SIBO: Small Intestinal Bacterial Overgrowth
Despite its name, the small intestine is actually a whopping 20 feet of very important tissue between your stomach and large intestine. The small intestine is divided up into 3 parts. The part closest to your stomach is called the duodenum, next is the jejunum and the last stretch before your large intestine is your ileum. The small intestine has the important job of digesting food and absorbing nutrients to keep us in good health. As if that wasn’t significant enough, it is also a key contributor to a healthy immune system.
The small intestine plays host to specific beneficial microorganisms that help protect our bodies against bad (pathogenic) bacteria and yeast. These good bacteria also do their part to produce vitamins and nutrients like vitamin K and folate. They are the keepers of the small intestine, ensuring that it continues to do its thing, muscling waves of food through the gut.
What is SIBO?
Small intestinal bacterial overgrowth or SIBO occurs when there is an increased number of bacteria and/or a change in the type of bacteria present in your small intestine. Overgrowth of bacteria in the small intestine is considered to be greater than 100 000 bacteria per millilitre of fluid. Most often SIBO is caused by an overgrowth of the wrong types of bacteria that actually belong in the colon (the large intestine). In truth, the small intestine is meant to be fairly clean. Food coming from the top down through the stomach is sterilized by stomach acid. So anything passing into the small intestine from the top shouldn’t contain much in the way of bacteria. Absence of adequate stomach acid may contribute to SIBO as this would allow passage of bacteria into the intestines. Another theory as to how this occurs is that there is a motor complex that propels everything in your intestines one direction – out the far end. This migrating motor complex or MMC can malfunction, allowing a backwash of bacteria from the large intestine to move up into the small intestine.
The bacteria that causes SIBO is like a bad tenant. It invites all its rowdy friends in for a party and damages the cell lining of the small bowel. This can lead to leaky gut, allowing large protein molecules to move through the intestinal barrier and escape into the bloodstream. As you can imagine, this causes a number of problems, including general inflammation, immune reactions that cause food allergies, and autoimmune diseases.
These havoc-causing bad bacteria are also responsible for poor digestion, constipation or diarrhea and malabsorption. Patients with SIBO may suffer from nutritional deficiencies, particularly iron, vitamin B12, and fat-soluble vitamins A, D, E and K, as well as having unintended weight loss, and even osteoporosis.
Do I Have SIBO?
SIBO is considered an under-diagnosed condition as many people do not seek medical care for their symptoms or they get wrongly diagnosed with irritable bowel syndrome.
The Most Common Signs and Symptoms of SIBO
Signs and symptoms of SIBO include:
· Bloating and abdominal swelling
· Abdominal pain or discomfort
· Diarrhea
· Constipation
· Gas and belching
· Weakness and fatigue
In the most severe cases, patients experience weight loss and vitamin deficiency-related symptoms.
Who is at risk for SIBO? How Do You Get SIBO?
While the elderly may be the most vulnerable population for developing SIBO as its prevalence rises with age, there are multiple other risk factors that can increase your chances, no matter your age. These include:
· Medication use, especially antibiotics
· Gastric acid suppression or Low Stomach Acid (due to stress, medications such as proton pump inhibitors (PPI’s) or antacids, and lifestyle factors)
· Fibromyalgia
· Celiac disease
· Crohn’s disease
· Prior bowel surgery
· Diabetes Types I & II
· Irritable bowel syndrome
Studies also indicate that moderate alcohol consumption (one drink per day for women and two for men) promotes the overgrowth of certain types of bacteria and also impairs vital functions. This results in small bowel injury and decreased muscle contractions impairing the migrating motor complex.
If you are experiencing any of the symptoms mentioned above or think you might be at risk, then we encourage you to make an appointment to assess your symptoms and get tested. Specialized testing can be accomplished through a breath test. This breath test measures your hydrogen and methane gas levels produced by bacterial metabolism and can be a very helpful indicator to determine if you are suffering from SIBO.
What Causes SIBO and How Can You Treat It?
Despite multiple courses of antibiotics being a risk factor, specific antibiotics (like Rifaximin) are still most often used to treat SIBO. However, studies show that SIBO returns in nearly half of all patients within a year after treatment.
