By Dr. Candace Haarsma

What is SIBO (‘see-bo’)?

SIBO, or Small Intestinal Bacterial Overgrowth, is a chronic bacterial overgrowth of the small intestine with bacteria that normally live in the gastrointestinal tract but have abnormally overgrown in a location not meant for so many bacteria.

What are the symptoms of SIBO?

The main symptoms of SIBO are those similar to irritable bowel syndrome (IBS), including:

• abdominal bloating, pain and cramping
• excessive gas/flatulence
• constipation, loose stool or alternating bouts of loose stool and constipation
• nausea
• heartburn and/or regurgitation of food
• slow digestion and sensation of fullness

Causes

The primary cause of SIBO is thought to be a dysfunctional migrating motor complex (MMC). A migrating what…? The MMC is like a house keeping process that sweeps remaining debris through the digestive tract in a cyclic, repeating pattern approximately every 3 hours. With a functional MMC, food waste and, importantly, bacteria are pushed from the small intestine into the large intestine and towards the rectum.

Secondary causes and compounding factors include low stomach acid, bile insufficiency, pancreatic enzyme insufficiency, intestinal strictures, ileocecal valve disorders and small intestinal inflammation and/or damage.

Associated conditions

Many conditions are associated with SIBO. These can include:

• GERD/heartburn
• iron deficiency
• vitamin B12 deficiency
• rosacea
• eczema
• acne
• gastroparesis
• gallstones
• intestinal permeability

What are the concerns with SIBO, besides symptoms?

Our normal digestion and absorption of food is disrupted, and the bacteria are associated with damage to the lining of the small intestine.

Problems in SIBO

• nutrient deficiency, such as vitamin B12 and iron
• accumulation of gas produced by the bacteria after eating our food contributing to symptoms (bloating, pain, belching, flatulence)
• decreased normal fat absorption through bile deconjugation, which can cause deficiencies of vitamins A and D and fatty stools
• increased excretion of acids by the bacteria which can cause cognitive and neurological symptoms
• food sensitivities

Testing

There is a non-invasive test frequently used in SIBO-based research, which is a breath test measuring amounts of certain gases produced by the bacteria over a three hour time period. This test is available at our clinic.

Treatment goals

The goals of treatment for SIBO include treating the overgrowth and recovery and prevention (which includes correcting the underlying cause, providing nutritional support, healing the intestinal lining and addressing any compounding factors).

References

About SIBO and Treatment. (n.d.). Retrieved July 05, 2016, from http://www.siboinfo.com/about-sibo.html

Hill, A., Dr. (n.d.). Identifying correlations between small intestinal bacterial overgrowth and micronutrients. Lecture.

Khangura, P., ND, & Saunders, L., ND. (2016, February/March). Superseding SIBO. Lectures.