The name stands for Small Intestinal Bacterial Overgrowth. As the name suggests, this bacterial overgrowth is present in the small intestine where bacteria should not reside. There should be bacteria present in the large intestine but the small intestine should be sterile. The small intestine is 20 feet long and is where our food is absorbed via our villi. However, if there is an excess of bacteria in this area, the food cannot be properly absorbed, and the bacteria feed off this stagnant food, fermenting it and create toxic gases. The gases that can be produced are hydrogen, hydrogen sulphide and methane.

This gas build up causes bloating in the abdomen, and an increase in intra-abdominal pressure. This excess pressure can cause the contents of the stomach to be forced up which can result in reflux, nausea and heartburn. This situation in the small intestine can cause problems in the large intestine too, resulting in constipation or diarrhoea, and inconsistent bowel movements. SIBO can result in gut inflammation and damage to the mucosal membranes which can lead to ‘leaky gut’ which has been linked to the onset of food intolerances and autoimmune diseases.

Usually the small intestine is kept sterile from the Migrating Motor Complex’s (MMC) sweeping action every 4 hours that ‘cleans’ any bacteria or debris in there, but if the bacteria are hiding in pockets or adhesions they can escape this cleaning action. Similarly, if the MMC is not working correctly then it cannot perform this job correctly.

Sometimes, if you take certain strains of probiotics, your symptoms can worsen if you have SIBO as this is like adding fuel to the fire where there is already too much bacteria present. This is because the bacteria present in SIBO are not always pathogenic, it can be overgrowth of good strains of bacteria like the ones in probiotics that are growing in the wrong place.

Symptoms of SIBO

There are plenty of G.I. symptoms associated with SIBO including constipation/ diarrhoea, flatulence (often quite smelly), burping, bloating, abdominal pain, acid reflux, bad breath, vomiting. However the symptoms extend beyond the G.I.tract and also include brain fog, fatigue, skin issues (rashes, eczema, acne), joint pains, anxiety, depression, hormonal imbalances, malnourishment, bile acid malabsorption (BAM), rosacea.

Risk factors for developing SIBO:

• Low stomach acid – allows bacteria to survive past the stomach
• Use of antibiotics, lowers immune defences
• Use of the contraceptive pill disrupts the microbiome
• Use of certain medications can affect transmit times
• Long term constipation can affect the ileocecal valve allowing bacteria to travel up from the large intestine to the small.
• Stress can cause the Lower Oesophageal Sphincter to become impaired. Stress can also cause low stomach acid
• Adhesions from surgeries including laparoscopy, appendectomy, caesarean etc can affect the MMC.
• Food poisoning – bacteria from food poisoning can secrete a toxin called Cytolethal Distending Toxin B (a neuro toxin). This damages the nerve cells in the small intestine which help the Migrating Motor Complex to work properly in ‘cleaning’ the small intestine of bacteria and debris. If this is not working properly then you get a build-up of bacteria in the small intestine
• Endometriosis and diverticular disease can allow for blind loops where bacteria can hide and multiply
• Diabetic neuropathy to the Autonomic Nervous System (ANS), particularly in the gastrointestinal tract (GIT) can cause hypomotility and SIBO.
• Autoimmune attack on the ileocecal valve
• Altered collagen levels (Ehler’s Danlos Syndrome)
• Impaired gut-brain axis function
• Hypothryoidism can affect transmit time and pre-dispose to SIBO
• Heavy metal toxicity

Testing options:

A SIBO test is a breath test and it measures hydrogen and methane gases from the small intestine. These gases are produced by bacteria residing in the small intestine. High levels indicate the presence of bacteria in the small intestine where they should not be.

The test is a home testing kit which you can easily complete following a prep diet and an overnight fast. You then post the test kit back off to the lab and wait 10 days for the results.

There is the option of 2 substrates for the test including lactulose and glucose. Generally speaking it is best to use lactulose as this measures a larger proportion of the small intestine whereas the glucose substrate only tests the top end, so it can produce a false negative result as it misses half of the picture.

Treatment:

It is advised that you work alongside a Nutritional Therapy Practitioner who is experienced in SIBO. The treatment will depend on the type of SIBO that you have and how severe the overgrowth is. Your therapist will prescribe the best and most suitable supplements for your individual makeup, checking them for any drug-nutrient interactions. They will also advise on the different dietary protocols that are available for treating SIBO, again they will discuss the best diet for you based on your individual needs and symptoms.

If you suspect SIBO and would like to arrange to have a test or you already have a SIBO diagnosis then feel free to book in for a free 15 minute discovery call with me to see how I can help you.