What You Need To Know About SIBO & Gut Health
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In this article:
- What Is SIBO?
- Your Digestive Tract
- SIBO Symptoms and Your Gut
- SIBO Causes
- SIBO Diagnosis
- SIBO Treatment
- SIBO Diet Plan
- Help Can be Found
Understanding Your Gut and Setting Up the Right SIBO Diet
What Is SIBO?
SIBO (small intestinal bacterial overgrowth) is sometimes referred to as small bowel bacterial overgrowth syndrome (SBBOS). This condition is exactly what it sounds like – excessive bacteria in your small intestine. It may sound like having bacteria in your digestive tract is normal, and it is — but only to an extent. Small intestinal bacterial overgrowth is a serious condition that only occurs when bacteria start to grow where it shouldn’t. As a result, this can lead to pain and diarrhea. SIBO can even lead to malnutrition as the body’s nutrients are eaten by the bacteria. Let's take a look at what causes SIBO, what it is, and what we can do about it.
Your Digestive Tract
Your digestive tract is responsible for handling the food and drink you take in, from your mouth to your esophagus to your stomach. From there, it's pushed to and through the small intestine, then through the large intestine (which includes the colon) — and then whatever is leftover exits your body in the form of poop. The small intestine is responsible for slowly breaking down the food we eat so its nutrients are absorbed into the bloodstream. When there's a problem with the small intestine, the body fails to absorb the nutrients it needs to become healthy.
Dr. Josh Axe, a nutritionist, tells SheKnows that in a healthy system, the small intestine is home to some bacteria, but not a lot — you'll generally find the highest concentrations inside the colon. This is why small intestinal bacterial overgrowth can be such a huge problem. If there is bacterial overgrowth in the small intestine, it can affect how your gut deals with nutrients. This means if there's a problem with excess bacteria in this part of your body, then you're not getting what you need to keep healthy. If the small intestine has too much bad bacteria, it may cause nutrient deficiencies and various digestive issues, as well as develop symptoms of SIBO.
SIBO Symptoms and Your SIBO Gut Health
"When in proper balance, the bacteria in the colon helps digest foods and the body absorb essential nutrients," says Axe. "However, when bacteria invade and take over the small intestine, it can lead to poor nutrient absorption, symptoms commonly associated with IBS, and may even lead to damage of the stomach lining." This can lead to several unpleasant symptoms. SIBO symptoms mainly affect the gut and can include:
- Excess gas
- Abdominal bloating
- Abdominal distension
- Diarrhea
- Abdominal pain, especially after eating
- Bloating
- Abdominal cramps
- Constipation
- Indigestion
- A regular feeling of fullness
- Nausea
Keep in mind that a few people with small intestinal bacterial overgrowth may experience constipation instead of (or in addition to) diarrhea. More severe cases may cause extreme weight loss and vitamin deficiency-related symptoms.
SIBO Causes
What could be causing your small intestinal bacterial overgrowth symptoms? It can be quite complex. SIBO is not yet understood all that well. However, we do know that it tends to occur when the patient has some small bowel abnormalities. This can include pH changes, the immune system isn’t working correctly, and food isn’t being removed effectively. Particularly, irritable bowel syndrome is a known related condition. Here are some risk factors for SIBO:
- Celiac disease
- Low gastric acid
- Crohn's disease
- Type I or II diabetes
- Irritable bowel syndrome
- Other chronic digestive diseases
- Viral gastroenteritis
- Nerve damage
- Cirrhosis
- Portal hypertension
- Some gastric bypass procedures
- Surgeries that result in strictures or adhesions
What Is Celiac Disease? This is an autoimmune disease caused by eating gluten. It results in inflammation and damage in the small intestine.
Food is normally being continuously digested through the digestive tract. This also helps to remove excess bacteria and making sure that some types of bacteria don’t enter the small intestine. When a condition that causes SIBO interrupts this normal action, bacteria stays around longer and grows in the wrong place – the small intestine. SIBO can affect the small bowel’s function by not allowing nutrients to absorb as they should. This can cause a leaky gut where toxins can pass through the bowel into the bloodstream.
SIBO Diagnosis
As you can see, these symptoms may sound an awful lot like a ton of other abdominal maladies. This can make it hard to pin down — even for your physician. If you suspect that you may have SIBO, you should see your doctor. Your doctor will ask you about your symptoms and medical history to determine whether you could have SIBO. You may be requested by your doctor to do some tests including blood and fecal.
Your doctor might want to rule out other conditions (such as diabetes or celiac disease) before jumping to SIBO testing. However, your mileage may vary according to your doc's preferences. Direct bacterial sampling from the small intestine and culturing any bacteria found is one way to diagnose SIBO. This involves anesthesia and a scope. Another option is the hydrogen breath test, which is not invasive and only requires a pretest fast. During a hydrogen breath test, you will be instructed to do the following:
- Exhaling into a balloon
- Consuming some of the test substance (some sort of sugar, usually)
- Then followed by more balloon breathing
- Which is then tested for hydrogen and methane
If the breath test doesn’t show a conclusive result, your doctor may need to do some other tests. Your doctor may request a sample of the fluid from your small bowel. This sample will show if any bacteria are growing there. After all these SIBO testing procedures, your doctor will be able to come up with proper diagnoses of whether or not you have an overgrowth of bacteria in your small intestine.
