Are Your Gut Issues Due to SIBO?

Small intestinal bacteria overgrowth (SIBO) is a common but under-diagnosed condition. Historically viewed as a controversial diagnosis, it has recently gained support as a viable explanation for gastrointestinal problems. Although antibiotics remain the most common treatment method for SIBO, functional medicine’s holistic approach is gaining popularity.

SIBO is a gastrointestinal disorder characterized by an excess and imbalance of bacteria in the small intestine. Unlike the large intestine, the small intestine normally contains few bacteria. This is due to the rapid movement of food and the presence of bile. However, if the passage of food and waste products in the small intestine slows, bacterial overgrowth may occur. Consequently this produces toxins and gas, and interferes with the absorption of nutrients. This causes chronic bloating, constipation, diarrhea, and other symptoms.

It is unknown how prevalent SIBO is because it is thought to be under-diagnosed or attributed to an underlying disease. Its presence is extremely common in several predisposing conditions. In fact, research suggests that up to 25% of patients with Crohn’s disease also have SIBO. Further, one-fifth of those with celiac disease do as well. Other autoimmune diseases that can cause SIBO, include:

• Chronic stress
• Vagal nerve dysfunction
• Gastroparesis
• Diabetes
• Illnesses that slow food movement through the small intestine

Notably, SIBO is present in over half of patients with irritable bowel syndrome (IBS) and is associated with symptom exacerbation of this condition. However, some trials report a significant improvement in IBS after treatment of SIBO.

SIBO may also be caused by abdominal surgery complications or structural problems in or around the small intestine.

SIBO may be asymptomatic or, in extreme cases, cause malabsorption. Other symptoms may include:

• Loss of appetite
• Abdominal pain
• Nausea
• Bloating
• Uncomfortable feeling of fullness after eating
• Chronic diarrhea or constipation
• Rapid, unintentional weight loss
• Malnutrition

It is important to note that the American College of Gastroenterology (ACG) states that no single symptom can be attributed explicitly to SIBO. This is because symptoms often masquerade as other diagnoses. The ACG explains that this is due to the varied presentation of patients with SIBO and the number of underlying risk factors that can lead to its development. For example, in a patient with chronic pancreatitis, it is hard to determine if diarrhea is caused by an exocrine insufficiency or coexisting SIBO. Therefore, the ACG recommends that the symptoms, risk factors, and any history of attempted treatments for underlying conditions all be considered.

If SIBO is left untreated, a variety of medical consequences may occur. The excess bacteria break down bile salts – an essential component needed to digest fats – resulting in the poor absorption of fats, carbohydrates, and proteins. Due to the incomplete absorption of fats, the body cannot fully absorb fat-soluble vitamins A, D, E, and K, leading to vitamin deficiency. The bacteria also use vitamin B-12, which is needed for nervous system functioning and blood cell and DNA production. Vitamin B-12 deficiency can cause fatigue and tingling and numbness in the hands and feet. The continued presence of SIBO may limit calcium absorption, eventually leading to osteoporosis and kidney stones.

Probiotics

Herbal Supplements

Herbal supplements intended for SIBO relief have become increasingly popular as patients look for an alternative to antibiotics.

Diet

Dietary changes may help relieve SIBO symptoms like bloating, flatulence, and abdominal pain.

Supplements

Nutritional support, especially in patients with weight loss or vitamin and mineral deficiencies, is an essential component of SIBO treatment.