SIBO, or small intestinal bacterial overgrowth, is a painful + uncomfortable condition that is usually triggered by various underlying conditions. SIBO occurs when some of the bacteria in the large intestine [which are beneficial + essential to health] start to creep into the small intestine where bacteria populations are typically minimal. This migration of bacteria can be problematic because it inhibits the small intestine from functioning correctly [altering the absorption + metabolism of nutrients] and can damage the lining of the small intestine, causing increased intestinal permeability over time.
Let's dive into some of the common causes + symptoms, how to diagnose SIBO and how to treat it to better understand this condition.
Causes of SIBO
While the cause of SIBO may actually be due to many compounding factors, the main causes are:
an imbalance of beneficial vs opportunistic species in the large intestine
chronic constipation or impaired gut motility
certain diseases / medications can cause impaired gut motility [i.e Parkinson's, IBS + IBD, opioids, antidepressants, narcotics] and cause a back-up in the large intestine that can lead to bacteria migrating into the small intestine
low stomach acid or medications that lower stomach acid
lowered stomach acid reduces the body's ability to kill off bacteria
disorders of the ileocecal valve
this valve separates the end of the small intestine [the ileum] from the beginning of the large intestine [the cecum]. If this valve is impaired, bacteria can easily migrate into the ileum
Symptoms of SIBO
nausea or vomiting
unintentional weight loss
malabsorption of nutrients [as demonstrated by lab results]
dysbiosis [as demonstrated by a stool panel]
How SIBO is diagnosed
To diagnose SIBO, you can take an at home test or have your healthcare practitioner run a test. The most common and accurate test is a breath test which determines the presence of SIBO, and is able to provide specific information about the type of bacteria that are overgrown [hydrogen-producing or methane-producing bacteria].
Here is a rough outline of what to expect from a SIBO breath test:
it is a fasted test [10-12 hour fast]
you will drink a sugary solution prior to completing the test
you will breathe into a machine that will test levels of hydrogen and methane gases in your breath at specific intervals [generally every 15-20 mins for up to 3 hours]
the test will generate a graph to show the levels of hydrogen / methane gases in your breath over the course of the test
How to decipher a SIBO breath test:
if your results show a rise in hydrogen gas of ≥ 20 ppm and / or a rise in methane gas ≥ 10 ppm during the first 2 hours, you are positive for SIBO
if your results show a rise in hydrogen gas of < 20 ppm and / or a rise in methane gas < 10 ppm during the first 2 hours, you are negative for SIBO
How to treat SIBO
If you receive a positive SIBO result, many practitioners may prescribe a gut-specific antibiotic to treat the overgrowth of bacteria in the small intestine. While very effective in the short term, this treatment plan can cause further dysbiosis as bacteria regrows after the antibiotic course and potentiate future relapses of SIBO if the underlying cause was not addressed.
Instead, a multi-faceted + holistic treatment plan that focuses on diet, lifestyle + herbal support is the best route. We recommend working closely with a functional practitioner to treat your specific type of SIBO [whether hydrogen-dominant, methane-dominant or a combination of the two] to eradicate the issue for good in a nourishing + comprehensive way.
If you think you may be suffering from SIBO, or if you have recently received a positive SIBO result, consider reaching out and working with us 1-on-1. We have seen many SIBO success stories under our care!
Resources to explore on your journey: