SIBO - What's it all about?

What is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) is a condition where an excessive number of bacteria are present in the small intestine. Normally, the small intestine has relatively low levels of bacteria compared to the large intestine. SIBO disrupts this balance, leading to various gastrointestinal symptoms. Having too much bacteria in the small intestines means that fibre in the diet begins to be digested too early and results in a disruptive digestive and unpleasant symptoms.

Symptoms of SIBO

Symptoms will vary in individuals as there a number of different bacteria that contribute to the problem. Also symptoms will depend whereabouts in the small intestines the bacteria has lodged itself. Common symptoms include:

• Bloating

• Abdominal pain or discomfort

• Diarrhoea or constipation

• Gas and belching

• Malnutrition and weight loss in severe cases

Causes of SIBO

Several factors can contribute to the development of SIBO but it will be individual to each person and these factors are only an indication of what might be going on:

1. Motility Disorders: Conditions that slow down the movement of the small intestine, such as irritable bowel syndrome (IBS) or gastroparesis.

2. Structural Abnormalities: Abnormalities like strictures, adhesions, or diverticula in the small intestine.

3. Immune Deficiencies: Weakened immune system can allow bacterial overgrowth.

4. Medications: Proton pump inhibitors (PPIs), antibiotics and other medications that affect gut motility or the gut microbiome.

5. Surgery: Certain abdominal surgeries, particularly those involving the small intestine, can predispose to SIBO.

6. Low stomach acid: stomach acid is the first defense in the digestive system to keep out infection, bacteria and other microbes. If the stomach acid it low this also means poorer digestion

Treatment And Recommendations

Treatment and recommednations for SIBO are wide and varied and may require it to be tackled in a number of ways. It is best to consult a relevant healthcare practitioner before embarking taking on the following recommendations:

1. Antibiotics: To reduce the bacterial overgrowth. Commonly used antibiotics include rifaximin, metronidazole, and ciprofloxacin. This treatment is quite harsh and doesn't really deal with the underlying issues that are causing the problem. Although it can help with some in others the symptoms may come back within a few weeks.

2. Dietary Changes: Specific diets, such as the low FODMAP diet, can help manage symptoms by reducing fermentable carbohydrates that feed bacteria. This is a difficult diet and should only be done with the help of a healthcare practitioner. It again can help some but it can also make things worse.

3. Lifestyle Changes: Mindful eating, stress reducing techniques and gentle exercise may all help to improve digestion and reduce te effects of SIBO.

4. Prokinetics: Medications that enhance gut motility. This can be done with a BANT registered nutritional therapist. There are natural prokinetics but they need to be part of a programme which will also address other aspects of gut health.

5. Nutritional Support: Supplements to address malnutrition and deficiencies maybe helpful. They will not resolve the issue but will help to address poor absorbency of nutritients.

6. Probiotics and Prebiotics: To help restore a healthy balance of gut bacteria. This would be the final stage of the programme. If introduced too early this may result in very uncomfortable symptoms. Look at lifestyle changes first.

Stool Test vs. SIBO Breath Test

• SIBO Breath Test: This is the most common test for diagnosing SIBO. It measures the levels of hydrogen and methane in your breath after ingesting a sugar solution (usually lactulose or glucose). Elevated levels indicate bacterial overgrowth.

• Stool Test: While stool tests can provide valuable information about the overall composition of gut bacteria and detect pathogens, they are not specific for SIBO since they do not measure bacterial overgrowth in the small intestine. Stool tests are more useful for diagnosing conditions affecting the large intestine, such as infections, inflammation, and dysbiosis.

Is a Stool Test Better than a SIBO Test?

Stool tests are not designed to detect bacterial overgrowth in the small intestine, however what they do is give an idea of the elevated bacteria in the colon that indicates which bacteria is causing problems in the small intestines. SIBO is often as a result of imbalances overall in the gut and this test can be used to rebalance that gut bacteria. This is a simple test which requires you to dip a sample stick into your stool and send it off to the lab for analysis.

The SIBO test is more complex and needs to be done over a number of hours whilst fasting. It can be unreliable and give both false positives and false negatives. My recommendation is to start with the stool test and work with your health practitioner to rebalance the gut and work on other underlying issues of the SIBO. If the SIBO is persistent, then I would suggest getting the SIBO test to see where the SIBO resides in the small intestines and if it's hydrogen, methane or a combination of the both.

For testing I recommend the Invivo GI Ecologix Test in the first instance and if needed the Invivo SIBO test.

Conclusion

If you suspect you have SIBO based on your symptoms, consulting a healthcare provider is essential. They can guide you through appropriate diagnostic tests and recommend a personalized treatment plan to address the underlying causes and manage symptoms effectively.

Working With Me

If you suspect you have SIBO and would like to work with me to get to the root cause of your issues, then why not book in for a 15 minute chat to discuss how I can help you.

I am a BANT Registered Nutritional Therapist that specialises in helping people with digestive issues or issues related to gut health. Please feel free to view my services.