SIBO (Small Intestinal Bacterial Overgrowth)

Could Your Digestive & Hormone Issues Really Be Caused By SIBO?

Do any of these typical signs of SIBO sound familiar….

• You’ve been diagnosed with IBS
• You’ve had lifelong issues with constipation
• You’re embarrassed by your gas and bloating… it gets so extreme you look and feel like you’re 9 months pregnant
• You’re plagued with abdominal pain and cramping
• You can’t figure out which foods are the cause of your digestive symptoms
• You’ve been labelled as having “acid reflux” or “GERD”, given an acid reducing medication, and sent on your way
• You have multiple food sensitivities and what you’re pretty sure is the symptoms of leaky gut
• You have iron deficiency of no known cause
• You’ve been struggling with weight loss resistant, thyroid issues, and hormonal issues

If any of this sounds like you, you NEED to know what SIBO is.

It’s pretty common for women to have several health concerns that span multiple systems, including the digestive system and endocrine system.

Most of us are pretty familiar with the term “leaky gut” or “dysbiosis” by now as they’ve received a lot of attention over the past few years. When we think of these terms, we are usually thinking about the presence of an out-of-balance microbiome within the context of the large intestine or colon. As our knowledge of the microbiome and digestive health grows, our understanding of gut infections has expanded and we are now starting to understand that dysbiosis and leaky gut is not just localized to the colon. It can actually take up residence higher up within the digestive tract along the small intestine.

When we talk about dysbiosis in the small intestine, we refer to this as SIBO, or small intestinal bacterial overgrowth.

While a long list of symptoms accompany SIBO, its trademark symptoms are a chronically bloated, distended belly especially after eating starches or sugars (ie. Carbohydrates). These carbohydrates are the most common for causing symptoms with SIBO:

• Starches
• Sugars
• Fructans
• Prebiotics
• Probiotics
• Sugar alcohols like maltitol, xylitol and sorbitol
• Fiber supplements
• Rice or pea protein supplements

It’s interesting to note that most women suspect that they have yeast or Candida overgrowth when they have poor tolerance to starches and sugars. But the more common culprit is actually SIBO. Now, it is possible to have both SIBO and yeast or Candida overgrowth in the colon, and it’s also possible to have SIBO and/or SIFO, which stands for small intestinal fungal overgrowth.

 

What Is SIBO?

SIBO occurs when bacteria in the small intestine become overgrown and problematic, often having migrated up from the large intestine. When bacteria overgrow in the small intestine, our absorption of nutrients becomes impaired due to an inflamed and leaky gut, and normally healthy foods like apples, garlic, onions, cauliflower, broccoli, avocados, etc. become our worst enemy due to microbial fermentation of the starch and sugar content of plant foods like these.

This overgrowth of bacteria causes bloating due to the production of methane and hydrogen gas, a natural by product of bacterial fermentation. This gas production can cause abdominal distension, pain, flatulence, diarrhea or constipation. An overgrowth with hydrogen producing bacteria typically cause diarrhea, where as methane producing bacteria cause constipation. When I see a woman with long standing chronic constipation, I commonly see elevations in both hydrogen and methane producing bacteria.

The most common types of bacteria that commonly overgrow include the anaerobic bacteria Bacteroides, Lactobacillus, and Clostridium, and the aerobic bacteria Streptococcus, E coli, Staphyloccocus, Proteus, and Klebsiella. You’ll note that many of these are actually probiotics, or good bacteria.

What Causes SIBO

There are several theories as to the cause of SIBO. One important underlying cause is the deficiency of the migrating motor complex (MMC). The MMC refers to the wave like movements that move food and waste from the small intestine into the large intestine while we fast (between meals and at night). Other important contributors include low levels of hydrochloric acid (stomach acid) and low or poor bile flow.

 

Here’s a comprehensive list of some of the known causes of SIBO:

• History of any gastrointestinal infection such as traveller’s diarrhea, food poisoning, or viral gastroenteritis (stomach flu)
• Low stomach acid
• Stress
• Celiac disease (long-standing)
• Undiagnosed gluten sensitivity
• Pancreatic insufficiency
• Use of opiate or opiate like drugs
• Hypothyroidism
• Crohn’s disease
• Prior bowel surgery
• Diabetes mellitus (type I and type II)
• Multiple courses of antibiotics
• Alcohol use
• Oral hormonal contraceptives pills

 

Symptoms of SIBO

Most of us experience some type of digestive symptom from time to time, but when these symptoms are recurrent, persistent, and interfere with your life, we need to look deeper.

For most women, the symptoms of SIBO are straightforward. One of the most common symptoms is bloating after eating, particularly after eating grains, bread, pasta, desserts, or other starchy foods. Other SIBO symptoms include gas, belching, indigestion, heartburn, nausea, abdominal pain and cramping, and either constipation, diarrhea, or both.

Doctors often misdiagnose SIBO as irritable bowel syndrome (IBS), as the symptoms are so similar. In fact, SIBO has been found in more than 80% of patients diagnosed with IBS.

