What You Need To Know About SIBO: From Symptoms To Treatment
ALEXANDER KRIVITSKIY/ UNSPLASH
First, What Exactly Is SIBO?
SIBO stands for small intestinal bacterial overgrowth, and as the name implies, it happens when there are too many bacteria living in your small intestine. As Marilia Chamon, gut health specialist and SIBO approved practitioner, explains, “SIBO happens when there’s an accumulation of bacteria in your small intestine. These bacteria usually live in your gastrointestinal tract – more precisely in the large intestine – but have overgrown to a location not meant to host so many bacteria. This becomes a problem because bacteria ferment dietary fibre and gas is produced as a result. This leads to a host of unwanted and uncomfortable side-effects.” Plus, as Andrea Burton, gut expert and technical advisor at Bio-Kult, adds, “SIBO isn’t caused by a single type of bacteria, but is an overgrowth of various types of bacteria, which together create a variety of uncomfortable symptoms.”
What Are The Symptoms?
Many typical symptoms of SIBO are also IBS symptoms. In fact, research has found people with IBS are five times more likely to have SIBO than people without IBS. “Common symptoms of SIBO include abdominal pain, bloating, diarrhoea, constipation, flatulence, indigestion and bad breath. Typically, over two-thirds of patients report these symptoms,” says Andrea. Registered nutritional therapist Natasha Evans adds that not all symptoms are related to the gut. “People with SIBO may also have very low energy levels, low mood, hormonal imbalances and poor skin, hair and nails due to poor nutrient absorption and inflammation triggered by SIBO.”
How Does It Differ From IBS?
SIBO and IBS are separate medical conditions, but they often co-exist and share similar symptoms, says Marilia. “This means that if you have been diagnosed with IBS, there’s a strong likelihood you’ll have SIBO, too. A systematic review and meta-analysis (considered to be the highest quality evidence on a research topic) found the prevalence of SIBO in IBS to be 38%. Another study found that of 202 IBS patients, 78% had bacterial overgrowth and eliminating it improved IBS symptoms in 48% of those individuals.” If you have IBS, Natasha adds that SIBO may be one of the imbalances driving your symptoms.
What Causes SIBO?
There can be many contributing factors, says Natasha. “These include insufficient chewing, stress, low stomach acid, taking medication and antacids, smoking, alcohol, poor diet, and a weak immune system. SIBO also becomes more common with age due to delayed gut motility, which means that food spends more time in the small intestine, providing food for bacteria to flourish. Also, people with conditions like hypothyroidism, diabetes, HIV and Crohn’s are more likely to have SIBO.” If you’ve recently had a bout of food poisoning or traveller’s diarrhoea, Marilia says this also increases your risk of SIBO.
How Is It Diagnosed?
SIBO is measured by a breath test. “The small intestine is difficult to reach, and while the gold standard for SIBO diagnosis is an aspiration of the small intestine (like a liquid form of a biopsy), this is an expensive and invasive procedure. Instead, the current alternative is a breath test which measures certain gases produced by bacteria and exhaled on our breath,” explains Marilia. “These results should be analysed together with symptoms for a conclusive diagnosis.”
How Can You Treat It?
SIBO is a complex condition, Marilia adds, and everyone responds differently to treatment. “SIBO requires a multifactorial approach to be treated, and that includes diet, lifestyle, specific antibiotics and/or supplementation,” she tells us. “One important thing to understand is that just focusing on killing the bacterial overgrowth is not enough – addressing the root cause of why it happened in the first place is an essential part of the treatment. For example, if you have gut motility issues the first question to ask is why that might be happening – it could be due to food poisoning, low thyroid function or chronic stress. We then need to work on that underlying cause as bacteria can repopulate the small intestine in as little as two weeks after finishing a course of antibiotics.” Natasha also recommends a holistic approach: “A doctor may prescribe an antibiotic like rifaximin to get rid of the overgrowth, but studies suggest recurrence after antibiotics can be as high as 50% within a year. Think about working with a nutritional therapist or functional medicine practitioner, who can provide additional diet and lifestyle support to ensure SIBO is eradicated for good.”
