Have you heard of SIBO?
It stands for Small intestinal bacterial overgrowth. Learning about this disease and its treatment has revolutionized the way I treat digestive health concerns.
When someone presents in my office with digestive complaints, big or small, I follow a fairly straight forward plan—identify any food sensitivities, heal the gut and reintroduce the offending foods to reassess their tolerability. For most of my patients, this has unequivocally improved not only their digestion, but their quality of life. There are, however, two types of patients that this approach hasn’t been enough for. Either they see almost no improvement from removing foods, or they do, but are so sensitive, that even the tiniest cheat sends them into gastrointestinal distress. For some patients we try a different type of diet, for some we look at other factors like stress or environmental toxicity. But, there have always been some that I just can’t seem to help.
Enter my education on SIBO. Here’s my basic spiel:
Generally, the small intestine has very few bacteria it (vs the large intestine which has tons and tons of bacteria.) There is component of the digestive system called the Migrating Motor Complex (MMC) that acts as a broom and sweeps the small intestine clear. However, the MMC can be damaged, and if it is, bacteria build up exactly where they shouldn’t be. Those bacteria then gorge on the fibre that is present in the small intestine. Bacteria Party Central. The byproduct of this feast is gas and toxins, causing many digestive symptoms, including: heartburn, bloating, nausea, burping, cramping, diarrhea and/or constipation. Sounds a lot like IBS, doesn’t it? Studies have shown that up to 75% of IBS cases can be attributed to SIBO. SIBO can cause other symptoms too, like rosacea, and B12 and iron deficiencies.
How do we know if a patient has SIBO? Since the symptoms of SIBO can be similar to other digestive problems, the best way to diagnose it is with a breath test—specifically a 3-hour lactulose breath test. What this entails is a 24 hour prep diet (to stop feeding the bacteria), a baseline breath test, drinking a serving of lactulose (bacteria’s favourite sugar) and then 10 additional breath tests, one every 20 minutes, to monitor for any change in the gases produced. Different kind of bacteria create different types of gas when they ingest lactulose. Looking at which gases are present, at what levels and when, lets us identify if and where SIBO is present (where because the small intestine is loooong.)
Here is a typical positive test. You can see that post prep diet the hydrogen producing bacterial are very low. The lactulose solution is drunk just after the first sample. See how the numbers increase, decrease, increase and decrease again—this show that the level of bacteria changes throughout the small intestine. The methane producing bacteria are much lower, but any reading over 3 is taken into consideration.
How is SIBO treated? Aggressively. We use herbs, supplements and sometimes antibiotics to kill the bacteria. And we switch up the protocol regularly—bacteria are adaptive little suckers and we don’t want to give them the chance to become resistant to the treatment. Once we feel that most of the bacteria are eradicated, we work on rebuilding and healing the rest of the digestive system—including the MMC. When the bacteria have been dealt with and the gut healed, patients can often go back to eating many of the foods that they had previously eliminated and remain symptom free.
How long does SIBO treatment take? Honestly, this is a tough one to answer because it is so variable. There are patients that respond to the eradication phase after only two weeks, though four or six is more typical, and I’ve treated patients that need much longer. Generally the rebuilding phase is about six weeks.
Can SIBO return? Unfortunately, it can. Some people just seem to have weak MMC systems. Completing the entire treatment definitely helps prevent this. As does continuing to check in on your health and symptoms. For patients who are susceptible, doing a round of anti-bacterial herbs after food poisoning or the stomach flu is a good idea. Or, continuing to focus on the MMC during periods of high stress or after a concussion. Once you become the expert on your own digestive system you can stop the SIBO chain of events before they get out of hand.
Does everyone have SIBO? No. At least I don’t think so. I certainly don’t test everyone for it. For new patients with digestive concerns, I still stick to the plan I outlined at the top. And this is still one of my most successful plans. However, there are a few red flags that might make me think SIBO even before looking at food sensitivities.
Have you seen people get better after SIBO treatment? YES!! I’ve had patients that have suffered with symptoms for years, return to normal bowel health/function and eat foods they hadn’t been able to eat in ages.
The treatment of SIBO is one of many under my naturopathic umbrella. However, the more I learn about it and the more positive results I see in my patients after treating it, the more excited I get about this specific tool. If you are interested in knowing more and SIBO, its testing and/or treatment, don’t hesitate to get in touch.