Here are the common symptoms of SIBO:

• Excess gas, flatulence, belching
• Abdominal bloating
• Abdominal pain and cramping
• Constipation, diarrhea, or both
• Nausea, heartburn or acid reflux
• Irritable bowel syndrome
• Multiple food sensitivities
• Leaky gut
• Fatigue
• Joint Pain
• Malabsorption (low vitamin D, B12 deficiency, low ferritin or iron, osteoporosis, anemia, greasy or floating stool)
• Rosacea and acne
• Neurologic and muscular diseases
• Pancreatic insufficiency
• Fibromyalgia
• Endometriosis
• Restless Leg Syndrome

Any of these symptoms or conditions may be due SIBO. Bacterial overgrowth has far reaching health consequences due to the damage it causes in the small intestine which leads to lowered digestive enzyme production and secretion, poor nutrient absorption, and inflammation.

Because hypothyroidism can cause poor motility, low hydrochloric acid, and constipation, it can predispose women to SIBO. But, SIBO can also cause hypothyroidism because of several factors.

First, SIBO impairs our ability to activate T4 to T3 in the gut. Secondly, SIBO can cause leaky gut, which means we need to consider SIBO as a cause of autoimmunity, including Hashimoto’s,

If you have SIBO and are taking thyroid medication, this may mean you can’t absorb your thyroid hormone very well, and you may continue to have hypothyroid symptoms like brain fog, hair loss, weight gain, depression, etc.

Here are 6 additional signs that may point to SIBO:

1. You notice that fiber worsens your constipation
2. You notice an improvement in your digestive symptoms when taking antibiotics
3. You feel more gas and bloating when you take probiotics that contain prebiotics
4. You have celiac or are gluten sensitive/intolerant and do not have complete resolution of symptoms on a gluten-free diet
5. You developed long-standing symptoms of gas, bloating, constipation or diarrhea after taking pain medications, like opiates.
6. Your blood work shows chronically low iron or ferritin or B12

How SIBO causes bloating, gas, constipation, and diarrhea

The entire gastrointestinal (GI) tract contains bacteria, both good and bad. In the case of SIBO, the small intestine becomes overrun with too much bacteria that should not be present there. These bacteria feed on sugars and carbohydrates, producing large amounts of gas through fermentation. Most find that their digestive symptoms improve on a low carbohydrate diet for this reason, as the bacteria are being starved of their favorite food source and gas production is significantly reduced.

SIBO Causes Leaky Gut

In addition to producing gas, the bacteria release endotoxins that irritate and damage the lining of the GI tract. This damage causes intestinal permeability, or “leaky gut,” a condition in which the lining of the intestine becomes damaged and “leaky”, allowing undigested foods, bacteria, and other pathogens into the bloodstream. This creates inflammation in the GI tract and throughout the body. And because the bacteria digest foods normally meant for the intestine to absorb, nutrient deficiencies and malabsorption are common side effects with SIBO.

SIBO Causes Nutrient Deficiencies

Bacterial overgrowth can lead to poor digestion and absorption of protein, carbohydrates, fats, vitamin and minerals.   This can lead to iron deficiency, vitamin B12 deficiency, calcium deficiency and deficiencies in the fat-soluble vitamins — Vitamin D, A, E and K. Poor blood sugar regulation (like reactive hypoglycemia) is commonly due to the malabsorption of nutrients due to SIBO.

How To Manage SIBO

The first step is getting proper testing. Diagnosing SIBO involves a breath test which has the patient ingesting a sugar solution and collecting breath samples over a period of several hours.   Once the results are analyzed and interpreted, a treatment plan can be initiated. The best test currently available is the 3 hour lactulose breath test.  Another test that can help to uncover if SIBO is an issue for you, plus screen for a host of other possible GI imbalances or infections like Candida/Yeast overgrowth, a parasite, or H Pylori, is the GI Map Stool Test.

Treatment often takes several months and involves a therapeutic diet such as the FODMAPs or Specific Carbohydrate Diet, antibiotic therapy, botanical antimicrobial therapy, and digestive system rebuilding and repair.

The goals of SIBO treatment are three-fold:

 

1. Reduce and eradicate the bacteria using a combination of diet, antibiotics, and botanical antimicrobials.
2. Heal the lining of the digestive tract
3. Prevent reoccurrence and restore normal functioning of the migrating motor complexes

We commonly use a prescription antibiotic called Rifaximin for its effectiveness in eradicating SIBO, specifically the bacteria that produce hydrogen gases. To eliminate methane producing bacteria, metronizadole or neomycin may be a consideration.

In addition to prescription antibiotics, herbal antibiotics are also very successful in eradicating SIBO including: Berberine containing herbs like goldenseal, high dose garlic extract, neem, oregano, thyme, myrrh, cinnamon, and many others.

Incorporating therapies that help to restore normal functioning of the migrating motor complex is also important and therapies can include prescriptions like prucalopride, low dose naltrexone, or nutrients like 5 HTP, ginger, or bitter herbal medicines.

The duration of treatment depends on the severity of symptoms and the levels of hydrogen and methane gas detected by the breath test but at a minimum, we usually start with 6 weeks.  Once SIBO has been diagnosed an a proper naturopathic treatment plan has been prescribed, you should start to feel better within 2 weeks.

 

Proper diagnosis is truly the first step.  Schedule your initial consultation today to determine if SIBO is behind your health concerns.