introduction

Small intestinal bacterial overgrowth, or SIBO, is a digestive condition referring to abnormally large numbers of bacteria in the small intestine, especially those that usually inhabit the large intestine. A healthy digestive tract would normally find large numbers of bacteria in the large intestine only. A small quantity of bacteria is normal for the small intestine and normal motility of the bowel moves this bacteria down into the large intestine. However, patients with SIBO have dysfunction in this healthy digestive process.

Interestingly the prevalence of SIBO is higher for older adults, however, it is becoming more common to see younger adults presenting with this condition. Studies have also found that SIBO sufferers typically also carry a diagnosis of preexisting chronic conditions including IBS.

signs & symptoms

Common SIBO symptoms may include:

• Nausea/vomiting
• Belching/burping
• Bloating
• Abdominal distension
• Flatulence
• Fatigue
• Diarrhea/constipation
• Fatty or floating stools
• Abdominal cramping, especially after meals
• Unexplained weight or muscle mass loss
• Malnutrition or nutritional deficiencies, especially vitamin B12, A, D, E, K, and iron
• Food intolerance or sensitivities, especially fructose and lactose

causes

The development of SIBO could be linked to:

• Diabetes
• Coeliac disease
• Inflammatory bowel disease, diverticulitis, Crohn’s
• Pancreatitis
• Immunodeficiency
• Dysfunctional bowel motility e.g. chronic constipation
• Low stomach acid and/or antacid use
• Cigarette smoking
• Obstruction or scarring of the intestines
• Helicobacter pylori infection i.e. stomach ulcers
• Aging

prevention

The best prevention for SIBO is maintaining good gut health. An indicator of this being healthy motility of the bowel e.g. stool elimination 1-3 times daily, with no blood, mucous, undigested food, should be solid and sausage-shaped (type 3 or 4) – refer to Bristol Stool Chart.

testing

• Lactulose, glucose, and/or fructose breathe test – the most common way to test the presence of SIBO
• D-xylose test – involves the patient drinking a quantity of D-xylose and measuring levels in the blood and urine
• Full blood test – may also be useful particularly if C-reactive protein, presence of coeliac disease, total IgE, total vitamin B12, serum folate, iron studies, plasma zinc, and vitamin D are examined
• Comprehensive stool analysis – mainly used to identify digestive markers, microbiome in large bowel, and parasites

treatment

Modern medicine will reach for antibiotics in the treatment of SIBO that can help to restore the gut microbiome. Modern naturopathy aims to reduce SIBO symptoms using natural medicine and treat the underlying causes including poor digestive secretions, restore gut microbiome, identify trigger foods, and address any dietary or lifestyle factors.

The aim of treatment is to reduce bacterial overgrowth in the small intestine, correct dysbiosis, reduce inflammation and address nutritional deficiencies. This is best done under the care of a health professional as SIBO can be very hard to resolve.

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