Introduction

Small Intestinal Bacterial Overgrowth (SIBO) is a common imbalance in the gut microbiome that can cause a variety of GI symptoms. For many, a SIBO diagnosis explains chronic GI symptoms that cannot be explained otherwise.

What is SIBO & How is it Diagnosed?

With SIBO too many bacteria inhabit the small intestine. Normally, the small intestine has a limited amount of bacteria and is the primary source for food digestion and nutrient absorption. On the other hand, the colon has an abundance of microbes that are responsible for taking undigestible food matter (fibers) and producing nutrients like vitamins and butyrate from them.

In SIBO bacteria migrates from the colon to the small intestine. The bacteria have access to more food that is not fully digested. The bacteria ferment these foods, releasing gasses and toxins that cause SIBO symptoms.

There are three types of SIBO, classified by the gasses produced from the bacteria; Hydrogen Dominant, Hydrogen Sulfide Dominant and Methane Dominant.

A SIBO breath test can diagnose SIBO and it’s type. Patients drink a carbohydrate solution and breathe into a bag to measure the gasses released from the drink. Depending on which gasses rise and when, we can determine that there are too many bacteria in the small intestines.

Comprehensive Stool tests are not diagnostic of SIBO but can idenifty bacteria patterns consistent with SIBO and potential root causes of SIBO.

SIBO Symptoms and the IBS Connection

The 3 different types of SIBO have some overlapping symptoms and some unique to each gas produced. Some individuals will have a mix of alternating symptoms due to high levels of more than one gas.

• Gas (H, HS, M)
• Bloating (H, HS, M)
  • Bloating after meals
  • And/or bloating not corrlated with any food (ex: waking up bloated)
• Abdominal distention (especially M)
• Sulfur or rotten smelling gas or bowel movements (H, HS)
• Diarrhea (H, HS)
• Constipation (M)
• Nausea (H, HS, M)

*H = Hydrogen Dominant / HS = Hydrogen Sulfide Dominant / M = Methane Dominant

Many clients that are diagnosed with Irritable Bowel Syndrome (IBS) are actually suffering from SIBO. IBS is a condition classified by a group of symptoms, not a cause for symptoms. Many people with IBS are experiencing their symptoms due to having SIBO.

Causes and Risk Factors of SIBO

For most, there are a several factors that contribute to developing SIBO. Certain conditions are also associated with a higher risk of developing SIBO.

• Frequent or long term antibiotic use
• Slow GI motility/Gastroparesis
• Low stomach acid
• Grazing on food throughout the day
• Food poisining/stomach bug
• Stress
• Structural issues in the GI tract
• Low immunity in the gut
• Other microbiome imbalances (parasites, yeast, etc)
• Liver/gallbladder issues
• Celiac Disease
• Inflammatory Bowel Disease

Considerations for Treating SIBO

There is not one treatment for SIBO. First, SIBO treatment will depend on the type of SIBO and it’s root causes.

One common treatment is antibiotic therapy. This can be an effective treatment for SIBO, however, in my practice I see a high repeat occerance of SIBO after antibiotic treatment when used on its own.

A holistic approach:

Here are all the factors that must be taken into account to heal SIBO naturally and prevent it from coming back!

• Testing to identify the type of SIBO & other microbiome imbalances
• Targeted herbal protocol to adress SIBO bacteria
• Motility support for daily bowel movements
• Digestive Support
• Replete nutrient deficiencies
• Address root causes
• Rebalance gut microbiome and pH of the gut with pre- and probiotics
• Nervous system support
• Lifestyle changes
  • Eating slowly
  • 3 big meals, no grazing
  • Chewing food thoroughly
• Diet changes during and after treatment

Conclusion

SIBO is a complex microbiome imbalance that can cause severe gut symptoms. To fully heal from SIBO, a holistic approach is needed to properly diagnose SIBO, identify the root causes, and rebalance the gut microbiome.