UNDERSTANDING SIBO: SYMPTOMS, CAUSES AND TREATMENTS
If you struggle with bloating and digestive issues that won't budge, no matter what you do, you might be dealing with Small Intestinal Bacterial Overgrowth (also known as SIBO). This condition develops when there is an abnormal increase in the bacteria populating your small intestine. SIBO causes pesky symptoms ranging from bloating to diarrhea and constipation, and can impact your overall wellbeing, leaving you feeling less than optimal.
In order to diagnose and treat SIBO it's important to understand what it is and what causes it. In this blog post you will learn about the connection between SIBO and Irritable Bowel Syndrome (IBS), how to identify common symptoms and how to recognise predisposing factors. Finally, you will find out how SIBO is diagnosed and treated. By the end I hope you will come away with a better understanding of this digestive condition and what you can do about it.
Recognising SIBO Symptoms
SIBO can present with an array of digestive issues that might easily be mistaken for other conditions. Some of the symptoms you may experience include;
- Bloating
- Wind pain
- Flatulence
- Diarrhea
- Constipation
- Heartburn
A classic sign of SIBO is bloating after meals. This can happen when bacteria in your small intestine ferment food and cause a build up of gas that causes distention. You might also notice changes in your bowel movements, including constipation or diarrhea that can be oily (steatorrhea) as a result of fat malabsorption.
Nutrient malabsorption is another common feature of SIBO that causes many downstream effects on health, such as fatigue, weakness and unintended weight loss. Viitamin B12 deficiency is often found in those with SIBO, despite adequate dietary intake. While frequently missed on blood tests due to inaccurate reference ranges, vitamin B12 deficiency is a more serious complication of SIBO which can appear as tingling or numbness in the hands and feet.
The SIBO-IBS Connection
With overlapping symptoms like bloating, diarrhea and constipation, you won't be surprised to hear that SIBO and IBS may be related. Research has found SIBO in a significant number of IBS patients. These studies investigated the prevalence of SIBO in IBS and found results ranging from 4% to 78%. A meta-analysis also found the odds of having a positive SIBO test were 3.45 to 4.7 times higher in IBS patients compared to healthy controls. Going further, research suggests that SIBO may be a contributing factor to IBS symptoms.
It's important to note that while SIBO and IBS share many symptoms, they are typically considered separate conditions. As distinct conditions, the main difference is that IBS is considered more pain-predominant. SIBO, on the other hand, is typically characterized by bloating and wind pain. However, distinguishing between the two can be challenging since SIBO may play a role in IBS.
Risk Factors for Developing SIBO
There are a number of factors that can increase your risk of developing SIBO. A key factor is intestinal dysmotility. This involves a slowing of the intestinal tract which encourages the proliferation of microflora in the small intestine and stops bacteria from being swept down the digestive tract. As a result conditions that slow gut motility, such as hypothyroidism, post-infectious anti-vinculin autoimmunity, diabetes, and scleroderma, can predispose you to SIBO.
Anatomical abnormalities also play a significant role in SIBO. Surgically created blind loops, small intestinal diverticulosis, bowel strictures and adhesions due to endometriosis or abdominal surgeries, can promote bacteria overgrowth and increase your risk of developing the condition. Additionally, chronic conditions such as liver cirrhosis, pancreatitis, and celiac disease have been associated with a higher prevalence of SIBO.
Age is another significant factor. As you get older your risk of developing SIBO increases due to decreased gastrointestinal motility and changes in gut immunity. Studies have shown that 15.6% to 33% of older adults may have SIBO. Certain medications can also contribute to the development of SIBO. A common example of this is long-term use of proton pump inhibitors (PPIs). This can lead to hypochlorhydria (low stomach acid) which alters the pH of the intestinal environment and facilitates bacterial growth. Similarly opioids decrease intestinal motility and should be avoided if you are at risk of SIBO.
Diagnosis and Treatment Options
The gold standard test used to diagnose SIBO is an aspirate and fluid culture. This test is done by a gastroenterologist using a sample collected from the small during an endoscopic procedure. SIBO breath testing is another less invasive and more accessible option for diagnosing SIBO. This test involves ingesting a small quantity of sugar (usually glucose, lactulose or fructose) and measuring increases in hydrogen and methane gas over a certain time frame. When these gases rise above normal levels SIBO is diagnosed. Clinical assessments that take into account symptoms and risk factors, are also an important part of diagnosis.
Treating SIBO effectively requires a multifaceted approach, including dietary changes, medication, and lifestyle adjustments. SIBO symptoms can be reduced and managed by following a diet that restricts sugars and fermentable carbohydrates. Dietary changes alone are not a long-term solution however, and SIBO resolution requires antimicrobial medications and supplements to reduce bacteria overgrowth in the small intestine. Prokinetic medications and supplements that increase intestinal motility are also used to address underlying dysmotility and prevent relapses.
A comprehensive approach to SIBO treatment will also draw on the therapeutic benefits of specific prebiotics, probiotic strains and digestive supports. These supplements work in a variety of ways to rebalance the gut environment, such as increasing motility, reducing gas levels, feeding beneficial bacteria, balancing pH levels and correcting low stomach acid and other digestive insufficiencies. Addressing underlying the conditions (e.g. hypothyroidism) driving SIBO can also play a key role in treatment.
SIBO is a digestive issue that has a broad impact on health. In order to resolve SIBO effectively it is important to understand what causes it, how to diagnose it, how to distinguish it from IBS and other digestive issues and how to apply a comprehensive treatment approach. If you suspect that you have SIBO I highly recommend seeking help from a professional versed in this condition and in digestive health.
Need Help With Gut Issues?
If you would like more information about what is causing your symptoms and how you can work with me, consider booking a free 30-minute gut health assessment. Remember that while SIBO can be challenging, with the right knowledge and support, it's possible to resolve symptoms and restore gut balance.