Small Intestinal Bacterial Overgrowth, or SIBO, is a digestive condition that occurs when there is an excessive growth of bacteria in the small intestine. Normally, the small intestine has only a small amount of bacteria, but when its motility (movement) is compromised, bacteria can proliferate. This overgrowth disrupts normal digestion, as the bacteria ferment food prematurely, leading to gas production and the creation of other waste by-products. These by-products can damage the delicate lining of the small intestine, causing inflammation, impairing nutrient absorption, and potentially leading to further digestive complications.
Symptoms of SIBO: Not Just About Bloating
Although abdominal bloating is often considered the hallmark symptom of SIBO, the condition doesn’t always present in the same way for everyone. In fact, bloating can manifest differently depending on the individual. For some, bloating may feel like pressure in the abdomen, whereas others experience noticeable abdominal distention—the visible swelling that can sometimes make your stomach feel hard or look “pregnant” by the end of the day.
Aside from bloating, individuals with SIBO often report a range of other digestive symptoms, including:
- Gas and excessive burping
- Abdominal discomfort or pain
- Heartburn or acid reflux
- Alternating between diarrhoea and constipation
- Nausea
- A feeling of incomplete bowel movements or frequent urgency
Interestingly, bloating in the context of SIBO isn’t always about how much the stomach expands but rather a sensation of fullness and pressure in the abdomen, often accompanied by changes in stool consistency. Many people find that their bloating is worse in the evening after meals, leading to a feeling of discomfort and fullness that lingers.
SIBO and Its Impact Beyond the Gut
While SIBO is primarily associated with digestive issues, its effects can extend beyond the gut, influencing various other aspects of health. Many people with SIBO experience symptoms such as:
- Brain fog and difficulty concentrating
- Persistent fatigue
- Skin problems like acne or eczema
- Joint pain or inflammation
- Mood swings, anxiety, or depression
- Hormonal imbalances leading to irregular periods or thyroid dysfunction
If you experience these systemic issues alongside digestive complaints, it could indicate that SIBO is contributing to the broader picture of your health.
Who’s at Risk for SIBO?
SIBO is more likely to occur in individuals with certain risk factors. You might be at a higher risk of developing SIBO if you:
- Have had food poisoning or other gastrointestinal infections
- Have undergone abdominal surgeries or have pelvic adhesions
- Struggle with conditions like endometriosis or connective tissue disorders (e.g., Ehlers-Danlos syndrome)
- Developed digestive issues following a viral illness
- Have diabetes, celiac disease, or Crohn’s disease
- Have been diagnosed with irritable bowel syndrome (IBS)
- Have a history of mold exposure or lived in a water-damaged building
- Have chronic fatigue syndrome or Lyme disease
These factors can interfere with the normal function of the small intestine, leading to bacterial overgrowth.
Testing for SIBO: What You Need to Know
A key part of diagnosing SIBO is a breath test, which measures the gases produced by bacteria fermenting sugars in the small intestine. There are several types of breath tests, depending on which sugar is used:
- Lactulose is typically the most reliable substrate for testing because it’s not absorbed by the small intestine and can assess bacterial overgrowth in the entire small intestine.
- Glucose is absorbed early in the small intestine, so it only detects bacteria in the upper part of the small intestine.
- Fructose may also be used, though it is less common.
The results from these tests can help pinpoint not only the presence of bacterial overgrowth but also the types of gases being produced, which can offer insight into what kinds of bacteria are involved and how best to treat the condition.
It’s important to note that neither stool tests nor blood tests can accurately diagnose SIBO. While these tests can offer information about gut health, they do not reveal bacterial overgrowth in the small intestine.
Treating SIBO: Exploring Your Options
There are several treatment strategies for SIBO, and what works best can vary from person to person. The main treatment options include:
- Antibiotics: The most commonly used antibiotic for SIBO is rifaximin, which remains in the small intestine and doesn’t affect the beneficial bacteria in the large intestine. Other antibiotics like neomycin or metronidazole may be used depending on the type of bacteria detected.
- Herbal Supplements: Herbal treatments can also be effective in reducing bacterial overgrowth. Commonly used herbs include berberine, oregano oil, garlic (allicin), and uva ursi. However, we prefer more selective antimicrobials as they cause less damage to the host and the microbiome overall. These can be gentler alternatives to antibiotics for some people, though they may require a longer course of treatment.
- Elemental Diet: The elemental diet involves consuming pre-digested nutrients in liquid form. This removes food sources from the small intestine, starving the overgrown bacteria and giving the gut a chance to heal. The elemental diet is very effective, but it’s usually done under medical supervision because it requires strict adherence and careful planning.
Why Treatment Duration and Follow-Up Matter
Treating SIBO isn’t just about choosing the right medication or supplement; it’s about understanding how long treatment should last and how to maintain long-term gut health. Once the bacteria have been reduced, it’s crucial to follow up with lifestyle changes and preventative treatments to ensure that the overgrowth doesn’t return. Gut motility may need to be addressed, and certain dietary or lifestyle changes may help maintain a healthy gut microbiome.
Working with the Right Practitioner
Because SIBO is a complex condition, working with a qualified healthcare professional is key to effective treatment. Ideally, you should seek someone who has experience with SIBO and who stays up to date with the latest research. Working with an expert can significantly improve the chances of successful treatment.
In some cases, prescription medications may be necessary, so finding a practitioner with prescriptive authority is important. If you are considering an herbal approach or the elemental diet, it is still advisable to consult with a professional who can guide you in the right direction.
SIBO and Long-Term Gut Health
For many people, SIBO is a manageable condition. Once diagnosed, effective treatment can reduce or eliminate symptoms, leading to improved digestion and overall well-being. However, SIBO treatment requires ongoing care and attention. After successful treatment, it’s crucial to make sure underlying issues are addressed to prevent relapse.
If you suspect you may have SIBO, or if you’ve been struggling with digestive symptoms without a clear diagnosis, it’s worth discussing breath testing and treatment options with a healthcare provider. Early diagnosis and appropriate treatment can make a significant difference in your gut health and overall quality of life.
