Understanding SIBO: Causes, Symptoms, and Natural Treatment Options

Understanding SIBO: Causes, Symptoms, and Natural Treatment Options 

Introduction to SIBO

SIBO, or Small Intestinal Bacterial Overgrowth, is a gastrointestinal disorder characterised by an overgrowth of bacteria in the small intestine. Under normal circumstances, the small intestine contains a relatively few bacteria compared to the large intestine. However, when the bacterial population in the small intestine becomes overgrown, it can lead to a variety of issues.

Small intestinal bacterial overgrowth disrupts the normal function of the small intestine by interfering with the absorption of nutrients, damaging the intestinal lining, and causing inflammation. It can result in a range of uncomfortable symptoms, such as bloating, abdominal pain, diarrhoea and/or constipation and fatigue. The presence of excess bacteria can lead to the production of gas and other by products, which can further exacerbate these symptoms and negatively impact overall gut health.

In SIBO, the excess bacteria in the small intestine can produce various byproducts during their metabolic processes. These byproducts include:

Short-chain fatty acids (SCFAs): While SCFAs like acetate, propionate, and butyrate can have beneficial effects on gut health when produced in the large intestine, excessive production in the small intestine may contribute to bloating and other symptoms associated with SIBO.

Organic acids: Excess bacteria can produce organic acids such as lactic acid and succinic acid, which can cause an imbalance in the small intestine's pH levels, potentially leading to irritation and inflammation.

Amines and ammonia: Bacteria in the small intestine can produce amines and ammonia from the breakdown of proteins. These compounds can be toxic in high concentrations and may contribute to the symptoms experienced in SIBO.

Hydrogen and methane gas: SIBO can produce either hydrogen and/or methane or sometimes hydrogen sulphide gas as by-products of their metabolism. These gases lead to the bloating, abdominal discomfort, and altered bowel movements.

The accumulation of these waste products in the small intestine contributes to the overall symptoms and complications associated with SIBO, making it essential to address the underlying bacterial overgrowth.

What are the main causes of SIBO?

The main causes of SIBO (Small Intestinal Bacterial Overgrowth) are factors that disrupt the normal balance of bacteria in the small intestine or alter the gut environment, promoting bacterial overgrowth. Some of these causes include:

Post infectious IBS: If you’ve ever had a bad case of gastroenteritis, food poisoning or traveller’s diarrhoea. This can cause impaired motility. Slow or disrupted intestinal motility can lead to poor clearance of bacteria from the small intestine. Conditions such as gastroparesis, scleroderma, or diabetic neuropathy can also contribute to this issue.

Dysfunction of the migrating motor complex (MMC): The migrating motor complex (MMC) is a series of contractions that occur in the digestive tract during periods of fasting between meals. It sweeps through the small intestine to propel its contents and bacteria towards the colon. Disruption of the MMC can lead to bacterial overgrowth in the small intestine.

Structural abnormalities: Anatomic abnormalities, such as small intestinal diverticula, adhesions from previous abdominal surgery, or strictures, can create pockets or narrowed areas where bacteria can accumulate and proliferate.

Low stomach acid: Adequate gastric acids are essential for killing ingested bacteria and maintaining a balanced gut environment. Conditions like atrophic gastritis, h. pylori infection or the long-term use of proton pump inhibitors (PPIs) can reduce stomach acid production, allowing more bacteria to survive and reach the small intestine.

Intestinal dysbiosis: An imbalance in the gut microbiome, potentially caused by a poor diet, antibiotic use, or stress, can disrupt the bacterial population in the small intestine, leading to SIBO.

Ileocecal valve dysfunction: The ileocecal valve separates the small intestine from the large intestine. If this valve is not functioning properly, bacteria from the large intestine can migrate into the small intestine, causing overgrowth.

Diet: Diet plays an important role in the development and progression of intestinal bacterial overgrowth. Consuming a diet that is high in fermentable carbohydrates, such as sugars, starches and alcohol, can provide a source of food for the bacteria in the small intestine, leading to an overgrowth. In addition, diets that are low in fibre and nutrient-dense foods can disrupt the balance of gut bacteria, leading to dysbiosis and an increased risk of SIBO. Moreover, diets that are high in fat or processed foods can slow down the digestive process, leading to stagnation of food in the small intestine and an increased risk of bacterial overgrowth.

