SIBO 101: 6 ways to fight Bacterial OVergrowth without antibiotics
If it feels like your bloating just appeared one day out of nowhere, or if it seems like everything makes you bloated, you are not alone. Up to 20% of the healthy population experiences these symptoms that are classic characteristics of the digestive condition known as Small Intestinal Bacterial Overgrowth (SIBO).
Author and dietician Tamara Freuman describes the condition of SIBO as “too many bacteria living in the wrong neighbourhood of your gut”. As a result of this displacement, these bacteria have the potential to cause a host of uncomfortable digestive symptoms, including severe and persistent bloating.
This post covers SIBO 101, discussing what you need to know about this condition, how to tell if you have it, and what you can do about it.
Understanding SIBO
To understand SIBO, you first have to understand some digestive system basics. When you swallow food, it travels through your stomach to the small intestine, and exits your body via the colon. Digestion and nutrient absorption happen largely in the stomach and small intestine. The colon is responsible for absorbing nutrients from remaining food, such as undigested carbohydrates. It also absorbs water from food waste to turn it into stool for excretion.
The colon is home to the largest and most concentrated population of bacteria in the human body – with up to 1,000 different bacterial species and a total population of approximately 100 trillion microbes. These bacteria break down undigested carbohydrates through fermentation which results in gas production. This process also produces substances called short-chain fatty acids that help keep your gut healthy.
Compared to the colon, the small intestine typically has fewer bacteria. They simply aren’t needed in the small intestine because this is where most of your nutrients are absorbed. However, under the right conditions, the small intestine can become hospitable to bacterial growth. When the usual harmless bacteria from your colon gain a foothold in the small intestine, this is known as SIBO, and it can lead to a range of uncomfortable symptoms.
Causes of SIBO
So, the next question you might be asking is, “What the heck is causing the bacteria to grow here in the first place???”
A healthy small intestine uses several protective factors to prevent bacterial growth and keep bacterial numbers low. Any disruption to these protective factors increases risk for developing SIBO. Some of the common causes include:
Impaired Intestinal Motility: When the muscles of the small intestine do not contract properly, it can lead to a stagnant environment where bacteria can flourish.
Structural Abnormalities: Structural issues such as intestinal strictures or adhesions can slow down the movement of food, creating an environment that promotes bacterial overgrowth.
Digestive Disorders: Certain conditions like Irritable Bowel Syndrome (IBS), Crohn's disease, and celiac disease can cause inflammation and increase the risk of developing SIBO.
Low Stomach Acid: Insufficient stomach acid can allow bacteria to survive the stomach's acidic environment and migrate to the small intestine.
Medications and Procedures: Prolonged use of proton pump inhibitors (PPIs), antibiotics, or undergoing gastrointestinal surgeries can disrupt the balance of gut bacteria, leading to SIBO.
Regular alcohol use: Moderate alcohol consumption can damage the lining of the intestine and increase risk for bacterial overgrowth.
Recognizing SIBO Symptoms
SIBO presents itself through various symptoms, and while each person’s experience may differ slightly, common signs of SIBO include:
Chronic Bloating: Bloating that occurs frequently or within an hour of eating. It’s common for individuals to feel as if their bloating just appeared one day out of nowhere.
Food Intolerances: Foods most likely to trigger bloating include high-fat meals, wheat-based foods, beans or chickpeas, and vegetables from the cruciferous family like broccoli, cauliflower, or cabbage. Some people may also be sensitive to certain fruits or dairy products.
Gas and Flatulence: Excessive intestinal gas production resulting in a distended belly and/or lots of farting. Gas is typically very foul smelling. Mornings usually have the least amount of gas because the digestive tract is empty, but as you eat more meals, gas and bloating may build up. After dinner is usually the peak time for bloating.
Abdominal Pain or Discomfort: Excess gas can build-up and cause a distended abdomen which may result in abdominal pain or a general discomfort in the belly. This may be more common for individuals who are prone towards constipation because the extra gas can get trapped behind excess stool which would normally provide relief of symptoms.
Diarrhea or Constipation: Alternating bouts of diarrhea and constipation, often accompanied by changes in stool consistency. Stool may be lighter brown or orange-like in colour, and it’s consistency may be sticky. This can result in stool that is hard to pass or requires several wipes to clean your bum.
Nutritional Deficiencies: SIBO can impair the absorption of nutrients leading to deficiencies in vitamins and minerals, which may cause fatigue, weakness, or other symptoms associated with nutrient deficiency. Common deficiencies associated with SIBO include vitamins B12, A, D, and E, as well as iron and calcium.
Diagnosing SIBO
Because the constellation of symptoms associated with SIBO are not exclusive to this condition alone, if you think you might have SIBO, it’s important to work with a healthcare practitioner to rule out other causes first, such as an infection, IBS, celiac disease, or inflammatory bowel conditions.
If SIBO is suspected, many practitioners will recommend a breath test because it is easily accessible and reasonably inexpensive.
With the breath test, you drink a sugary solution of lactulose or glucose, and breathe into a bag over a period of 2 to 3 hours. The breath test measures the levels of hydrogen and methane gases on your breath. Since only bacteria produce these gases, if they show up on the test, you know that the bacteria made them.
