Do you struggle with gas, bloating (that gets worse as the day goes on), distention, pain, or chronic IBS? Have you ever stopped to question the root cause? It could be SIBO.
What is SIBO?
Small intestinal bacterial overgrowth (SIBO) is an overgrowth or accumulation of bacteria in the small intestine (SI). Normally, we want a diverse amount of healthy bacteria in the large intestine (colon) but not in the small intestine. The overgrowth in the SI can cause discomfort and a host of other symptoms. Current research indicates that more than 75% of patients with IBS also have SIBO.
What causes SIBO?
- Low stomach acid (hypochlorhydria) – Stomach acid kills bacteria
- Compromised motility (gastroparesis, Parkinson’s, scleroderma)
- Intestinal permeability (leaky gut)
- Compromised gallbladder
- Food poisoning
- Traumatic brain injury (TBI)
- Chronic use of NSAIDs, Antibiotics, or opioids
- Liver dysfunction
- Chronic pancreatitis
- Ehlers-Danlos syndrome
- Intestinal surgery
What are signs and symptoms of SIBO?
- Diarrhea, Constipation, or a combination of the two
- Weight loss/gain
How do you test for SIBO?
You can test for SIBO using a breath test. Breath tests can be done at your doctor’s office or at home. A brief fast is required (24-48 hours) in which you eat certain foods such as chicken and white rice. During the test, a lactulose or glucose solution is consumed. Once consumed, you will be asked to breath into a bag in intervals for up to 2 hours.
What are the different types of SIBO?
- Hydrogen dominant
- Methane dominant
- Hydrogen sulfide dominant
During testing, different levels of hydrogen and methane gas in the breath will be measured. If there is a rise in either hydrogen or methane at the 90 minute mark, SIBO is present. For hydrogen, a rise in >- 20ppm is indicative of SIBO. For methane, a rise in >- 10ppm is indicative of SIBO
How is SIBO treated?
- Antibiotics such as Xifaxan/Rifaximin or neomycin
- Herbal microbials
- Dietary intervention
- 5R Gut Protocol
What is the best diet for SIBO?
There are many different diets that have been studied and implemented to help support a patient with SIBO. These include Low FODMAP, the Specific Carbohydrate Diet (SCD), a Bi-Phasic diet, and an Elemental diet. By far the most well researched diet for SIBO is the low FODMAP diet. It is also the most flexible and least restrictive diet of those mentioned, so this is the diet I recommend starting with. Many individuals with SIBO develop food sensitivities, so it is common that by the time they come to see me, they are already avoiding a number of different foods because they have become intolerant to them. The goal with dietary intervention is to implement a diet that will support the treatment phase (when you are taking antibiotics or microbials) and allow you to have a well balanced diet that provides you with adequate calories and nutrition. With any SIBO diet, your goal is to do this temporarily (on average 6 weeks) until you start to feel better.
If you want to learn more about SIBO or if you have been diagnosed and are looking for dietary support and counseling, contact me here.