Underactive thyroid: Thyroid disorders can be a contributing factor to the development of SIBO. The thyroid gland plays a crucial role in regulating metabolism, and when thyroid function is impaired, it can lead to a slow digestive motility, which increases the risk of bacterial overgrowth in the small intestine.

Other risk factors & considerations: Diabetes mellitus or pre-diabetes, mould toxicity or chronic inflammatory response syndrome, hyper mobility disorder (Ehler’s Danlos Syndrome), coeliac disease, crohn's disease, irritable bowel syndrome, history of chronic antibiotic use, or having an autoimmune condition.

It is important to note that SIBO can have multiple contributing factors, and identifying the underlying causes and risk factors is important for effective treatment and prevention of recurrence.

What are the main symptoms of SIBO?

The main symptoms of SIBO (Small Intestinal Bacterial Overgrowth) can include:

  1. Bloating: This is the most common symptom of SIBO and is caused by excess gas production in the small intestine.
  2. Abdominal pain: SIBO can cause discomfort and pain in the abdominal region, often accompanied by the bloating.
  3. Diarrhoea: SIBO can cause diarrhoea or loose stools due to water being pulled into the small intestine.
  4. Constipation: In some cases, small intestinal bacterial overgrowth can cause constipation due to a slowing of transit time from the methane gas and more water being absorbed from the bowel.
  5. Gas: Excess gas production in the small intestine can lead to flatulence and burping.
  6. Nutritional deficiencies: SIBO can interfere with nutrient absorption, leading to deficiencies in certain vitamins and minerals. The most common mineral & vitamin deficiencies I see are: B12, iron, vitamin D, magnesium and fat soluble vitamins.
  7. Fatigue: SIBO can cause fatigue due to a few factors. Firstly, the connection to the nutrient deficiencies listed above. The link to histamine excess, which can lead to insomnia, which contributes to fatigue. Plus, the body's increased energy expenditure to combat the bacterial overgrowth.

It's important to note that these symptoms can be indicative of other digestive disorders as well, and it's best to consult with a healthcare professional for proper diagnosis and treatment.

Is SIBO contagious?

Small Intestinal Bacterial Overgrowth, is not considered contagious in the traditional sense, as it is not caused by a specific pathogen that can be transmitted from person to person. Instead, SIBO arises due to an overgrowth in the bacterial population within the small intestine, which can result from a variety of factors such as slow intestinal motility, structural abnormalities, or immune system issues.

While some bacteria involved in SIBO may be transferred between individuals through close contact or sharing of personal items, simply being exposed to these bacteria does not cause the development of SIBO. The condition is primarily determined by the individual's gut environment and predisposing factors, which means that SIBO cannot be spread like an infectious disease. Therefore, it is important to focus on addressing the underlying causes of SIBO and maintaining a healthy gut environment rather than worrying about catching it.

The Link Between SIBO and Histamine Intolerance

Small intestinal bacterial overgrowth (SIBO) and histamine intolerance are two distinct health conditions that are often associated with digestive symptoms. SIBO occurs when there is an overgrowth of bacteria in the small intestine, which can lead to various digestive symptoms such as bloating, abdominal pain, diarrhoea, and malabsorption of nutrients. Histamine intolerance is a condition where the body is unable to properly metabolise histamine, which is a compound found in various foods and produced by the body's cells.

There is a link between SIBO and histamine intolerance because some of the bacteria that can overgrow in the small intestine can produce histamine. Additionally, the inflammation and damage to the gut lining caused by SIBO can lead to a reduced ability to break down histamine, by reducing the production of DAO enzyme in the small intestine.  Further exacerbating histamine intolerance symptoms. DAO breaks down histamine, so without sufficient production this can lead to an excess of histamine in the body, which can trigger symptoms such as headaches, skin rash, itching, and digestive issues.

