Could SIBO be the cause of your chronic digestive issues?

Have you heard of SIBO, aka small intestinal bacterial overgrowth? It is a digestive health condition that affects many of us, and it is often mistakenly diagnosed as “IBS” or irritable bowel syndrome.

We normally have different kinds of bacteria in the small intestine (the long squiggly bunch in the middle) and in the large intestine (the big loop on the outside). The different bacterial communities are kind of analogous to a pond and the sky — we find fish in the pond and birds in the sky but we don’t usually find fish in the sky!

What are the symptoms of SIBO?

​In SIBO, the bacteria from the large intestine get into the small intestine where they just don’t belong. This can happen for a variety of reasons that I’ll get to shortly. These bacteria can then create havoc, producing gases in response to what we eat, which can cause bloating, abdominal pain, diarrhea, constipation, heartburn, nausea, and all kinds of other unpleasant digestive symptoms. SIBO is also a leading cause leaky gut (also known as intestinal permeability) which can present with a variety of symptoms around the body such as:

• Food sensitivities
• Joint pain
• Fatigue
• Headaches
• Skin symptoms like eczema or rashes
• Respiratory symptoms like asthma
• Mood symptoms like depression
• Brain symptoms like in autism
• Iron deficiency anemia
• Vitamin B12 deficiency
• Fatty stools

How is SIBO diagnosed?

​There is a test for SIBO that involves collecting breath samples over several hours after drinking a sugary solution called lactulose. The testing is about $200. If the test is positive, then we obviously treat! The test results will tell us which kind of bacteria are present! The testing is important as it determines the severity of the infection and which treatment would be most effective.

Testing requires the individual to follow a limited 24-hour prep diet the day before testing, which includes:

• Baked or broiled meat or fish (raw fish is allowed)
• Plain, steamed white rice
• Eggs
• Clear meat broth (no bouillon, bone/cartilage or vegetable broth)
• Fats and oils (coconut/olive/vegetable oil, butter, lard)
• Salt and pepper
• Weak black coffee/tea (no sweeteners or cream)

Nothing outside of this list is permitted during the 24-hour prep diet, because anything else could feed the bacteria and we want to calm any bacteria down a bit before the big test day!

The night before the test collection, the individual must fast for 12 hours, which isn’t usually too difficult because mostly the individual is asleep! In the morning, the person is ready to start the test collection, which involves drinking the lactulose solution and providing breath samples every 20 minutes over 3 hours. Test results usually arrive about 7-10 business days after the lab has received the samples.

How is SIBO treated?

​There are many approaches to treating SIBO out there, from the low FODMAP diet to the elemental diet, Cedar Sinai diet, prescription medications, herbal therapies, and more. The way I treat SIBO is a multi-phase approach:

• Prepare the body for treatment (takes about 2 weeks)
• Remove the bacteria from the places we don’t want it (takes 2-4 weeks)
• Repair any inflammation that the infection caused (takes about a month)
• Restore healthy micro biome
• Prevent relapse by addressing the root cause of the infection

What would be the root cause of SIBO?

​Some of the potential underlying factors that can cause SIBO in the first place include:

• Stress, chronic anxiety, and trauma that lead to delayed peristalsis (aka gut motility)
• Low thyroid function (hypothyroidism)
• Low stomach acid or frequent use of proton pump inhibitors (heartburn medications)
• An episode of acute gastroenteritis (ie. stomach flu)
• A history of voluntarily withholding stools
• Scar tissue in the abdomen from surgeries or injuries
• Ileocecal valve dysfunction
• Diet can certainly contribute but is rarely the cause all by itself

It is important that we determine the root cause of the issue and treat it to prevent SIBO symptoms from returning again and again.

In summary, I really love testing and treating for SIBO. It’s really pretty easy, and most people see a complete resolution of their digestive symptoms, which is so, so satisfying. Most people who eventually come in and get tested for SIBO have usually been struggling with digestive symptoms for many years - sometimes up to 20 or 30 years. You can imagine how wonderful it is when these individuals feel well in their digestive system after all that suffering.

To learn more about SIBO or to discuss digestive health, please contact me or schedule an appointment.