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.
What is SIBO?
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.
Risk factors and causes of SIBO
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
- Illnesses that slow food movement through the small intestine
SIBO and IBS
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
- Uncomfortable feeling of fullness after eating
- Chronic diarrhea or constipation
- Rapid, unintentional weight loss
Underlying risk factors
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.
The potential consequence of untreated SIBO
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.
Functional medicine treatment
Probiotics are live microorganisms that can reduce SIBO symptoms when taken in sufficient quantities. They modulate gut microbiota, sustain the intestinal epithelium’s integrity, up-regulate anti-inflammatory cytokines and growth factors, and produce fatty acids and regular endocrine and neurological functions.
Herbal supplements intended for SIBO relief have become increasingly popular as patients look for an alternative to antibiotics.
Dietary changes may help relieve SIBO symptoms like bloating, flatulence, and abdominal pain.
Nutritional support, especially in patients with weight loss or vitamin and mineral deficiencies, is an essential component of SIBO treatment.
Lifestyle and prevention
SIBO prevalence increases with age and the risk increases by 50% in people over 75. One study found 33% of disabled older adults and 15.6% of older, non-hospitalized adults had SIBO. Medications that slow GI motility, the onset of new diseases, dietary changes, and changes in gut immune function likely play a role in older adults developing SIBO.
A 2018 study found that patients suffering from weight issues were 11 times more likely to have SIBO than other patients, but more research is needed to understand the link
Manage gut health
Prevention of SIBO may not always be possible due to the underlying causes. However, there are ways to manage gut health.
- Diet: eating a wide range of food can help boost gut flora diversity, reducing the possibility of dysbiosis – the microbiome becoming imbalanced. Fruits, vegetables, and whole grains are recommended.
- Stop smoking: nicotine products can change the composition of the gut flora, which may cause dysbiosis.
- Prokinetics are a drug that promotes digestive motility and may reduce the risk of SIBO. A 2018 study found that patients who took prokinetics and proton pump inhibitors (PPI) were less likely to develop SIBO than those who only took PPI.
- Treating hypochlorhydria, or low stomach acid, may reduce the risk of developing SIBO.
- Managing other conditions associated with SIBO may help relieve their impact on the digestive system.
Healthy eating and lifestyle
Focusing on healthy eating and lifestyle habits benefits everyone’s gut, not just those with SIBO. We would be privileged to help you discover what is causing your symptoms, develop a plan to treat the root causes, and come alongside you to implement healthier eating patterns and lifestyle habits to improve your health.
The future of healthcare
Even at Bion Aesthetics and Med Spa, we understand the importance and impact root cause medicine offers our clients. The future of healthcare, the way we look at it at Bion Aesthetics and Med Spa, falls under the premise that more people are interested in rediscovering what total wellness feels like. Through our personalized medical approach we can help our clients reach that wellness level.