Is SIBO Driving Your IBS?

Young beautiful woman having painful stomachache

There is a growing awareness among naturopathic and medical experts alike that many people presenting with Irritable Bowel Syndrome (IBS) have a bacterial imbalance in their digestive tract known as Small Intestinal Bacterial Overgrowth (SIBO). It is thought that approximately 50% of people with IBS have SIBO.


What is SIBO?

We all know now about how important our gut bacteria are, and many advertisements promise wonderful foods to improve your good bacteria. But what happens when the bacteria are in the wrong place? Our small intestines are not designed to have too many bugs living in them, really its our colon, or large intestine, where most of our gut bacteria reside.


To put it simply, SIBO is what happens when bacteria from our large intestine (or occasionally elsewhere, eg. our mouth) set up shop in our small intestine and start to reproduce. Our small intestines are usually fairly free of bacteria, so is NOT happy about its new residents, it wasn’t designed for them, and this causes a number of problems:


  • Inflammation

  • Damage to cells lining the small intestine

  • Reduced ability to digest and absorb nutrients

  • Nutritional deficiencies

  • Increased reactivity to foods

  • Decreased brush border enzymes on the surface of cells in the small intestine, increasing intolerance symptoms

  • Production of excessive gas

  • Changes in bowel transit time (too fast or too slow)


Common Signs & Symptoms of SIBO:

  • Digestive discomfort

  • Bloating

  • Diarrhoea or Constipation

  • Erratic bowel movements

  • Digestive pain and cramping

  • Multiple food intolerances

  • Being unsure what to eat for fear of tummy upsets

  • Gas: farting and burping

  • Nutrient deficiencies (B12, Iron, Vitamins A & D)

  • Fatigue

  • Nausea

  • Foggy brain

  • Weight changes


How Did I Get SIBO?

Good question! There may be multiple causes. There are definitely lots of different risk factors. A risk factor is something that makes it more likely you will get SIBO, and you’ll notice that on this list are some things are are risk factors for all sorts of health problems:

  • Stress

  • Over-eating

  • Fasting

  • History of gastrointestinal infection (Eg. Giardia, Clostridium)

  • Surgery

  • Poor digestive enzymes or low stomach acid

  • Disorders of the digestive system, (eg. pancreatitis, Coeliac disease)

  • Other health conditions (eg. low thyroid, diabetes, scleroderma, neurological conditions etc)

  • Some medications (eg. opiates, antibiotics, proton pump inhibitors)

  • IBS

  • Changes in motility (the natural movement of food through your digestive tract)

  • Any structural changes in the digestive tract (eg. from surgery)


Testing for SIBO

Talking with your naturopath or health practitioner you can work out whether it is necessary to test for SIBO or simply to start treating it. Various tests including comprehensive stool tests and urine tests for organic acids are available. Breath testing is specific for SIBO and can also help you work out where the overgrowth is (in what part of your small intestine) and what kind it is (by what gases it produces, methane or hydrogen).


What About Foods?

An important part of treating SIBO is removing trigger foods, or foods that ‘feed’ the bacteria. This is why special diets may be needed short-term.


Diets which can be useful here include the low FODMAPS diet, the Specific Carbohydrate Diet and the SIBO Bi-Phasic Diet. Personalised diets can also be developed based on your own food triggers.


Key elements of your nutrition plan should be:

  • A clear time-frame for working through a restricted diet (you can’t do this forever!)

  • Regular review of what is working and how you are progressing

  • A clear guideline around what you CAN eat, not just what you can’t!

  • A focus on fresh whole foods

  • Avoidance of sugar and sugary foods which can encourage bacterial growth

  • Pre-biotic foods with high fibre or starch often cause discomfort because they are so good at feeding bacteria. If the bacteria is in the wrong place, as it is in SIBO, this will produce more of the wrong bacteria in the wrong place and make symptoms worse. This is sometimes also true of fermented foods, but not always! We are all individuals after all, and our microbiome is highly personalised too.


Treating SIBO

  • Dietary interventions as outlined above are key for reducing symptoms, calming gut inflammation and reducing bacterial overgrowth.

  • While conventional treatment may consist of using antibiotics, we know enough about the importance of our microbiome to know that this probably isn’t the best option!

  • Natural antimicrobials including botanical extracts, specific essential oils and herbs are excellent for removing unwanted bacterial overgrowths, and can be tailored to each individual.

  • Specific strains of probiotic bacteria can be prescribed to help establish a better bacterial balance right throughout the digestive tract.

  • In some cases additional hydrochloric acid or digestive enzymes may be useful to help break down food more efficiently before it reaches the small intestine.

  • Gut healing work is often warranted once bacteria are under control, using nutrients such as glutamine, zinc, and vitamin A to help repair the tissues lining the small intestine.


So if you have any digestive discomfort, bloating or bowel irregularities, its worth thinking about SIBO. If you have IBS, definitely look into SIBO! It is really common for people to get used to their digestive symptoms, to feel like this is ‘just the way they are’ and that they will always live in fear of food or of not finding a toilet in time. Understandings about the digestive system have come a long way in the past 10 years, even the last 5 years, and there is so much that can be done to help you feel free to enjoy your food and enjoy your life.

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