Small Intestinal Bacterial Overgrowth, SIBO, is an overgrowth of bacteria within the small intestine often due to a change in the microbiome, which is the environment of the bacteria that reside in the intestines.

The small intestine is the longest part of the digestive system. Within the small intestine, food mixes with digestive enzymes and as the food is broken down into smaller particles, nutrients are able to be absorbed into the bloodstream. Most of the beneficial bacteria are meant to be located in the large intestine and in the colon where they help break down food, manufacture vital energising B vitamins and also help to detoxify acids and toxins. If these bacteria begin to thrive in the small intestine, the result is SIBO. The excess bacteria then feed off the undigested food especially sugars, carbohydrates and starches.

So what happens in SIBO?

As the bacteria feed in the small intestine, the carbohydrates begin to ferment releasing excess amounts of hydrogen which can result bloating. Within the intestines, there are single cell organisms that reside called archaea. These micro-organisms use hydrogen which they convert into methane. This means that the when the beneficial bacteria have overgrown within the small intestine, both hydrogen and methane are released within the region which results in bloating, gas and abdominal pain.

The symptoms of bloating may also be accompanied by either constipation or diarrhoea. If hydrogen is the dominant gas, then bloating may be accompanied by diarrhoea whereas if methane is more dominant then it may be accompanied by constipation.

The overgrowth of bacteria interferes with nutrient absorption often resulting in nutrient deficiencies. Usually antibiotics are prescribed for chronic cases of SIBO but these are not usually without side effects and often relapse rates are high.

SIBO Symptoms

Digestive enzymes help break down food whilst the muscles through a series of neurotransmitters work to move food along through the digestive tract from the stomach to the small intestine and finally to the colon. Damage to the muscles and nerves surrounding the digestive tract can increase the risk of developing SIBO. Diabetics and those suffering from some immune disorders such as scleroderma are more likely to suffer from SIBO.

Physical obstructions, scarring from surgeries, inflammation in the gut and those suffering from diverticulitis all are factors that may make one susceptible to Small Intestinal Bacterial Overgrowth, SIBO.

The symptoms of SIBO mirror those of other inflammatory bowel concerns including IBS and include:

• nausea
• bloating
• diarrhoea
• constipation – less common than diarrhoea
• food intolerances to gluten, lactose and fructose in fruits

A SIBO breath test which is the usually the preferred route to diagnosing this concern even though it is cumbersome. The breath test measures the amount of hydrogen and methane within the body because these gases can only be produced by the bacteria in the intestine.

Treating SIBO

Treating SIBO requires patience because like candida overgrowth, relapses can be common. The standard treatment is the use of antibiotics for SIBO to destroy all of the bacteria in the small intestine but of course these do destroy the beneficial bacteria in the colon too.

Initially, it would be prudent to consider the use of a natural remedy which enhances the production of stomach acid. This is important because stomach acid helps to break down food into smaller particles so that it does not stagnate in the small intestine. This is important to tackle small intestinal bacterial overgrowth because stomach acid kills off bacteria in the small intestines. A supplement that increases the amount of hydrochloric acid is Betaine HCl with Pepsin by Lamberts Healthcare. This supplement is not suitable for people with peptic ulcers and if you do suffer from peptic ulcers then please use one of the best digestive enzyme supplements such as DoSe Digestive Enzyme Complex which works to break down food into smaller particles. 

There are natural herbal remedies for SIBO that may prove to be equally useful at eradicating bacteria – although their role is the same as antibiotics, their use does not increase the chances of antibiotic resistance which is clearly on the increase. The herb Oregano contains a chemical called carvacrol which displays potent antimicrobial properties and may prove to be effective treatment for SIBO. Nature's Answer Oil of Oregano is an alcohol-free tincture with a high amount of carvacrol to help reduce these numbers of methane dominant SIBO bacteria.

Researchers have also found that probiotics for SIBO may be of great benefit in helping to get rid of small intestinal bacterial overgrowth. A study which used a four strain probiotic supplement to half the people and antibiotics to the other half showed greater clinical improvements in the probiotic group. The study used specific strains of bacterial species which can be found in Bio-Kult Advanced Probiotic supplement.

Additional measures:

Start with a FODMAP elimination diet for two or three weeks. FODMAPS are foods that are not fully absorbed in the body and may end up fermenting in the small intestine. Typical examples include broccoli, legumes, soya, some fruits, fruit juices and dairy products. More details may be obtained online and it is absolutely important to avoid these completely in the first two or three weeks.

Eat smaller meals so that food does not get time to stagnate in the small intestine. Chew food thoroughly because partially chewed food requires more work by the digestive system and is liable to ferment in the intestine.

Eat high quality clean proteins such as lean poultry, grass-fed beef and wild caught tuna or salmon.

Incorporate coconut oil to cook with because this is a source of medium chain triglyceride which is easy to digest and is naturally antibacterial.

SIBO is more prevalent than previously believed and occurs in many digestive disorders such as IBS and also in patients using proton pump inhibitors. Proton pump inhibitors reduce acid production in order to alleviate the symptoms of acid reflux and this group are more likely to suffer from SIBO since optimal acid production inhibits bacteria from thriving in the small intestine. Those with metabolic disorders such as long standing diabetics may also have SIBO. Your gastrointestinal concerns may simply be a case of SIBO and perhaps tackling this issue will greatly improve the symptoms.

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