What causes SIBO and why it’s so hard to treat

What is SIBO?

SIBO  is the overgrowth or imbalance of bacteria in the small intestine (Small Intestinal Bacterial Overgrowth).

Symptoms of SIBO

Picture a client of mine who has SIBO, let’s call her Jane. She comes to me with bloating most of the time, even first thing in the morning. Even water can make her bloat. She’s constipated and relies on laxatives for relief. A breath test tells us she has methane dominant SIBO.

We’ll come back to what we can do to help Jane later on..

A more complete list of symptoms of SIBO includes

• Bloating
• Altered toilet habits (constipation or diarrhoea or a mixture of the two)
• Belching and flatulence
• Abdominal pain or discomfort
• Malnutrition
• Food intolerances
• Restless leg syndrome

A bit of Anatomy

The small intestine is the part of the gut between the stomach and large intestine, and normally contains far fewer bacteria than the large intestine.

When the bacteria in the small intestine become overgrown, this can damage the lining of the intestine, causing inflammation, and may significantly interfere with digestion of food and absorption of nutrients.

SIBO is a common cause of irritable bowel syndrome (IBS) and so treatment of SIBO can resolve IBS.

So now, like Jane, you suspect you have SIBO, or you have returned a positive breath test  (available through our practice), but what now?

Causes of SIBO

Treatment of SIBO should always include consideration of the underlying causes (treating the root cause is always part of a Functional Medicine treatment).

To understand the cause of SIBO for a particular person, we need to understand that the body has in-built ways to prevent bacterial overgrowth of the small intestine. These include

• The acidity of the stomach (which prevents bacteria from our mouth and food entering our gut)
• The timely movement of food through our gut
• Intestinal immunoglobulins (immune system protection)
• The valve that normally allows the flow of contents into the large intestine but prevents them from refluxing back into the small intestine

If the movement of food through your gut is slow and you are constipated, like Jane, this provides the bacteria in the small intestine more time to feed on the food and multiply, potentially leading to an overgrowth of bacteria.

When constipation is not treated, so that the person is having at least one bowel movement a day, this is the most common reason why SIBO returns (typically six months to a year after treatment).

Treatment of SIBO

I worked with Jane over a 4 month period to improve her diet. We removed the junk food that would have been feeding the SIBO.

We did breath testing for SIBO, and the results showed methane dominant SIBO(and she was constipated), so we made sure there was plenty of fibre in her diet to support her bowel movements.

We improved her gut bacterial balance using probiotics and prebiotics, and used herbs to reduce the  bacterial overgrowth. These herbs were specific to her methane dominant type of SIBO.

Most importantly, we improved her constipation using diet and supplements and made sure she was digesting her food well with good stomach acidity. She now passes bowel movements every day without the use of laxatives, and no longer suffers from the terrible bloating.

Treatment for SIBO should always include assessment of the potential underlying causes of SIBO. We can then address the underlying cause so that SIBO is less likely to reoccur at a later time. In my view, this is a better approach than using antibiotics which do not tackle these root causes.