Small Intestinal Bacterial Overgrowth (SIBO)

Irritable Bowel Syndrome (IBS) is the most common reason GI disorder in the general population.  Small Intestinal Bacterial Overgrowth (SIBO) is quickly becoming recognized as the cause of up to 80% of IBS cases, according to leading researchers.  This means that, if correct, SIBO is the most common digestive disorder in the US – and one of the newest. SIBO was only recently described and studied as a gastrointestinal disorder and, as a result, is often unrecognized and untreated.  Patients are sometimes given poor advice, go through multiple tests that do not lead to a diagnosis,  or just told they have “IBS” instead of being sent for the appropriate testing that can determine the true cause of their symptoms.

Causes of SIBO

SIBO, as the name implies, is too much bacteria within the small intestine.  Normally, the small intestine has a very small amount of bacteria.  However, a number of different issues can lead to an over-abundance of bacteria including constipation, a dysfunction in the proper ‘cleansing waves’ of a normal bowel, the use of anti-acid medication, food intolerance, and food poisoning to name just a few.  These and similar conditions can cause either a migration of bacteria from the large intestine to the small intestine and/or an inability of the body to properly control bacterial levels in the small bowel.  This results in a lot of gas production as the sugars and fibers in your meals come in contact with the overgrowth of bacteria which causes bloating discomfort.

Symptoms and Related Disorders

SIBO is most commonly characterized by significant and uncomfortable bloating following most meals and generally worsens as the day progresses.  Associated symptoms can include belching, abdominal cramping, nausea, heartburn, constipation, or diarrhea.  The more that we learn about SIBO, the more we recognize that in many cases symptoms extend well beyond the gut.  These may include rosacea, headaches, fatigue, weight loss, and joint pain as SIBO can trigger an inflammatory response.  There is a growing body of evidence linking SIBO to many chronic conditions such as Anemia, Celiac Disease, Chronic Fatigue Syndrome, Fibromyalgia, Hypothyroid/ Hashimoto’s Thyroiditis, IBD (Inflammatory Bowel Disease), Leaky Gut Syndrome , Restless Leg Syndrome, Parkinson’s, and Rheumatoid Arthritis.  In many cases, we expect to see an improvement in these conditions if SIBO is present and treated appropriately.

Diagnosis of SIBO

SIBO is diagnosed through history, physical examination, and evaluation for the presence of bacteria in the small intestine by a breath test that can be done at home.

SIBO Treatment

The treatment of choice at this point focuses on antibiotics that primarily remain in the digestive tract with little systemic absorption. This has become the standard of care even among many naturopaths.  Herbal medicines are sometimes used as well to normalize intestinal contraction and regulate bile secretion.  It is possible to treat with a very aggressive herbal protocol, if that is the wish of the patient, but we have less hard evidence of long term success.  In the experience of Dr. Stadtmauer, and many other naturopaths, treatment is often enhanced by the use of various herbal medicines and probiotics. Dietary therapy is also absolutely vital to the successful treatment of SIBO long term.

Specific treatment depends on the results of the breath test used to diagnose SIBO.  In some cases, multiple rounds of treatment are required for resolution.  Simply treating SIBO with one course of antibiotics alone (prescription or herbal) almost guarantees relapse as the underlying condition needs to be recognized and corrected or SIBO will return.  Emerging evidence is even showing how SIBO can kick-off an auto-immune reaction within the small intestine making successful treatment even more important for long term health.

This complex, stubborn and very wide spread condition responds well to a comprehensive functional medicine approach.  The emphasis must be on treating the current symptoms as well as addressing the underlying causative dysfunction.