What Happens If It’s Left Untreated?
Left unmanaged, SIBO can cause complications. “As the condition affects how well nutrients are absorbed, it can lead to the malabsorption of fats, proteins and carbohydrates, which may lead to vitamin deficiencies and dehydration,” Andrea adds.
How Can Diet And Lifestyle Help?
Getting on top of SIBO is all about rebalancing gut bacteria and improving digestive health, says Andrea. Here are her golden rules…
- Think about how you eat. Put your fork down in between mouthfuls and chew until your food is mush. Don’t snack, unless absolutely necessary, and have three nutritious meals per day that are full of fibre, healthy fats and protein, and free from processed sugars. Leave a 14-hour gap between dinner and breakfast where possible.
- Set aside time for relaxation. Do what makes your body happy – yoga, mindful journaling, breathing exercises, soaking in the bath, meditation or walking outside. Stress is a contributing factor to SIBO.
- Try live bacteria supplements. Emerging evidence suggests promising benefits from the use of probiotics in SIBO, especially in conjunction with antibiotics. Studies suggest the species Lactobacillus casei, Bifidobacterium breve and Bifidobacterium bifidum (among others) are effective against SIBO. But take this slowly; it’s important to introduce live bacteria gradually, monitoring symptoms and testing tolerance to difference products, strains and dosages.
- Try the low-FODMAP diet. FODMAP is an acronym for molecules in food that are difficult for some people’s bodies to absorb – they are often present in dairy products, grains, legumes, and certain fruits and vegetables.
Here, Natasha Evans, 31, Shares Her Experience Of Living With And Treating SIBO…
I had IBS for ten years. I experienced daily bloating – I’d wake up with a flat stomach and as the day went on, my stomach would swell until I looked six months pregnant by the evening. This happened every day, without fail. The bloat would extend from my lower stomach to chest and affected my self-confidence and how I dressed. It was also incredibly sore and uncomfortable, so much so that I’d often take myself to bed early in pain.
It's not all about the gut. As the years went by, I developed other issues I didn’t realise were linked to my IBS, including severe fatigue, low mood, anxiety, thinning hair and dry skin.
Working with a nutritional therapist was invaluable. When researching IBS, I stumbled across something on SIBO and immediately got tested via a nutritional therapist (your GP can also provide a referral to a gut specialist for testing). Like most other people with SIBO, there wasn’t one sole cause, but rather it was an amalgamation of factors. I suspect it came from a change in lifestyle when I started university – not eating a balanced diet and drinking more than usual, as well as stress and poor eating habits.
Recovery didn’t happen overnight. I’d recently done a stool test, which also revealed I had an imbalance in my gut microbiome, so there was a lot to work on. My nutritional therapist encouraged a holistic approach – we worked on gut motility, stress management and supplementation. I also tried a few different elimination diets – low FODMAP, low histamine and low sulphur – to figure out which foods were contributing to my symptoms. Reducing sugar and processed carbs and eating more quality meats, oily fish, healthy fats and plant diversity has also helped. I also took a course of probiotics with specific strains that don’t aggravate SIBO, as many can.
Managing stress is key. When we’re in our ‘fight or flight’ mode, we’re out of ‘rest and digest’ – our gut motility halts, we don’t digest food properly and therefore don’t absorb nutrients properly. Food can linger in the small intestine, creating ripe conditions for SIBO. Mindfulness, meditation, CBT, breathwork and gentle movement have all been fundamental to getting on top of my symptoms.
Visit NENutrition.co.uk and follow @NENutrition for more information. Also visit Bio-Kult.com and GutfulnessNutrition.com and follow Marilia @GutfulnessNutrition.
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