SIBO, or Small Intestinal Bacterial Overgrowth, seems to be a nearly viral topic lately. Frustratingly, SIBO symptoms mimic the symptoms of IBS, causing many people to be misdiagnosed. Here’s what you should know.
Please note: As with all my health-related posts, this is in no way intended as a means for self-diagnosis or medical advice. As always, if you suspect you or a loved one may have SIBO or any other medical condition, please seek help from an experienced medical professional.
SIBO, or small intestinal bacterial overgrowth is as you might expect, exactly what its name implies. We’re all familiar with the fact that many people have far too much unhealthy bacteria in their large intestines and not enough of the healthy bacteria, which is why so many of us load up on probiotics.
And for the most part, that’s a good thing, provided we’re getting the types of probiotics our individual bodies need. There are tests to help determine that, or for those who find the price too steep or simply don’t want to deal with icky stool samples, there’s always the shotgun approach: switch it up.
Every time you need a new bottle of probiotics, you can get one that contains different bacteria than what you had before. This way, you can sow a large, healthy variety of needed microbes in your gut.
This is not a good approach for those who have SIBO, but I’ll get into that later. For now, let’s look at the symptoms.
Unfortunately, many (but not all) of the SIBO symptoms are identical to those of IBS, which is why so many people are being misdiagnosed:
- Abdominal cramping and/or pain
- Gas and bloating
- Diarrhea, constipation (less common), or both
- Food intolerances like lactose, fructose, histamine, gluten, casein
- Skin rashes, such as rosacea
- Leaky gut
- Diagnosed with IBS or IBD
- Vitamin and mineral deficiencies
- Autoimmune diseases
- Chronic diseases, such as chronic fatigue syndrome or diabetes
What is SIBO (or, What’s in a Name)?
Although it’s common knowledge that lots of people have too much unhealthy bacteria in their large intestines, what isn’t so well known is that many also have an overgrowth of this bacteria in their small intestines. How many people are suffering from SIBO is not known, but some estimates suggest that perhaps 80% of people with IBS have SIBO, and somewhere between 6% and 15% healthy people with no symptoms have it.
How they arrived at the latter numbers is beyond me, because if you have a group of healthy people with no SIBO symptoms, why would you even suspect they have SIBO? Just one of those mysteries of life, I suppose.
But how do we end up with all these hostile microbes in our small intestines?
There are several ways, but here are just a few:
- A diet high in refined carbs and sugar
- Diabetes can affect the gut muscles, meaning food doesn’t move through the small intestine as it should, resulting in bacteria getting left there
- Too much alcohol
- Surgeries and Crohn’s can cause a bacterial buildup in the small intestine
- Diverticulitis in the small intestine can do the same, by housing bacteria
- Antibiotics, steroids, and acid-blockers
Except They’re Not All Hostile!
This is a glaring difference between the bacterial imbalances in the large and small intestine. As I mentioned earlier, conventional wisdom tells us that if we have a very small population of unhealthy bacteria in our large intestines and a gigantic population of the healthy kind, then this is a good balance that will greatly contribute to all-around good health.
But with SIBO, it doesn’t matter if we have a large population of the good guys in our small intestines. A large population of even the healthy bacteria in the small intestine is decidedly unhealthy, as it was never designed to harbor that much of any bacteria.
The bacteria, whether “good” or “bad,” adore sugar, starches, and carbs. If you’ve read my post, Resistant Starch: What it is and Why You (May) Need it, you might remember that, towards the end of that post, I commented that many in the health industry say that people with SIBO should avoid RS until their SIBO has been dealt with first. RS is great food for the healthy microbes in the large intestine, because it functions as a prebiotic.
But loading up even on healthy prebiotics might not be such a grand idea for those with SIBO, since the idea there is to get rid of the bacterial overgrowth in the small intestine, not encourage it to reproduce faster than a cold virus by providing it with an irresistible 24/7 banquet. Our small intestines are not cruise ships, after all.
So, as the little guys gobble up the carbs, the carbs ferment and produce hydrogen (as opposed to the butyrate produced in the large intestine when you eat RS, a good thing). Other little organisms in the small intestine, called archaea, gobble up the hydrogen and produce methane. Not good.
This is why one popular form of SIBO testing, the breath test, measures the levels of both hydrogen and methane present. People with SIBO have excessive levels of one or both of these gases.
Bacterial overgrowth of the healthy kind is also the reason many practitioners don’t want their SIBO patients to take probiotics, as they don’t want to encourage any more bacterial growth in the small intestine. Makes sense.
Except that other practitioners disagree, saying that there is strong evidence that certain types of probiotics are extremely helpful – even essential – in treating SIBO, and their patients are recovering completely.
Confused? You won’t be when you read Part II next week, where I’ll clear up the confusion for you, plus let you in on the testing methods and treatment for SIBO.
See you next week!