What is SIBO?
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine and the wrong types of bacteria in the small intestine, which begin to more closely resemble the bacteria of the large intestine. Unlike the large intestine, which is rich with bacteria, the small bowel usually has a lot less and different types of bacteria. In a healthy person, bacteria are moved out of the small bowel into the large bowel via intestinal muscle contractions and a valve prevents movement of bacteria from the colon back into the small intestine. However, disruptions can inhibit this natural defensive pattern and bacteria begin to accumulate in the small intestine.
SIBO is associated with irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS). Bacterial overgrowth may break down bile acids, which are needed for fat digestion, thus reducing absorption of fats and fat-soluble vitamins A, D and E and the metabolism of other hormones. In severe cases, bacteria may damage small intestinal wall impairing carbohydrate and protein absorption resulting in malnutrition. Anaemia may also develop, when bacteria interfere with B12 reabsorption.
SIBO may include all or some of the following symptoms
Testing for SIBO is an option
Hydrogen breath tests - Breath tests have been developed to test for bacterial overgrowth, based on bacterial metabolism of carbohydrates to hydrogen. The hydrogen breath test involves giving patients a load of carbohydrate (usually in the form of rice) and measuring expired hydrogen concentrations after a certain time.
Bacterial culture - Bacterial culture is now seldom used due to the invasiveness of endoscopy, contamination of the endoscope and catheter, inaccurate sampling and because many bacterial species do not grow in routine culture media and quantitative culture may underestimate the bacterial population. Furthermore, due to the location of the small intestine it is not easily accessible to obtain a sample.
D-xylose - The D-xylose test involves having a patient to drink a certain quantity of D-xylose, and measuring levels in the urine and blood; if there is no evidence of D-xylose in the urine and blood, it suggests that the small bowel is not absorbing properly which is often an indicator for SIBO.
Small bowel bacterial overgrowth syndrome is commonly treated with antibiotics, which may be given in a cyclic fashion to prevent tolerance to the antibiotics.
Alternative natural treatment options include diet and lifestyle changes and the inclusion of nutraceuticals. Diet changes may include gluten free, FODMAP diet, or an elimination diet depending on your particular profile. Supplements such as specifically selected probiotics, herbs such as, dandelion, ginger and slippery elm and digestive enzymes made from papaya and pineapple.
Regardless of which treatment you choose the condition that predisposed the small intestine to bacterial overgrowth should also be treated.