SIBO : Causes, Symptoms, Diet and Treatment

Gastrointestinal symptoms and distress occur frequently for many. Diagnosis of conditions such as Celiac, Crohn’s and Leaky Gut Syndrome as well as IBS continue to grow. Researchers cannot put their fingers on which digestive systems are under threat. An equally dangerous stomach condition is SIBO or small intestinal bacterial overgrowth. It is found among many people suffering from stomach related problems such as IBS.

SIBO: Nature and Symptoms

SIBO stands for small intestine bacterial overgrowth. In other words, it is excessive bacteria in the small intestine. While bacterium occurs naturally within the digestive tract, in a system that is healthy, small intestine has low bacteria levels. It has been associated with the highest concentration within the colon.

Small intestine is the largest section that the digestive tract has. This is where food meets the juices of digestion, and bloodstreams absorb nutrients. In case SIBO is diagnosed, lack of absorption of nutrients especially fat-soluble iron and vitamins can be an issue. When the bacteria in the colon are properly balanced, the digestion of food and absorption of critical nutrients is easy. When the bacteria invades and overcomes the small intestine, it leads to lack of absorption of nutrients, symptoms associated with IBS and damaged stomach linings.

SIBO is characterized by food passing through the small intestine and facing a serious digestion issue because bacterial overgrowth interferes with the digestion and absorption procedures. Bacteria associated with SIBO consumes most of the food and nutrients and causes problems such as pain, flatulence and bloating.

Despite SIBO treatment with antibiotics, relapses are quite common. This chronic condition can be cured, only if patience is exercised, along with diet control and perseveration. SIBO treatment includes a healing diet, and certain foods should be given a wide berth till there is balance in the gut flora.

SIBO is a condition where colonic-type bacteria are found in massive numbers within the small intestine. Bacteria such as these are normally found in the colonic region. Essentially, intestinal nerves or muscles and anatomic abnormalities of the intestine include intestinal obstruction or the presence of a small intestine that is bypassed, a blind loop(in other words), The symptoms of SIBO include abdominal bloating or distension, diarrhea, gas, and abdominal pain. In advanced cases, there are also mineral and vitamin deficiencies and weight loss. This condition results from culturing of intestinal fluid following a breathing test involving hydrogen. In some cases, the cause of the symptom can also be conditions associated with irritable bowel syndrome. SIBO is treated using probiotics, antibiotics, low FODMAP diet or a blend of the three.

What Does SIBO stand For?

Small intestinal bacterial overgrowth is when more than 100 thousand bacteria per milliliter of fluid are present in the small intestine. These types of bacteria in the intestine resemble more bacteria of the colon than the small intestine. Many conditions associated with SIBO include Crohn’s disease, Scleroderma, Diabetes and much more. There is a similarity between IBS and SIBO. SIBO is responsible for symptoms that some people diagnosed with IBS may manifest.

The small bowel or the small intestine, is part of the GI/gastrointestinal tract connecting the colon with the stomach. The main purpose of the small intestine is digestion and absorption of food and nutrients. The small intestine measures around 21 feet in length and commences at the duodenum where the food from the stomach releases, followed by the jejunum and ileum. This is where the food that has not been digested in the small intestine is emptied into the colon/large intestine.

The entire GI tract, including the small intestine, contains bacteria. This bacteria numbers more than 100 thousand per milliliter of fluid in the colon, whereas in the small intestine, the number present is lower at 10 thousand bacteria per ml of fluid. The categories of small intestine bacteria differ from the ones in the colon. However, SIBO and its symptoms occur within smaller numbers of bacteria too, according to some.

SIBO leads to chronic constipation rather than bowel movements that are frequent or excessive. SIBO patients report problems unrelated to the GI tract such as fatigue or body aches as well. Symptoms of SIBO tend towards being chronic. Symptoms can fluctuate in intensity over months, years or decades even before diagnosis comes into play.

How Does SIBO Cause Symptoms?

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When bacteria digests food in the intestine, it leads to flatulence. This gas increases in the abdominal region and gives rise to distension. Bacteria also converts foods such as carbs and sugars into substances that are toxic and irritating to the inner lining cells of the small intestine and colon. These substances initiate diarrhea and production of methane or CH4 causes constipation.

Bacteria in the small intestine present in large numbers competes with the human host for the consumed nutrients. This leads to malnutrition with mineral and vitamin deficiencies. In advanced SIBO cases, bacteria use up enough food insufficient for hosts leading to the calorific downfall and resulting weight loss.

