Abdominal pain, loose stools, constipation, gas, bloating…

These are classic symptoms of Irritable Bowel Syndrome or IBS.  Many people are told there is nothing they can do, so they either live with the discomfort or eat a restrictive diet to help minimize the symptoms.

But what if these symptoms are due to an underlying issue? What if you could do something about it? There is hope!!

Small Intestine Bowel Overgrowth (SIBO)

SIBO is a chronic bacterial infection of the small intestine. The infection consists of bacteria that normally live in the gastrointestinal tract but have abnormally overgrown in a location not meant for so many bacteria.  Normally, the small intestine is comparably sterile in regards to bacteria. This is accomplished by the coordinated waves of muscular contraction called the migrating motor complex (MMC) that flush bacteria out of the SI.

It is suspected that SIBO may be the underlying cause of 84% of IBS cases.

Why is SIBO important?

  • The bacteria interfere with normal digestion and absorption of food and are associated with damage to the lining of the digestive tract.

  • Bacterial overgrowth in the small intestine can cause deficiencies in nutrients (eg. B12, iron), causing anemia.

  • The bacteria consume food unable to be absorbed in the SI. This is due to SI lining damage, and can lead to excessive gas and bloating, abdominal pain, constipation, diarrhea (or both) – the symptoms of IBS.  

  • They decrease proper fat absorption, leading to fat soluble vitamin deficiencies and fatty stools.

Why does SIBO occur?

  • The most common cause of SIBO appears to be gastroenteritis (food poisoning, traveler’s diarrhea, stomach flu etc.). In approximately 20% of people an immune cross-reactino occurs and the body begins to attack important neuromuscular components of the Migrating Motor Complex (MMC). This causes long-term dysfunction in the MMC and allows bacteria to colonize the small intestine.

  • Other suspected and contributory causes of SIBO include hypochlorhydria (low stomach acid), bile insufficiency, adhesions and strictures.

Who should be evaluated for SIBO?

  • Anyone who has been diagnosed with IBS or who has chronic digestive symptoms including diarrhea, constipation, gas, burping, cramping, or bloating.

  • Other factors that increase the likelihood of SIBO include: celiac disease, impaired intestinal motility, history of acute intestinal infections or abdominal surgery, food poisoning or traveller’s diarrhea, opiate drug use, and a high sugar/starch diet.

How do you test for SIBO?

  • In a clinical setting a breath test is often employed. This involves an at home test in which the patient collects breath samples over a 3-hour period (following a prep diet and ingestion of a sugar substrate).  The breath samples measure the type and amount of gas produced by the bacteria as it travels through the gut.  Hydrogen and methane are measured from the breath samples and used to evaluate for bacterial colonization. Glucose and lactulose are common substrates that are used, each having pros and cons. Glucose is absorbed by the small intestine and may miss distal SIBO. Lactulose Is not absorbed by the intestinal tract and is more sensitive for distal SIBO.

How is SIBO treated?

  • If SIBO is identified, then the first step is to eradicate or kill off the bacteria from the small intestine. Once the bacterial numbers have been sufficiently reduced, focus shifts to addressing the factors that allowed the overgrowth the occur. This is aimed towards strengthening the MMC and supporting digestive secretions like gastric acid, bile and enzymes, as well as re-inoculating and supporting a healthy microbiome.

Other symptoms and conditions associated with SIBO:

IBS symptoms: gas/bloating/flatulence, abdominal pain, cramps, constipation, diarrhea or both

Other Symptoms:

-        Heartburn (reflux or GERD)

-        Nausea

Leaky Gut Symptoms:

  • Food sensitivities

  • Headaches

  • Joint pain

  • Fatigue

  • Skin symptoms – eczema, rashes

  • Asthma

  • Depression

  • Steatorrhea – fatty stools

  • Anemia – iron and B12

  • Weight loss

SIBO Associated Conditions:

  • Rosacea

  • Anemia

  • Atrophic gastritis

  • Celiac disease

  • Chronic fatigue

  • Diabetes

  • Diverticulitis

  • Dyspepsia

  • Erosive esophagitis

  • Gallstones

  • Gasroparesis

  • GERD

  • Hepatic steatosis

  • H. Pylori

  • Hypochlorhydria

  • Hypothyroid

  • IBD – Crohn’s, colitis

  • Lactose intolerance

  • Non-Alcoholic Fatty Liver Disease

  • Pancreatitis

Book an appointment with Dr. Ryan Nakama ND to evaluate your digestive health, and take the first steps towards a better gut!