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An Epic Guide to SIBO: Symptoms, Treatments, Diets, & More

60 million.

That’s the approximate number of Americans across the country suffering from IBS.

I want to talk to you about a gut issue that’s known to affect up to 86% of IBS sufferers: SIBO.

SIBO stands for Small Intestinal Bacterial Overgrowth. By definition, if you’ve got an excess of bacteria in your small intestine, you’ve got SIBO.

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You see, we’re not supposed to have much bacteria in the small intestine because an overgrowth (in the small intestine) interferes with organ function.

Yeah, sure, some bacteria taken in from food or the environment inevitably passes, but the grand total number of bacterial organisms living there should be a pretty small amount.

And, by small amount we mean less than less than 103 organisms/mL (10,000 per 1/5th of a tsp) found in the upper small intestine. That’s normal (in case you’re a numbers person). Anything exceeding that is classified as SIBO.

The majority of the bacteria that live in our bodies is supposed to live in the large intestine (colon), and that’s where we want all of those gut-friendly probiotics from fermented foods and quality supplements to go. That is where bacteria helps do things like make acids that break down food and absorb vitamins.

The honest truth though is that it’s hard to figure out exactly what kind of bacteria is in the small intestine because it’s hard to culture.

What we do know is that SIBO is likely a combination of the bacteria that normally resides in the small intestine, bacteria that’s backed up into the small intestine from the large intestine, oral bacteria, and opportunistic bacteria.

Natural Mechanisms That Prevent SIBO

The good news is, it’s not that easy to get SIBO.

The human body is incredibly intelligent,which means you’re not just going to get SIBO out the blue. Our bodies actually have built-in mechanisms that work to prevent that bacterial overgrowth, such as:

  • Stomach acid (kills bacteria)
  • Digestive enzymes (break down food)
  • Bile (kills bacteria)
  • “The GALT” (the immune system of the small intestine which fights infections and bacteria)
  • Migrating motor complex (a cleansing wave that sweeps away bacteria, food debris, and leftover cells between meals and during sleep)
  • Ileocecal valve (prevents backflow of bacteria from the large intestine)

That’s a minimum of six “normalizing” mechanisms working on the front lines of your small intestine to keep things running smoothly and prevent bacterial overgrowth.

SIBO Symptoms

sibo symptoms
Bloating is a common symptom of SIBO.

When any one of those “normalizing” mechanisms (the ones we just talked about) goes haywire, you will undoubtedly experience symptoms.

If you or someone you know have SIBO it’s likely that you’ll notice both GI and systemic symptoms.

GI Tract Symptoms

  • Bloating
  • Belching
  • Flatulence
  • Cramps
  • Diarrhea
  • Constipation
  • Heartburn/Acid reflux
  • Nausea

Systemic Symptoms

  • Food sensitivities
  • Headaches
  • Fatigue
  • Moodiness
  • Asthma
  • Skin rashes

Because SIBO goes hand in hand with leaky gut, a lot of the above systemic reactions are common.

How Do I Get SIBO?

Ok, so now you know what symptoms to look for if you think you might have SIBO, but how in the world do you get it in the first place?

Well, there are a lot of different ways to get SIBO as it’s been link to diabetes, diverticulitis, celiac disease, certain medications, and aging, but I’d like to talk about three of the most common, as well as, a little know reason that people get it:

  • Low stomach acid
  • Antacids
  • Ileocecal valve syndrome
  • Lack of breastfeeding

Low Stomach Acid

As you read above, stomach acid, or HCL, helps to kill of bacteria. When it gets too low, it can’t do it’s job properly.

H. pylori (Helicobacter pylori) is a nasty bacteria (that can lead to ulcers and stomach cancer) often responsible for lowering stomach acid.

Another big player in lowering stomach acid is, which may surprise you, is chronic stress.

