*SIBO stands for Small Intestine Bacterial Overgrowth. It is a chronic bacterial infection of the small intestine. The bacteria should normally live in the gastrointestinal tract and its overgrowth in the small intestine becomes very problematic.
1. The bacteria cause damage to the lining of the small intestine, causing “leaky small intestine”, which is the same idea as leaky gut.
2. The bacteria consumes some of our food, which in turn leaves us with nutrient deficiencies.
3. The bacteria produces uncomfortable symptoms such as gas, flatulence, abdominal bloating, pain, constipation or diarrhea.
4. Fat digestion/absorption is usually impaired.
5. “Leaky gut” can cause food allergies and intolerances from large particles of food entering the blood stream and the immune system seeing intruders.
6. Bacteria can enter the blood stream which is exhausting for the immune system, causing chronic fatigue.
How do you know if you have it?
1. Go off of symptoms:
*Symptoms of IBS are the most prevalent: the most common is bloating or distention, but there can also be belching, flatulence, abdominal pain, and there is either constipation or diarrhea.
*Systemic symptoms can go along: food allergies, headaches, brain fog, body pain which are all attributed from leaky gut
*Hydrogen breath test: tests for hydrogen and methane. Hydrogen breath tests are based on the fact that there is no source for hydrogen gas in humans other than bacterial metabolism of carbohydrates. You can do it at home with a take-home kit or your doctor will send you to a facility that will help you do the test. You breathe into the kit every 20 minutes for 3 hours or longer (since that’s how long bacteria hangs out in the small intestine for). Although there is controversy over the subject of exactly how to define the presence of SIBO, there is a good amount of research that shows the definition of SIBO as >105 colonic‐type bacteria as clinically relevant. Since doctors can interpret the tests differently, it’s good to understand how to interpret it yourself.
*Another test option is the Lactulose Breath Test or the Glucose Breath Test. They aggravates the symptoms and tell you where exactly the SIBO is located. The lactulose test tells you if you have SIBO in the lower part of the small intestine, which is more common. This may mean that the overgrowth is also coming from the colon, which will change treatment. The glucose test only reflects the first 2-3 feet because that is where glucose is absorbed, so it gives you less information (and is therefor less expensive) than the LBT.
Retesting is crucial so you can move forward accordingly. If you’re using a “quick kill” method (antibiotics, herbal, or elemental diet), you should retest within a week finishing the treatment. The bacteria can recolonize within 2 weeks, so in order to understand what you have accomplished you should retest that quickly.
What are the treatment options?
There is a spectrum of intervention needs. Some people find results from minimal intervention, while others need to continue the strictest form of treatment for many years. The severity of treatment depends on the many other predisposing factors a client has. It is a good idea to try an intervention method and change or add on methods later if it’s not working as planned. It is recommended to stay on the diet for one year after symptoms are improved for a better chance of being able to return to a more full spectrum (“normal”) diet.
If you want to kill the bacteria:
1. Antibiotics- Rifaximin is the most common option as it doesn’t absorb into our body at all, making it more effective and safer than other antibiotics. It usually takes about 2 weeks. Antibiotics are often strongly recommended, although it always depends on the severity of the case. Having constipation symptoms of SIBO (as opposed to diarrhea) is primarily caused by methane gas, which is more challenging to treat (as compared to having more hydrogen gas).
2. Herbal antibiotics- A study by Dr. Logan shows the effectiveness of peppermint oil. Standards in herbal antibiotics are barberry, goldenseal, Oregon grape, and garlic pills. Use these for around the same length of time as antibiotics, maybe a little longer. Many herbal antibiotics can be very strong so it is recommended to use while in the care of a wonderful health care practitioner.
If you want to starve the bacteria:
3. Elemental Diet- Lab predigested food made into a powder. (Sounds tasty, huh?) It’s available online or over the counter. The difference between protein shakes and the elemental formula is that the elemental formula is completely predigested. This is also effective and also done for 2 weeks. But let’s be honest- these are expensive, boring, and I’m assuming not the tastiest nor most pleasant way to enjoy nourishment. This is for someone who doesn’t care about food (do those people exist?) or are at least extremely focused on eating exactly and only what they should be.
4. Diet only- This takes longer than the other three options, but is by far the least invasive and most natural method. The recommended diet is the Specific Carbohydrate Diet (SCD), which works by eliminating complex carbohydrates, lactose, sucrose and other man made ingredients from the digestive process. You are therefor starving the bacteria in the small intestine. While the diet can be intimidating and challenging to follow through on for many people, there are many support groups and recipe blogs available to provide guidance and support for its followers. If you’re not feeling some relief from diet alone within a month, consider including another treatment method. It is important to remember that there are also many variations of the diet, such as some people including the low FODmap diet, and it is critical for everyone to be aware of what does and doesn’t work for them. Some general pitfalls to be aware of are having too many carbs (even vegetables and fruit), honey, nuts, beans, probiotics, and including FODmaps just because they’re all “SCD diet legal”.
What to expect from die off:
Die off symptoms can occur with any treatment option, although sometimes they are less dramatic when using Rifaximin. As bacteria dies, they release things that were in our bodies such as gas, endotoxins, or acids. The die off symptoms are usually more dramatic when your diet change is more drastic. It usually lasts for about 3 days to a week. The symptoms can be a worsening of normal symptoms or flu or cold like symptoms. Having low blood sugar can also aggravate the symptoms.
SIBO is usually a part of another issue.. Some believe that IBS and SIBO are always connected. Dr. Siebecker shared that SIBO has been shown to exist in up to 84% of IBS patients!
Following the SCD can be a wonderful long term way to prevent SIBO. While diet is crucial, it’s also important to address other possible underlying causes of SIBO such as the migrating motor complex (this causes the fasting movement of the small intestine which is needed to maintain a healthy small intestine) and hydrochloric acid in the stomach (along with other enzymes to help us digest our food completely). There are prescriptive agents that are used to stimulate the migrating motor complex. There are only two left on the market today, which are azithromycin and erythromycin. These are usually known as antibiotics, but in this case they are used in extremely low levels, not making it an antibiotic. Natural ways to work on your migrating motor complex are acupuncture specifically for stomach paralysis, and certain probiotics (lactobacillus acidophilus is the recommended probiotic to start with). Some probiotics can aggravate symptoms, so back off if that’s the case. If you are going to go the probiotic this route, take the probiotic before bed, as rest and fasting is when the migrating motor complex works best. Keeping your meals separated by about 3-5 hours is helpful as well, so that the migrating motor complex can work while you’re fasting. It’s also important to understand that peristalsis out of the duodenum (from the migrating motor complex) requires a parasympathetic state, or “rest and digest”. One must be relaxed and undistracted for proper movement. If the vagus nerve is damaged at all (such as from whiplash from a car accident), it is difficult to be able to ever be in a parasympathetic state.
SCD Lifestyle Sweet & Spicy Pumpkin Chili
I made my first SCD friendly meal tonight (although I’m sure many of my recipes are by accident) and I’m so excited to have yet another chili recipe to proudly serve at a chili cook off.
And even though I had three bowls (yes, you read that right) and Brian had one of as many meat chunks as he could find (it’s maybe not for people who dislike tomatoes), there were plenty of leftovers!
If you have any experience with SIBO, please share your thoughts!
SCDLifestyle.com *a lot of the information on this post is from ‘SCD podcast 25’, an interview with leading expert Dr. Siebecker.