SIBO…what’s that?
SIBO stands for Small Intestinal Bacterial Overgrowth. Okay, so what’s that, and why might it be an issue for you?
Although the lower, or large, bowel has a huge number of bacteria, both beneficial and harmful, the small intestine that precedes the bowel usually has far fewer. In SIBO, the number of bacteria, usually harmful, in the small intestine is quite a bit higher than normal as well as being bacteria that are normally found only in the bowel.
If someone you know has been diagnosed with SIBO, there’s at least one thing you don’t need to worry about – SIBO isn’t contagious despite the fact that bacteria are involved.
What problems can SIBO cause?
The small intestine is the part of the gastrointestinal (GI) system that connects the stomach to the bowel. In the small intestine, food is digested and nutrients are absorbed. One of the major SIBO problems is malabsorption of nutrients, which in turn can cause any illness in which malnutrition is a factor, i.e. almost any illness.
Since the problem is in the intestine, there are, not surprisingly, a number of gastrointestinal symptoms that can occur, including bloating and distension, gas, abdominal pain, diarrhea, and constipation. GI symptoms are typically the first symptoms of the disorder, with systemic symptoms occurring over time if the SIBO is undiagnosed and untreated. The symptoms can change in type and intensity.
SIBO can cause body aches and fatigue, and is a cause of what is diagnosed as chronic fatigue or fibromyalgia. Anemia is common, since iron and other components of blood production can be absorbed in the bacteria-laden small intestine rather than being available for blood.
A good balance of bacteria, especially beneficial bacteria, benefits the immune system. A poor bacterial balance, or bacteria where they don’t belong such as with SIBO, can lead to immune system problems such as autoimmune disease, cancer, infection, or allergies.
SIBO and leaky gut syndrome, discussed in another article, are intertwined and can keep each other going in a vicious cycle. SIBO and irritable bowel syndrome (IBS) are also similarly intertwined, with interchangeable symptoms. Up to 80% of those with IBS also have SIBO.
What causes SIBO?
The GI system is essentially a muscular tube that propels food downward. This muscular activity keeps bacteria from the bowel from backing into the small intestine. But when this downward muscular action is interfered with, these bowel bacteria end up in the small intestine, which by definition is SIBO. Things that can interfere with this activity include intestinal obstruction, neurological and muscular diseases, scarring and adhesions from surgery, and IBS. Other contributing factors are diabetes, celiac disease (gluten sensitivity), low stomach acid (often due to the habitual use of antacids), and liver or kidney problems. Overuse of antibiotics can seriously unbalance the GI bacteria, as can the overuse of alcohol and the use of birth control pills.
It has relatively recently been found that the food you eat affects the kinds of bacteria in the system. Fiber promotes the growth of beneficial bacteria, while sugar and processed food promote bacteria that can be damaging.
How can you tell if you have SIBO?
Culturing the bacteria from the small intestine is one way to determine whether SIBO is an issue. However, this test is inconvenient and uncomfortable and so is rarely used. A much more common test is hydrogen or methane breath testing. When bacteria that are normally in the colon digest sugars, gases, including hydrogen and methane, are produced. These gases circulate in the blood and go to the lungs, where they are exhaled and measured. In the breath test, a baseline amount of hydrogen is measured in the breath after a 12-hour fast. Then a sugar solution is given and the breath measured at intervals. A person without SIBO will show one peak of hydrogen when the sugar reaches the colon. A person with SIBO will show two peaks, since the colon bacteria that digest the sugar are also in the small intestine and the sugar is digested in both places. In a related test, the sugar glucose is used; only those with SIBO will excrete gas in their breath. Many people who have been diagnosed with IBS have an abnormal breath test, proof of a link between the two.
Blood tests and other tests can help identify other health problems that can be either cause or effect of the SIBO.
What can be done about SIBO?
One of the most common treatments for SIBO are short term antibiotics followed by long term probiotics to repopulate the intestine with beneficial bacteria. These beneficial bacteria were probably low to begin with, and antibiotics will reduce their numbers still further, one disadvantage of antibiotic treatment for SIBO or for any bacterial ailment. Antibiotics used alone will help, but only short-term, so their use alone, without other supportive measures such as probiotics and diet, isn’t recommended. For antibiotics, or any therapy, to be useful, the underlying cause of the SIBO needs to be addressed.
Diet is important, and a diet high in vegetables and other fiber along with eliminating sugars and other (non)foods that feed the harmful bacteria will help establish a good balance of bacteria as well as keeping the bacteria in the part of the GI system where they belong.
One of the important aspects to treating SIBO is to identify and address any underlying health issues that might have contributed to the SIBO in the first place. Looking at the root cause of any illness is where CAM practitioners excel.
