Small Intestinal Bacterial Overgrowth, or SIBO for short, is a condition that happens when our small intestine is colonized by too many harmful bacteria. In this article, we will discuss the causes of SIBO, how it affects our bodies, and how it is diagnosed. We will also explore its symptoms and what can be done to manage it.
Causes and Risk Factors
Several things can increase the chances of developing SIBO. These include:
1. Motility Disorders: Our small intestine has a special system called the migrating motor complex (MMC) that helps keep too much from bacteria building up in the digestion as it works to continually propel the contents of the stomach through and along the colon. Some people have problems with this system, making them more likely to get SIBO. Conditions like irritable bowel syndrome, diabetes, and others can affect the MMC.
2. Anatomic Disorders: Physical issues like adhesions, strictures, and diverticulosis in the small intestine can also lead to SIBO because they can slow down the movement of food and bacteria.
3. Immune Disorders: Our immune system helps keep harmful bacteria in check. If our immune system is weak it can increase the risk of SIBO.
4. Gastric Hypochlorhydria: Having low stomach acid can be a factor. This can be caused by taking certain medications or having chronic gastritis. Gastritis happens when the stomach lining becomes damaged and inflamed. This prevents the cells lining the stomach from secreting stomach acid. Gastritis itself can be caused by alcohol, stress, infections, and possibly excessive intakes of certain aggravating foods. People with gastritis may have a gnawing or burning pain in the stomach, frequent belching or hiccups.
5. Metabolic and Systemic Disorders: Conditions like pancreatic problems or liver disease can change how our body's enzymes and bile work, and may make SIBO more likely or at least appear to be associated with SIBO. Without sufficient enzyme and bile production, the body cannot break down food properly. This leaves more food in the colon for bacteria to feed off of.
Impact of SIBO on Digestion
SIBO happens when our small intestine becomes home to too many bacteria, including harmful ones. This can lead to problems like:
1. Carbohydrate Malabsorption: When bacteria break down carbohydrates in our gut, they produce gases and other substances that can cause diarrhea, bloating, and gas.
2. Fat Malabsorption: SIBO can also interfere with how we absorb fats. This can lead to greasy stools, weight loss, and a lack of fat-soluble vitamins.
3. Protein Malabsorption: SIBO can damage the lining of our intestines, making it harder to absorb proteins and leading to symptoms like diarrhea.
4. Vitamin Deficiencies: Bacteria consume the bile acids that are produced by the body. Without bile acid, the body cannot absorb fats and fat-soluble vitamins. This can lead to deficiency.
The symptoms of SIBO can vary, but they often include:
In more severe cases, people with SIBO might experience:
Steatorrhea (greasy, bulky stools)
Vitamin deficiencies, leading to symptoms like weakness, numbness, and muscle cramps
D-lactic acidosis, a rare condition that can cause confusion, seizures, and other neurological problems
Conditions Mistaken as SIBO
SIBO can have symptoms similar to other conditions, including:
1. Celiac Disease: This is a condition where your body reacts badly to gluten, a protein found in wheat and other grains. People with celiac disease can have diarrhea and other digestive problems.
2. Crohn's Disease: This is a type of inflammatory bowel disease that can cause diarrhea, stomach pain, and other symptoms.
3. Irritable Bowel Syndrome (IBS): This is a common condition that can lead to diarrhea, constipation, and abdominal pain. Some people with IBS may also have SIBO.
Evaluation for the Underlying Cause
Most people with SIBO also have an underlying condition that makes them more likely to develop it. At our clinic, our naturopaths will usually perform tests to look for these underlying causes, this includes blood testing:
For nutritional deficiencies that can lead to a weak immune system, predisposing to SIBO
To assess the function of other organs involved in digestion
For causes of low motility (migrating motor complex)
For other conditions that are often mistaken as SIBO and could be causing digestive problems
For conditions that can cause anatomical changes and may be impacting the movement of food through the digestive system (such as diverticulosis and inflammatory bowel disease)
For deficiencies that are caused by SIBO itself
Natural Therapies for SIBO
There are many different treatment options that Dr. Baker (ND) and Dr. D’Silva (ND) may consider, depending on the specific cause. There has been research completed on herbal, supplemental and dietary options that can be considered for addressing SIBO and factors underlying SIBO. Usually, treatment starts by addressing SIBO itself and reducing the total amount of bacteria in the small intestine. A 2014 study compared antibiotics to herbal therapy and found that SIBO resolved in a similar number of patients in the herbal therapy group compared to the antibiotics group. At the same time, if there is a motility issue as well, then herbal therapies may be considered to help stimulate digestion and increase movement of the digestive contents through the colon to ensure SIBO is fully resolved. Other treatments are considered depending on the characteristics of your case. Keep in mind, it is important to discuss with a health professional, such as a naturopath, before considering any therapies.