SIBO (SMALL INTESTINAL BACTERIAL OVERGROWTH)
WHAT IS SIBO?
SIBO is a little known condition with BIG symptoms !
SIBO stands for SMALL INTESTINAL BACTERIAL OVERGROWTH.
SIBO is defined as "the presence of excessive bacteria in the small intestine".
Our Colon should be home to billions of beneficial bacteria but the numbers of bacteria in our small intestine should be much, much lower in comparison.
Relatively few bacteria usually inhabit our small bowel (less than 10,000 bacteria per ml of fluid) when compared with our colon (at least 1,000,000,000 bacteria per millilitre of fluid). Also, the types of bacteria normally present in the small bowel are different from those in the colon.
Do you Suffer from Any of These? You Could Possibly Have SIBO
- Abdominal Pain
- Abdominal Cramps
- Steratorrhea – light coloured floating stools – due to poor fat absorption
- GERD/heartburn – SIBO feed on undigested, fermentable food in the Small Intestine. They then produce gases which cause pressure in the digestive system which for some people pushes upwards causing GERD and heartburn.
- Fatty stools – SIBO bacteria deconjugate (break down) bile acids which can lead to fat malabsorption. Bacteria in the colon usually break down bile acids once they have done their job in the small intestine. If you have SIBO, these bile acids get broken down too early by bacteria in the small intestine before they have had a chance to do their job of digesting fats. This in turn can lead to malabsorption of fat and fat soluble vitamins such as A, D, E, K and K2)
- Nutrient deficiencies such as anaemia/B12 deficiency/calcium/magnesium. – SIBO bacteria love to feed on iron, calcium, magnesium so thrive on these before our body gets to absorb them. Many SIBO sufferers are anaemic.
- Weight Loss/Weight Gain
- Food/supplement intolerances (caused by an immune response)
- Fibromyalgia (one study showed 42 and out of 42 fibromyalgia sufferers tested positive for SIBO) (www.pubmed.com - study number PMC2890937)
As you can see, these symptoms are very similar to IBS and studies by leading Gastrointestinal Doctors in the US have been carried out suggesting high numbers of IBS patients actually had SIBO.
There are several leading doctors and functional medicine practitioners in the USA who specialise in SIBO, including Dr Alison Siebecker, Dr Mark Pimental, Chris Kresser, details of whom can be found in resources section.
SIBO is frequently implicated as the cause of chronic diarrhoea and malabsorption. Patients with SIBO may also suffer from unintentional weight loss, nutritional deficiencies, and osteoporosis. SIBO can cause damage to the intestinal lining, as toxins like ammonia are released when bacteria break down stagnant food. These toxins harm the mucous lining of the small intestine which prevents the absorption of nutrients. These toxins also cause pain, bloating, gas etc.
SIBO bacteria love to feed on sugars and carbohydrates. They get most of their energy from carbohydrates and they make a LOT of gas !
In his book, the Fast Tract Diet, Dr Norm Robillard quotes that “30 g of carbohydrate that escapes absorption in a day could produce more than ten liters of hydrogen gas in the small intestine.” That is a lot of gas !! 10 LITRES of Gas from just 30G of Carbs (weigh it - its not a lot!)
Is it any wonder that these fermentable foods can cause our bodies to become so bloated, distended and full of gas! This terrific gas pressure can also push upwards and be a contributing factor to indigestion and GERD.
Risk Factors for Developing SIBO
Anything that slows down the peristaltic wave like contractions in the gut (known as the MMC or migrating motor complex)
• Low stomach acid – Overuse of PPI – decreased pancreatic enzymes
• Long standing celiac disease (often undiagnosed)
• Crohn’s disease
• Gut infections
• Multiple courses of antibiotics
• Organ system dysfunction, such as liver cirrhosis, chronic pancreatitis, or renal failure
• History of Anaemia – low ferritin/magnesium/calcium due to malabsorption
• High sugar/carb diet or food sensitivities
• Ileocaecal valve dysfunction – the ICV can stick open or spasm which then allows
bacteria to flow back from the colon into the small intestine
• Excessive alcohol use
• Oral contraceptive pill/hormonal imbalances/medications
• Previous gut surgery causing intestine to kink
I have trained in SIBO with two world renowned SIBO experts, Functional Medicine Practitioner, Chris Kresser and Dr Allison Siebecker from www.siboinfo.com
TYPES OF SIBO
There are three SIBO gases that could be present. We can easily test for two, Methane and Hydrogen using the lactulose breath test.
The third type of gas Hydrogen Sulphide is a little more tricky to test for at present, but there is a pattern on the breath test that I look for and specific questions that may be relevant.
Methane SIBO has been reclassified as IMO (Intestinal Methanogen Overgrowth) and is not necessarily just located in the small intestine. Hydrogen Sulphide SIBO (H2S) cannot presently be detected in the UK on a breath test but, similarly to Methane SIBO I can run the GI EcologiX stool test and look for the presence of certain H2S producing bacteria.
TESTING FOR SIBO
You can test for SIBO using a lactulose breath test. It is a simple breath test carried out over 3 hour period which you can do in your own home. We should not be breathing out hydrogen or methane and this breath test looks for these gases which should not be in our small intestine. Please contact me if you wish to purchase a SIBO breath test. For further information on Testing please click here
For further information on SIBO please look at the Resources section.
One thing we know about the intestines, is that they are not isolated from each other – if there is something ‘wrong’ in one area, it will have major impacts on the other areas of the intestine. In other words, SIBO is part of a whole digestive ecosystem disorder so for this reason I would always recommend testing with the GI EcologiX too to try and dig deeper into what else is going on in the GI tract.
When using this combined approach when looking for SIBO, we are more likely to find other issues like inflammation, degradation of the mucin lining, poor host defences, pathogens, issues with diversity, poor digestive function, complications with fungi etc and this helps me to formulate a plan to support the whole ecosystem.