What is SIBO and Is it the Root of Your Digestive Problems?
Bloating, abdominal cramping, inconsistent poops, acne, eczema, diarrhea, acid reflux — do any of these things sound familiar?
If you’re struggling with one or more of these painful and annoying symptoms, SIBO could be to blame.
What Is SIBO?
SIBO, or small intestinal bacterial overgrowth, results when you have an excess of bacteria in your small intestine, the part of the gastrointestinal tract connecting the stomach to the colon, helping to digest and absorb food.
Until recently, SIBO was thought to be a mythical health condition. But today, research has proven that it’s a real thing. In fact, a whopping 80 percent of people who are diagnosed with irritable bowel syndrome are also said to have SIBO (1). However, SIBO does share many of the same symptoms as irritable bowel syndrome, which makes it tricky to diagnose.
SIBO is different than other common digestive conditions, such as leaky gut or candida. It only affects the small intestine, whereas other conditions affect the entire GI tract. However, SIBO can be even more problematic to your health because this is where 90 percent of nutrient absorption occurs (2). This means that when SIBO is present, the rest of your organs that depend on essential nutrients can also be affected (1).
If left untreated, SIBO can lead to permanent cellular damage, leaving the body more susceptible to developing a variety of autoimmune diseases (3). But don’t lose hope. Although it’s described as chronic and stubborn, SIBO is a treatable condition. The first step to healing SIBO is to arm yourself with knowledge. You need to understand how it develops and affects your body, and how to successfully treat it.
What Does It Mean to Have SIBO?
Under normal circumstances, the majority of your gut bacteria is found in the large intestine, where it helps break down food, synthesize certain vitamins and eliminate the waste from digestion.
We’re not meant to have much bacteria in the small intestine because it can interfere with nutrient absorption and organ function.
Your body has an extremely intelligent system in place to keep the contents between your small and large intestines separate. Digestive fluids such as bile, enzymes, valves, intestinal muscle movements and contractions are all components that help keep things moving along.
In fact, the small intestine is a pretty clean place. Your body helps keeps it in pristine condition by using a mechanism called the migrating motor complex — a cleansing wave that sweeps away bacteria, food debris and leftover cells between meals and sleep (4). There’s also the GALT tissue, which acts as an immune system, helping to fight off infection and bacteria (5).
Under certain circumstances, the healthy functioning of your gut can become compromised, and bacteria from your large intestine can trespass its way into the small intestine. This can cause SIBO.
Research suggests that the bacteria involved in SIBO is a combination of oral bacteria, bacteria from the large intestine and opportunistic bacteria, such as Candida albicans, a form of yeast (6). When muscle function is impaired, waste and fecal material can “backwash” from the large to small intestine (yuck, we know).
7 Common Causes of SIBO
It’s near impossible to pinpoint the exact causes of SIBO because everyone’s internal environment is so different. However, studies suggest SIBO is caused by a structural change in the GI tract. It could also be caused by disordered peristalsis of the gastrointestinal tract, or a disruption of the normal mucosal defenses of the small intestine (7).
In other words, anything that causes the regular function of the GI tract to go haywire — especially valve and muscle function — can cause SIBO.
Here are the most common SIBO risk factors. (Note: SIBO is still in the early stages of being studied as a medical condition. While these are the current known causes, there could be more we’re not yet aware of.)
1. Low Stomach Acid
Stomach acid activates digestive enzymes and kills pathogenic bacteria. Low stomach acid — which can be caused by frequent antibiotic use, a diet high in processed foods or a natural decline with age — can lead to microbial overgrowth, and is therefore a greater risk for bacteria entering the small intestine.
The majority of SIBO causes are linked to low stomach acid (1).
2. Pre-Existing Medical Conditions
Any medical condition that affects the gut’s muscle function can lead to SIBO.
Type 2 diabetes (also called diabetes mellitus), prior bowel surgeries, leaky gut syndrome, Crohn’s Disease and long-term celiac disease can all increase your risk of developing SIBO (1).
3. Dietary Factors: Alcohol, Gluten, Refined Sugar
One study showed a much higher rate of SIBO with moderate alcohol consumption compared to people who don’t drink alcohol at all (8). Moderate alcohol consumption is considered one alcoholic beverage per day for women, and two per day for men (9).
Alcohol has been shown to damage small bowel mucosal cells, which can decrease the muscular contractions of the ileocecal valve, which keeps the contents of the small and large intestine separated (10).
How does this lead to SIBO? Damaged bowel mucosal cells can cause impaired muscle function, thereby causing a greater risk of SIBO.
Both alcohol and refined sugar feed certain types of “bad” bacteria in your system, such as yeast, which is harmful when it overgrows and outnumbers your healthy gut bacteria (11). Yeast overgrowth, or candida, can lead to leaky gut syndrome, which further impairs gut muscle function and creates an ideal environment for SIBO (and other health conditions) to manifest.
Eating gluten may also increase your risk for SIBO, because it’s one of the main contributors to leaky gut.
