SIBO: what is it, and how do I know if I have it?

There may be something lurking within your gut, when and where you least expect it.

You’re probably already in tune with keeping the large intestine healthy, balanced and well- populated with good bacteria (got probiotics?).

But, what about the health of the small intestine that is located before it in the digestive tract?

The truth is, this is where the serious business of nutrient absorption happens before the waste products are sent through to the large intestine or bowel to be expelled.

As you can imagine, there’s quite a slippery slope that ensues when the flora in this critical stretch of digestive highway goes out of balance.

What is SIBO and what are the symptoms?

At its most basic level, SIBO or Small Intestinal Bacterial Overgrowth is when bacteria or other microorganisms, good or bad, grow out of control in the small intestine - an area that would normally have a low bacterial count, as compared to the large intestine.

Microorganisms setting up shop in this area (colonization) end up damaging the cells lining the small intestine. This is otherwise known as leaky gut or an increase in intestinal permeability.

This, in turn, impairs the digestive process and overall absorption of nutrients which exacerbate nutritional deficiencies, allow toxins, pathogens and undigested protein molecules to enter the bloodstream that then cause widespread inflammation, food sensitivities/intolerances, autoimmune disorders, and other immune reactions. For further information of food intolerances, see my blog here: http://www.stephaniefarwellnd.ca/Blog/ArticleID/1227/Can-My-Symptoms-Actually-Be-a-Food-Intolerance

The most common symptoms of SIBO are:

• Malabsorption issues and malnutrition
• Weight loss (or gain)
• Nausea and/or vomiting
• Abdominal bloating or distention
• Abdominal pain or discomfort
• Acid reflux or heartburn (GERD)
• Excessive gas or belching
• Constipation and/or diarrhea
• Fatigue
• Skin issues like rashes, acne, eczema and rosacea
• Aches & pains, especially joint pain

As mentioned, one of the biggest concerns with SIBO is that essential nutrients, protein, carbohydrates and fats aren’t being properly absorbed, causing deficiencies of iron, vitamin B12, calcium and in the fat-soluble vitamins: A, D, E and K.

What causes SIBO?

According to experts, the causes are not clearly defined but contributing factors to being diagnosed with SIBO can include:

• Aging
• Metabolic disorders including diabetes
• Chronic pancreatitis
• Diverticulosis
• Injury to the bowel
• Recent abdominal surgery

Celiac disease is also associated with an increased risk for developing SIBO, and can be of particular concern, as it disturbs gut motility leading to poor functioning of the small intestine.

Another common conditions associated with SIBO is Irritable Bowel Syndrome. As a matter fact, studies have found that SIBO occurs simultaneously in more than half of all cases of IBS.

It has even been reported that successful elimination of bacterial overgrowth in the small intestine resolves symptoms of IBS too.

The use of certain medications, including immunosuppressant medications, and proton pump inhibitors (acid reflux medications) as well as heavy metal toxicity, low stomach acid, inflammatory diets, and yep, you guessed it, stress - are all thought to be contributors as well.

How can you test for SIBO?

It is typically diagnosed using a breath test in which the patient drinks a sugar-containing drink and exhaled gases are measured.

If there are too many bacteria, excess gases (hydrogen, methane or both) will be produced. It should be noted that the reliability of this test is considered less than ideal, but it’s one of the only methods available at this time.

What’s the treatment for it?

Most holistic health practitioners advise adhering strictly to the “SIBO diet” for at least 2 weeks - which may include any (or all) of the following protocols:

• Herbal antibiotics, including oregano oil
• A low FODMAP, GAPS and/or AIP diet; unfortunately, this includes avoiding garlic & onions
• Stress management; yes, this can help heal your gut!
• Repopulating the good bacteria using probiotics, and then feed with prebiotics

In more severe or persistent cases, a prescription antibiotic may be needed to get the overgrowth under control.

References

World Journal of Gastroenterology: “Small Intestinal Bacterial Overgrowth Syndrome”

World Journal of Gastroenterology: “Irritable Bowel Syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype?”

Journal of Clinical Gastroenterology: “Gastrointestinal motility disturbances in celiac disease”

 

Recipe:

SIBO-friendly Beef Bone Broth - Slow Cooker Version

Ingredients:

* no onions, leeks or garlic

2 lbs beef marrow bones, thawed, grassfed preferable

3 large carrots, unpeeled

1/2 medium celery root (not stalks)

combination of fresh “antibacterial” herbs: few sprigs of each - rosemary, oregano & thyme

2 bay leaves

1 Tb apple cider vinegar, unpasteurized

¼ - ½ tsp himalayan pink or grey celtic salt

Water to desired dilution

How to prepare:

1. Preheat oven to 425 degrees F
2. Wash and chop veggies into large pieces - large enough that they won’t turn to mush.
3. Place your bones onto a baking sheet and place into the oven. Cook for 30 minutes.
4. Tie your herb sprigs into a bundle with cooking-safe string.
5. Once your bones have roasted, pull them out of the oven and put them directly into a slow cooker. Add the veggies and the herb bundle into the cooker with the bones.
6. Fill a 6-quart slow cooker with fresh water up to about ¾ inch under the rim. Add the bay leaves, ACV and salt.
7. Cook in your pot on low; you should have a gentle, rolling boil after an hour or so.
8. Remove the herbs after about 4 hours, otherwise your broth may look strange from the colors seeping out!
9. Remove the veggies once they’re very soft, but not yet mushy.
10. Let the bones cook for a total of 12-48 hours. Strain the broth, let cool a bit, and store in glass jars for up to ONE WEEK in your fridge. You can also freeze the broth if you don’t use it right away.
11. The appearance of a gel-like substance (natural gelatin) is normal and desired - enjoy the gut-friendly goodness!