Dr Hagmeyer explains exactly what you need to know If you suspect Small Intestinal Bacterial Overgrowth (SIBO)- A Common Problem with IBS Sufferers
Have you ever just finished eating and start to feel so bloated that it feels like a struggle just to keep your pants buckled? Patients often tell me about how they wake up with a normal feeling belly, but by the time they finish a meal, they feel like they just gulped down a balloon from the Thanksgiving parade. Perhaps your experiencing embarrassing diarrhea that causes you to have to map out where the nearest restroom is.
Regardless of the symptoms, If you’re having gas, bloating, cramping, diarrhea regularly, you could have food sensitivities and/or a gut infection, such as SIBO. (Small Intestinal Bacterial Overgrowth)
What is SIBO?
Small intestinal bacterial overgrowth (SIBO) is pretty much what you’d expect from that name. Bacteria in the gut can be a good thing, but SIBO occurs when bacteria in the gut get out of balance and overgrow.
How Do We End Up With Certain Bacteria Overgrowing Others?
This can manifest in several different ways, and often occurs in those eating a diet high in sugar, alcohol and refined carbohydrates. Certain strains of bacteria strive in an environment that provides refined carbohydrates, breaking them down into short-chain fatty acids, which creates gas and causes bloating.
Another strain of bacteria can break down bile salts before your body has a chance to use them. The body uses bile salts to breakdown fats; without them, the result is fat malabsorption or diarrhea.
A third type of bacteria can produce toxins that damage the lining of the small intestine. This inhibits your body from absorbing necessary nutrients, similar to the results of a leaky gut.
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What Causes The Bacterial Overgrowth?
Food digestion is a collective effort within the gut, relying on nerves, muscles, enzymes, and neurotransmitters to create an effective process. The main role of the enzymes is to break down our food, while the nerves, muscles and neurotransmitters physically move the food through our digestive tract from the stomach, to the small intestine, and to the colon. In a healthy gut, bacteria, along with food, are passed through the digestive tract to its final destination in the colon. Complications happen when something interferes with that process.
When nerves or muscles in the gut are damaged, as can happen with autoimmune diseases, diabetes mellitus, scleroderma, Fibromyalgia, excess sugar, low stomach acid. The resulting leftover bacteria can fester in the small intestine and begin to take over. This creates an environment in the gut SIBO develops. Given that IBS is the number one gastrointestinal diagnosis, bacterial overgrowth could be underdiagnosed.
A study by researchers at Cedars-Sinai Medical Center in California examined 202 people who met the diagnostic criteria for irritable bowel syndrome and gave them a test for bacterial overgrowth called the lactulose hydrogen test.
Researchers found that 157 of the 202 people (78%) had bacterial overgrowth. When the unwanted intestinal bacteria were eradicated, symptoms of IBS improved in 48% of the subjects, particularly diarrhea and abdominal pain.
It’s not just people with IBS-like symptoms that have bacterial overgrowth. Bacterial overgrowth can also present with non-digestive symptoms such as fatigue. It’s believed to be involved in chronic fatigue syndrome, fibromyalgia, allergies, arthritis, lupus, autoimmune diseases, diabetes, and many other chronic conditions.
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Another issue that I have noticed to be quite common among my IBS patients is an overgrowth of Candida or yeast.
Physical obstructions in the gut, for instance scarring from surgeries or aggravation from Crohn’s disease, can cause an irregular accumulation of bacteria in the small intestine. Diverticuli, which are little pockets that can form on the wall of the intestine, can accumulate bacteria rather than correctly passing it on to the colon.
Some medications can also impact or upset the normal bacterial environment of the gut. Medications that can have this effect include antibiotics, acid-blocking drugs, and steroids. While medications like these can impact the flora of the gut, make no mistake, the most common cause I see, as agreed upon in my functional medicine clinic, is from a diet high in sugar, leaky gut, thyroid imbalances, refined carbohydrates, and alcohol.
