Updated: Apr 26
SIBO is short for “Small Intestinal Bacteria Overgrowth,” and what this means is that bacteria growth in the small intestine has gotten out of balance. The bacteria in your gut is extremely important, and forms part of your microbiome. Gut bacteria however are meant to be located in the large intestine and colon, and when these healthy bacteria colonize the small intestine, SIBO occurs. These displaced bacteria in the small intestine ferment the carbohydrates and sugars you eat, and cause hydrogen gas to be produced. This hydrogen can then feed an organism in the small intestine called archaea, which then produce methane gas. It is these gasses that cause many of the symptoms of SIBO: bloating, acid reflux, belching and food sensitivities.
SIBO is often misdiagnosed as IBS (Irritable Bowel Syndrome) or Candida overgrowth. In all three of these conditions gas, bloating, irregular bowel movements and abdominal cramping are common. There area few more unique symptoms that differentiate SIBO, and also accurate testing to confirm. You’ll learn more through this short article.
Signs you may have SIBO
The most telling are signs of SIBO include:
Upper abdominal bloating and belching
Feeling worse from fermented foods (pickles, vinegar, sauerkraut, kombucha, kimchi)
Bloating and gassiness from probiotics.
Digestive symptoms that improve dramatically on a low-carb, low-grain diet.
Additional symptoms can also include:
Abdominal pain and cramping
Constipation, diarrhea or both
Acid reflux / GERD
Multiple food sensitivities
Poor nutrient absorption (B12 and iron especially)
SIBO and histamine intolerance
I’m going to briefly mention a connection between histamine intolerance and SIBO, as this is a link I see quite frequently in my patients. Histamine intolerance is characterized by an array of symptoms indicating a chronic histamine reaction in the body. These symptoms can include headaches, itchy & runny nose, chronic urticaria (hives), anxiety and sleeplessness, dizziness, nausea and abdominal cramps (most people don’t have all of these symptoms).
The link between SIBO and histamine intolerance is that some of the bacteria that build up in the small intestine can produce histamines. These include Lactobacillus casei and Lactobacillus bulgaris, which are both part of a healthy lower bowel microbiome. The histamine reactions can be further exasperated by emotional stress which can stimulate mast cell production, and worsen SIBO by impairing motility, which is why we often see a significant emotional stressor associated with the onset of histamine reactions.
Please note that not everyone who has SIBO has histamine intolerance.
What causes SIBO?
There are many possible causes of SIBO, and in most cases there are usually two or more layers. Here are some of the causes:
Medications that disrupt the microbiome: steroids, antibiotics and acid-blocking drugs.
A diet high in sugar, refined carbohydrates and alcohol.
Scarring or blockage in the digestive tract from Crohn’s disease or abdominal surgeries.
Long-standing Celiac disease.
Diabetes (type 1 and 2) due to nerve damage around the intestines causing motility issues.
Ongoing high stress, or an acutely stressful event (affects motility and ileocecal valve function).
Multiple rounds of antibiotics in a short period of time.
Testing and treatment
The good news is that there is a very simple and conclusive test for SIBO, that measures both the Hydrogen and Methane gas in your breath. These gasses are the fermentation products of small intestinal bacteria overgrowth, and the higher the numbers the more likely you have SIBO. The SIBO breath test is also an accurate way to confirm that treatment has been successful.
Treatment must include several steps:
To thoroughly and permanently treat SIBO, there are several important steps. Unfortunately this is a condition that relapses very often if we don’t address all of the factors. Antimicrobials alone will only provide temporary relief.
(1) Nutrition plan that starves the bacteria
An essential part of treating SIBO is to temporarily remove sugars, refined carbohydrates and alcohol to starve the bacteria. In some cases, we also remove complex carbohydrates and legumes during the first phase of treatment. The intensive phase typically lasts 3 weeks, and then we move to a more moderate nutrition plan for the next two months. Throughout, you can eat plenty of non-starchy vegetables, proteins and healthy fats.
(2) Anti-microbial treatment
There are many anti-microbial herbs that work extremely well to treat SIBO, and in fact studies show that they work at least as well as the typical antibiotic treatment of rifaximin and neomyacin. Herbal products contain ingredients such as oregano, thyme, berberine, coptis and garlic in fairly high doses, and are used for at least 30 days.
(3) Correction of underlying causes – poor stomach acid or motility issues
This step is absolutely key in preventing SIBO relapse. We need to look carefully for the underlying cause of SIBO and address it to promote optimal digestive function. This may include addressing low stomach acid, promoting motility with herbs or medication, and addressing stress levels. A nutrition plan would also target long-term reduction in simple carbohydrates, sugar and alcohol.
(4) Intestinal lining repair and gradual reintroduction of specific probiotics
Finally, we work on restoring intestinal lining integrity with nutrients to repair intestinal permeability (leaky gut), and gently and gradually bring back in probiotics. Soil based probiotics and Saccharomyces boulardii probiotics are usually a good starting point, as many Lactobacillus and Bifidus species can cause a return of symptoms and possible relapse.
If this article rings a bell for you and you suspect that you may have SIBO, the next step is a SIBO breath test to confirm. From here, we can walk through your personalized treatment plan to resolve your digestive symptoms.
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