As you can see, SIBO goes hand in hand with leaky gut. In fact, SIBO and leaky gut are almost like a “chicken and egg” situation, because it can be hard to tell which one came first.
4. Small Intestine Dysmotility
This occurs when your small intestine is functioning at a slower rate than it should be. It can be caused by genetics, autoimmune conditions and any illness that causes inflammation in the GI tract (12).
5. Slow Bowel Transit Time
A sluggish bowel transit time means it takes longer than 72 hours for food to move through your digestive tract from the time it’s eaten to the time it’s eliminated. It’s a risk factor to SIBO because it allows more time for harmful bacteria to accumulate. (Psst — here’s what to do about that.)
6. Lack of Breastfeeding
This is a highly controversial topic, and by no means are we pointing the finger at any mothers. However, anyone suffering from SIBO may find this information helpful, which is why we’re bringing it up.
Research suggests that babies who weren’t breastfed, were born by c-section, or were breastfed by a mom who had a lack of healthy gut bacteria herself, are also more prone to having a lack of beneficial bacteria in their GI tract (13). So, in a way, you can “inherit” bacterial dysbiosis.
The type of bacteria that colonizes in your body as a baby becomes your “personal bacterial fingerprint.” Dr. Allison Siebecker, a self-proclaimed SIBO expert, said it well: “If you’re improperly colonized, you’re going to accept and get fingerprinted with bacteria that shouldn’t be there.”
Of course, this doesn’t mean that all babies who weren’t breastfed or were born by c-section are going to end up with SIBO. It’s just some food for thought.
7. Prescription Use
Prescription medications such as antibiotics, antidepressants and birth control can deplete healthy gut flora and damage bowel mucosal cells (14).
SIBO can cause both systemic and gastrointestinal symptoms. They can include the following:
- Chronic bloating (meaning you start your day with a flat stomach and go to bed with a 6-month-old food baby every night)
- Gas (accompanied by a foul odor)
- Abdominal pain
- Weight loss (caused by malnutrition)
- Acid reflux or heartburn
- Skin issues: acne, psoriasis, eczema
- Food sensitivities
- Joint pain
- Mood disorders: depression, anxiety
- Skin conditions: acne, eczema, psoriasis, rosacea
As you can see, many of these symptoms overlap with other digestive conditions, which is why SIBO shouldn’t diagnosed based on symptoms alone. The only way to be sure is by using a SIBO testing method.
How Do You Test for SIBO?
SIBO is a tricky little guy, and even endoscopies and colonoscopies can’t really dig deep enough to get you an answer. Even stool tests, currently considered the “gold standard” in testing for SIBO, have drawbacks. So, how the heck do you figure it out? You have to test your breath.
The hydrogen breath test is the most common and accurate SIBO testing method at this time (15). And for bonus points, it’s not at all invasive.
Here’s how breath testing works.
The hydrogen breath test detects two gases — hydrogen and methane — in your breath. These gases aren’t produced by humans, but bacteria in the small intestine as they ferment the sugar from carbohydrates (16). These gases are released into the blood, sent to the lungs and exhaled through the breath, which is why a breath test can detect SIBO.
As you’ll remember, the small intestine is only meant to be the site of nutrient absorption, not the stage of digestion where food is fermented — that’s the large intestine’s job. Therefore, if hydrogen and methane are detected in your breath, it means there are bacteria present in your small intestine breaking down carbs before they can make it to your large intestine (17). The presence of methane can increase the production and absorption of short-chain fatty acids, which can lead to obesity (18). This could indicate you have SIBO.
The hydrogen breath test is said to be the most effective way to test for SIBO. However, there’s also the Glucose Breath Test and the Lactulose Breath Test, but they may not provide as accurate of results.
SIBO tests can be administered by GI specialists or certain physicians. You can also order a take-home hydrogen breath test from specific labs and do it in the comfort of your own home. A take-home SIBO testing kit usually costs between $100 to $150.
How to Treat SIBO
Once you’ve determined that you have SIBO, there are several treatment options to help get rid of it.
Eeek — don’t antibiotics cause SIBO?
Certain antibiotics, such as Rifaximin (Xifaxan), Flagyl (metronidazole) and Neomycin, have shown a 91 percent success rate for killing unwanted bacteria in the small intestine and eradicating SIBO. These antibiotics differ from others because they stay in the intestines and only work in the areas where they’re needed, which means they don’t spread to other areas of the body and cause unwanted side effects.
You can learn about dosages and the rest of the details on how antibiotics work for SIBO here.
(Important note: while antibiotics may be helpful in the initial stages of healing SIBO, like any medication, it only treats the symptom, not the underlying cause. For this reason, dietary and lifestyle changes may also be required alongside antibiotics.)
2. Probiotic Supplements
While it’s true that SIBO is caused by small intestinal bacterial overgrowth, research shows that supplementing with healthy, non-pathogenic bacteria (such as the ones found in probiotic supplements) can help improve digestive symptoms, especially diarrhea. Additionally, supplementing with Lactobacillus was shown to reduce hydrogen breath levels (19).
