SIBO 101: What is SIBO, How to Test for it and What to Do
What is SIBO?
SIBO stands for Small Intestinal Bacterial Overgrowth and arises when there is an abnormal proliferation of bacteria in the small intestine. This overgrowth of bacteria can cause a variety of gastrointestinal problems because the small intestine is not designed to accommodate for a large bacterial load. In fact, the vast majority of our gut bacteria typically find their home in the colon, also known as the large intestine, where they exert profoundly positive effects on our overall health and wellbeing. Same bacteria, different (wrong) location.
So what happens when bacteria migrate upwards into our small intestine and why is it such a big deal?
The trillion of bacteria that live within your gut and form your microbiome dictate a myriad of processes in your body such as the production of vitamins (yeah, you read that right - some bacteria are responsible for synthesizing B vitamins, for example), influence your mood via the gut-brain axis, determine your food cravings and the way you regulate blood sugar… the list truly goes on and on.
Needless to say, you want the “good” bacteria (also known as commensal bacteria) to be the most prevalent in your gut, and you want them in the right location (your colon). When there is an overgrowth, it means that certain species (usually the “bad” bacteria, also called opportunistic bacteria) multiply and take over, bringing a bacterial imbalance (dysbiosis) in your digestive tract.
Bacteria are useful for a lot of processes, such as fermenting foods we are not able to breakdown (for example resistant starches) and in doing so, produce metabolites like Short Chain Fatty Acids (SCFAs) and Vitamins which are helpful in lowering inflammation and contribute to optimal gut health.
Symptoms of SIBO
The problem occurs when the bacteria are located in the Small Intestine as opposed to the Colon and is broadly twofold:
1) they compete with your body for nutrients because they ferment foods that are only partly digested higher up in the digestive tract. This can lead to malnutrition, including muscle loss, hair loss, dry skin, weight loss, etc.
2) they create an important amount of gases (mainly hydrogen, methane and hydrogen sulfide) during the fermentation, causing bloating, discomfort, cramps and inflammation in the small intestine. This often also leads to diahrrea and/or constipation.
SIBO & Friends: SIBO Co-Morbidities
Once SIBO is occurring in your body, it can create a chain of reaction for a wide range of health issues. SIBO doesn’t heal by itself and can cause a terrain where your gut becomes hospitable for opportunistic bacteria, fungi, pathogens, viruses and parasites. There are a lot of co-morbidities with SIBO, the most common being:
IBS (Irritable Bowel Syndrome)
IBD (Crohn's disease, Ulcerative Colitis)
Celiac disease and Gluten Sensitivity
Diabetes
Hypothyroidism
Restless leg syndrome
Fibromyalgia
Skin issues such as Rosacea and Acne
If left untreated, SIBO can cause more serious complications with long-term consequences. Malabsorption of fats, proteins and carbohydrates can lead to malnutrition and vitamin deficiencies.
In particular, vitamin B12 deficiency can cause nervous system problems and anemia. Poor calcium absorption can lead to long-term osteoporosis or kidney stones. Moreover, ongoing research continues to support the link between small intestinal bacterial overgrowth (SIBO) and Parkinson’s disease.
If you find yourself dealing with symptoms linked to this condition, there’s hope. It's essential to consult with a knowledgeable practitioner to explore targeted solutions that can help you regain control over your digestive wellbeing.
Why Test for SIBO?
Let me start by saying that you can’t diagnose SIBO based on symptoms. If a healthcare practitioner doesn’t test you before prescribing or recommending a protocol, they simply don’t know what they’re doing. Here’s why:
You could have Hydrogen SIBO, Methanogen SIBO (IMO) or Hydrogen Sulfide SIBO or even a combination of these (mixed SIBO)
It’s worth knowing what bacteria and gas is causing your discomfort, and how much of it is present. Knowing this will determine your treatment plan and also help you know how long the treatment may take.
Symptoms are not consistent from one person to the other
While some people may have a dominant set of bacteria (or archaea) and the typical related symptoms, others may experience the complete opposite symptom. For example, Hydrogen SIBO (H2) and Hydrogen Sulfide (H2S) are known for diarrhea while Methane SIBO (IMO) is known for constipation. That is usually true but not always the case. Assuming that it’s one type of SIBO, without testing, can lead to incorrect or failed treatments.
Symptoms are not exclusive (it may not be SIBO)
There are other factors that can cause IBS symptoms and gut dysfunction. It could only be SIFO, for example. If you have SIBO, there are very specific treatments needed to clear it (such as herbal antimicrobials and/or antibiotics). If you don’t have SIBO, then we can look at other potential cause for your symptoms and the range of treatment options to choose from will vary greatly.
How to Test for SIBO?
The most recommended testing method for SIBO is a Breath Test. It is the preferred testing method for SIBO because it is accurate and comprehensive while being the least expensive and invasive test. You can do it at home and it is a rather simple process, by breathing into a tube to collect the gases produced from your intestinal tract.
There are different substrates (type of sugar) used as food source for the bacteria. The most proven ones are Lactulose (not to be confused with Lactose) and Glucose. They each have their pros and cons. In my practice I usually start with a Lactulose test, which is my preference in terms of accuracy and the information it gives us. It is important for the test to measure both Hydrogen and Methane gases, as well as CO₂ for control. There is also a newer test available in the United States called trio-smart that tests for Hydrogen Sulfide as well.
You can order an at-home SIBO test directly from laboratories or click here to order now. I recommend you work with a reputable lab for SIBO testing and can provide you with referrals with preferential pricing. You will need a practitioner to be able to accurately interpret the results (you wouldn’t want to get a false positive!) and provide you with an appropriate course of action for your specific case.
NOTE: Be wary of hand-held devices like the ones from FoodMarble that claim they can be used for SIBO testing. While highly promising, I have seen many inaccurate results from these devices. It is preferable to complete an at-home test from a proper lab (typically using Quintron technology) for clear, actionable results.
You’ve tested positive. Now What Can You Do?
There are many avenues to treat SIBO. Unfortunately, it won’t resolve or go away on its own, at least without addressing motility or any digestive impairment. Once a bacterial overgrowth is in place in your small intestine and causing some symptoms, we would need to eradicate it, for reasons mentioned above. The only exception to this is a case of very mild or borderline SIBO, which can be determined by a Breath Test. And that’s usually because SIBO was not the main contributor to your symptoms in the first place.
I highly recommend you work with an experienced and trained practitioner for the treatment of SIBO. It is not a simple course of action and a lot of unpleasant symptoms may occur. You will most likely go round in circles by trying to implement a protocol you found online because it won’t be targeted to you. It can also lead to deeper imbalances if done incorrectly.
It is also important to find your root cause, the reason why the overgrowth occurred in the first place. A practitioner can help you find the root cause and address it whenever possible. By addressing the root causes, you can prevent SIBO relapse, which is known to occur in about 2/3 of patients.
A functional health practitioner will also be able to answer your questions and give you tools to manage your discomfort if it were to happen. Someone trained in the SIBO field (such as myself) can also guide you through the protocol and reassess along the way, tweaking things as we go according to the success of the treatment plan and your symptoms.