The human gastrointestinal tract is home to billions of bacteria, and although you’ve thought of bacteria as a bad thing up until now, many of these bacteria are essential for our everyday health. Beneficial gut bacteria support a healthy immune system, improve absorption nutrients, protect against invading microorganisms like parasites and yeast, and even produce some helpful vitamins. These essential bugs typically take up residence in the large intestine, but if this delicate balance of probiotics is disrupted, digestive problems can follow suit.
Small Intestinal Bacterial Overgrowth, or SIBO, happens when an increase in number or a different type of bacteria take up residence in the small intestine. Under normal circumstances, the small intestine has a relatively low number of bacteria relative to it’s neighbour, the large intestine. However, when bacteria from the large intestine take up residence in the small intestine, they begin to ferment carbohydrates, leading to gas production and bloating.
The following offers a general overview of strategies used for assessment and treatment of SIBO. While many of these symptoms may sound familiar, each case is unique, and we encourage you visit Aumakua for a digestive assessment with one of our physicians who are highly trained in this topic.
5 Signs you might have SIBO
• Gas, belching
• Bloating, abdominal distention
• Abdominal discomfort: pain, cramping
• Change in bowel habits: diarrhea, constipation, or alternating diarrhea / constipation
• Nutrient deficiencies (and even weight loss in severe cases)
A recent study found that 84% of IBS patients also had positive breath tests suggestive of SIBO. In fact, another study showed that 20% of asymptomatic healthy volunteers also tested positive. Today, SIBO remains largely prevalent as an underlying cause of these digestive complaints, and its under diagnosis is leaving many patients without the treatment they need to find relief.
What Causes SIBO?
In a healthy gastrointestinal tract, the body has protective mechanisms to keep the small intestine free of bacterial overgrowth. For example, the stomach produces stomach acid, the intestines contract to push bacteria and food through the system, and bile creates an inhospitable environment for bacterial growth in the small intestine. However, certain risk factors can lead to a breakdown of these protective mechanisms, causing changes in gut anatomy and movement, pH, and immunity, all of which can lead to a shift bacterial balance that we identify as SIBO.
These risk factors include:
- A diet high in refined carbohydrates, sugar, and alcohol
- Use of medications that alter gut flora: antibiotics, proton pump inhibitors, steroids
- Diabetes and hypothyroidism: both lead to a slowing of gut motility
- Anatomical abnormalities such as diverticula and fistulas
- Prior bowel surgery leading to scaring adhesions
- Chron’s disease
- Long standing celiac disease
- Low Stomach Acid or pancreatic enzymes, particularly due to long standing use of acid blocking medication (proton pump inhibitors)
- Cirrhosis, morbid obesity, pancreatitis, irritable bowel syndrome (IBS)
How is SIBO tested and treated?
The most common clinical tool used in testing for SIBO is a Lactulose Breath Test which measures the levels of hydrogen and methane gas that are produced in the small intestine after a fasting and sugar challenge.
If you are interested in reading more about testing for SIBO, please refer to SIBO Canada for more trusted details.
If a Lactulose Breath Test is positive, treatment for SIBO typically this involves a two to six week course of either herbal antimicrobials or traditional antibiotics, depending on the case. This is then followed by a six week gut healing protocol where a SIBO specific diet starves remaining unwanted bacteria of their food source, and supplements are used to heal the lining of the gut and re-establish normal movement of the intestinal tract. After treatment, a long-term low glycemic diet can used to prevent future recurrences of SIBO.
SIBO is often wrongly or under-diagnosed because the symptoms are typically nonspecific (indigestion, bloating, abdominal discomfort), and are similar to those of many other digestive conditions. This is problematic as long-term consequences of untreated SIBO can include chronic gut inflammation, and malabsorption of nutrients leading to deficiencies and malnutrition.
Aumakua practitioners are well versed in the assessment of SIBO, and its varying treatment options. While SIBO affects a wide range of patients, each case is specific, and individualized treatment is necessary to ensure symptoms do not recur. If you believe your digestive symptoms might be linked to SIBO, we welcome you to come see one of our naturopathic doctors to start your SIBO assessment today.
Bures, Jan, Jiri Cyrany, Darina Kohoutova, Miroslav Förstl, Stanislav Rejchrt, Jaroslav Kvetina, Viktor Vorisek, and Marcela Kopacova. “Small Intestinal Bacterial Overgrowth Syndrome.” World Journal of Gastroenterology : WJG. Baishideng, 28 June 2010. Web.
Dukowicz, Andrew C., Brian E. Lacy, and Gary M. Levine. “Small Intestinal Bacterial Overgrowth: A Comprehensive Review.” Gastroenterology & Hepatology. Millennium Medical Publishing, Feb. 2007. Web.
Fasano, A. “Leaky Gut and Autoimmune Diseases.” Clinical Reviews in Allergy & Immunology. U.S. National Library of Medicine, Feb. 2012. Web.
Krajicek, Edward J., et al. ”Small Intestinal Bacterial Overgrowth.” Mayo Clinic Proceedings. Mayo Clinic, n.d. Web.
Lauritano, E.C., Bilotta, A.L., Gabrielli, M. et al. Association between hypothyroidism and small intestinal bacterial overgrowth. J Clin Endocrinol Metab. 2007; 92: 4180–4184
Lo, W.K. and Chan, W.W. Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clin Gastroenterol Hepatol. 2013; 11: 483–490
Rezaie, A., Pimentel, M., and Rao, S.S. How to test and treat small intestinal bacterial overgrowth: an evidence-based approach. Curr Gastroenterol Rep. 2016; 18: 8
Roland, B. C., M. M. Ciarleglio, J. O. Clarke, J. R. Semler, E. Tomakin, G. E. Mullin, and P. J. Pasricha. “Small Intestinal Transit Time Is Delayed in Small Intestinal Bacterial Overgrowth.” Journal of Clinical Gastroenterology. U.S. National Library of Medicine, Aug. 2015. Web.
Sachdev, A.H. and Pimentel, M. Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance. Ther Adv Chronic Dis. 2013; 4: 223–231