Moreover, the symptoms of SIBO and histamine intolerance can overlap, which can make diagnosis and treatment challenging. Patients with SIBO may have increased levels of histamine in their blood, and those with histamine intolerance may experience gut dysbiosis or bacterial overgrowth in their small intestine. Therefore, it is essential to identify and address both SIBO and histamine intolerance to achieve optimal digestive health.

The Complex Link Between SIBO and Weight

The link between SIBO and weight loss is complex and not fully understood. Small intestinal bacterial overgrowth can cause a range of digestive symptoms which can lead to a loss of appetite and unintended weight loss. Additionally, malabsorption of nutrients due to bacterial overgrowth can also contribute to weight loss.

However, it's important to note that not all individuals with SIBO experience weight loss, and in some cases, SIBO may actually contribute to weight gain. For example, bacterial overgrowth can disrupt the balance of gut bacteria, leading to dysbiosis, inflammation and changes in metabolic processes that can contribute to weight gain. Overall, the relationship between SIBO and weight is complex and varies depending on the individual case.

Natural Treatment Options For SIBO

Over the years I’ve found it’s important to follow a SIBO treatment plan in the right order to achieve long-term success with SIBO and histamine intolerance symptoms.

Step 1 is Dietary Changes: Following a low FODMAP diet and/or a specific carbohydrate diet (SCD) may help manage SIBO symptoms by limiting the types of carbohydrates that can feed the bacteria in the small intestine. Reducing symptoms is where we want to start.

Step 2 is SIBO Testing: Knowing which gas is being produced, how high up in the small intestine and how much gas, which correlates to how much bacteria you have means we can be more accurate with which supplements will be most helpful and what the treatment time is more likely to be.

Step 3 is Supplements: Once we’ve done testing we can set the supplements. For the killing off phase we use herbal antimicrobial supplements. Certain herbs like oregano oil, berberine, and allium extract have antimicrobial properties and may help to kill off the harmful bacteria in the gut. Sometimes we use specific probiotics to help to restore the balance of healthy bacteria in the gut. If needed supplements to support gut motility and heal leaky gut.

Step 4 is Stress Management: Chronic stress can impair gut function and contribute to the development of SIBO. Practicing stress-reduction techniques like meditation, yoga, or deep breathing exercises may help to improve gut function and prevent SIBO. Other lifestyle factors like sleep habits and exercise are also important.

Step 5 is Challenge & Reintroduction: It’s important not to remain on a restrictive diet too long. The elimination diet phase is just to reduce symptoms while we identify and address the underlying causes. After addressing the causes and killing off the SIBO, tolerance for foods usually dramatically increases.

Step 6 is Optimising Your Microbiome: In my opinion this is the most important step in preventing SIBO recurrence. A healthy microbiome is also linked to a wide range of benefits, including improved digestion, enhanced immune function, and reduced risk of chronic diseases. To optimise your microbiome, it's important to focus on a healthy and diverse diet, rich in plant-based foods like fruits, vegetables, whole grains, and legumes.

Steps 7 is Individualised Support: It's important to note that SIBO treatment is complex and it's best to work with a healthcare professional, like me to develop a personalised treatment plan and identify the root cause. Following the right steps in the right order is key to success.

The Elemental Diet: A Liquid-Based Treatment Approach for SIBO

The elemental diet is an approach to treat SIBO that involves consuming a liquid formula that provides all the necessary nutrients for the body, without the use of solid food. The formula is designed to be easily absorbed by the body, and is low in fermentable carbohydrates, which can feed the bacteria in the small intestine. By providing the body with easily digestible nutrients and limiting the availability of fermentable carbohydrates, this liquid diet can help to starve the bacteria in the small intestine, leading to a reduction in SIBO symptoms. This nutritional liquid formula is typically used as a short-term treatment option, as it can be difficult to sustain for longer periods of time. While some individuals may experience significant improvement in their symptoms with the elemental liquid diet, it isn't appropriate for everyone, so it's important to work with a healthcare provider to determine the most appropriate treatment plan for your specific needs.

If you have IBS, suspect SIBO or histamine intolerance book in for a Free strategy session to see if my Gut Fix Program is right for you.

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