Gut issues are very common in our modern population and according to the Gut Foundation, at least 50% of our population complains of a digestive complaint in any twelve month period. In many respects the health of our gut dictates or reflects the health of our overall body, so sorting out gut issues is very important – to help with everything from mental health to immunity and energy levels.
Small intestinal bacterial overgrowth (SIBO) is a relatively new digestive disorder on the radar and appears to have increasing prevalence. SIBO is a condition with strong links to irritable bowel syndrome (IBS). Based on some studies, it is estimated that at least 80% of people with irritable bowel syndrome in fact have SIBO.
So before we dive into look at testing, diagnosing and treating SIBO, lets take a look at the backdrop to the digestive landscape and get the lay of the land.
The digestive tract mostly comprises of the mouth/oesophagus, the stomach, the small intestine and large intestine or colon and (indirectly the liver, gallbladder and pancreas). Its primary role is to process and breakdown food so that we can use the nutrients for growth, development, repairs and maintenance of our body.
Most of us are aware by now that we need healthy flora (also called the microbiome) in our digestive tract for maintaining health. But the types and location of bacteria in the digestive tract can make the difference between health and disease. For example the bacteria, Helicobacter pylori, in the stomach can contribute to ulcers, while lactobacilli bacteria promote health in the bowel. The small intestine, unlike the large intestine, has only small amounts of bacteria present. The large intestine has approximately one million times more bacteria than the small intestine, and the types and functions of the bacteria in the small intestine differ in some ways to the large.
The small intestine and the bacteria present play an important role in digesting food and absorbing nutrients, protect us from absorbing damaging bacteria or yeasts from our food and thus plays an important part in maintaining a healthy immune system.
So SIBO refers to a condition where the amount of bacteria in the small intestine increases or changes in type and composition. This gives rise to a whole set of symptoms. The bacteria ferment carbohydrates and produce gases such as hydrogen and methane which in turn contribute to symptoms such as bloating after meals, burping and wind, constipation or diarrhea, cramping and nausea. Less obvious symptoms can be experienced outside the digestive tract and show up throughout the body, as nutrient levels are affected, the gut is inflamed and immunity is impaired. Particular conditions which have a strong link to SIBO include food intolerance, allergies, acne rosacea, arthritis, restless legs, liver disease, diabetes, depression and even Parkinson’s Disease has been found to be linked to SIBO.
A range of possible causes have been linked to the development of SIBO. These include prior antibiotic use, previous episodes of food poisoning, viral or bacterial gut bugs, acute or prolonged stress, the oral contraceptive pill, antacid medications, nutrient deficiencies and underlying diseases such as coeliac disease or other autoimmune diseases.
To test for SIBO, a simple home test kit measuring breath gases is an accurate way of identifying bacteria in the small intestine. The sugar lactulose is used after a period of fasting and the gases are collected every 20 mins and can determine if there was a rise. It takes around 2 hours for lactulose to enter the large intestine, so any gases produced from fermenting are the product of the small intestine. If there is a high baseline or a rise in gases during the test period, then a diagnosis of SIBO is likely. The test is not covered under medicare and costs around $200. (I use sibotest.com for the SIBO lactulose breath test.)
Treatment involves a combination of dietary change and antimicrobial treatments to both starve and kill the bacteria present.
The FODMAPs diet is often recommended for irritable bowel syndrome and it is thought that the fermentable sugars and carbohydrates contained in these foods are the problem. Avoiding these foods will certainly eliminate or reduce digestive discomfort in many people with IBS. However, when they eat those foods again, the bloating, constipation or diarrhoea often returns. It appears that there is still an underlying cause not being addressed and in my opinion in most cases it is SIBO. The diet alone doesn’t always deal with the bacterial imbalance, although avoiding the foods that the bacteria feed on is a very important part of treatment. The diet to follow during active the SIBO treatment phase is one that is very low in carbohydrates, starches, sugars and dairy to eliminate food supply for the bacteria.
Antimicrobials to kill the abnormal bacteria are also necessary. These can be conventional antibiotics or herbal therapies. These options have been shown to be equally successful for treatment of SIBO. Herbal antibiotic therapies normally combine a range of different herbs such as wormwood, berberine containing herbs, garlic and certain essential oils. They are rotated over a 2 week period in many cases to reduce the risk of antibiotic resistance. Holistic strategies always include a follow-up phase after active antibiotic treatments. This involves specific probiotics to restore the gut flora, gut repair strategies to help heal the lining of the digestive tract and motility agents.
If you suffer from digestive disturbances such as irritable bowel or inflammatory bowel disease and suspect you have SIBO, then please make an appointment to assess your options. Restoring the health of your gut will improve your health in many diverse ways!