An estimated 60 million people in the U.S. have something called Irritable Bowel Syndrome (IBS), the symptoms of which can include anything from bloating, pain and discomfort, diarrhea and/or constipation, heartburn, and nausea. . IBS is not so much a disease as a “catch all” term used by doctors to categorize people with similar symptoms. According to Dr. Allison Siebecker as many as 84% of all people with IBS have Small Intestine Bacteria Overgrowth (SIBO) as the underlying cause of all their troubles. Interestingly, as many as 70% of people with fibromyalgia also have some form of IBS, and so it isn’t surprising that a study done at Cedars-Sinai Medical Center in Los Angeles found that 100% of fibromyalgia patients (42/42) studied also had SIBO.
What is SIBO?
It is becoming much more common knowledge that people need beneficial bacteria to keep healthy, in fact these beneficials outnumber our own cell 10:1. Just exactly where these helpful critters are isn’t quite as clear to most people. A small amount can be found all throughout the entire digestive tract from the mouth to the other end, but the majority should be in the large intestine and colon. The small intestine, whose job is to host most of the digestion of our food, shouldn’t have a large bacteria population. Having too many bacteria in the small intestine would get in the way of all of the digestive enzymes and other digestive chemicals while slowing down the whole process of absorbing the nutrition and moving along the leftovers. The small intestine uses powerful muscle contractions, called peristalsis, to mix digestive enzymes with the food and to keep it all moving along smoothly into the large intestine. When this is slowed or halted bad things can happen.
The small intestine is super-important because it is technically the first place where your food actually enters into your body. Your mouth, esophagus and stomach are actually still part of the “outside” since all they do is crush and mix the food with chemicals to break it down. Only in the small intestine does our dinner begin to filter into us giving us energy and nutrition. So the small intestine has a huge responsibility – it has to figure out exactly what part of our food is safe and healthy, and what part needs to get passed along and eliminated. Proteins and fats are the main things digested in the small intestine, this includes all the fat soluble vitamins like vitamin A, D & E; and the protein-related vitamins like zinc and many of the B vitamins. It is critical that your food is broken down correctly and then continues to move on through instead of slowing down or stopping there in the small intestine.
Anything that slows down the movement, or motility, of the small intestine brings with it the potential to cause SIBO. When your small intestine gets overrun by bacteria that aren’t supposed to be there you feel bloated; you also don’t absorb the nutrition from your food no matter how organic or healthy it is.
Dr. Siebecker explains that there are many events which could bring on SIBO including a bout with food poisoning, stomach flu or traveler’s diarrhea. Other triggers can be scleroderma (where you skin or connective tissue hardens), Type II diabetes, hypothyroidism, abdominal tumors or any kind of abdominal surgery that produces scar tissue around or on the small intestine. On her website, SIBO Info.com, Dr. Siebecker gives an extensive list of symptoms and related diseases to help you figure out if you might have SIBO. There are also medical tests you can have your doctor give you, one is the Lactulose Breath Test. Another is a urine organic acids test.
So what do you do if you have SIBO?
Dr. Siebecker, as well as functional medicine practitioners like Chris Kresser, use four different approaches to healing depending on the age of the patient and the severity of the symptoms. The first strategy is to go on a carbohydrate-restricted healing diet such as GAPS or SCD. This is because carbs, especially sugars, grains and beans, are favorite foods for the SIBO bacteria. It is especially important to be gluten-free while you are trying to eliminate SIBO.
Next, depending on how severe the overgrowth is, there are special antibiotics, such as rifaximin, that target primarily the SIBO bacteria. If someone doesn’t want to take antibiotics, or if their overgrowth is not severe, there are also specific herbal remedies that have antibiotic effects. Some of the more common ones include cats claw, wormwood, goldenseal, pau d’arco, olive leaf extract, garlic, barberry, and Oregon grape. If the overgrowth is extremely severe practitioners might recommend something called an elemental diet which is a liquid formula of free amino acids to keep any stress off the small intestine while also eliminating anything that would feed the bacterial overgrowth.
Treatment doesn’t work overnight. You may feel relief from your symptoms very quickly, but you have to keep going with the treatment, especially the GAPS or SCD diet, for several months until your body has time to heal. After undergoing treatment for SIBO it is also common to relapse unless you fix the underlying problem that caused it in the first place. (such as a diet of refined carbs and processed foods) It is very important to stay in tune with your body, monitor your digestion and make sure you don’t get constipated or have diarrhea again. Dr. Siebecker gives her patients special supplements to keep motility going smoothly. Taking ginger each day to keep food from just sitting in the stomach is one of her recommendations.
What about probiotics?
Everywhere you look you see probiotics added to all kinds of things. Probiotics are definitely important to supplement, especially from lacto-fermented and naturally cultured foods, but people with SIBO need to read labels carefully and not choose any probiotic that also contain a PRE-biotic. Pre-biotics can aggravate SIBO because they are made from the same kind of carbohydrates that feed the unwanted bacterial overgrowth. According to Chris Kresser you also want to avoid taking any probiotics that have D-lactate-forming species like Lactobacillus acidophilus. Unfortunately those are some of the more common species in many probiotics. Saccharomyces boulardii, on the other hand, is a good strain to look for when taking probiotics for SIBO. All of this is why it is always important to work with a practitioner and not try to self-treat SIBO. It’s tricky to kill off some bacteria while supporting others and also not do any more damage to your digestive tract.
For some people staying on a permanent low FODMAP, gluten-free diet can keep them SIBO-free.
Dr. Siebecker has a new book coming out soon. Visit her website and sign up for her newsletter to receive news on the book, and to learn lots more about SIBO. She also recommends A New IBS Solution by digestive disorders researcher Dr Mark Pimentel as a great resource for further reading.
Maybe SIBO is part of your puzzle. Ask your doctor or practitioner to find out more.
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