Unfortunately, a recent review of the literature found that there are significant limitations with breath testing due to a lack of test standardization and poor reliability of test results. For example, glucose breath testing detects about 55% of patients with SIBO, which means 45% goes undetected; versus the lactulose breath test which detects about 42% of patients with true SIBO, leaving 68% undetected. Based on this information, if you decide to go ahead with breath testing, you are better off choosing the glucose hydrogen breath test.
It is also possible your healthcare provider may recommend a stool analysis for SIBO. It’s important to note that a comprehensive stool analysis can provide a lot of useful information about digestive health, but the information about the gut microbiota comes from your colon, not the small intestine.
We don’t yet have the technology to analyze and make clinical decisions about the small intestine microbiome. Stool analysis can be helpful in piecing together the puzzle, but don’t expect it to give you a clear diagnosis.
What’s the take-away from this information? It’s true we don’t yet have the technology for accurate analysis and diagnosis of SIBO, but there are tools available to help you piece together clues to give an overall picture of what’s going on in your gut.
Working with a health professional with experience in managing digestive disorders can be useful when trying to figure out next steps. If you are working with a holistic practitioner, the diagnosis may be less important than the symptoms or clinical picture because it allows a broader focus on well-being in all areas rather than to keep things narrowly focused on a specific condition. After all, everything in the body is connected – and don’t forget about mindbody connection too!
Mainstream Treatment Options
When addressing SIBO, the focus should be on the underlying causes, eliminating bacterial overgrowth, and restoring a healthy balance in the gut.
Common mainstream approaches include antibiotic therapy, probiotics, and dietary modifications. However, there is not strong evidence to support the use of these therapies for eradicating SIBO.
Antibiotics: Antibiotics are not specific to the type of bacteria they kill. Because of this, there is potential for this treatment to further disrupt the microbiome. It is not uncommon for individuals with SIBO to be treated with multiple rounds of antibiotics, and since this is a known risk factor for the development of SIBO, it could perpetuate the problem further.
Probiotics: Certain strains of probiotics are marketed to help restore the balance of gut bacteria and support the healing process with SIBO. However, it’s important to note that with SIBO, you are trying to eliminate the extra bacteria in your small intestine. So, it’s possible that taking a supplement full of more bacteria could do more harm than help.
Dietary Modifications: A low fermentable carbohydrate diet, such as the low FODMAP diet, is often recommended as a therapeutic diet for individuals with SIBO. (FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are carbohydrates that are easily fermented by bacteria – and therefore, have the potential to cause lots of gas.) However, most of the data on the effectiveness of low FODMAPs is based on IBS, not SIBO. In addition, this diet is low diversity and may lead to nutrient deficiencies, which is not ideal when it comes to creating a balanced microbiome.
Holistic Approaches:
Diet: A diet rich in plant foods and whole foods with sources of polyunsaturated fatty acids and polyphenols has the potential to improve intestinal microbiota and provide the body with a nutrient-rich diet that supports a healthy gut and immune system.
Food triggers: With SIBO, it can feel like everything makes you bloated, but that doesn’t mean you want to cut out all foods. Instead, a food and symptom tracker can be useful in identifying foods that consistently increase digestive symptoms like gas and bloating. Reducing or eliminating these foods can be helpful during the healing period.
Support digestion: Supporting optimal digestion through mindful eating, proper chewing, and avoiding overeating can reduce the risk of bacterial overgrowth. You can support stomach acid by incorporating bitter foods, using digestive bitter formulas, or taking a supplement containing betaine hydrochloride.
(If you’re not sure if you have low stomach acid, check out this article for 12 signs of low stomach acid.)
Stress: Chronic stress can increase inflammation, slow gut motility, and decrease stomach acid production – which increases risk for SIBO. Incorporating stress management techniques like meditation, yoga, or regular exercise can be beneficial.
Probiotics: As mentioned above, bacteria-based probiotics may not be a wise option when dealing with SIBO. However, a yeast-based probiotic called Saccharomyces boulardii (S. boulardii) may be a helpful addition. S. boulardii does not colonize the gut, but it has the ability to compete with the unwelcome bacteria for real estate in the gut lining and makes the environment inhospitable to the bacteria. It also has antimicrobial properties and the ability to enhance immune function so our body is more capable of dealing with bacterial overgrowth.
Supplements: There are several supplements available that have the potential to help with eradicating SIBO. However, supplements are very individual-based, depending on the root cause of a person’s symptoms. Working with a nutrition professional can help target supplements for your specific needs.
If you struggle with persistent, chronic bloating and unexplained digestive issues, you may want to consider the possibility of SIBO.
By recognizing the symptoms and understanding your root cause, you can begin to take the necessary steps towards reclaiming your digestive health.
Remember, each person's journey with SIBO is unique, so working with a nutrition professional can help you to develop an individualized treatment plan and meet your goals faster. Click here to book your free Gut Health Strategy Session and learn how I can help you overcome SIBO with my 5-step gut healing framework.
