I have recently had a few patients tell me that they were recently diagnosed with SIBO and they asked me if I could help them. My first step was to learn more about it which I have. Turns out a large percentage of people with IBS also have SIBO. I though this month I would post a blog that explains what SIBO is to help people get a better understanding of what it is and how it can affect you.
The information below is from: Erika Stowe-Madison, MS, RDN. She is a Biocidin Botanicals Clinical Consultant and a licensed Registered Dietitian Nutritionist.
Everyone experiences gas and bloating from time to time. Even diarrhea or constipation. But what if those become the norm? Perhaps they are accompanied by weight gain or weight loss, anemia, abdominal pain, or food intolerances. Those symptoms could indicate Small Intestinal Bacterial Overgrowth (SIBO).
What is SIBO?
SIBO (Small Intestine Bacterial Overgrowth) is a condition where bacteria that should normally inhabit the colon (large intestine) are present in increased numbers in the small intestine.
What does SIBO look and feel like?
- Gas
- Bloating
- Diarrhea and/or constipation
- Malabsorption
- Anemia
- Weight gain or loss
- Abdominal pain
- Food intolerances
- Systemic inflammation
If these symptoms sound like Irritable Bowel Syndrome (IBS), that’s because 60%-80% of all IBS cases are actually caused by SIBO!
Why does SIBO happen?
Normally, our gut has natural mechanisms (such as hydrochloric acid, motility, and the ileocecal valve) to keep bacteria relatively quarantined in the large intestine so that the small intestine remains comparatively sterile.
In SIBO, however, microorganisms from the colon excessively populate the small bowel. Some possible causes may include:
- Intestinal infection (parasites or food poisoning)
- Low fiber and high sugar diet
- History of abdominal surgery
- Diabetes (or other conditions that can affect the neurological system)
- Celiac disease
- Intestinal adhesions (or other anatomical differences)
- Chronic antibiotic use or acid-blocking medications
SIBO Diagnosis
Diagnosis of SIBO can be a challenge. Standardization and mainstream acceptance are lacking in the medical community.
Types of SIBO
Currently, three types of SIBO have been identified. While bloating, gas, and abdominal pain are the hallmark SIBO symptoms, each SIBO type has distinct symptoms.
- Hydrogen Dominant: diarrhea or mixed constipation/diarrhea.
- Methane Dominant: now referred to as Intestinal Methanogen Overgrowth (IMO) – constipation.
- Hydrogen Sulfide: diarrhea, nausea, bladder pain, and gas that smells like sulfur (rotten eggs).
While each SIBO type has typical presentations, symptoms may also present atypically. Testing options are available, but limited.
Diagnostic Tools
- Breath Tests. The least invasive and most widely available test for SIBO, breath tests are now available for all three SIBO varieties. Research suggests they are not validated diagnostic tools, and prominent clinicians have varying opinions about their usefulness.
- Jejunal Aspirates. Although considered the “gold standard” in the research community, these tests are invasive. (They include biopsies of mucosal juices in the mid-region of the small intestine). These tests are expensive and largely unavailable.
Bearing all this in mind, taking a breath test may offer greater insight versus diagnosis based on symptoms alone.
Treatments
To date, addressing SIBO has been largely empirical, as it has not undergone the scrutiny of sponsored clinical trials. As such, there are currently three supported types of therapeutic approaches: antibiotics, botanicals, and dietary.
Antibiotics
The mainstay of conventional SIBO treatment is antibiotics. Practitioners are using rifaximin (non-systemic) to treat hydrogen dominant, while metronidazole (systemic) and neomycin are often used for methane dominant.
Perhaps the most important question to consider regarding using antibiotics to treat SIBO is, do the benefits outweigh the risks? Evidence has revealed that the impacts of some antibiotics can remain for long periods.
Botanicals
While the research into herbs to address SIBO is still evolving, it offers a promising alternative to costly antibiotics and may be less disruptive to the microbiome. Herbs tested for their effects regarding SIBO include oil of oregano, berberine, wormwood, lemon balm, red thyme, Indian barberry, garlic, black cumin, cloves, cinnamon, thyme, all-spice, bay leaves, mustard, peppermint, and rosemary.
Dietary
Individuals with SIBO run the risk of developing a B12 deficiency (leading to neuropathy in some cases), as well as anemia due to B-12, B6, folate, or iron deficiency. Fortunately, as Hippocrates said, we can let food be our medicine.
Foods containing glutamine, curcumin, zinc, and omega-3 fatty acids are particularly useful at alleviating intestinal inflammation, often present in SIBO. Think meat, shellfish, and peanut butter (zinc); bone broth (glutamine), turmeric (curcumin), and salmon (omega 3). Other foods replete with common SIBO nutrient deficiencies include:
- Vitamin A: Eggs, lactose-free milk, carrots, arugula, spinach
- Vitamin D: Lactose-free milk, fatty fish such as salmon, sardines, as well as the sun
- Vitamin E: Sunflower seeds, peanuts, olive oil (garlic-infused olive oil too!)
- Vitamin K: Arugula, spinach, swiss chard
- Vitamin B6: Salmon, chicken, spinach
- Folate: Broccoli, spinach, romaine lettuce, fortified white rice
- Vitamin B-12: Meat, fish, poultry, lactose-free milk
- Iron: Meat, fish, poultry, quinoa, potatoes, spinach
If you or a loved one think you might be dealing with SIBO, this overview will hopefully help you create a game plan to address it. Understanding the symptoms, types of SIBO, diagnostic tools, and therapeutic approaches is a great place to start!
If you have any questions about this blog or about your health in general, please feel free to contact me at: drtomball@performancehealthcenter.com