SIBO stands for small intestinal bacterial overgrowth, a condition in which commensal bacteria overgrows in the small intestine causing gas, bloating, diarrhea, constipation and malnutrition.

We have bacteria (and other microbes) in and on our body that play an essential role in several biological functions such as digestion, nutrient absorption, mood regulation, hormone metabolism and immunity.

Normal gut bacteria offer far reaching benefits however, when the wrong type of bacteria overgrows in the wrong place, such as the small intestine, symptoms occur.

Signs and symptoms

• Low stomach pain

• Bloating*

• Gas

• Diarrhea

• Constipation

• Fullness after small meal

• Weight loss

• Vitamin and/or mineral deficiencies

• Mood changes

SIBO is largely underdiagnosed primarily due to a lack of understanding of the disease process and a lack of an accessible and specific testing process.

Along with this, many people don’t seek care for gastrointestinal symptoms.

Between 4% and 78% of patients with IBS have SIBO.

(Ghoshal, Shukla & Ghoshal, 2017)

Risk Factors

• Decreased gastric motility

• Low stomach acids

• Deficient digestive enzymes

• Antibiotics*

• Oral contraceptives

• Proton pump inhibitors

• Alcohol

• Inflammatory bowel disease i.e. Crohn’s disease

Testing

• Lactulose Breath Test*

• Organic Acids Test (OAT)

• Stool Test (GI Map, Genova Diagnostics)

As harmful bacterial colonies take hold, digestion is further compromised, causing inflammation leading to leaky gut, food sensitivities, skin eruptions and sometimes mood changes like anxiety and depression.

Fortunately, there are simple yet effective dietary and lifestyle strategies that can balance your microbiome and restore gut function. As a nurse health coach, I help my clients develop a personalized gut healing protocol similar to the following.

Treatment

• Diet

  • Low FODMAP — Reduce foods that can potentially ferment in the gut causing gas and bloating.

  • Anti-inflammatory — No sugar, soy, gluten or dairy.

  • Avoid fermented foods.

  • Intermittent fast and break fast with a smoothie.

  • No snacking — Frequent snacking inhibits the migratory motor complex, the sweeping motion of the intestines.

  Or

  • Elemental diet — In refractory cases, you may consider an elemental diet.

• Lifestyle

  • Low-impact exercise i.e. walking, yoga or pilates.

  • Start mindfulness practice i.e. meditation, gratitude journal.

• Supplements/Medications — Treatment plans are patient-specific.

  • Antibiotics and/or antimicrobials.

  • Motility agent if necessary (ginger, neomycin, low-dose naltrexone).

  • S. Boulardii containing probiotic.

  • Gut lining support — i.e. L-Glutamine, aloe vera, bone-broth, collagen.

References

Deloose, E., Janssen, P., Depoortere, I., & Tack, J. (2012). The migrating motor complex: control mechanisms and its role in health and disease. Nature reviews. Gastroenterology & hepatology, 9(5), 271–285. https://doi.org/10.1038/nrgastro.2012.57

Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterology & hepatology, 3(2), 112–122.

Fujimori S. (2015). What are the effects of proton pump inhibitors on the small intestine?. World journal of gastroenterology, 21(22), 6817–6819. https://doi.org/10.3748/wjg.v21.i22.6817

Gabbard, S. L., Lacy, B. E., Levine, G. M., & Crowell, M. D. (2014). The impact of alcohol consumption and cholecystectomy on small intestinal bacterial overgrowth. Digestive diseases and sciences, 59(3), 638–644. https://doi.org/10.1007/s10620-013-2960-y

Ghoshal, U. C., Shukla, R., & Ghoshal, U. (2017). Small intestinal bacterial overgrowth and irritable bowel syndrome: A bridge between functional organic dichotomy. Gut and Liver, 11(2), 196–208. https://doi.org/10.5009/gnl16126