Small Intestinal Bacterial Overgrowth: SIBO

If you have gas, bloating, diarrhea and other uncomfortable symptoms in your gut, you may have SIBO. SIBO, which is pronounced “see-bo”, stands for Small Intestinal Bacterial Overgrowth. This develops when too many bacteria colonize in the small intestine. In a healthy colon (or large intestine) there should be 100 billion bacteria per milliliter but in your small intestine you should have less than 100,000 per milliliter. You can see a big difference between 100 billion and 100 thousand.

SIBO is uncomfortable, usually underdiagnosed and can cause damage to intestinal cells. There are estimates that more than 80% of people with IBS also have SIBO. Individuals with other digestive issues are more likely to have SIBO, conditions such as Celiac and Crohn’s Disease.

What symptoms are present along with SIBO:

• Abdominal bloating and distention
• Gas
• Heartburn
• GERD
• Diarrhea (persistent)
• Abdominal Pain

What brings SIBO on?
In a normal healthy intestine there are cleansing waves that take place between meals and snacks that sweep food through the small intestine into the large intestine. If these cleansing waves are compromised it can lead to more time for bacteria to colonize in the small intestine.

Other anatomical issues such as the valve between the small and large intestines becoming compromised and allowing bacteria to migrate from the large intestine back up to the small intestine.

Chronic inflammation leading to an underactive immune system. Most of the immune cells are located in the intestinal tract, if the immune system is compromised then it can not fight off invading unfriendly bacteria or manage concentrations of bacteria.
Insufficient stomach acid can lead to intestinal bacterial overgrowth. The pH of stomach acid kills acidophobic(or acid hating) bacteria. If the pH is higher than normal, it can lead to certain bacteria surviving that would have otherwise died in the stomach.

If SIBO persists, what else happens?

• Vitamin and mineral deficiencies
• Leaky Gut
• Fatigue
• Food sensitivities
• Headaches
• Skin problems
• Inflammation
• Autoimmune cascades

Many physicians will treat SIBO with antibiotics. This can be necessary depending on the amount of overgrowth. Other treatment options include diets that starve the bacteria. Diet options include: Specific Carbohydrate Diet, GAPS diet, or low FODMAP diet.

Working with a Functional and Integrative Dietitian can help as these diets are implemented. Preventing SIBO from returning is essential, correcting for vitamin and mineral deficiencies and healing the gut lining is very important. If you think you have SIBO, it is important to visit your physician and obtain testing for accurate diagnosis.

Here is tip #1 for preventing SIBO: Encourage cleansing waves in your intestine. Drink hot lemon water or take a shot of apple cider vinegar. You can do this before bed or after meals (just make sure to brush  your teeth after). It's also important to wait sufficient time between meals and snacks before eating again (at least 2 hours).