A bulk of what we see in practice as Naturopathic Doctors, and what I’d say we often excel at, is improving (if not resolving) people’s digestive symptoms. Commonly we see people at the office experiencing variations of constipation or diarrhea, bloating, gas, indigestion, and heartburn. What we are coming to figure out, is that Small Intestinal Bacterial Overgrowth (SIBO) can often be the root cause of these digestive disturbances. Keep reading to find out exactly what SIBO is, how it is diagnosed, and how we can treat it as Naturopathic Doctors.
What is SIBO?
It means having bacterial growth exceeding 100,000 CFU/ml in the small intestines.
What are the Symptoms of SIBO?
- Abdominal discomfort/pains after meals
- Excessive burping and/or gas
- Nausea
- Chronic constipation
- Chronic loose stool
- Alternating bouts of loose stool & constipation
- Heartburn and/or food regurgitation
- Tendency to feel full easily
Correlation Between Irritable Bowel Syndrome (IBS) and SIBO:
- As you may have noticed from the symptoms listed above, SIBO symptoms are almost identical to those of IBS. Studies vary, however some have shown that up to 74% of people diagnosed with IBS, will test positive for SIBO via breath testing (1). Studies have also proven that treatment of diagnosed SIBO reduces IBS symptoms significantly (2) and we see this regularly in practice.
Other Conditions that can be Associated with SIBO:
- Reflux, fat in the stool, nutrient deficiencies (such as B12 and iron), and skin conditions such as rosacea, eczema, and acne.
How Does SIBO develop?
- Frequently develops after a gastroenteritis infection.
- Certain bacteria (for example, Campylobacter spp., E.coli, Shigella, Salmonella) release a toxin and create an immune response that directly injure and impair communication of intestinal cells.
- The injury to these cells is of significance, because they are crucial for proper functioning of the gut’s Migrating Motor Complex (MMC). The MMC is responsible for moving food waste and bacteria from the small intestine to the large intestine. When there is disruption here, you can get back up of bacteria from the large intestine into the small intestine (thus, leaving susceptible to SIBO).
Other Causes of MMC Dysfunction:
You can get this same breakdown in intestinal cellular communication with Celiac Disease, Inflammatory Bowel Disease (Crohn’s & Colitis), ulceration, and due to traumatic brain injury (and it’s impact on digestive function).
Other Contributing Factors to Developing SIBO:
- Low stomach acid (including medication induced, such as proton pump inhibitors)
- Pancreatic enzyme insufficiency
- Bile insufficiency
- Small intestinal inflammation/damage
Common Types of SIBO:
- Hydrogen producing bacteria overgrowth (H2): Bacteria ferment fibres and some carbohydrates which can cause chronic loose stool and diarrhea.
- Methane producing bacteria overgrowth (CH2): Significantly slow gastrointestinal transit time and is very much linked with constipation, even at relatively low numbers.
How do you Know if you have SIBO?
The current gold standard for diagnosing SIBO is small-bowel aspiration with quantitative culture; however, this method is obviously limited because of it’s invasive nature and cost. Although not perfect in themselves, hydrogen and methane breath testing is the simplest noninvasive and easily accessible diagnostic test for suspected SIBO (1, 3). Eighty percent of the gases, like hydrogen and methane, are eliminated with gas and the remaining 20% are absorbed and exhaled by lung, which can be measured in breath (1). Such breath testing kits are available at our clinic (find out if SIBO is the cause of your digestive symptoms)!
How is SIBO treated?
At the clinic, we approach SIBO with a 3 step system: 1) Anti-microbials (this can be herbal and/or in conjunction with pharmaceuticals via your family doctor, 2) Anti-SIBO dietary changes and nutrients/herbs supporting the MMC, 3) . Gut healing, food re-introduction, and continuing to ensure proper functioning of the MMC.
Interested in Seeing if SIBO is at the Root of your Digestive Symptoms?
Call 216-3000 or contact us, to schedule your FREE 15-minute meet & greet with one of our Naturopathic Doctors to see if naturopathic medicine is the right fit for you to help restore your regular, bloat-free, digestive function.
Resources:
- Ghoshal, U.C., Shukla, R., & Ghoshal, U. Small intestinal bacterial overgrowth and irritable bowel syndrome: a gap between functional organic dichotomy. Gut Liver. 2017 Mar; 11(2): 196–208.
- Pietrzak, A., et al. Guidelines in the management of irritable bowel syndrome. Prz Gastroenterol. 2018; 13(4): 259–288.
- Saad, R.J., & Chey, W.D. Breath testing for small intestinal bacterial overgrowth: maximizing test accuracy. Clinical Gastroenterology and Hepatology 2014;12:1964–1972.
- Webinar study via Dr. Preet Khangura ND