Small Intestinal Bacterial OVERGrowth (SIBO)
By Ramnique Ubhi, Naturopathic Doctor
One of the worst feelings is being bloated and unable to have a good bowel movement. Having to coordinate your daily activities around your bathroom schedule is no one's idea of a good time. So is cancelling plans because you have no idea how your digestion is going to react that day. If you’ve ever felt like this, you know how all consuming your poor digestion can become.
Gastrointestinal/digestive concerns like bloating, gas, diarrhea and constipation are extremely common but can be very difficult to diagnose and treat. Imaging, colonoscopies and blood work can often come back normal but symptoms are still present. When this occurs, individuals are often told they have IBS but treatment does not improve their symptoms. One diagnoses that is becoming more and more recognized as an underlying factor to many of these digestive concerns is Small Intestinal Bacterial Overgrowth (SIBO).
What is SIBO?
The human digestive system is full of an array of micro-organisms (bacteria, fungus/yeast, parasites, viruses, etc.). These micro-organisms are essential to our survival but the types and amounts of these organisms can change and this can lead to digestive issues.
SIBO occurs when excessive amounts of bacteria become present in the small intestine. Normally the large intestine/colon should hold the majority of bacteria in our gut but when they start overgrowing in the small intestine, the bacteria start to ferment the food we eat. This fermentation produces gas, chronic bloating, abdominal pain and bowel changes like diarrhea and/or constipation. This can ultimately lead to inflammation and poor absorption of the nutrients from our food.
Common Symptoms of SIBO:
Bloating/abdominal distention
Excessive gas/flatulence/belching
Abdominal pain or discomfort
Diarrhea
Constipation
Indigestion/Heartburn/GERD
SIBO can also lead to many other non-digestive symptoms like brain fog, fatigue and headaches due to its impact on the absorption of nutrients.
There are 3 types of SIBO: Hydrogen, Methane and Hydrogen Sulfide.
These three types are classified based on the dominant type of gas being produced by the bacteria in the small intestine. Individuals can have one, two or all three types of SIBO.
To determine if SIBO is present, the gold standard is a small intestinal aspiration and culture. This is an invasive procedure so is often not performed. A non-invasive and gentler option is a breath test which assess the type of gas being released from the mouth and, subsequently, which type(s) of SIBO is present, if at all.
But How Does SIBO Occur in the First Place?
A variety of factors can create an environment in the small intestine that is more favourable for bacteria to overgrow. One major factor in SIBO is decreased motility/movement of the entire digestive tract. The digestive system is a long tube that moves the food we eat using a motion caused peristalsis. When this movement slows down, it causes food and bacteria to sit in the gut and this is where fermentation can happen. IBS, dysmotility disorders, hypothyroidism and diabetes all slow down this movement. Anatomical changes to the gut like small intestinal diverticulosis, bowel strictures, adhesions from abdominal surgery (such as hysterectomy and gallbladder removal), and gastric bypass can cause direct slowing of the gut too.
Concussions can also lead to SIBO because they impact the Migratory Motor Complex in the brain, which is the area of the brain that starts peristalsis in the gut.
The introduction of unfavourable bacteria into the digestive system, like with food poisoning and traveler’s diarrhea, also makes one susceptible to SIBO.
A common medication that is associated with SIBO is stomach acid medications like proton pump inhibitors. Stomach acid is needed to kill bacteria from everything we ingest but if it is too low, the bacteria will survive and end up in the small intestine. Antibiotic use may also change the type and amount of bacteria in the digestive system over time, leading to SIBO.
Individuals may have one or many of the above factors which will increase their likelihood of having SIBO.
It is important to screen for SIBO when other health concerns are involved because SIBO is associated with more than just digestive concerns.
Health Concerns Associated with SIBO:
Irritable Bowel Syndrome
Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s disease)
Diverticular and Celiac Diseases
Cirrhosis of the liver
Fatty liver disease
Gallstones
Rosacea
Hypothyroidism
Diabetes
Pancreatitis
Parkinson’s Disease
Multiple Sclerosis
Autism
Asthma
Fibromyalgia
And more
If you are struggling with digestive concerns that are not improving, consider speaking to a Naturopathic Doctor to see if SIBO may be the answer. Once diagnosed, a Naturopathic Doctor can help treat SIBO by eliminating the excess bacteria, such as with botanical medicine, and discuss diet and lifestyle changes to help prevent SIBO from recurring
Dr. Ramnique Ubhi, ND
Naturopathic Doctor
References
1. Efremova, I., Maslennikov, R., Poluektova, E., Vasilieva, E., Zharikov, Y., Suslov, A., Letyagina, Y., Kozlov, E., Levshina, A., & Ivashkin, V. (2023). Epidemiology of small intestinal bacterial overgrowth. World journal of gastroenterology, 29(22), 3400–3421. https://doi.org/10.3748/wjg.v29.i22.3400
2. Rao, S. S. C., & Bhagatwala, J. (2019). Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. Clinical and translational gastroenterology, 10(10), e00078. https://doi.org/10.14309/ctg.0000000000000078
3. Sorathia, S. J., Chippa, V., & Rivas, J. M. (2023). Small Intestinal Bacterial Overgrowth. In StatPearls. StatPearls Publishing.
4. What is Sibo?. SIBO Diagnostics. (n.d.). https://sibodiagnostics.com/what-is-sibo/
