I remember sitting in my gastroenterology class in 2017 and learning about Small Intestinal Bacterial Overgrowth (SIBO). It appeared that this was not a very common condition. I sorta brushed it off thinking this would not be something I would be treating often. But boy, was I wrong! Only a year later would I personally be dealing with SIBO. And since then I’ve helped hundreds of patients heal from it as well. SIBO actually accounts for 70-80% of people who have been diagnosed with IBS.
Symptoms started mid July of 2018. Daily uncomfortable bloating and right lower quadrant abdominal pain. But that wasn’t the worst part. The worst part was something I had never experienced before, generalized anxiety. Feeling constantly unsettled, having chest tightness relieved by releasing frequent small burps, unexplained weight loss and inconsistent bowel movements. At first my naturopathic doctor and I assumed it was stress related. I had graduated from naturopathic school just a month prior and was getting ready to take my licensing boards.
Fast forward to 2019. I was adjusting to a busy work schedule while still dealing with digestive concerns. Slowly symptoms started to get worse. I developed adult acne (on my forehead only), began to experienced changes in my cycle, the anxiety was out of control, and the bloating in the evening was so painful that I struggled to sit up or stand up straight. I knew something was really off. After visiting my school notes, I was certain I had SIBO.
Back to my doctor I went and we decided to test for SIBO and to complete a comprehensive stool analysis. To no one’s surprise, my hydrogen and methane gas levels were HIGH, confirming the SIBO diagnosis and validating my symptoms. Which was quite comforting.
SIBO is an overgrowth of bacteria in the small intestine. These bacteria are not always “bad” but they’re definitely in the wrong location. Majority of our gut bacteria should be living in the large intestine (the intestine that follows after the small intestine). When there is SIBO, the food we eat, especially fiber and carbohydrates get fermented and gas is released. This gas often causes symptoms of malabsorption, gas, bloating, belching, abdominal discomfort, etc. Symptoms can range from mild to severe, regardless of your gas levels.
The two most common gases that are produced by these bacteria are hydrogen gas and methane gas.
Signs and Symptoms:
Bloating
Constipation or diarrhea (or a mixed of them)
Abdominal pain
Excessive belching and/or flatulence
Other symptoms:
Weight loss or weight gain
Anxiety
Depression
Brain fog
Acid reflux
Nausea
Sensation of food sitting in the stomach (dyspepsia)
Fatigue
Gut permeability (also known as leaky gut) leading to food sensitivities
Skin rashes
Steatorrhea (fatty stools)
Acne rosacea
Malabsorption of fat soluble vitamins such as: A, E, D, K, and essential fatty acids and of vitamin B12, magnesium, and iron.
What causes SIBO?
There are several risk factors for SIBO but no known single cause.
Stress (very common)
Hypothyroidism or low thyroid function (very common)
Food poisoning
Ileocecal valve dysfunction
Abdominal surgery (like an appendectomy)
Intestinal obstruction (due to a tumor, chronic constipation)
Autoimmunity (Crohn's, Celiac Disease, Scleroderma)
Diabetes
Ehlers-Danlos Syndrome
Recurrent antibiotic use
How is SIBO diagnosed and treated?
The easiest and most cost-effective way to diagnose SIBO is through a 3 hour breath test preferably using lactulose as the substrate. The 3 hour breath test is best because it will gather information from the entire small intestine and into the large intestine. This is important because a 2 hour breath test may not catch SIBO that’s towards the ileum (the end of the small intestine). My own SIBO was primarily at the ileum. Getting an aspirate from an endoscopy usually comes from the duodenum or at the most the jejunum, therefore SIBO may be missed if found in the ileum and no aspirate was done from there.
Eradicating SIBO can be a bit tricky, and may take more than one round of treatment. There are 3 main options for treatment- antibiotic(s) (with supporting supplements), herbal antimicrobials, and the elemental diet. Treatment with antibiotics may range from 14-21 days and herbal antimicrobials from 30-45 days. Both effective.
A crucial aspect of treating SIBO, is ensuring to treat for potential biofilms. I call these the “gooey capsules” that can form in our digestive lining and “trap” infection. If biofilms go untreated, then there’s a high chance that not all SIBO will be fully eradicated.
After eradicating SIBO, it is important that we support motility with a prokinetic for at least 6 months. This will help prevent relapse.
Another important aspect of treatment after eradicating SIBO, is to restore the gut lining and rebuild a healthy gut microbiome.
Final Thoughts:
SIBO is a very common issue I treat in practice. Often times missed by conventional medicine. The goal is not only to eradicate it but to also address what causes it in the first place. If it was stress, how can we respond to stress differently? What changes can we make in our lifestyle to reduce the stress burden we carry? If it was hypothyroidism, lets ensure your thyroid levels are adequate. If you have SIBO, find a practitioner that understands the different nuances that can take you from simply managing it to eliminating it. Lastly, as a former SIBO sufferer, don’t give up! You are not going crazy, the symptoms can be extremely difficult and may be affecting different areas in your life and the quality of your life. But there is hope! Reach out if you’d like work with me.