Small Intestinal Bacterial Overgrowth (SIBO) - The Potential Hidden Cause of Your Symptoms

21 Jul

Introduction to SIBO symptoms

If you suffer from bloating, gas, chronic diarrhoea, constipation, stomach pain or indigestion, chances are your doctor might have diagnosed you with irritable bowel syndrome (IBS).

The usual drugs prescribed are Mebeverine hydrochloride, Buscopan or even proton pump inhibitors like omeprazole or lansoprazole to name a few.

As a GP, I can attest that these drugs do work for a certain cohort of patients but not all.

However, some patients simply never get better, and others go on to develop additional symptoms like brain fog, mood changes, joint pain, muscle aches and much more.

Unfortunately, conventional medicine views these symptoms as separate entities, explaining why patients might end up on antidepressants or anti-inflammatories to manage each of these symptoms.

But what if I were to tell you your gut symptoms, brain fog, joint pain and muscle aches and pains are all related?

In fact, a relatively common cause of all these symptoms is small intestinal bacterial overgrowth, commonly known as SIBO.

If you have never heard of it, you are not alone – your doctor might not have either!

What is SIBO?

Simply put, SIBO is a condition that arises when there is an unusual increase in the number or type of bacteria in the small intestine.

Normally, our gut bacteria are predominantly present in the large intestine (colon), with the small intestine containing very few.

The increase in the number or type of bacteria in the small intestine is, therefore, an unnatural situation, and can potentially lead to a wide range of symptoms.

Before we discuss the symptoms of SIBO, it is worth explaining the causes.

What causes SIBO?

There are many potential causes of SIBO, and more than one could be present at any one time.

In essence, the various causes of SIBO all tend to decrease the gut's motility or decrease its secretory or digestive function.

These three factors are what eventually lead to SIBO.

Once we discuss the different causes, the above statement will make more sense.

With that said, let's start with the various causes:

Chronic stress

Chronic stress is unfortunately extremely common due to the modern busy lifestyle we all lead.

For starters, stress causes a reduction in stomach acid.

A less acidic environment leads to poorly digested food and also favours the growth of unwanted microbes, which would otherwise not thrive.

Moreover, stress also leads to reduced bile flow and pancreatic enzyme function.

Both these factors also lead to partial digestion of food, providing fodder for bacteria to overgrow.

Hidden gut Infections

When most people hear of gut infections, they think of food poisoning or traveller’s diarrhoea.

While standard stool tests would normally pick these sorts of infections up after a few days, many don’t realise some of these infections could hide in your gut for years.

The problem is standard tests are simply unable to detect the more chronic cases.

For these, you would need an advanced stool test based on polymerase chain reaction (PCR) technology.

Some relatively common infections I see in my practice are candida and cryptosporidium among others.

Chronic disease

Chronic disease is generally caused by inflammation, and as we know, inflammation leads to immune dysregulation.

Immune dysregulation effectively leads to a diminished capacity to fend off infections in the gut.

Common chronic diseases include diabetes, low thyroid function (hypothyroid), and rheumatoid arthritis, to name a few.

Covid-19 is increasingly becoming a common cause, which I am seeing quite a lot in my practice.

Medications

Commonly prescribed medications like proton pump inhibitors, commonly known as PPIs and prolonged courses of antibiotics are frequent culprits.

Ironically, some antispasmodic drugs frequently prescribed for irritable bowel syndrome (IBS) have also been known to cause SIBO.

Surgery

Interestingly, some types of bariatric surgery where the bowel is either shortened or manipulated to different positions.

Patients are usually happy they have shed the excess weight but usually say they "don’t feel right".

In my experience, many of these patients eventually put the weight back on, but I digress…

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What are the symptoms of SIBO?

The symptoms of SIBO can be varied.

This often causes confusion and diagnostic difficulty, as patients are pushed from one speciality to the other.

Typical symptoms of SIBO include bloating, indigestion, gas, diarrhoea, constipation, joint pain, muscle pain, low mood, brain fog, fatigue, and even low libido.

How do you diagnose SIBO?

SIBO is usually diagnosed using a lactulose breath test.

In this test, you are asked to drink a small solution of lactulose, and your gut bacteria start to work.

The amount of hydrogen and methane gas in exhaled air is then measured every 15 minutes or so for up to three hours.

The amount of gas is measured correlates with the amount and type of bacteria present.

It is worth pointing out that like every test, there is potential for false negatives. In other words, you might have SIBO, but your test comes up negative.

This is why the history (signs and symptoms) are always crucial.

What is the treatment for SIBO?

There are various treatment strategies for SIBO.

It can be occasionally challenging to find the right treatment plan, but patience is a virtue.

In addition, SIBO has a relatively high tendency to relapse, especially if the root causes are not eradicated.

Also, as soon as some people feel better, they revert to eating processed foods or return to their old poor lifestyle choices.

This is unfortunate, as its causes frustration and prolongs the journey to recovery.

As with any gut disorder, diet is key.

Eliminating processed foods and drinks is a key step if you are hoping to get rid of SIBO.

This seems easier said than done, as cravings have little to do with willpower, and more to do with your microbiome/biochemistry which would likely be compromised.

However, don't despair, as every little helps.

The next thing to do is consider going on a low FODMAP diet.

FODMAP stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols.

FODMAP foods are carbohydrates that are relatively difficult to digest by the body and easily fermented by gut bacteria, resulting in gas and bloating.

The rationale of a low FODMAP diet is, therefore, to starve your gut bacteria and prevent overgrowth.

FODMAP foods comprise a vast category, including many fruits, artificial sweeteners, vegetables, dairy, legumes, and wheat.

Regarding the non-dietary treatment for SIBO, there are generally two approaches.

The first one is the antibiotic approach, while the second is the herbal approach.

Commonly prescribed antibiotics for SIBO are Rifaximin and Neomycin.

Antibiotic therapy is effective in some patients, but not all, and in some cases makes symptoms worse!

Some herbs like berberines, oregano oil, garlic and grapefruit seed extract can be effective for SIBO, but a combination of herbs, possibly on a rotating basis increases effectiveness.

From my experience, the key to successful treatment is approaching treatment from different angles if you like.

This approach would be generally guided by the history, and include optimizing hydrochloric acid if needed, optimising the liver, and so on.

Although seemingly counterintuitive, some probiotic strains are helpful in some cases of SIBO.

Conclusion

Small intestinal bacterial overgrowth, commonly known as SIBO is a condition that arises when there is an unusual increase in the number or type of bacteria in the small intestine.

It is a relatively common cause of gut and other not so obvious symptoms.

Finding the underlying cause is key to successful treatment, which includes a dietary change alongside either antibiotics or herbal remedies.

Healing from SIBO can take some time so dedication and patience are key.

Please share this article with anyone you know might benefit, and if you have any questions, please feel free to get in touch.

Thank you!

Disclaimer - The content in this blog and supplements mentioned are not intended as a substitute for professional medical advice, diagnosis, or treatment.

Please consult with your doctor or any other qualified healthcare provider regarding any medical condition you may have and follow their advice.