Understanding SIBO

Eating healthily, getting enough sleep, and exercising are supposed to be the key to living a long, healthy life. But in cases of SIBO, even the most effective lifestyle plan might not help.

SIBO can easily be disregarded as an uncomfortable feeling that will eventually go away. Some people may even consider over-the-counter drugs hoping it will dissipate. 

What is SIBO?

SIBO is an acronym for small intestinal bacterial overgrowth. This is described by the abnormal growth of bacteria present in the gut, specifically in the small intestine.

Most of the time, people don't usually realize that they are already experiencing SIBO. Patients can easily confuse SIBO with bloating, gas, food intolerances, and other stomach issues. So how do you know it's SIBO?

Signs and Symptoms of SIBO

Though SIBO may be easily confused with typical digestive troubles, some symptoms can help identify whether you're actually suffering from it or a completely different health problem. 

 Common SIBO Symptoms:

• Stomach pain
• Frequent and watery bowel movements
• Dizziness with the urge to vomit
• Infrequent bowel movement
• Stomach pains
• Weight loss
• Difficulty passing gas
• Bloating
• Gas

These symptoms are similar to dairy intolerance symptoms and other food sensitivities. The stomach pains may be severe in one person, while another can experience a lighter case combined with infrequent bowel movement. In more extreme cases, the small intestine may also stop absorbing nutrients from food.

SIBO also causes vitamin deficiencies. Vitamin B12 deficiency occurs from ileal mucosal damage. Vitamin B1 and B3 deficiencies occur because of bacterial overutilization.

What Causes SIBO

The etiology of small intestinal bacterial overgrowth is complicated. The body possesses many important host defense mechanisms against bacterial overgrowth. There is no single cause of SIBO. But many identified causes may trigger the body to produce too much gut bacteria.

Here are just some of them:

Longer digesting time

When we eat, the body processes the food and moves it along with muscle contractions, also known as GI motility. This movement doesn't let the food become stuck in the intestines. If the flow of food through your body slows, abnormal bacterial growth can be encouraged. This slow digestion will also limit the bacteria from moving along and exiting the body. Therefore, leading to an overgrowth of unwanted bacteria. Disorders of abnormal gastrointestinal motility account for the majority of the cases.

Altered Fluids in the Digestive Tract

The right amount of stomach acid, enzymes, and bile in the small intestine make for a working stomach. If those fluids are altered, the small intestine can be a breeding ground for bacteria.

Shorter digesting time

As opposed to the longer digesting time, food that goes through the stomach too quickly can also cause SIBO. If a food passes through your digestion too fast, it's most likely not digested/assimilated enough to absorb nutrients.

Other possible causes of SIBO are:

• Viral infection in the intestine
• Severe stress
• Certain medications

 There are also medical conditions connected to having SIBO. Though these conditions are not the actual cause of the illness, they most likely set the stage for SIBO to happen. Here are those conditions:

• Underactive thyroid glands - This condition immediately affects the production of cells in the body, including the cells present in the gastrointestinal tract. An underactive thyroid can effectively slow down the digestion and passage of food.
• Abnormal blood sugar levels - This condition can cause damage to a patient's vision, blood vessels, and kidney. But it can also cause damage to the nerves in charge of housekeeping in the guts - the process that happens after food is digested.
• Extreme stress - If the body experiences excessive stress, it enters the fight or flight state, and stomach functions becoming disrupted. Stress also affects the part of the nervous system that controls the electromechanical activity that happens between meals.
• Underlying infections - Aside from extreme stress, there can also be complications from underlying infections present in the body. A common complication related to SIBO is gut dysfunction.
• Too much estrogen - If there is too much estrogen in the body, it can inhibit the production of bile salts in the liver. Bile salts play a significant role in fighting microbial elements. Without bile salts in sufficient amounts, it can give way for bacteria to flourish.

Food to Eat If You Have SIBO

Although SIBO can be very uncomfortable, there are ways one can avoid it. For example, doctors may suggest a 4 to 5-hour break between meals.

But most of the time, the patient's diet will be limited to a few food choices that can involve the food items below. These are usually food items that are very low in sugar and high in fiber.

• Wild-caught fish
• grass-fed/pasture-raised meats
• Oatmeal
• Broccoli heads (Should be less than ¾ of a cup)
• Carrots
• Leafy green veggies
• Olives
• Summer squash
• Spaghetti squash
• Potatoes
• Few fruit species like oranges, strawberries, blueberries, and grapes
• Seeds

Food to Avoid If You Have SIBO

SIBO thrives in an environment with sugar. So you want to avoid processed foods and carbohydrate-rich foods.

 Here are some examples:

• Fructose

Fructose is the simple sugar found in most fruits. Fructose is also in sweeteners like agave honey and nectar.

• Fructan

Fructans are in fruits, some vegetables, gluten products, and prebiotics. Fructans are also a sugar compound.

• Lactose

Lactose is the sugar molecule that is commonly found in pure dairy products.

• Polyols

Polyols are sugar alcohol components that are often used as product sweeteners.

• Galactans

These are peculiar compounds found in legumes.

If you're missing these food items, you won't have to worry. Avoiding them is only temporary and will most likely last just until the bacteria overgrowth in the small intestine has calmed down. The diet can last from 2 to 6 weeks but may vary depending on what your doctor suggests.

References:

Sorathia SJ, Rivas JM. Small Intestinal Bacterial Overgrowth. [Updated 2019 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546634/

Bures, Jan et al. “Small intestinal bacterial overgrowth syndrome.” World journal of gastroenterology vol. 16,24 (2010): 2978-90. doi:10.3748/wjg.v16.i24.2978

Dukowicz, Andrew C et al. “Small intestinal bacterial overgrowth: a comprehensive review.” Gastroenterology & hepatology vol. 3,2 (2007): 112-22.