UNDERSTANDING SIBO: Causes, Symptoms, and Management

 

 

Small Intestinal Bacterial Overgrowth (SIBO) is a condition that affects the small intestine, where excessive bacteria proliferate, leading to a range of gastrointestinal symptoms. Unlike the large intestine, where a high concentration of bacteria is normal (this is where our gut microbiome resides), the small intestine typically harbours relatively few bacteria.

When this balance is disrupted, and higher number of bacteria start to take hold, it can result in various health problems. Rosacea, IBS, MS, Restless Leg Syndrome and Rheumatoid Arthritis are some of the conditions linked to SIBO (this does not mean that SIBO causes these conditions, but it might play a role in their progression).

 

What is SIBO?

SIBO occurs when the small intestine becomes overrun with bacteria that are usually found in the colon. These bacteria can interfere with the digestion and absorption of nutrients, leading to malnutrition and a range of gastrointestinal symptoms.

The condition is often diagnosed through breath tests that measure hydrogen and methane produced by bacteria in the small intestine.

 

Causes of SIBO

Several factors can contribute to the development of SIBO, including:

1. Poor Motility: Conditions like irritable bowel syndrome (IBS) and diabetes can affect the normal movement of the small intestine, allowing bacteria to accumulate.
2. Structural Abnormalities: Surgeries or diverticula in the small intestine can create a favourable environment for bacterial overgrowth.
3. Immune System Dysfunction: A weakened immune system can fail to control bacterial populations in the gut.
4. Low Stomach Acid: Conditions or medications that reduce stomach acid (such as PPis) can lead to an increase in bacteria, as stomach acid typically helps to kill bacteria before they reach the small intestine.

 

Common Symptoms of SIBO

The symptoms of SIBO can vary widely, but they often mimic those of other gastrointestinal disorders. Common symptoms include:

1. Bloating and Gas: One of the most prevalent symptoms, bloating can be severe and persistent, often worsening after meals.
2. Diarrhoea: Frequent, loose stools are a common symptom due to the malabsorption of nutrients.
3. Abdominal Pain: Cramping or discomfort in the abdomen is often reported by individuals with SIBO.
4. Constipation: Some individuals may experience constipation, which can alternate with diarrhoea.
5. Malnutrition: Due to poor absorption of nutrients, individuals with SIBO may experience weight loss, fatigue, and deficiencies in vitamins and minerals.
6. Fatigue: Chronic tiredness can result from nutrient deficiencies and the body’s ongoing battle with bacterial overgrowth.
7. Food Intolerances: People with SIBO may develop intolerances to certain foods, particularly those high in fermentable carbohydrates (FODMAPs).

 

Diagnosis

Diagnosing SIBO typically involves breath tests that measure hydrogen and methane production. These gases are produced by bacteria in the small intestine and can be detected in the breath after consuming a sugar solution. Elevated levels of one or both gases indicate bacterial overgrowth.

At the time of writing, very few hospitals and doctors in the UK are knowledgeable about SIBO and are offering testing options, this is why many people will have to consider private healthcare.

 

Management of SIBO often includes:

1. Antibiotics or Antimicrobial Herbs: Specific antibiotics or antimicrobial herbs can dramatically reduce bacterial overgrowth, providing relief from symptoms. Antibiotics works very quickly but kill indiscriminately good and bad bacteria, while herbs are slower, giving the chance to work on repopulating the good bacteria while killing the bad ones.
2. Dietary Changes: A low-FODMAP diet can help reduce symptoms by limiting fermentable carbohydrates that feed bacteria. This is not a long-term solution, but it can be implemented to improve symptoms while tackling the root cause.
3. Probiotics and Prebiotics: These can help rebalance the intestinal microbiome, although their use in SIBO should be tailored to the individual.
4. Addressing Underlying Conditions: Treating underlying conditions, such as poor motility or immune deficiencies, is crucial for long-term management, otherwise the SIBO can reoccur in few months.
5. Nutritional Support: Supplements may be necessary short term to address nutrient deficiencies caused by malabsorption.

 

Conclusion

SIBO is a complex condition that requires a multifaceted approach to diagnosis and management. Understanding its symptoms and potential causes is crucial for effective treatment. If you suspect you have SIBO, it’s essential to consult with a healthcare professional who can guide you through appropriate testing and treatment options. With the right approach, many people with SIBO can find relief from their symptoms and improve their quality of life.