Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine and the types of bacteria in the small intestine more closely resemble the bacteria of the colon. Unlike the colon (or large bowel), which is rich with bacteria, the small intestine usually has much less bacterial organisms per milliliter of fluid. Also, the types of bacteria within the small intestine are different than the types of bacteria within the colon. Ordinarily bacteria are moved out of the small intestine into the colon via peristalsis and the ileocecal valve prevents movement of bacteria from the colon back into the small intestine. However, disruptions in intestinal motility or physical disturbances inhibit this natural defensive pattern and bacteria begin to accumulate in the small intestine.
SIBO is associated with irritable bowel syndrome and chronic fatigue syndrome. Flora overgrowth may break down bile acids, necessary for absorption of fats, thus reducing absorption of fats and fat-soluble vitamins A, D and E. In severe cases, bacteria may damage the small intestinal wall thus impairing carbohydrate and protein absorption resulting in malnutrition. Anemia may also develop, when bacteria interfere with B12 reabsorption.
Possible causes of SIBO:
- Post infectious: a case of gastroenteritis can often be the “heralding event” for the development of SIBO
- Over consumption of simple carbohydrates
- Medications: proton pump inhibitors, morphine and other opiates, narcotics, possibly beta agonists and calcium channel blockers
- Stress: chronic stress can decrease stomach acid output (hypochlorhydria). Normal stomach acid levels are required to kill bacteria.
- Stress also causes changes in the motility of the small intestines, causing a pooling and stagnation which allows for bacterial overgrowth
- Altered anatomy: malformation of the ileocecal valve, surgical intervention causing scarring and adhesions altering the normal anatomy of the small intestines
- Initial colonization of bad bacteria: caesarean birth, no breast feeding
Signs and Symptoms
Common signs and symptoms of SIBO include the following:
- Diarrhoea or alternating constipation and diarrhoea
- Abdominal cramping
- Bloating and/or wind
- Burping and Acid Reflux/GORD
- Food sensitivities
- Joint pain
- Skin rashes
- Iron and B12 deficiency
- Respiratory symptoms such as asthma
Testing and Treatment
The natural treatment of SIBO is an evolving field. The currently most effective natural treatment strategy consist of a combination of herbs, nutrients and a diet that mainly restricts the intake of high fibre carbohydrates. This diet is a combination of the low FODMAPS Diet and the Specific Carbohydrate Diet (SCD). This treatment has been found to be as effective as taking antibiotics.
Breath testing for SIBO see link – https://sibotest.com/pages/about-the-sibo-breath-test