As an experienced naturopath, I commonly diagnose SIBO in our clinic at Pulse on the Sunshine Coast. SIBO is an acronym for small intestinal bacterial overload.
When abnormally large numbers of bacteria (even friendly bacteria) overgrow in the small intestines, they actually cause problems with your health. Small Intestinal Bacterial Overgrowth (SIBO) is a condition where abnormally large numbers of bacteria are present in the small intestine.
In a healthy gut, the small intestine (SI) has relatively low levels of bacteria. Bacteria should be at the highest concentrations in the large intestine. The SI is the longest section of our digestive tracts. This is where the food mixes with the digestive juices and is where we absorb nutrients into the bloodstream. Most of the bacteria in your intestines should be in your colon or large intestines, not your small intestine.
If SIBO is present, malabsorption of nutrients, particularly fat soluble vitamins ( A,D,E and K) and iron, vitamin B12 and calcium can be a serious issue. We may not absorb protein, carbohydrates and fats either. Deficiencies can cause weakness, fatigue, brain fog and anxiety.
The bacterium in the colon, when in proper balance, help digest foods and help the body absorb essential nutrients. With SIBO, as food passes through the SI, the bacterial overgrowth interferes with the healthy digestive and absorption process. Bacteria feed off of sugars and starches in the diet (both refined sugars and natural sugars) and produce methane and hydrogen gas. They also inhibit the enzymes in the small intestines that breakdown starches into simple sugars for absorption. This can result in abdominal bloating, belching and/or flatulence (intestinal gas), especially when you eat grains and other complex carbohydrates. What is more, the gases produced by these bacteria can also cause abdominal pain, intestinal cramping, and constipation and/or diarrhoea.
Gas pressure in the small intestines can push upwards against the stomach. This causes heartburn (ie acid reflux or GORD) and nausea.
Other common symptoms are:
Certain risk factors and underlying conditions contribute to SIBO, including
use of proton pump inhibitors (ie somac, nexium, zoton, pariet, losec)
SIBO also causes an increase in a hormone called zonulin. This results in an increase in small intestinal permeability (aka leaky gut syndrome.) What is more, the excess bacteria in SIBO also consume essential nutrients like fats, iron and vitamin B-12. The nutrient deficiencies from SIBO, along with the absorption of large protein molecules, can cause problems with the immune system. What is more, leaky gut can contribute to allergies, asthma and autoimmune disorders, and a general decline in health.
SIBO may be a cause or a major factor in all of the following diseases: acne rosacea, acne vulgaris, autism, coeliac disease, CLL (chronic lymphocytic leukemia), chronic fatigue syndrome, diabetes, diverticulitis, fibromyalgia, gastroparesis, GORD (gastroesophageal reflux disease), H. pylori infection, hypochlorhydria (low stomach acid), hypothyroid/hashimoto’s thyroiditis, IBD (inflammatory bowel disease) such as Crohn’s and ulcerative colitis, IBS (irritable bowel syndrome), interstitial cystitis, lactose intolerance, non-alcoholic fatty liver disease), obesity, pancreatitis, parasites, Parkinson’s, prostatitis (chronic), rheumatoid arthritis and scleroderma (systemic sclerosis). Please note, this does NOT mean that SIBO causes all these diseases, it just means that it may be a contributing factor or may accompany these conditions.
Other clues that SIBO may be a problem include having better bowel movements after taking antibiotics and having bowel problems get worse when taking probiotics or fibre.
Treatment for SIBO (see below) is individualised and involves a change in diet ( not all diets will suit one person,) and the correction of nutritional deficiencies. I also often use certain probiotics, and a combination of botanical supplements, possibly in conjunction with antibiotics, depending on severity. Relapse rates of SIBO are quite high, especially if risk factors are not dealt with. So it is best an experienced naturopath like myself helps treat you, rather than you treat yourself.
Experts in SIBO estimate that about 35-50% of the general public has this problem. Unfortunately, mainstream medical people are usually not familiar with it, so they don’t diagnose or treat it. An experienced naturopath like myself or an holistic doctor is more likely to make the correct diagnosis.
Many people who have SIBO think they have a Candida or yeast infection. Yeast overgrowth can occur with or without SIBO.
Medical diagnosis of SIBO is difficult because it is hard to get a culture from the small intestines. There are tests available on the Sunshine Coast involving collecting breath samples from patients that drink either glucose or lactulose. The lactulose test is the most accurate. An experienced naturopath can order these tests, yet they are not covered by medicare. I usually find them not necessary as I assess this condition fairly accurately by symptoms.
If you have an auto-immune disorder, pain in multiple joints, chronic allergies, chronic skin conditions, chronic fatigue or depression or general malaise, (just don’t feel good) you may have leaky gut. When you have symptoms of leaky gut coupled with chronic diarrhoea or constipation, regular abdominal pain, IBS, bloating or belching after meals, GORD and/or regular indigestion, you may have SIBO.
What Causes SIBO?
An experienced naturopath knows there are several major factors that contribute to the development of SIBO.