10 Warning Signs Of Small Intestinal Bacterial Overgrowth (SIBO)
1. Gas
2. Bloating
3. Diarrhea
4. Abdominal pain or cramping
5. Constipation (much less common than diarrhea)
6. Diagnosis of irritable bowel syndrome or inflammatory bowel disease
7. Food intolerances such as gluten, casein, lactose, fructose and more
8. Chronic illnesses such as fibromyalgia, chronic fatigue syndrome, diabetes, neuromuscular disorders and autoimmune diseases.
9. B12 deficiency, Iron Anemia, as well as other vitamins and minerals
10. Fat malabsorption
Testing Methods for SIBO
Breath Test: As far as testing for SIBO goes, this is the most accurate method, but it can be quite cumbersome. A breath test includes a need to fast for 12 hours before breathing into a small balloon, ingesting a precise amount of sugar, and repeating breath samples every 15 minutes for 3 or more hours. Abnormal breath tests can also signify pancreatic insufficiency and celiac disease.
Organix Dysbiosis Test: In this test, a lab tests a urine sample for by-products of yeast or bacteria in the small intestine. If the small intestine has a yeast or bacterial overgrowth, byproducts will appear in the urine. This test is much easier for patients than the breath test and requires only a single urine specimen. This is the test I prefer to use most often to diagnose my patients.
Comprehensive Stool Test: Like organix dysbiosis, this is a functional medicine lab test. As the name would suggest, a stool sample is observed for analysis of the flora of the large intestines. If I observe all elevated levels of good bacteria, SIBO is the primary suspect. Learn more about Comprehensive stool testing.
How to Effectively Treat SIBO
Usually, traditional medicine would have SIBO treated with an antibiotic called Xifaxan. Xifaxan does not get absorbed throughout the body very well, so it tends to stay in the digestive tract, allowing it to focus its work against SIBO. However my studies have shown that antibiotics are often the root cause of why so many IBS sufferers have SIBO to begin with. I like to follow the approach that addresses why the infection is there in the first place. This is part of the reason I created a 5 video E course Free For people who suspect they have SIBO.
I learned many years ago, “Rats don’t cause garbage, they are attracted to the garbage”. To expand on this analogy, the bacteria in the gut is analogous to the rats, while the antibiotic is like the rat poison. However, as long as we have garbage, rats will be attracted to it.
So, even after the existing rats are gone, others arrive and the problem persists. The real solution is to clean up the trash.
Many patients with SIBO also have additional problems like yeast overgrowth, parasites, mold, food sensitivities, leaky gut, LPS bacteria, and low levels of good anaerobe bacteria.
My clinical experiences and studies lead me to believe that the antibiotics commonly used for people who have SIBO are inviting future infections within 6-12 months. That is, if a more restorative protocol is not followed.
It has been my practice to place patients with SIBO on a low carbohydrate diet, free of refined flours, grains, nuts, seeds, beans, sugars and alcohol. I also prescribe a customized combination of natural antibacterial, antifungals, anti-yeast, and antiviral for a minimum of 90-120 days while we wait for more diagnostic testing to come back to the office.
Similar to Candida overgrowth, those who are susceptible to SIBO may have reoccurrence after treatment. It is advised to adopt a long-term diet that is low in carbohydrates and especially refined carbohydrates.
The Personal Program For People with Yeast, SIBO, IBS, Crohn’s, Celiac is a Natural Treatment Approach geared towards individuals with GI related problems.
Our office utilizes nutritional supplements, Dietary modifications, Nutritional Counseling, Advanced Testing, Hormone and endocrine support formula, and lifestyle guidance.
Our Personal IBS and SIBO Recovery Program Is A Great place To Start
- To Schedule a Free 15 minute Phone Consult to see if this program is right for you Fill out our online questionnaire.
- If you’re ready to get started and schedule an appointment take a moment and fill out our contact us form and in the comment box let us know what time of the day works best to contact you. One of our New Patient Coordinators will contact you with the next available new patient opening within 24-48 hours.
- Still have questions? Our Free 15 minute personalized Phone consult is a great place to start.
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