SIBO comprises two different kinds. One is associated with the intestine conditions while the other is not. SIBO of either type can cause bloating, indigestion, diarrhea and abdominal pain. The type associated with intestinal conditions and diseases results from the incapacity of the body to absorb nutrients from the intestine and lead to vitamin and malnutrition deficiencies. The need for a diagnosis is critical at this stage. SIBO associated with intestinal conditions can be diagnosed through blood tests, biopsies or tissue samples and breathing tests. Diagnosis of either type of SIBO requires testing of samples. The antibiotics may be prescribed but both duration and type of treatment are based on the intensity of the symptoms. Underlying medical conditions also may need treatment once therapy for SIBO starts. The prognosis is based on how well-associated illnesses are managed and the type of response to therapeutic measure.

Conditions Associated With SIBO

SIBO is also linked with other illnesses affecting the functionality of the small intestine. The body has distinct mechanisms to protect it and keep the bacteria under control, including intestinal motility and stomach acidity, the capacity of intestines to move content downstream at desired speeds. Bacteria growth is stopped due to the presence of immunoglobulins and bile. The ileocecal valve prevents the release of stool from the colon into the latter part of the small intestine called the ileum.

Many people develop SIBO on account of problems with intestinal muscles or anatomy. This includes abnormal anatomy of intestines through gastric bypass surgery, bowel adhesions and strictures that can lead to bowel obstruction, outpouchings or diverticula of the small intestine as well as tumors. The bowel motility, in turn, can be impacted by neurological diseases such as Parkinson’s or myotonic dystrophy as well as a rare condition called pseudo-obstruction. The autonomic dysfunction affects the intestinal muscles and leads to dysmotility.

Other intestinal diseases impacted with SIBO include:

• Celiac disease 
Crohn’s disease
• Achlorhydria
• Cirrhosis of the liver
• Alcohol abuse
• Non-alcoholic steatohepatitis
• Scleroderma, lymphoma, and leukemia may increase the risk of development of SIBO

Symptoms of SIBO

Indications of SIBO mirror other GI disorders including IBS. There’s a critical reason for similar symptoms leading to an association between IBS and SIBO.

Common Symptoms of IBS and SIBO include nausea, vomiting, bloating, diarrhea, weight loss, malnutrition, joint pain, rashes, fatigue, acne, eczema, depression, asthma, and rosacea.

Initial symptoms specific to the abdomen and GI tract include bloating, indigestion, abdominal pain, diarrhea, and excessive flatulence. A SIBO patient does not have all the symptoms generally.

But as the disease advances, the symptoms can manifest or worsen. The bacteria overgrowth inhibits the ability of the body to a absorb nutritional value from food items consumed. This leads to vitamin and electrolyte imbalances, protein deficiencies and fat absorption issues.

The incapacity to absorb vitamin B12 can lead to symptoms such as low RBC count, peripheral neuropathy, and pernicious anemia. Anemia is also the result of lack of iron, while vitamin A deficits can lead to night blindness and metabolic bone disease is on account of vitamin D deficiency. Malnutrition leads to loss of weight and excessive muscle wasting. or cachexia. The lack of fat absorption leads to excess fat in stool and foul-smelling discharge. It also leads to incontinence.

SIBO has been associated with digestive and system-wide symptoms.

Gastrointestinal symptoms include chronic bloating, flatulence, constipation, heartburn or acid reflux, diarrhea, nausea, skin issues and more. System-wide symptoms range from asthma to depression, anxiety, mood disorders, food sensitivity, joint pain, fatigue, and headaches. Persistent skin problems like acne, psoriasis, rosacea, and eczema also result. SIBO should not be diagnosed based on symptoms alone. SIBO testing methods are the only ones to help.

Causes of SIBO

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There are numerous underlying conditions leading to SIBO. This includes aging, chronic pancreatitis, diverticulosis, diabetes, structural defects in the small intestine, injury, fistula, and scleroderma. Use of medicines such as immunosuppressant medications, immune system problems, proton pump inhibitors, recent surgery and celiac disease are also associated with the risk for development of SIBO. Celiac disease can lead to improper functioning of the small intestine and gut motility leading to problems.

Around 66 percent of patients with celiac disease maintain a strict zero-gluten diet combining antibiotics, prescription medications, parasites and changes in diet. Symptoms are abated post-SIBO. An underlying cause of SIBO is something known as the blind loop. The small intestine forms a loop causing food to escape the digestive tract, fostering the growth of bacteria.

Metabolic disorders like type 2 diabetes which are not properly controlled can lead to GI disorders. SIBO was found in a vast percentage of patients with chronic diabetes. Another risk factor is aging for the development of small intestine bacterial overgrowth. As the digestive tract slows down, the chances of developing this disorder are high. Rosacea is a skin condition that is also associated with SIBO systems.

