SIBO

WHAT IS SIBO

The majority of our gut bacteria should be in the colon (aka large intestine), where they have a very positive effect on our health.

However, various factors (we will get to that in a minute) can cause the bacteria to overgrow into the small intestine — where they should normally be present in fairly small amounts— causing IBS-like symptoms such as diarrhea, constipation, gas, reflux and/or bloating.

In other words, SIBO is like a chronic infection in your gut. It is not that the bacteria overgrowing are pathogenic (causing disease like E. coli or Salmonella) but too many of them in the wrong location (small intestines vs large intestines) is a problem.

* Candida/yeast can also overgrow in the small intestine, which is known as SIFO. Read more about SIFO here.

SYMPTOMS OF SIBO

  • Diarrhoea
  • Constipation
  • Alternating Diarrhoea and constipation
  • Abdominal cramping
  • Bloating and/or wind
  • Burping and Acid reflux
  • Food sensitivity
  • Joint pain
  • Skin rashes
  • Iron and B12 deficiency

WHAT CAUSES THE SYMPTOMS OF SIBO

The bacteria are not supposed to be present in high number in the small intestine and when they are, they cause a number of problems.

  • They damage the microvilli — the absorptive surface of the small intestine — which interferes with our normal digestion and absorption of food. Research shows that SIBO is a major cause of intestinal permeability (aka Leaky Gut). Leaky gut can cause a wide variety of symptoms, such as restless leg syndrome, fatigue, skin rashes, muscle and joint pain and can even lead to auto-immune conditions. Read more about Leaky Gut here.
  • When we eat certain foods (especially those high in FODMAPs), they are fermented by the gut bacteria, producing gas within our small intestine. The gas can cause abdominal bloating and pain, constipation, diarrhea or both. Excess gas can also cause acid reflux (from the excess pressure in the stomach), belching and flatulence.
  • The gas produced by the bacteria / archea can affect the motility in our gut, leading to either diarrhea or constipation. The 2 main gases produced are hydrogen (bacteria) and methane (archae). Typically, hydrogen gas causes diarrhea and methane causes constipation... although it's not always that clear cut!
  • The bacteria can consume some of our food which over time leads to deficiencies in their favorite nutrients such as iron and B12, causing anemia.
  • They can decrease proper fat absorption — by deconjugating bile — leading to deficiencies of vitamins A & D and potentially fatty stools.
  • Bacteria themselves can also enter the body/bloodstream. Immune system reaction to bacteria and their cell walls (endotoxin or LPS) causes chronic fatigue and body pain and burdens the liver.
  • Finally, the bacteria excrete acids which in high amounts can cause neurological and cognitive symptoms.

DO YOU HAVE SIBO?

SIBO is very common and knowing if you have it can make a difference in your long term treatment plan.

We recommend doing the quiz below to help you determine if you might have SIBO.

CAUSES OF SIBO

So, you did the quiz, you think you might have SIBO and now you wonder… WHY?

Note: Most of our clients diagnosed with SIBO don’t actually recall any specific events that would have led to it, so even if you don’t think you fit in the below ’causes’, it doesn’t mean you don’t have SIBO. Many of our clients believe they have had it since childhood.

  • Post infectious: a case of gastroenteritis can often be the “heralding event” for the development of SIBO and is believed to be the #1 cause of SIBO. In this case, what actually happens is a type of auto-immune reaction (via anti-vinculin antibodies) where your immune system attacks the small intestine (by mistake!), leading to the disruption of epithelial tight junction proteins and damaging nerve cells. This damage to the nerve cells will eventually lead to a dysfunction of the migrating motor complex, your small intestine 'cleaning' system, and an accumulation of bacteria. Symptoms of SIBO can become apparent immediately after, or many months later.
  • Over-consumption of simple carbohydrates (refined sugar, white flours, processed food, grains)
  • Medications: proton pump inhibitors (very often prescribed for reflux/ GERD), morphine and other opiates, narcotics, possibly beta agonists and calcium channel blockers
    • Stress: chronic stress can decrease stomach acid output. Normal stomach acid levels are required to kill bacteria. Stress also causes change in the motility of the small intestines, causing a pooling and stagnation which allows for bacterial overgrowth. Many of our clients recall a stressful periods before the start of their gut issues… do you?
  • Altered anatomy: malformation/dysfunction of the ileo-cecal valve (which separates the small and large intestine), surgical intervention causing scarring and adhesions altering the normal anatomy of the small intestines. Learn how to find and massage your ileo-cecal valve in the Belly Massage 2.
  • Dysbiosis: An imbalance of gut bacteria. Read more about dysbiosis here.
  • Traumatic brain injury (TBI): This can be anything causing a head or spinal injury, such as a horse riding, bike or car accident, a sport injury — especially if causing a concussion— or a fall on your coccyx or tailbone.
  • Slowing down/damage to the Migrating Motor Complex (MMC): as mentioned above, post-infectious SIBO is caused by a dysfunction of the MMC. However, the MMC can also be affected by stress, trauma, TBI and anything that impacts the vagus nerve, eventually leading to SIBO.

