Small intestinal bacterial overgrowth (SIBO) is when excessive numbers of bacteria are present in the small intestine. Unlike the colon (or large bowel), which is rich with bacteria, the small bowel usually has less than 104 organisms per millilitre of fluid. Likewise, the types of bacteria in the small intestine are different from those of the colon. A disruption to the motility of the small intestinal or other physical disturbances can lead to this bacteria build up in the small intestine.
SIBO is associated with irritable bowel syndrome and chronic fatigue syndrome. Flora overgrowth may break down bile acids, necessary for the absorption of fats, thus reducing the absorption of fats and fat-soluble vitamins A, D and E. In severe cases, bacteria may damage the small intestinal wall thus impairing carbohydrate and protein absorption resulting in malnutrition. Anemia may also develop when bacteria interfere with B12 reabsorption.
Factors that can contribute to the development of SIBO include:
- Disordered motility of the small bowel
- Coeliac Disease
- Immunosuppressant Medications
- Low stomach acid
- Removal of the ileocecal valve
- Proton Pump Inhibitors (e.g. Nexium, Omeprazole)
- Neurological conditions
- Obstruction or scarring of the small intestine, as can be found in Crohn’s Disease or after surgery
Common signs and symptoms of SIBO include the following:
- Nausea and/or Vomiting
- Bloating after eating
- Chronic diarrhoea
- Abdominal cramping, worse after meals
- Weight loss and/or malnutrition
- Steatorrhea (fatty stools)
- B12 deficiency
- Malabsorption and nutritional deficiencies
Hydrogen breath tests: Breath tests have been developed to test for bacterial overgrowth, based on bacterial metabolism of carbohydrates to hydrogen. The hydrogen breath test involves giving patients a load of carbohydrate (usually in the form of rice) and measuring expired hydrogen concentrations after a certain time.
Bacterial culture: Bacterial culture is now seldom used due to the invasiveness of endoscopy, contamination of the endoscope and catheter, inaccurate sampling and because many bacterial species do not grow in routine culture media and quantitative culture may underestimate the bacterial population. Furthermore, due to the location of the small intestine, it is not easily accessible to obtain a sample.
D-xylose: The D-xylose test involves having a patient drink a certain quantity of D-xylose, and measuring levels in the urine and blood; if there is no evidence of D-xylose in the urine and blood, it suggests that the small bowel is not absorbing properly which is often an indicator for SIBO.
Treatment for SIBO
SIBO is a chronic condition. It can be cured, but it takes patience, perseverance and a change in diet. Priority areas are: 1) Correcting the bacterial overgrowth, 2) Restoring the function of the microbiome, 3) Reducing inflammation and repairing damage to the intestinal lining. Jodie takes specific steps to address the biofilms* that can develop in those who suffer from SIBO.
Herbal Medicines, Diet, Probiotics and Nutrients play an important role in recovery.
- Herbal Medicines (most have multiple actions and Jodie chooses herbs that are beneficial to other health conditions you may have): Oregano, Berberine herbs (Barberry, Golden Seal, Phellodendron), Myrrh, Sarsaparilla, Boswellia, Echinacea, Garlic, Slippery Elm, Wormwood, Turmeric, Clove, Thyme and others
- Nutrients: Vitamin D3, Vitamin A, Glutamine, Zinc, Vitamin C, Magnesium, NAC and others
- Probiotics: Lactobacillus rhamnosus GG (LGG), L. paracasei (LP-33), L. plantarum (299v), Bifidobacterium lactis (BB-12) and others
- Binders (for endotoxins): Charcoal, diatomaceous earth, pectin, high tannin teas and others
- Diet: Anti-inflammatory diet, Low FODMAP diet**, Identify food intolerances, low alcohol and caffeine, minimise processed foods
* Bacteria are capable of adapting to avoid (and hide) from our immune system. They can form biofilms which effectively ‘shield’ them from our immune system. In chronic health conditions, breaking down biofilms is a key strategy in supporting the body to recover and heal.
* *A low FODMAP diet is a short term strategy for reducing symptoms (and inflammation). Once recovered from SIBO, returning nutritious, well tolerated high FODMAP foods to the diet is important to gain benefit from their pre-biotic actions (they provide fuel for your good gut bugs!)
Small intestinal bacterial overgrowth is commonly treated with antibiotics. While this reduces the problem bacteria it also kills off the healthy bacteria essential for proper digestive function. For patients choosing to treat with antibiotics, herbs and probiotics to support the gut lining and microbiome can also be taken, helping to reduce the negative effects of antibiotics and speed recovery.