Small intestinal bacterial overgrowth is caused by or linked to a wide array of conditions. Even those not related to GI tracts correlate with SIBO systems. The GI tract is a continuous muscular tube while digestion of food is transported on the way to the colon. The coordination activity of muscles of the stomach and small intestines move food from the stomach into the colon. The muscular activities sweeping through the small intestine is critical for food digestion, limiting the number of bacteria in the small intestine. Conditions that interfere with muscular activity in the small intestine cause bacteria to increase in numbers. Lack of muscular actions also permits bacteria to spread towards the back into the colon and the small intestine.

Conditions associated with SIBO include neurologic and muscular diseases, partial obstruction, diverticulitis of the colon or small intestine. Common causes of SIBO are further explained below. The exact causes of SIBO vary because the internal environment is different. SIBO results from the structural change in the GI tract. It is caused by peristalsis of the stomach and small intestine, or disruption of mucosal defenses in the small intestine. Anything that causes regular functions of GI tract to suffer, especially muscle and valve function and this can cause SIBO.

#1 Low Amount of Acid in the Stomach

Stomach acid leads to activation of digestive enzymes and this kills disease-causing bacteria. Low stomach acid is caused by frequent use of antibiotic, diet high in processed food and natural decline with age can lead to microbial overgrowth, causing greater risk for small intestine bacteria. This is associated with low stomach acids.

#2 Medical Conditions Pre-Existing

The medical conditions that impact the muscle function of the gut lead to SIBO. Type 2 diabetes, prior bowel surgeries, Celiac disease and leaky gut syndrome increase the risk of developing SIBO.

#3 Diet Factors like Gluten, Alcohol and Refined Sugar

A study demonstrated that the higher rate of SIBO with moderate levels of alcohol consumption as against people who don’t consume any drinks at all. Alcohol causes SIBO because it damages the mucosal cells of the small bowel which decreases muscular contractions of the ileum valve, which separates the content of small and large intestine. Both alcohol and refined sugar also act as catalysts for bad bacterial growth in the system. This test is harmful because it overgrows and outnumbers healthy gut bacteria. Yeast or candida growth can cause the leaky gut syndrome to manifest, imparting muscle function of the gut. Eating gluten also increases the risk of SIBO. Leaky gut and SIBO can manifest simultaneously.

#4 Dysmotility of Small Intestine

This means the small intestine is functioning at a slower rate. It is caused by autoimmune conditions, genetics, and other illnesses that cause inflammation in the GI tract.

#5 Small Bowel Transit Period

A sluggish bowl transmit time means it takes more than 3 days for food to move to the point of elimination from your digestive tract. This is a risk factor to SIBO because it allows harmful bacteria accumulation.

#6 OTC Prescriptions

Prescription medications like antibiotics or antidepressants and birth control pills can damage the mucosal cells of the bowel and deplete healthy stomach gut bacteria.

Diagnosis of SIBO

Initial symptoms of small intestine bacteria overgrowth are non-specific and take time for healthcare professionals and persons to consider SIBO. Lack of absorption of proteins, vitamins, and fats make it important to look for SIBO. A blood test may also be ordered for different types of electrolyte imbalance, vitamin deficiencies, and anemia.

Breath tests diagnose SIBO caused by bacteria. Additionally, upper GI endoscopy allows stomach doctors to examine the upper part of the small intestine.

While diagnostic tests are performed, symptoms that correlate with SIBO also need to be taken into account

#1 Hydrogen Breath Test

This is the most common and accurate SIBO testing method used at this time. It detects hydrogen and methane in the breath. These gases result when small intestine bacteria garment the sugar from carbs. These gases are released into the blood, sent to lungs and exhaled through the breath. Breath tests detect SIBO.

Small intestine is meant to be the location of nutrient absorption, not digestion where food is fermented. If hydrogen and methane are found in the breath, the bacteria in the small intestine break down carbs before they can make it to the larger intestine. This indicates SIBO. Hydrogen breath test is not the only breath test.

#2 Other Breath Tests

SIBO tests for Glucose Breath Tests and Lactulose Breath Test are also there. Such breath tests can be administered by GI specialists or physicians. Order hydrogen breath tests from labs. SIBO left untreated causes serious health issues. Bacterial overgrowth can lead to malnutrition as well as iron and vitamin deficiencies. These deficiencies cause symptoms like weakness, fatigue, and CNS damage.

SIBO Treatment Methods and Types

Treatments for SIBO include control and treatment of underlying associated illnesses. The goal is for controlling the symptoms of SIBO since it may not be possible to find a cure, though management is possible. Antibiotics are one of the treatments for controlling more bacteria.