If you’re chronically stressed, you’re also chronically using your sympathetic nervous system, which most people know as the “fight of flight” system. That’s the same one that gets turned on when you’re running from danger, like a hungry tiger. When your sympathetic nervous system is in overdrive, your body reprioritizes its internal actions so that it can help you flee from perceived danger faster and better, which means helping you digest your food is pretty low on the totem poll. Needless to say, it’s not going to allow you to secrete much stomach acid.

To do that, your body needs to be in it’s parasympathetic nervous system i.e. the “rest and digest” system, which is why stress management is such an important part of nourishing your body.

Finally, antacids like Rolaids are also a major contributor to low stomach acid. So, if you have SIBO and you’re on antacids, part of your treatment protocol is going to be to get off of them.

Ileocecal Valve Syndrome

The ileocecal valve is located between the large and small intestine (near your appendix). Think of it as a “pet door” of sorts that prevents backflow of bacteria, toxins, and food from the large intestine to the small intestine.

That process does happen a little bit naturally, but if it get’s stuck open, as is sometimes the case when you have SIBO, it’s going to cause some real issues, one of them being low stomach acid. If it’s stuck shut, it can also cause constipation. If it’s stuck open, it can cause diarrhea.

Fortunately, chiropractors, naturopaths, and massage therapists who are trained in manipulating the ileocecal valve can do just that with the right adjustment. Sometimes one adjustment is enough, but you may need a few before the manipulation holds correctly.

Lack of Breastfeeding

As a disclaimer, this is a highly controversial topic and I just want to say that by bringing this topic to light, I point no fingers at any mothers. I do, however, think that anyone suffering from SIBO has a right to know this information, which is why I’m bringing it up as a topic of conversation here.

So, here’s how it goes.

Research suggests that babies who aren’t breastfed, were born by c-section, or were breastfed by a mom who herself experienced dysbiosis are prone to improper colonization of bacteria in their GI tract.

Exposure to antibiotic-resistant hospital bacteria and environmental toxins (babies who aren’t breastfed will be colonized by their environment) alter a baby’s bacterial colonization. If that happens, a baby’s intestinal function can be at risk.

Not so great…

Whatever bacteria colonizes in a baby’s body becomes their personal bacterial fingerprint.

“If you’re improperly colonized you’re going to accept and get fingerprinted with bacteria that shouldn’t be there.” -Dr. Allison Siebecker

That then affects the immune system, and has been linked to a rise in immune and digestive related issues such as asthma, allergies, celiac, low stomach acid, and even SIBO.

For further reading on related topics, check out these posts:

How to Have the Healthiest Pregnancy Possible: It All Starts in Your Gut

How to Increase Fertility Naturally with Bone Broth

The SIBO Breath Test

We’ve covered in detail, at least four reasons why you might get SIBO. Now, let’s talk about how to test for it and determine if you truly have it.

Endoscopies and colonoscopies can’t really get dig down in there and give us all the information we need to know. Unfortunately, neither can stool tests. Being that the small intestine is 20 feet long, it’s not exactly an easy place to reach!

So, if endoscopies, colonoscopies, and stool tests can’t tell you whether or not you have SIBO, how the heck do you figure it out?

Enter, the Hydrogen Breath Test.

The most common hydrogen breath test is called the Lactulose Breath Test and it’s a pretty simple and straightforward test.

Here’s how it works:

  • You eat a special diet for one day
  • You fast overnight
  • You drink a lactulose solution (a synthetic sugar known for to make you poop) in the morning

Lactulose isn’t easy to break down, which is why we don’t come equipped with the enzymes to do that. However, the bacteria (potentially overgrowing in our small intestine) do. And, if they’re present in the small intestine, they’ll digest it and make gas which will eventually make its way into the lungs. If there’s an excessive rise of gas, that’ll show up on the breath test when we breath out and determine whether or not you have SIBO.

Because the average transit time for the small intestine is about 2 hours, most lab tests have you collect your breath in 20 minute intervals over that time span.