DIAGNOSIS

SIBO is usually diagnosed with a 3-hour breath test, using a sugar solution of either lactulose (not to be confused with the lactose breath test, which is commonly ordered by GPs to rule out dairy intolerance) or glucose.

We recommend doing a lactulose breath test.

The breath test is a simple, non-invasive test. The test can be performed at home or at a lab. In most countries, you can order the test yourself without a prescription from a doctor, although it is recommended to be under the care of a practitioner (like Gen & Leisa) for test interpretation and treatment.


Recommended Labs offering direct patient order:

Australia (also ships internationally). Select 'Nourishing Therapies' when asked for your practitioner's details.

UK

USA (except NY)

New-York

Canada

After a 24-hour preparatory diet, the lactulose or glucose test substrate is swallowed, and then gas production is measured every 20 minutes for 3 hours.

The sugar solution is not absorbed and therefore acts as a food source for bacteria, if present, in the small intestine.

The bacteria ferments the testing substrate and produce hydrogen and/or methane. These are exhaled via the breath. A high amount of either methane (usually associated with constipation) or hydrogen (usually associated with diarrhoea) indicates SIBO.

* Candida/yeast can also overgrow in the small intestine, which is known as SIFO. SIFO will NOT show on a breath test. If you have all the symptoms of SIBO but your test comes back negative, you may have SIFO. Read more about SIFO here.

TREATMENT OF SIBO

SIBO is a complex condition and its successful treatment involves finding the root cause.

Here's the good news:

Following the recommendations and protocols in the Happy Gut At-Program (from Phase 1 to Maintenance) will cover the most common root causes we see in our clients.

We have also included extra tips specific to SIBO in the 'Personalise Your Protocol' section in Phase 2 - The Big Clean Up: Supplements & Protocols.

When treating SIBO, everything counts... it's not just about killing the bugs!!

A FEW IMPORTANT STEPS THAT ARE OFTEN MISSED:

Addressing structural issues: The belly massage and yoga sequences will help a lot here.. don't skip those. We also recommend reading the section 'Getting to Know Your Psoas'.

Stress, trauma and emotions: Do everything you can to lead a low stress lifestyle. Eliminate key stressors in your life and create a personalised zen tool kit - a list of strategies that you know will induce a relaxed state where you feel calm, centred and at peace. We have provided you with many tools in the 'Light Up Your Spirit' sections in each Phase of the program. Try them all and see what works for you.

Stimulating the migrating motor complex: Most people with SIBO have a dysfunction of the migrating motor complex (MMC) — the small intestine's cleaning system. This is why it's recommended to take a prokinetic for at least 3 months after you have finished treating with anti-microbials. You can find a list of prokinetic options here. This will prevent SIBO from re-occuring, which unfortunately is very common... but less so if taking a prokinetic and addressing other issues mentioned above. Another important fact is that the MMC is active in between meals, when the small intestine is empty. This means that if you snack constantly, your small intestine will never be cleaned, allowing bacteria to accumulate, and more fermentation to occur. Once you have balanced your blood sugar, try to leave a good 3-4 hours between meals... a good way to know that it's been cleaned up is if you hear a bit of rumbling in your tummy! Many people with SIBO have great success with intermittent fasting.

Transcutaneous Auricular Vagus Nerve Stimulation can help stimulate the migrating motor complex and reduce the effect of stress and trauma!

Learn more about Vagus Nerve Stimulation here.

Complete and Continue