RELATED: 7 Signs Your Gut Is Out Of Balance
SIBO Treatment
So, your doctor diagnosed your digestive issues as SIBO. Treatment follows. SIBO can be treated with a combination of a change in diet and antibiotics. Antibiotics will allow you to get the bacteria in the small intestine under control first. You may also need to have IV therapy if you have been left dehydrated and/or malnourished.
Dr. Mahmoud A. Ghannoum, a professor of dermatology at Case Western Reserve University who specializes in medically important fungi and bacteria, explains that treatment depends on its underlying cause. It can be as relatively noninvasive as a diet change (such as is necessary for those who have celiac disease) or as involved as surgery for those who have a problem in the anatomy of their small bowel. Ultimately, unless the underlying condition is treated, SIBO will not be affected. Additionally, in patients who have experienced weight loss or other signs of nutritional deficiencies, Ghannoum says nutritional support is another aspect of SIBO treatment. Nutritional recommendations are usually based on the individual patient, but many find relief from symptoms by following a low-FODMAP diet.
What Is FODMAP? It stands for fermentable oligo-, di-, monosaccharides, and polyols, which are known for causing digestive problems like bloating and abdominal pain. And finally, the other step of treatment should target and eliminate the bacterial overgrowth. "Antibiotics reduce or eliminate the bacterial overload and reverse the mucosal inflammation associated with overgrowth and malabsorption," he notes. In some cases, patients get better and stay better after antibiotic treatment. However, others see their symptoms return when their course of antibiotics is complete and must take antibiotics repeatedly — or continuously. Since antibiotics kill both good and bad bacteria, it also disrupts the digestive system.
SIBO Diet Plan
While there is no evidence to support or prove that a certain diet can cause SIBO. Some patients have found relief after following a SIBO-friendly diet. Before making any changes to your diet, you should speak with your doctor. You may find that you only need to make some small adjustments to your diet. Such as eating a more balanced diet, eating frequently smaller meals, or avoiding gluten products if you have celiac disease.
By incorporating both the SIBO diet plan and antibiotics, you may be able to speed up your recovery time. The SIBO diet plan is not an all-at-once deal. It is a gradual elimination process that aims to reduce any inflammation in the digestive tract and any bacteria overgrowth in the small intestine. For this reason, eliminating just one product from your diet can do the trick. For instance, some patients may find relief by eliminating sugar.
While the SIBO diet plan, designed by Dr. Allison Siebecker, can be restrictive, it may relieve uncomfortable symptoms. Each category within the diet is color-coded. The codes for the SIBO food list range from less fermentable to more fermentable foods. The less fermentable foods on the SIBO food list are those that can relieve symptoms.
A SIBO diet plan should focus on foods that are high in fiber and low sugar. A low-FODMAP diet may include the following SIBO food list items:
- Oatmeal
- Fish
- Meat
- Leafy greens
- Olives
- Peanuts
- Quinoa
- Gluten-free noodles
- Potatoes
- Pumpkin
- Eggs
- Carrots
- Unsweetened cereals
- Gluten-free crackers
- Gluten-free noodles
- Strawberries
- Oranges
- Grapes
- Blueberries
- Head of broccoli
- Spaghetti squash
- Rice
- Seeds
If there are foods to eat, there are also foods that should be eliminated from the SIBO diet. Reducing or eliminating these foods can help to improve your digestive health. The SIBO diet plan focuses on foods in these main categories:
- Fructose – simple sugars that are found in some fruits and vegetables. As well as honey and agave nectar.
- Lactose – a sugar that is found in dairy products
- Galactans
- Fructans – a sugar compound that is found in gluten products. As well as some fruits, vegetables, and prebiotics.
- Polyols – often used as a sweetener.
Foods that should be eliminated are ones that have high amounts of FODMAPs. This SIBO food list includes:
- Natural fructose like agave, honey, and high-fructose corn syrup
- Sodas
- Apples
- Dried fruits
- Ice cream
- Barley
- Grains
- Cauliflowers
- Artichoke
- Beans
- Flavored yogurt
- Rye
- Butternut squash
- Garlic
- Onions
- Sausage
- Sweetened cereals
- Asparagus
- Beans
- Peas
Help Can be Found
If you've been experiencing uncomfortable and distressing abdominal symptoms, a visit to your doctor is in order. While some people have a hard time getting a solid SIBO diagnosis and treatment plan, help can be found, and hopefully, you'll be feeling back to your old self soon.
If you would like some further information on SIBO, visit Healthline for everything you need to know about the small intestinal bacterial overgrowth.
Here are 3 simple steps to boost digestive health in the morning from BIOHM Health:
Following a SIBO diet plan can help balance the gut and relieve symptoms. Boost its effects on the body by supplementing with gut nourishing cultures. Do want to know more about creating a more detailed SIBO diet plan? Let us know in the comments section below! Up Next:
Editor's Note: This post was originally published on April 13, 2018, and has been updated for quality and relevancy.