On the downside, other studies haven’t shown such promising results, so more research is needed to determine whether probiotic supplements should be taken for SIBO.
Whether or not probiotic supplements are the right choice for SIBO will depend entirely on the individual. However, you can always add fermented foods to your diet, which naturally contain strains of beneficial bacteria in smaller amounts than supplements. This means they’re less likely to aggravate SIBO or cause other symptoms. The bacteria in fermented foods may help reduce intestinal inflammation and repair damage to the intestinal lining caused by SIBO or leaky gut (20).
Our favorite fermented foods are sauerkraut, beet kvass, kimchi and dairy-free yogurt made from almond, cashew or coconut milk.
3. Herbal Supplements
Mother Nature has an antibiotic for almost everything in the form of herbs. Capsules and tinctures made from ingredients like berberine, lemon balm, garlic, neem and chinese skullcap may be just as effective as the aforementioned antibiotics at treating SIBO (21).
Like any medication or therapy, it’s important to speak with a qualified healthcare practitioner before taking any type of herb. This will ensure you have the most therapeutic formula and the correct dosage for your needs, and that it won’t negatively interact with any medications or health conditions you have.
4. Follow a Diet That Supports SIBO Recovery
While all of the above treatments have a high success rate, the recurrence of SIBO is common. The best way to increase your odds of beating SIBO for good is by making sure to follow a SIBO-supportive diet.
Luckily, there are a few different options for SIBO diets to choose from. And while they’re all unique, the one thing they have in common is reducing carbohydrates and sugar, which is the quickest way to stop feeding the bad bacteria and get your system back on track.
This diet was first introduced by Elaine Gottschall in her book “Breaking the Vicious Cycle.” The goal of the Specific Carbohydrate Diet is to heal the GI tract by removing sugar, carbs and other foods that can irritate the digestive tract.
The Specific Carbohydrate Diet is like a lenient version of the Paleo diet. It removes grains, but allows some legumes and certain dairy products. However, starchy vegetables and most sweeteners are off limits, with stevia only being allowed on occasion. The rest of the time, you’ll be eating animal proteins, ripe fruit, nuts, seeds and non-starchy veggies such as zucchini, broccoli and leafy greens.
B. Gut and Psychology Syndrome Diet (The GAPS Diet)
The GAPS diet was created by Dr. Campbell-McBride to treat gastrointestinal imbalances associated with neurological and psychiatric conditions including autism spectrum disorders and depression.
GAPS is similar to the Specific Carbohydrate Diet but encourages more non-dairy fermented foods such as kimchi, as well as healthy fats, organ meats and bone broth.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. In a nutshell, FODMAPs are foods that contain the fermentable sugars that feed bad bacteria and encourage them to grow. High FODMAP foods are mostly foods that are higher on the glycemic index, such as dried fruit, sweeteners and certain carbohydrates (22).
The FODMAP Diet replaces high FODMAP foods with low FODMAP foods, and requires a two- to six-week initial elimination phase. Here’s more information about the Low FODMAP Diet, and a complete list of high and low FODMAP foods.
This is Dr. Allison Siebecker’s dietary protocol for SIBO. It’s similar to the Specific Carbohydrate Diet, GAPS and Low FODMAP Diet, but is more restrictive on carbohydrates than the others. However, she says her SIBO patients get the best results with this diet compared to others.
In addition to the diets above, you can also find SIBO cookbooks online or at your local bookstore.
5. Bone Broth
Lastly, bone broth is rich in collagen and gelatin, which help heal and seal the gut lining, as well as several anti-inflammatory amino acids, such as proline and glycine. Bone broth’s benefits for gut health may bring you gradual relief from digestive symptoms, and help resolve the underlying issue of why SIBO is there in the first place.
Additionally, drinking bone broth can help replenish several essential vitamins and minerals, such as calcium and magnesium, which may be deficient when SIBO is present (1).
However, it’s important to note that for those who are sensitive, bone broth may irritate your digestive tract initially. This is because carbohydrates called polysaccharides get released into the broth from the animal bones and joints, which may end up feeding the existing overgrowth of bacteria.
By no means are these polysaccharides bad, it just means that you may need to start off with regular meat broth, known to cause fewer digestive symptoms in a compromised gut.
The difference between meat broth and bone broth is that meat broth is cooked with the meat still attached to the bones, whereas bone broth is purely bones, tendons and ligaments. Meat broth is also only simmered for two to four hours at a time — compared with 24 hours for bone broth — which allows fewer carbohydrates to be released. Meat broth still contains gelatin and other amino acids and minerals needed for gut repair, so it’s a great place to start if bone broth doesn’t agree with you at first.
Healing SIBO may sound overwhelming at first, but we assure you it’s not impossible. Now that you have the basic knowledge for healing your gut, putting these tips into action will help you overcome your symptoms and bounce back healthier than before.
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