SIBO, also recognized as Small Intestinal Bacterial Overgrowth, has come into the limelight in recent years. This gut condition is when our good bacteria from our colon find their way into the small intestine and create an overgrowth. These good bacteria we have in our colon help digest soluble fiber for us, absorb and transform vitamins and minerals into our body, and are only considered good if they are living in the right areas in our body, as well as in the right amounts. But when they migrate into the small intestine, they populate, which can lead to the bacteria robbing our cells of sugar/simple carbs and get in the way of nutrient absorption. This isn’t good as the small intestine is WHERE we absorb most of our nutrients and transport the remaining fibers. In addition, as the bacteria lay in the small intestine, we are also susceptible to malnutrition, as they also devour the bile salts we excrete to help absorb our fats. The bacteria is pretty much competing with our very own body. When this occurs, one can experience uncomfortable symptoms like gas, bloating, nausea, cramps and even vomiting.
Bacterial overgrowth can also cause leaky gut by irritating the tight junctions and causing permeability, as well as wear-and-tear on the villi which subjects us to poor nutrient absorption. Unfortunately, with an overgrowth, this can lead to a thinning of the mucosal lining and increase of inflammation.
We’re not 100% if there is one fixed reason on as to why people develop SIBO, but there are 5 common causes that have been linked to it.
1. A deficiency in the migrating moto complex (MMC): Our MMC is a series of stomach and small intestine contractions that help push out remaining food particles and bacteria. This should occur every 1 ½ – 2 hours when one is fasting which sends bacteria to the colon. Think of it as our “automatic clean up”. However, if MMC doesn’t occur, common causes of why it is slowed down or not happening is usually due to food poisoning or diabetes. We say food poisoning because usually it comes either a parasite or a virus that can produce a toxin that damage one’s nerves in the gut, which then can slow down MMC.
Diabetes on the other hand can damage the nerves which can also slow down motility.
2. Defect in the ileocecal valve: The ileocecal valve Is the sphincter that separates the small and large intestine. If there is a defect, this can allow bacteria to move up and down the pipe (which can also lead to reflux). Common causes are infections, parasites, or irritation from undigested food.
3. Structural issues: In some cases, small pouches are formed in the small intestine that create nooks for the bacteria to grow in. This can be caused by a multitude of things such as low fiber diets, constipation, surgery, or in rare cases, diverticulitis.
4. Weak immune system: Normally, a strong immune system can take care of unplaced bacteria, but if one is lacking the resources needed to handle an overgrowth, or a toxin, bacteria can take advantage. This can be caused by chronic stress, antibiotics, or an infection.
5. Low stomach acid and poor digestive enzyme production: Lastly, low stomach acid and the inability to produce enzymes endangers digestion which can lead to an overgrowth of bacteria. Normally, stomach acid can kill off unwanted bacteria, but if there is not enough, it can’t do its job. Stress, again, can be a culprit, an overuse of antacids, proton pump inhibitors, or poor diet can be the cause.
In order to be diagnosed with SIBO, individuals must go to their doctor and ask for the Breath test, which is a 48-60 hour long test. One has to have a “prep” diet of about 12-48 hours that avoids high fiber foods, and drinking a glucose or lactulose formula, which is ended with a 12 hour fast. One has to breathe in some tubes through out the day to measure how much hydrogen and methane one is producing.
If diagnosed with SIBO, patients have 3 options to go about treatment:
1. Antibiotics that doctors prescribe like rifaximin
2. Herbal antimicrobials: cinnamon, lemon balm, neem, oil of oregano, red thyme, ginger root which can be prescribed by a natural medicine practitioner
3. The elemental diet which is a liquid diet that can last up to 2-3 weeks. It is highly recommended to work with a functional practitioner that knows of this diet.
Conversely, SIBO, is tricky to get rid of permanently for there is usually an underlying cause of it, and in most cases, it’s due to a deficiency in the MMC.
Ways in which one can manage SIBO is through a few methods:
1. Temporarily eat a low reside diet: This is when one tries to starve the overgrowth of bacteria by avoiding starchy foods, both complex and simple carbs. The reason carbs are limited is because bacteria get their energy through sugar.
2. Focus on eating healthy fats and high protein intake: Bacteria have trouble digesting fats and proteins- particularly animal protein. As much as I would not advise this method, I wanted to you to understand what drives the bacteria and what weakens them.
3. Avoid sugar alcohols and fermented foods: This tip goes hand in hand with the first one, but I wanted to mention that sugar and sugar alcohols are different. Sugar from food is food for both us and the bacteria. Sugar alcohols on the other hand do NOT feed us in any shape or form, yet the bacteria will eat it nonetheless. As for fermented foods, it is a good idea to stray away from them until one’s SIBO is under control, for it can add more bacteria into the mix.
4. Support the MMC: In most cases, our MMC is working when we’re sleeping for most people fast when they’re asleep. Try and focus on eating 3 meals every 4-5 hours so the MMC can do work in between meals, and when you’re asleep. This, in turn, means eliminate snacking and not eating right before bed.