Successful treatment of SIBO must be handled just like any other health condition – not with a temporary Band-aid solution, but by addressing the underlying cause! Intestinal bacteria can be influenced by numerous factors beyond what we eat and how much. Environmental effects, drugs, alcohol, sedentary lifestyle, mood disorders, hormone imbalances and lifestyle factors such as stress can all be contributing factors to poor gut health. Therefore, the treatment must be unique to the individual and all-encompassing.
Once you have identified the cause, treat SIBO symptoms through a healthy diet, nutritional supplements and positive lifestyle changes that help return the body to balance.
Tips for dealing with SIBO
- Eat three meals per day spaced 4-5 hour apart and avoid snacking. We need to give our body time in between meals to fully digest the previous meal.
- With guidance from your naturopathic doctor try an elimination diet for two weeks to get your body back on track by reducing inflammation and bacteria overgrowth. If this doesn’t seem to help, you may want to pursue food sensitivity testing through one of our ND’s. The test checks for antibodies in your bloodstream to either 96 or 184 foods. Employee benefits will sometimes cover the cost of this test along with other lab or diagnostic testing.
- Enjoy foods that assist digestive health like fresh pineapple which is rich in bromelain and can also help lower inflammation, and bananas which are an excellent source of potassium and manganese that your stomach lining needs for healing. Boiled cabbage water is an excellent source of the amino acid glutamine that helps heal the gut lining. Vitamin A is also essential for a healthy gut. Eating liver and beta carotene-rich foods like leafy greens and orange vegetables like carrots as well as taking cod liver oil help insure adequate vitamin A intake.
- Keep your fat intake in check. Research has shown that a high-fat diet, increases the growth of fat digesting bacteria at the expense of other more healthful ones. That is, microbes from the Clostridiaceae and Peptostreptococcaceae families increased while beneficial bacteria from the Bifidobacteriacaea and Bacteroidacaea families (which are commonly associated with leanness) went down.
How to Get Rid of SIBO: The Steps for Successful Treatment
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Elimination/modification of the underlying causes. This may involve changing your diet to a whole food, low FODMAPs diet, reducing your stress, eating 3 meals per day, reducing or eliminating the need for antibiotics, optimizing digestive juices like stomach acid, bile and pancreatic enzymes.
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Induction of remission (antibiotics or natural anti-microbials and elemental diet)
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Maintenance of remission (promotility herbs, dietary modifications, healthy lifestyle, optimized digestive juices, repeat or cyclical antimicrobials, hormone balancing, reduced alcohol intake).
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SIBO Diet Food List (derived from the work of Dr. Alison Siebecker)
| Foods to Eat with SIBO | Foods to Avoid with SIBO |
|---|---|
| Nuts and Seeds Almonds Almond flour Coconut: flour/shredded/milk Hazelnuts Macadamia Peanuts Peanut butter Pecans Pine nuts Pumpkin seeds Sesame seeds Sunflower seeds Walnuts | Nuts and Seeds Cashews Pistachios Pumpkin seeds |
| Legumes Lentil: brown, green or red Lima beans | Legumes Borlotti beans Cranberry beans Kidney beans Red beans Navy beans White beans Haricot beans Baked beans Spilt pea Butter beans Cannellini Chickpea Garbanzo beans Fava beans Broad beans Pinto beans Soy beans |
| Protein Sources Bacon Broth: homemade meat or marrow bones Beef Eggs Fish Game Lamb Organ Meats Pork Poultry Seafood | Protein sources None |
