What is SIBO?
SIBO stands for Small Intestinal Bacterial Overgrowth. It is a common, yet under recognised problem. SIBO is characterised by the presence of an abnormal number of bacteria in the small intestine in combination with a host of GI symptoms. Basically, bacteria that normally lives in the large intestine, moves up to the small intestine area where it does not belong!
Testing for SIBO
Getting an accurate diagnosis of SIBO can be incredibly difficult. The condition often goes undiagnosed as it a relatively new concept in the scientific literature and research is evolving every day in this area.
Testing for SIBO typically involves a hydrogen and methane breath test. During bacterial overgrowth we produce elevated levels of gases such as hydrogen and methane (these are produced by the bacteria and cause gas and bloating) which are exhaled through breath. These gases allow us to measure bacterial load in the small intestine.
There are limitations to this test though with several researchers and practitioners questioning the accuracy of this test to identify SIBO. It has been suggested that some bacteria in the small intestine produce hydrogen sulfide rather than methane or hydrogen. And at this stage we do not have a test for hydrogen sulfide.
Prior to a SIBO breath test there is important nutritional preparation steps that mut be taken up to 2 weeks before the test for an accurate reading.
There is also potential for overgrowth of fungus in the small intestine (SIFO) which can cause symptoms very similar symptoms of SIBO. However, there is currently no test available for SIFO.
Different types of SIBO
There are three main types of SIBO; methane, hydrogen and hydrogen sulfide. These are the three main gases produced by the bacterial overgrowth in the small intestine.
1) Methane SIBO
This is diagnosed by the elevation of methane on a SIBO breath test. Specifically, M.smithii bacteria accounts for 94% of species that produce methane. Everybody has M.smithii bacteria however it really depends on how much you have. The higher amounts of M.smithii in their stool will typically have higher methane levels on a breath test.
Methane has had been shown in the literature to decrease GI transit time. Which may lead to constipation and excessive bloating which is a major symptom for methane SIBO. The annoying this about methane SIBO is these bugs can be antibiotic and antimicrobial resistant. Making healing longer and more difficult.
2) Hydrogen SIBO
This is typically the most prevalent SIBO and is diagnosed by the rise in hydrogen on a SIBO breath test, as a result of carbohydrate-fermenting bacteria that produce hydrogen gas in the small intestine. The issue arises when we have too much bacteria in the small intestine producing hydrogen. Increased hydrogen production is often associated with loose stools or diarrhea, bloating and GI discomfort.
3) Hydrogen Sulfide SIBO
Hydrogen sulfide SIBO is quite new and research is still merging on this type of SIBO. Sulfar is an essential mineral that plays a role in amino acid composition, energy production, metabolization of food, it protects us against oxidative stress and contributes to the health of our skin, tendons and ligaments.
This issue becomes when there is too much hydrogen sulfar which overwhelms our gut due to over detoxifying which can become problematic and lead too intolerance to sulfar containing foods (onion, garlic, eggs, cruciferous vegies), leaky gut, foul smelling gas, brain fog and leaky gut.
If you have this form of SIBO you will need to follow a low-sulfar diet. Interestingly, research has shown a low-FODMAP diet is not actually beneficial for hydrogen-sulfide SIBO.
Root cause of SIBO
Finding the root cause of your SIBO is going to be vital in your healing and bringing balance back to your gut and your body. Some underlying causes of SIBO include;
· Hypothyroidism – low thyroid function has a direct impact on your gastrointestinal health and effect overall gut motility which can predispose you to SIBO
· Chronic Stress – when you are in constant state of fight or flight your gastic function is reduced which can make you more susceptible to SIBO
· Excess Estrogen – Excess estrogen can decrease the production of bile salts (this is required in order to breakdown and assimilate fats) but they also have antimicrobial properties and a deficiency can be a predisposing factor for SIBO.
· Adhesions and Scar Tissue – if the structure of the small intestine is compromised this increases the likelihood of SIBO developing.
· Lowered Immune Function – when the immune system does not work correctly it cannot remove bacteria out of the small intestine which allows it to overgrow.
· Low Stomach Acid – this can typically be caused by stress and/or low zinc, B12 and low chloride, and over use of PPIs and NSAIDs. HCL protects the stomach and kills bacteria before it can enter it. If you have lowered stomach acid it predisposed you to SIBO. Side note; if you have had H Pylori this also lowers stomach acid.
· Oral Contraceptive Pill – Yes, the pill can lead to SIBO, yeast infections, gut dysbiosis, and even autoimmune issues.
How to treat SIBO
Firstly, you need to understand which type of SIBO you have and ensure you followed all the appropriate steps prior to your testing (as I mentioned nutritional alterations from 2 weeks out) so you know you have an accurate result.
There is nutritional, training and lifestyle interventions that will need to take place depending on which type of SIBO you have in order for you to heal appropriately.
For hydrogen and methane SIBO you may need to follow a low-FODMAP diet for a period of time while you are eliminating the SIBO. But you do want to ensure you reintroduce FODMAPS at some point as they are vital for the health of our gut and colonisation of good gut bacteria. For hydrogen sulfide SIBO a low-sulfar diet is generally recommended until irradiation it confirmed.
You will need to eradicate the bacteria through use of herbal antimicrobials along with other supplementation (generally fiber and probiotics). Depending on your type of SIBO, symptoms and any other issues will depend on what course of antimicrobials your practitioner may suggest. Along with addressing any nutrient deficiencies that can lead to gut inflammation.
Along with reducing stress, focusing on recovery, sleep quality, self-care and reducing training load whilst healing are all vital steps in your recovery