What is SIBO?? Is it the cause of my IBS?

SIBO stands for Small Intestinal Bacteria Overgrowth. It is a common condition that is the result of having too much bacteria in the small intestine. It is normal to have some bacteria there. However, the majority of gut bacteria are usually in the large intestine. Once more bacteria starts to setup in the small intestine, that's when your symptoms tend to start. 

Signs and Symptoms of SIBO

Symptoms of SIBO vary from person to person. However the most common things I see in office are:

• Bloating after meals, within 20-45 minutes
  
• gas
  
• loose bowels
  
• constipation
  
• burps
  
• abdominal pain and discomfort
  
• iron deficiency anemia
  
• b12 deficiency
  

A lot of the time, these symptoms will be diagnosed as IBS. 

SIBO vs IBS

Most SIBO symptoms can commonly fall under the diagnosis of IBS. When comparing the two clinically, it is tough to differentiate the two conditions. The only way to confirm the diagnosis is the hydrogen and methane lactulose breath test.

The Most Common Root Causes of SIBO

 FOOD POISONING
An infection in the gut leading to changes in the natural gut bacteria over time. 

​ANATOMIC

• Diverticulosis - Small pouches formed in the wall of the digestive tract that can hold excess bacteria. 
• Strictures - A narrowing of the digestive tract, like pinch in the tube. This decreases the normal movement of digestive contents through the gut. 
• Surgical Procedures - Alter the function of the gut. 
• Ileo-cecal valve dysfunction - This valve separates the small and large intestine. A change here allows for back flow of contents from the large intestine to the small intestine.
• Head injury - Changes in brain function can lead to changes in the autonomic function of your gut. Autonomic function is the part of your physiology that does work without you thinking about it (ex digestion, heart, liver, lungs, immune etc...) 

POOR MOTILITY (movement of food through your digestive tract)
Lack of normal movement of gut contents along the tract allows for food stagnation and overgrowth of bacteria. The lack of movement of digestive contents allows bacteria to stay still, grow, and overpopulate. This then allows the bacteria to overgrow in certain areas where they normally would not be in such large numbers. When bacteria sit still, they will begin to eat and consume the digestive contents as fuel. This manifests as excess gas, bloating, constipation, diarrhea. 

HYPOCHLORHYDRIA (AKA LOW STOMACH ACID pH)
A less acidic stomach environment could lead to more bacteria and undigested foods passing through the stomach and ending up in the small intestine to fuel the growth of more bacteria. 

How To Treat SIBO

• Patient intake to determine the symptom picture and individual treatment plan. 
• Testing 
  • Bacterial overgrowth in the small intestine via a hydrogen and methane lactulose breath test. 
  • Iron, Ferritin, TIBC, B12, CBC, Amylase, AST, ALT, GGT, folic acid via bloodwork.
  • Other relevant testing depending on your symptoms.
• Initial support of the organs of elimination (skin, liver, digestive tract...).
  • ​NAC, glutathione, milk thistle, schisandra, rosemary, ALA, bismuth substrate, DMPS...
• Use antimicrobials to decrease the amount of bacteria in the small intestine.​
  • Oregano, Berberine, Thyme, Myrrh, Hydrastis, Rifaximin... 
• Repair and heal the gut
  • Diet - a FODMAP style approach. Click here to download a FODMAP diet handout.
  • Glutamine, NAG, DGL, Zinc, Aloe, Slippery elm, chamomile...
  • Prucalopride to help get motility back to normal. 
  • Probiotics
• Restore nutrient deficiencies
  • B12, Iron, Magnesium, vitamin A, D, E, K, omega fatty acids