Lots of hospitals and GI offices offer this type of breath test. To find those offices, clinics, and doctors who can help you run that test, here’s what you do:

  • Contact the labs that offer this (mail order) test and/or, QuinTron, the manufacturer of the Breath Testing Machine (found in some offices and clinics)
  • Ask them to help you find offices, clinics, and doctors in your area who can either send you a mail order lab (that you can do at home) or who have access to the Breath Testing Machine (that you can do in their office or clinic)

There is some controversy over the legitimacy of the hydrogen breath test. However, Dr. Allison Siebecker, one of the foremost experts on SIBO in the country, stands by it as a reliable tool for her patients, which solidifies my personal confidence in them.

SIBO Treatment

sibo treatment

Once you’ve determined you have SIBO, there are a number of ways you could work to get rid of it.

One way is to use antibiotics.

Now, before you freak out about the fact that I just mentioned antibiotics, let me first say that these are not the same you hear about regularly causing further GI issues. These antibiotics, more specifically Rifaximin, Neomycin, Metronidazole, stay in the intestinal tract and work locally. That means they’re not absorbed into the bloodstream, which means they won’t cause UTI’s and yeast infections. Read here for Dr. Allison Siebecker’s page which walks her protocol and explains how it all works in detail.

There’s also the option of using herbal antibiotics to get rid of SIBO. Dr. Allison Siebecker recommends using a combination of allicin from garlic, oregano, berberine, neem, and cinnamon for about 4 weeks. She outlines her exact protocol here.

The Elemental Formula is another treatment option for getting rid of SIBO. According to Dr. Pimentel, author of A New IBS Solution, it has shown an 85% success rate and can be used in place of antibiotics and herbal antibiotics. Although it very much adheres to naturopathic practices and is effective in getting rid of SIBO quickly, it can also be really challenging.

Why? Because it’s basically 2 straight weeks of easily absorbable, pre-digested, powdered nutrient meal replacements (for three square ones a day). Also, it’s expensive. But you can’t argue with the results – it gets the job done!

SIBO Diet Breakdown

The good news is that all of the above listed treatments have a high success rate. The bad news is that recurrence of SIBO is very common.

Which means there’s still more work to do.

If you currently have SIBO or have had it, then it’s really important to follow a SIBO-friendly diet as a preventative strategy.

There are quite a few bacterial overgrowth  diets out there. I’m going to break it all down for you below, as they’re all unique, but the one thing they all have in common is reducing carbohydrates and sugar. Carbohydrates and sugar feed bacteria. These diets all aim to nourish you while starving the bacteria. They can be used in combination with or after the different SIBO treatments listed above.

Small Intestine Bacterial Overgrowth Diets to Follow

1. Specific Carbohydrate Diet (SCD)

This diet was first introduced by Elaine Gottschall in her book Breaking the Viscious Cycle, but you may be familiar with it from our friends over at SCD Lifestyle. It’s very similar to The Paleo Diet in many ways, especially in that it doesn’t allow grains; however, it does allow some legumes. It also doesn’t allow starchy vegetables, lactose, and most sweeteners with the exception of honey and stevia on occasion. Instead, it focuses on eating animal proteins, ripe fruit, nuts, seeds, eggs, and non-starchy vegetables.

2. Gut And Psychology Syndrome Diet (GAPS)

It’s very similar to the SCD diet but includes fewer legumes, using only fresh (not store bought) juice with live enzymes), and emphasizes removing dairy and baking soda (it’s alkalinizing) while increasing consumption of healthy fats, organ meats, and bone broth.

sibo diet

3. Low FODMAP Diet

FODMAPS stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. This diet is similar to the SCD and GAPs diets, but focuses on removing foods that fall under the FODMAP categories like chickpeas, pistachios, apples, dried fruit, garlic, honey, and soy milk. Here’s a complete list of high and low FODMAP foods.

4. SIBO Specific Food Guide

This is Dr. Allison Siebecker’s dietary protocol for those with SIBO. It’s also similar to the SCD, GAPs, and Low FODMAP Diet, but reduces fermentable carbohydrates more than the others. It’s also probably the most restrictive, but she’s found that it’s had the best results of all the diets with her patients.