The first is a lack of hydrochloric acid (HCl) in the stomach. HCl helps the body digest proteins, but it also helps to kill bacteria in the food we eat and prevent them from colonizing the small intestines.
A second factor is a lack of intestinal motility. In between meals, peristaltic movements of the small intestine called migrating motor complexes (MMCs) occur. These help to flush bacteria down towards the large intestine. They are responsible for what we call hunger pains, the “rumblings” we feel in our gut when we haven’t eaten in a while. Surgery, intestinal scarring, various diseases and intestinal infections can inhibit MMCs. Medications that can inhibit these intestinal movements include antibiotics, proton pump inhibitors, antacids and opiates (pain killers) like morphine.
Stress can be a factor in both low hydrochloric acid and the lack of intestinal motility. The sympathetic nervous system (responsible for the fight or flight response) inhibits both digestive secretion and intestinal motility. When we relax, the parasympathetic nervous system is more active, which enhances digestion and intestinal motility. Unfortunately, many people on the Sunshine Coast eat on the run and do not take time to relax and chew their food thoroughly. An experienced naturopath can usually recognise if a patient is overly stressed, and we can work on treatments for that too.
Another factor in SIBO is a malfunctiong ileocecal valve. This valve is between the small and large intestines and it prevents backflow (it keeps material in the large intestine from migrating back into the small intestine.) When this valve is not shutting properly, intestinal bacteria migrate from the colon into the small intestine causing gas, bloating and general weakness and malaise ie SIBO.
Here are seven things an experienced naturopath can help you do to overcome SIBO.
We recommend much of following for leaky gut too.
Step One: Remove food and chemical irritants
It is absolutely essential to eliminate all refined sugars and most starchy foods from the diet. That means the removal of gluten (wheat, rye, barley), but eliminating all grains may be required.
We usually need to remove dairy too. This is so because bacteria thrive on lactose, the sugar in dairy. Milk products and cultured dairy foods are beneficial for some people, yet other people may have to eliminate all dairy foods.
Fermented foods are helpful for SIBO (see below) and leaky gut.
I usually recommend the paleo diet for SIBO and leaky gut.
Step Two: Stimulate stomach production of acid and/or supplement with acid and enzymes
There are two ways an experienced naturopath can help a patient increase stomach acid and enzymes. I often get patients to take supplements such as betaine HCL. The other is to get them to take herbs and nutrients that stimulate their production. With SIBO, it is usually necessary to do both.
A lack of acid may be due to a lack of the following nutrients: chloride (low serum levels), zinc and thiamine (B12.) These are primary nutritional factors required for the synthesis of hydrochloric acid, so I always check for these with a simple blood test.
Step Three: Improve intestinal motility (if necessary)
With SIBO it is also important to make sure that there is good intestinal motility between meals. This flushes the small intestine and clears out bacteria. One way to do this is to allow adequate time between meals. We need three to five hours between meals. So ideally, you should wait until you get stomach rumblings indicating your digestive tract is clear before you eat the next meal.
If motility is slow there are some supplements to speed it up. For example, a cup of ginger tea is helpful. Or 100 mg of 5-HTP twice daily may also help.
Step Four: Close the ileocecal valve (if necessary)
If there is severe gas and bloating, you probably need to work on the ileocecal valve. You can massage this valve to reduce swelling and inflammation and get it to close properly. This ileocecal valve is located on the lower right side of the abdomen, midway between the umbilicus and the right hip bone.
Step Five: Reduce bacterial overgrowth
If a person has SIBO, they should take some supplements to reduce bacterial overgrowth in the small intestine. Pharmaceutical antibiotics or herbal antibacterial agents do this.
I recommend a digestive bitters blend with antibacterial herbs in it. Another great remedy is enteric coated peppermint oil. Take one capsule with three meals each day for about 20 days. This may produce a 25-50% reduction in small intestinal bacteria. Another antimicrobial agent is garlic. The best way to take it is to chop up or crush fresh garlic, then mix it with a teaspoon of honey to make it easier to take. Another useful supplement is cinnamon, which removes both lactic acid producing bacteria and yeast.
Goldenseal is helpful; it reduces intestinal bacteria, Take two capsules three times daily with meals.
Step Six: Restore beneficial bacteria
Cultured vegetables help treat SIBO and leaky gut. You can make your own cultured vegetables, or you can purchase them from a health food store or from some supermarkets. We can find these easily on the Sunshine Coast.
After we eliminate dairy for six weeks, we can slowly reintroduce cultured dairy products like yoghurt and kefir provided you are not lactose intolerant.
Probiotics may also play a role.
Step Seven: Repair Leaky Gut
Since SIBO always causes leaky gut, we try to to rebuild the integrity of the intestinal membranes. One of the best ways we do this is to prescribe bone broth. Bone broth is high in glutamine and glycine, both of which are essential in healing the gut. Also, zinc therapy, omega 3’s and vitamin D will all help.
Danielle Roberts is a highly experienced naturopath at Pulse in Minyama on the Sunshine Coast. She has always had a passion for health, vitality and she helps others to be the best they can be. She works with patients and fitness clients to help them better understand and develop their own optimal path. Danielle helps her patients be better, happier and healthier.