Underlying Cause for Many Digestive Issues is SIBO

Tuesday, February 23, 2016

Woman holding stomach with red inflammation illustration.

Are you worried about your digestive health? Learn about the symptoms and risk factors of small intestine bacterial overgrowth, a treatable condition that has been seeing a growing number of diagnoses.

Digestive issues are a common complaint in today’s fast-paced society. Many of us want to eat better but just can’t find the time, and meanwhile stress caused by our day-to-day lives can take a further toll on our physical health.

You might blame digestive issues like gas, bloating, diarrhea, abdominal pain and even irritable bowel syndrome (IBS) on these stressors, but they could be underlining a more serious health concern: small intestine bacterial overgrowth (SIBO).

“SIBO is a relatively new diagnosis, although it is not a new problem,” says Lela Altman, ND, MS, LAc, a clinical supervisor at Bastyr Center for Natural Health. “Some studies estimate that 40 percent to 60 percent of people with IBS actually have SIBO when tested for it.”

Nutrition supervisor Kelly Morrow, MS, RDN, CN, says in addition to the most obvious symptoms listed above, other symptoms can include:

  • Constipation
  • Flatulence
  • Abdominal pain
  • Dyspepsia
  • Malabsorption
  • Weight loss
  • Malnutrition
  • Anemia (usually low B-12)

Many symptoms previously diagnosed as IBS are now being linked to SIBO, Dr. Altman says, which is significant because IBS affects as much as 15 percent of the population and is one of the highest causes of missed work due to illness. However, IBS can be managed but is rarely cured, while SIBO can be cured.

Read one patient's success story treating SIBO symptoms with Lela Altman, ND, MS, LAc.

What is SIBO?

Our intestine is normally full of bacteria, but it congregates in much larger quantities in the large intestine compared with the small intestine. With SIBO, the small intestine often has more of the bacteria normally seen only in the large intestine.

“That part of the intestine simply isn’t able to support such a large number of bacteria,” Morrow says.

The overgrowth of bacteria diminishes the small intestine’s ability to do its job properly, making it harder for your body to digest food and absorb nutrients. Over time, that can lead to more long-term symptoms including leaky gut, food allergies, autoimmune diseases or skin disorders.

Diverse Risk Factors

When determining whether you might have SIBO, your Bastyr Center care team will note not only your symptoms, but also risk factors that are common causes of SIBO. Those include:

  • History of intestinal infections such as food poisoning, especially at a higher rate.
  • History of abdominal surgery
  • Diabetes, which can disrupt the nerves and affect your intestinal functions
  • Anatomical issues (some people might simply be more prone to SIBO because of the way their anatomy is aligned, or if the valves between the large and small intestine are more prone to leaking bacteria between the two organs)
  • Motor neuron problems
  • Diverticula
  • Celiac disease
  • Chronic pancreatitis
  • Intestinal fistula
  • Hypochlorhydria
  • Ehlers-Danlos syndrome

If your symptoms and risk factors signal that you might have SIBO, your doctor may order the lactulose breath test to help determine your diagnosis. The results of your breath test also will help your naturopathic medicine and nutrition teams work together to formulate a treatment plan tailored specifically for you.

Diet is Key

Diet is often a part of the treatment, as some foods are more likely to inflame the small intestine, while others can help it heal faster.

“You don’t heal by just eliminating foods,” Morrow says. “You heal with good nutrition.”

She often encourages SIBO patients to increase their intake of omega-3 fatty acids, zinc, vitamin A-rich foods, glutamine-rich foods and supplements and bone broth, while also decreasing foods that are high in what are known as FODMAPS, which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

“FODMAPS are components of plant-based foods that are digested by bacteria,” Morrow explains. “If you have an overgrowth of bacteria in the small intestine, they are going to get really energized by those plant components and that is where the digestive symptoms come from.”

FODMAPS in general are difficult for your to body digest, but if you decrease your intake of these foods and your digestive issues decrease, it could be an indicator that you have SIBO, Morrow says. Some common examples of FODMAPS include:

  • Avocadoes
  • Onions
  • Garlic
  • Asparagus
  • Apples
  • Cherries
  • Watermelon
  • Legumes
  • Milk because of lactose (cheese is not as much of a problem because the lactose gets broken down in the aging process)

“Dietary changes are almost always necessary and are a very important part of treatment,” Dr. Altman says. “In addition to diet, a patient may be given herbs or medications to stimulate motility of the small intestine after eradication of the bacteria is complete.”

She adds that one of the most common reasons that people develop SIBO is due to poor intestinal motility. “This is really the underlying cause of SIBO in most cases and results in bacterial overgrowth,” Dr. Altman says. “If you do not address the motility issue, you are not treating the underlying cause and the SIBO will likely return.”

Treatments your team may recommend, depending on your breath test results, include:

  1. Antibiotics, typically for a duration of two weeks.
  2. Herbs, typically for six to eight weeks.
  3. A liquid-based elemental diet of three “shakes” per day for 14 days. The shakes can be made at home, but you may not eat any other food, solid or otherwise.

“It is important to make sure that the eradication is complete before moving onto the next phases of treatment to prevent SIBO from retuning,” Dr. Altman says. “This often includes dietary changes and treatments to improve gut motility.”

Acupuncture also can help with some of the symptoms of SIBO, such as constipation and abdominal pain.

“People with SIBO often have other heath complaints that exacerbate their symptoms such as stress, anxiety and other digestive disorders which acupuncture can address,” Dr. Altman says. “Acupuncture in conjunction with naturopathic medicine is very helpful, however, acupuncture alone is unlikely to cure SIBO.”

Can’t I Just Take Probiotic?

If you believe all of the hype around probiotics, you’d think they could heal anything. But SIBO is one disorder they usually worsen.

“With SIBO, you have an overgrowth of pathobionts – the bacteria that are not good,” Morrow says. “Think of it like you’ve got a bunch of bad bacteria having a party in the gut. Then if you add good bacteria, sometimes they just join the party and make it worse since they're in the wrong place.”

She adds that some people feel better with probiotics, but the vast majority will get worse.

However, once you’re in recovery mode, your team may consider a probiotic.

Make an Appointment

If you have some of the symptoms and risk factors of SIBO and would like to make an appointment with a naturopathic or nutrition team at Bastyr Center, please call (206) 834-4100.