SIBO – What is it? And how to test for it?

SIBO or small intestinal bacterial overgrowth has come to the forefront of functional and integrative medicine within the past few years. It has even been recognized among gastrointestinal disorders. In fact, the American College of Gastroenterology is currently working on diagnostic and management guidelines for SIBO.

 

What is SIBO?

SIBO or small intestinal bacterial overgrowth is a condition where there is an over colonization of specific bacteria in the small intestines. Unlike the large intestine, the small intestine should essentially be sterile.

Symptoms of SIBO

Common symptoms of SIBO include abdominal pain, bloating, altered bowel habits, abdominal cramping, diarrhea, and constipation. Severe cases of SIBO may even lead to weight loss.

There is overlap between SIBO and irritable bowel syndrome. Irritable bowel syndrome, also known as IBS, was once considered a psychosomatic condition. Now we understand that IBS is related to altered intestinal microbial balance.

How is SIBO diagnosed?

Symptoms of SIBO are similar to many other gastrointestinal disorders. Therefore, testing is needed for an accurate diagnosis. The gold standard to SIBO diagnosis at this time is an aspirate of the intestinal fluid. This is invasive as well as expensive. Also, if SIBO is not present in all regions of the small bowel, the aspirate can be inaccurate.

 

Breath Tests

Breath tests are commonly used for small intestinal bacterial overgrowth testing and are non-invasive. In a breath test, gases such as hydrogen and methane are measured at set intervals after you drinking a measure about of a carbohydrate substrate. The breath test is not very sensitive or specific by itself. Breath testing is only one part of the clinical picture. Therefore, it is important to work with a knowledgeable practitioner if you are concerned about SIBO. Future testing may involve PCR or biomarkers but such testing is not commercially available at this time.

 

What to do if you were diagnosed with SIBO?

If you were diagnosed with small intestinal bacterial overgrowth, the first thing to do is to take a deep breath. There is a lot of alarm in the interwebs. It is important to know that this condition is treatable. If you have been diagnosed with SIBO it is essential to work with an experienced practitioner. SIBO and altered intestinal balance have been linked to thyroid disease, depression, fibromyalgia and many more illnesses. The Institute of Functional Medicine, as well as the Academy of Integrative Health and Medicine , have guides to find a practitioner in your area.

 

In addition to working with an experienced practitioner, SIBO treatment should include the following.

Diet

It goes without saying that you want to eliminate highly processed and sugary foods. When it comes to SIBO, eating healthy foods may make you feel worse. You may temporarily need to avoid foods that are high in FODMAPS or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Many of these foods like onions, legumes and starchy fruits and vegetables are extremely good for you so the avoidance is only temporary until your intestinal flora comes back into balance.

Anti-Microbials

You may need to be treated with a conventional or herbal anti-microbial. Most practitioners will aim to treat for the shortest time period whenever possible.

Probiotics

Probiotics may either improve or worsen SIBO depending on where on the type of organisms that are in imbalance and where you are in your treatment. Probiotics seem to have an antibiotic-like effect and may be helpful with the symptoms of SIBO. Probiotics in general also reduce some of the GI side effects of antibiotics.

Practice Healthy Eating Habits

When it comes to general health and small intestinal bacterial overgrowth, it is the simple foundational blocks that are most helpful. Make sure to thoroughly chew your foods. It will help boost your gastric acids and enzymes so your food can break down efficiently. Also, eat smaller meals and eat slowly.

While small intestinal bacterial overgrowth can be a frustrating condition, it is important to know that it gets better and it is treatable. A practitioner that is knowledgeable with this conditional is essential to get your gut back in health.

References:

J Neurogastroenterol Motil. 2011 Jul;17(3):312-7.doi:10.5056/jnm.2011.17.3.312. Epub 2011 Jul 14. How to interpret hydrogen breath tests.Ghoshal UC1.

Gut Liver. 2017 Mar 15;11(2):196-208. doi: 10.5009/gnl16126.Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy.Ghoshal UC1, Shukla R1, Ghoshal U1.

Arab J Gastroenterol. 2018 Jun 20. pii: S1687-1979(18)30021-2. doi: 10.1016/j.ajg.2018.02.008. [Epub ahead of print] The gut microbiome and irritable bowel syndrome: State of art review. Salem AE1, Singh R2, Ayoub YK3, Khairy AM3, Mullin GE4.

Dig Dis Sci. 2017 Dec;62(12):3525-3535. doi: 10.1007/s10620-017-4726-4. Epub 2017 Sep 4. A Prospective Evaluation of Ileocecal Valve Dysfunction and Intestinal Motility Derangements in Small Intestinal Bacterial Overgrowth. Chander Roland B1, Mullin GE2, Passi M3, Zheng X4, Salem A5, Yolken R2, Pasricha PJ2.

J Clin Gastroenterol. 2017 Apr;51(4):300-311. doi:10.1097/MCG.0000000000000814. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. Zhong C1, Qu C, Wang B, Liang S, Zeng B.

https://www.cedars-sinai.edu/Research/Research-Labs/Pimentel-Lab/

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