5. Cedars-Sinai Diet (C-SD)

This is Dr. Pimentel’s dietary protocol which actually does allow for some grain, starch and sugar consumption. But, of course, if you’re gluten-sensitive, you’d have to forgo the grains either way.

A Few SIBO Diet Recipes to Hold You Over

Coconut MCT Balls by Aglaée Jacob

Carnitas Tacos by SIBO Diet Recipes

Lemon Tart by SIBO Diet Recipes

Leftover Breakfast Soup by SCD Lifestyle

Chicken with Cauliflower & Olives by Elana’s Pantry

PS – get familiar with the parameters of your particular SIBO friendly diet and substitute any ingredients as needed.

To Probiotic or Not?

This is one of those situations in which there isn’t exactly a simple answer and it’s actually a hotly debated topic.

Some people with SIBO really don’t tolerate probiotics very well, and yet for others, they help a lot and are an integral part of their gut-healing process.

One argument against using them is that it might not be the best strategy to throw more bacteria into a space with compromised “normalizing” mechanisms that’s already overpopulated with bacteria.

Makes sense, right?

Another argument, from Elaine Gottschall (of the SCD diet) points out that:

“Supplementing with bifidus (a probiotic strain) is a bad idea because it mostly populates in the large intestine. If you have SIBO, part of the issue is likely that there’s already a backflow of bacteria from the large intestine to the small intestine, so again, why would we want to add more bacteria into the equation.”

For that reason, a lot of people shy away from using it.

On the other hand, there are lots of IBS studies showing that supplementing with bifidus is not only beneficial, but brings relief.

Whether you have a positive or negative experience with probiotics while healing from SIBO is clearly extremely individual. You just basically have to do a little biohacking and see if it works.

According to Dr. Allison Siebecker, one that this is definitely certain is that if you have SIBO, don’t take a probiotic supplement with a prebiotic in it! Examples of prebiotics are:

  • FOS
  • GOS
  • Inulin
  • Chicory root

Prebiotics feed bacteria, which means it will likely aggravate you if you have SIBO.

If you’re considering taking probiotics, check out our super comprehensive post on gut healing supplements, which has a really great section on it.

Also, here’s an awesome study on the effects of probiotics on SIBO.

Alternatively, if you have both SIBO and leaky gut, a really good option may be to use a plant-derived supplement called Restore, which is neither a probiotic nor a prebiotic. It’s made of lignite extract and works to filter out toxins (which can contribute to holes in the gut lining) and positively change your internal ecosystem. More on that in our post over here.

Bone Broth & SIBO

Because of bone broth’s propensity towards gut healing, it’s plays an integral part in the SCD, GAPs, and SIBO Specific Food diet. It can bring a ton of relief to you if you have SIBO.

In some cases, extremely sensitive SIBO patients, bone broth might be an irritant at first, because of the polysaccharides that get released into the broth from the animal bones and joints. These polysaccharides are by no means inherently bad, but they can accidentally end up being lunch for the overgrowth of bacteria inside.

If you find yourself in that boat, switch to plain ol’ meat broth (i.e. simmered stew meat), then work your way up to small doses of bone broth, followed by larger doses of bone broth.

Closing Thoughts

No, this is not a walk in the park. But, armed with the knowledge from this post, solid results from a hydrogen breath test, and the support of your doctor + some really great SIBO friendly cookbooks, and you absolutely have all the tools you need to heal from SIBO and bounce back even stronger.

Interested in learning more about SIBO? We recommend checking out this SIBO training module from FDN Advanced.

Dealing with SIBO and gut issues? Sign up for our free gut healing email course and get 7 lessons. Grab your spot by clicking here.

Delfina bio picDelfina is the spirited nutrition + movement coach and alternative health blogger behind Code to Wellness. She uses her #eatmovethink method to help clients reclaim their health & thrive in their bodies.

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