| Sweeteners Honey: alfalfa, cotton, clover, raspberry Stevia-pure (no inulin) in small amounts, occasionally | Sweeteners Agave syrup Barley Malt syrup Brown Rice syrup Cane sugar (Rapadura, Sucanat) Coconut sugar Fructose, powdered High-fructose corn syrup Maple syrup Molasses Sugar/Sucrose Sucralose Polyols/Sugar alcohol: isomalt, erythritol, lactitol, maltitol, mannitol, sorbitol, xylitol |
| Beverages Coffee 1c/day (weak) Tea: black (weak), chamomile, ginger, green, hibiscus, lemongrass, mate, mint, oolong, rooibos/rooibos chai, rose hip Water | Beverages Fruit Juices Coffee substitutes with chicory Coconut milk-with thickeners (guar gum, carageenan) Soda (fructose, sucrose) Tea: chicory root, licorice, pau d’arco |
| Fats and Oils Bacon fat Butter Coconut oil Cod liver oil & Fish oil Duck fat Garlic-infused oil Ghee Lard & Tallow Medium Chain Triglyceride/MCT oil Macadamia oil Olive oil Palm oil Polyunsaturated Vegetable Oils: Borage, Canola Flax, Grape seed, Hemp, Pumpkin seed, Sesame, Sunflower, Walnut | Fats and Oils Soybean oil |
| Herbs, Spices, Condiments and Seasonings All spices (except onion & garlic) Garlic-infused oil Ginger (fresh & dried) Mayonnaise, homemade or commercial with honey Mustard - without garlic Pickles/Relish - no sweetener or garlic Tabasco sauce (McIlhenny Co) Wasabi - pure Vinegar: apple cider, distilled/white, red & white wine (NOT balsamic) | Herbs, Spices and Seasonings Asafoetida powder Chicory root (leaves ok) Cocoa/chocolate-unsweetened Gums/Carrageenan/Thickeners Sauces or Marinades with High Fodmap ingredients Soy Sauce/Tamari Spices: Onion & Garlic powder Vinegar: balsamic |
| Fruit Berries: blueberry, boysenberry, strawberry, raspberry Carambola Citrus: lemon, lime, oranges, tangelos, tangerine Currants Dragon Fruit Durian Grapes Guava Kiwifruit Longon Melon: cantaloupe/rock, honeydew Papaya/Paw Paw Passion fruit Pineapple Pomegranate Prickly Pear Rambutan Rhubarb | Fruit Apple Apricot Avocado Berries: cranberry Cherries Citrus, grapefruit Custard Apple Date, dried Fig, dried Mango Nectarine Papaya, dried Peach Pear Pear: nashi Persimmon Plum Pomegranate Prunes Raisins Tamarillo Watermelon Canned fruit |
| Vegetables Artichoke Hearts (small amounts) Arugula Bamboo Shoots Beets Bok Choy Broccoli Brussels Sprouts Cabbage Carrot Celery Root/Celeriac Chives Cucumber Eggplant Endive Fennel bulb < 1 cup Green Beans Greens: lettuce, collard, chard, kale, spinach Olives Peas, green Peppers: Bell/Sweet Peppers: Chili Radicchio Radish Rutabaga Scallion: green part Snow Peas Squash: Butternut Kobocha, Sunburst, Yellow, Zucchini Tomato | Vegetables Asparagus Bean Sprouts Canned vegetables Cauliflower Corn Garlic Jerusalem artichoke Leek Mushrooms Okra Onions Potato: white/all colors Potato: sweet Scallions: white part Seaweeds Shallot Starch powder: all arrowroot, corn, potato, rice, tapioca Sugar Snap Peas Taro Turnip Water Chestnuts Yam Yucca |
Download our free one-week SIBO diet guide, low FODMAPs meal plan here.
Do any of the above symptoms or risk factors sound familiar? Do you think you might be suffering from SIBO? We can help! Please contact us and we’ll get to the bottom of what’s going on and create a plan of action to bring your body back to good health.
Call or email us at 416-481-0222 or Info@ForcesofNature.ca for more information or to book an appointment.
To your best health!
The Team at Forces of Nature Wellness Clinic – Naturopathic Doctors, Chiropractor, Massage Therapist, Acupuncturist/TCMP, Osteopath, Registered Dietitian, Psychotherapist
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/
https://www.ncbi.nlm.nih.gov/pubmed/22109896
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890937/
“Small intestine microbiota regulate host digestive and absorptive adaptive responses to dietary lipids,” Cell Host and Microbe (2018). DOI: 10.1016/j.chom.2018.03.011