Antibiotics

These include Augmentin and Xifaxan. These common antibiotics are not the only ones SIBO treatment is used for. Clindamycin, Flagyl, florins like Ciprofloxacin and Levaquin. Additionally, there is Septa/Bactrim.

A single course of antibiotics for one-two weeks may be enough. However, SIBO can also have a release and repeated courses of antibiotics may be needed. They need to, therefore, be routinely cycled alternating one-two weeks on antibiotics and weeks off. Underlying vitamin and nutrient deficiency on account of malabsorption should be taken care of too.

Herbal Remedies

Researchers have found herbal remedies are as effective as courses of antibiotic therapy in patients who did not respond to rifaximin. Some of the best herbal remedies are wormwood oil, lemon balm oil, berberine extract, oregano oil and Indian barberry root extract.

It is important to identify if there are underlying causes. Starting to reverse nutritional deficiencies is important through a healthy diet, lifestyle changes, and nutritional supplements.

Another important point is that smaller amounts of food should be consumed during meals. Spread meals over five-six small portions rather than three large ones. Eat smaller meals to digest food more quickly. Don’t overeat as it causes food to sit longer in the stomach and damage the gastric juices. Low stomach acid production is a contributing factor, so watch your diet.

The Diet for SIBO Patients

To get started on the SIBO management, start with FODMAP elimination diet for 2 weeks. FODMAPS are foods that are not fully absorbed into the body and ferment within the digestive tract. The fermentation feeds bacteria, making it possible to fight SIBO linked symptoms.

Foods to Leave Out in Phase 1

• Fructose or fruit and fruit juices, honey, baked goods, processed cereals, sugars and maple syrup as well as corn syrup.
• Lactose products such as conventional dairy and processed products with dairy
• Frutanssuch as cabbage, leeks, onion, garlic, and wheat.
• Galactansincluding soy, Brussel sprouts and legumes should be given a wide miss.
• Polyols such as isomalt, xylitol and sorbitol need to be given a wide berth too.

Foods to Eat in Phase 1

• Fresh fish like tuna and salmon
• Free-range poultry and eggs
• Grass-fed beef and lambs
• Almond
• coconut milk
• Raw hard cheese
• Greens and Veggies
• Select Fruits like Blueberries and Pineapple
• Quinoa
• Sprouted nut butter.

SIBO diet repairs the lining of the intestine, easing inflammation, removing bacterial overgrowth and eating a diet rich in essential nutrients. Quality proteins are easy to digest and give your body energy. FODMAPS elimination of fruits does not mean you cannot enjoy lemons, strawberries, bananas, tomatoes and blueberries to name just a few. Pineapple improves inflammation issues through bromelain.

Phase 2

Following two weeks in FODMAPS avoidance, GAPS diet plan and protocols must be in place. GAPS repairs leaky gut syndrome, rebalancing bacteria through digestive tract and toxins entering the blood stream. This plan also helps combat food sensitivity and enhance neurological functioning, reducing anxiety and depression and boosting immunity besides healing IBS.

Numerous foods need to continue to be avoided on this plan. Grains, processed sugars, starchy and processed foods and non organic meats and dairy should be avoided. Systems are healing from SIBO and repairing the digestive tract.

GAPS/Gut and Psychology Syndrome Diet

• Bone broth must be consumed with every meal
• Use coconut oil for cooking
• Eat fruits between meals, not with them
• Have probiotic rich foods such as kombucha
• Consume raw dairy fermented 24 hours or longer
• Include tablespoon of fermented veggie juice with each meal.
• Consume vitamin supplements, iron supplements, probiotics, digestive enzymes, zinc and essential SIBO oils.

Essential herbs to have include peppermint oil, oregano oil, tarragon oil, clove oil and frankincense oil.

SCD Diet

This specific carbs diet was introduced by Elaine Gottschall in a book. The aim was to improve sugar, carbs, and foods that can irritate the digestive tract. It is a milder version of the Paleo diet which removes grains but allows dairy and legumes. Sweeteners and starch-rich foods are prohibited. Instead, you eat ripe fruits, seeds, and non-starchy veggies.

Bone Broth

This is rich in collagen and gelatin which seals the gut lining and heals inflammation. Drinking bone broth also replenishes vitamins and minerals such as magnesium and calcium which may be deficient when SIBO is available.

Lifestyle changes also accompany this diet. FODMAPS needs to be eliminated while GAPS and SCD must be followed along with essential herbal oils for best results. If you like to know more about SIBO, please check SIBO Survivor.