Do you have SIBO?

SIBO stands for, Small Intestinal Bacterial Overgrowth, where an overgrowth of bacteria occurs in the small intestine, where they are not usually present to a high degree. The bacteria then act on poorly digestible carbohydrates, due to a lack of movement through the small intestine, causing fermentation and symptoms such as gas, extreme bloating, pain, diarrhoea and or constipation.

The high levels of fermenting bacteria excrete toxins that systemically can affect the nervous system causing brain fog and fatigue. The gut becomes more permeable and the immune system becomes activated, attacking nerve cells in the intestine and motility or movement through the intestine slows down complicating the condition. Nutrient deficiencies can arise as the bacteria consume some of the ingested foods, such as B12, iron and essential fatty acids.

SIBO is the most common cause of Irritable Bowel Syndrome or IBS, or post infectious IBS which occurs after food poisoning, travellers’ diarrhoea, or a bout of gastroenteritis. Acute stress and medications such as proton pump inhibitors, which decrease stomach acid can trigger SIBO. If SIBO is diagnosed and treated after one of the above triggers occurs, then it usually resolves quickly. But cases of SIBO are notorious for being difficult to treat and its reoccurrence is high, and we now know why. Some predisposing factors if present before SIBO occurs can allow SIBO to take hold. Conditions such as hypothyroidism, diabetes, chronic stress, depressed immunity, stealth infections like Lyme and co-infections, Epstein Barr virus and others , and even abdominal adhesions from endometriosis and Crohns disease, can all in some way affect the intestinal motility and make the treatment of SIBO tricky.

Treatment of SIBO will take into account triggers and predisposing factors for the individual person. I like to use a protocol which involves rotating gentle anti-bacterial herbs, restoring motility to the small intestine, and digestive bitters. Most importantly, a low carbohydrate diet must be followed to limit the food source for the bacteria in the small intestine to reduce the amount of gas production and then the pain and bloating will decrease. A low FODMAP diet works well here. Good eating practices such as chewing well and not rushing whilst eating also help.