SIBO stands for Small Intestinal Bacterial Overgrowth and is characterised by the presence of an abnormal amount of bacteria in the small intestine. (1) Patients diagnosed with Irritable Bowel Syndrome (IBS) and especially diarrhoea-predominant IBS are likely to show a higher frequency of SIBO. (2) Other digestive symptoms commonly experienced include abdominal pain, belching, bloating, distension, flatulence and indigestion. (1) Alternating bowels (both diarrhoea and constipation) are also commonly experienced when SIBO is present, and cases may also present with constipation varying in severity.
If you have IBS, consider SIBO, naturally.
As a growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health(3) a diagnosis of SIBO is more likely to be identified by a Naturopath. A meta-analysis has shown that the prevalence of SIBO is approximately 56% among patients with IBS(3) so it is well worth understanding if it is at the root of your digestive problems. The good news when it comes to natural solutions is that Herbal therapies are shown to be at least as effective as antibiotic therapy(3) when it comes to treating SIBO. Once identified, there is a real opportunity to offer solutions – especially when IBS symptoms are poorly managed – by helping to improve the associated digestive complaints.
Read on for further insight into SIBO including how it impacts digestive health, associated conditions (including thyroid health), testing and treatment.
The impact of SIBO
Bacterial overgrowth in the small intestine:(2)
Disrupts digestion and absorption > Ferments ingested carbohydrates causing increased gas production > Results in bloating and flatulence > Cause abdominal pain or discomfort > Produces toxic by-products > Damages the inner lining of the small intestine and colon.
Causes and Associated Health Conditions
There are many conditions which have a strong correlation with SIBO, some of which predispose a person to develop SIBO and others, which may be the result of the presence of SIBO. A variety of disorders include:(1),(3),(4),(5)
- Acne rosacea
- Abdominal surgery (e.g., hysterectomy, gastrectomy, cholecystectomy, and colectomy)
- Anaemia and/or B12 deficiency
- Bariatric surgery (such as gastric bypass surgery) in morbidly obese patients
- Coeliac disease
- Diabetes
- Hypothyroidism
- Inflammatory bowel disease (IBD)
- Non-alcoholic fatty liver disease (NAFLD)
- Obesity
- Older age
- PPI therapy (proton pump inhibitors) for the treatment of reflux
- Restless legs syndrome
Hypothyroidism and SIBO
Patients with hypothyroidism and especially patients taking prescribed Levothyroxine showed a higher prevalence of SIBO in a multivariate analysis. (4) Since hypothyroidism slows gut motility and is a common cause of constipation, this stagnation may allow for the overgrowth of bacteria to occur in the small intestine.
Testing
Symptoms alone cannot be used to establish a SIBO diagnosis since they are broad-ranging testing is required. (1) Lactulose and glucose breath tests are patient-friendly methods and the most utilised diagnostic tests, which are low cost, non-invasive and provide sufficient accuracy in results. (5,6) The test measures for hydrogen and methane gases which are produced by the gut flora in response to the ingested lactulose or glucose.
An innovative new blood test named ibs-smart™ can help to diagnose whether the cause of SIBO resulted from an episode of food poisoning. Research shows that over 60% of diarrhoea-predominant IBS cases could be post-infectious. This test was due to be launched in Australia in March 2020 but has since been delayed. We look forward to a time soon when we can offer this invaluable test to our patients to help them to understand the root cause of their gut issues potentially fully.
Treatment
A general approach to treating SIBO includes:
1 A tailored diet – Dietary manipulation may help those with SIBO(5) and similarly to the FODMAPS diet used to manage IBS, aims to reduce gas and bloating. Our Naturopaths expertly guide you on your individual needs, including vegetarian preferences, appropriate carbohydrate and calorie intake as well as considering food intolerances and meal planning.
2. Herbal medicine – Aimed at reducing bacterial counts in the small intestine and improving digestive function an individualised prescription of herbs in liquid, tablet and capsules forms are elected according to your clinical presentation and test results
3. Gut healing agents – Additional script items may be suggested based on the need, for example, to improve and heal associated leaky gut, to manage bowel movements and to support the treatment phase. Prebiotic and probiotic therapy is often included at a later stage of a treatment since the addition of both fibres, and ‘good’ bacteria can potentially be aggravating in the presence of SIBO.
As always, when it comes to Naturopathic care, we seek to treat the individual and the root cause. SIBO is a diagnosis that is relevant to many who suffer from IBS and is at the root of the problem. Working with a Naturopath can be very worthwhile to address all aspects of your health and especially gut health. As the Ancient Greek physician, Hippocrates (also known as the Father of Modern Medicine) said: “All disease begins in the gut”.
