benefit from an AIP (autoimmune protocol) diet, especially if they have an existing autoimmune disease.
AIP removes all grains, dairy, gluten, nightshade vegetables, nuts and seeds.
It's a very restrictive diet, so I don't typically recommend this diet unless absolutely necessary.
*Important: never self prescribe any of these diets. They are meant to be used short term (ie no longer than 6 months) and under the guidance of a practitioner.
Because they are very restrictive, long term use can result in nutrient deficiencies and other illnesses.
Long term consequences of SIBO
Left untreated, consequences of SIBO include:
Leaky gut
Chronic diarrhea or constipation
New or worsened allergies
Difficulties swallowing/GERD
Nutrient deficiencies
Mental health issues
Brain fog
Unintended weight loss and muscle wasting
Chronic fatigue
Autoimmune diseases including IBD
How long does it take to heal SIBO?
Since people often have SIBO for quite a while before diagnosis, and also have multiple underlying causes, it can take anywhere from 3 months up to a year or more to heal.
It also depends on how committed you are to making these new healthy habits and dietary changes part of your new lifestyle.
You must be ready to commit to healing, and not look at it as a temporary "gut reset".
Often, in people that have pre-existing conditions, SIBO can come back, which is why it's very important to incorporate these changes into your new lifestyle to prevent recurrence.
To fully heal your gut and feel your best, you must include all 6 Foundational Pillars of gut healing.
Factors that need to be addressed as part of your healing journey:
managing stress: meditation, deep breathing and treatments (acupuncture, massage etc)
including daily movement: exercise promotes the growth of healthy bacteria, supports mood and your immune system
mindset: having patience with your healing, not comparing to others, faith in your practitioner
stop self diagnosis & treatment: Google doesn't know your body, you won't find the answers there, and you'll probably just become more worried
social support
optimizing sleep
ditching the diet mentality
