Small Intestinal Bacterial Overgrowth, commonly known as SIBO, is a condition that occurs when there is an abnormal increase in the number of bacteria in the small intestine. This can lead to a variety of uncomfortable symptoms and challenges in treatment as it is often misdiagnosed. Let's deep dive into SIBO, its, treatments and why it can be such a challenge to overcome.
Understanding Small Intestinal Bacterial Overgrowth
SIBO is characterised by an unwanted proliferation of bacteria within the small intestine. This abnormal increase disrupts the natural ecosystem of the gut, leading to the malabsorption of nutrients and an array of unpleasant digestive symptoms. The precise reasons behind the migration and multiplication of these bacteria from the colon into the small intestine remain complex, sometimes caused by gut motility issues, anatomical abnormalities or by also suffering from IBS. It’s this intricacy that demands a nuanced approach to both diagnosis and treatment, aiming to restore harmony within the digestive tract.
Recognising the Symptoms & When to Seek Help
Firstly, if you are suffering from any form of uncomfortable digestive symptoms that are recurrent or chronic, please speak to a health professional. No symptom is too small and no one should live daily with being uncomfortable.
Symptoms to watch out for include persistent bloating, excessive wind, discomfort in the abdomen, bouts of diarrhoea and/or constipation, foul-smelling stools, acid reflux, bad breath nausea and signs of nutrient deficiencies such as fatigue or anaemia. Another give away, which is different to IBS, is if you have trouble digesting fatty foods such as dairy or rich meats.
These manifestations mirror other gut-related conditions, making it all the more important to seek professional advice for an accurate diagnosis.
Diagnosing & Confirming SIBO
Navigating the pathway to a definitive diagnosis of Small Intestinal Bacterial Overgrowth is actually very easy! A breath test, where expelled air is analysed for the presence of hydrogen and methane gases, which is the bi-product from the bacteria. Due to the overlap of symptoms with other digestive disorders, at The Natural Balance, we often also do a breath test to ensure we can rule out a client does not have SIBO in addition to any other conditions. We do this, as often sufferers of IBS also have SIBO!
Very rarely, a small intestinal aspirate may be utilised, allowing for the direct sampling and cultivation of bacteria from the small intestine, but this would be done within a hospital setting.
Treating SIBO - A Personalised Approach
Treating SIBO requires a bit harder work than the test to diagnose it. A holistic nutritional approach relies on the use of antimicrobials to restore balance to the gut flora. This is nuanced and can take a little bit of trial and error to find the right treatment that best eliminates the specific bacteria that's proliferated.
Additionally, during the immediate treatment of the overgrowth, there may be short-term dietary adjustments to ensure we do not continue to 'feed' the unwanted bacteria. We would also look to ensure long-term health is maintained by adjusted diet and lifestyle to improve the overall gut health, making it as healthy and resilient as possible to avoid a future overgrowth.
FODMAP & It's Role In Treating SIBO
FODMAP refers to short chain carbohydrates, which are known to aggravate digestive discomfort in people prone to digestive problems, as they are easily fermentable once ingested. Foods classified as high in FODMAPs include a range of fruits, vegetables, dairy products, and grains.
Often, when people hear about an elimination diet, they are concerned they will be left withi nothing left to eat. However there are two key things to remember when we talk about doing a FODMAP diet with SIBO;
It is a short term change to allow the gut to heal, let the microbials do their work and restore balance to the gut bacteria.
It allows us to identify if there is a specific trigger food that should be avoided, which is preferable to eliminating how categories. For some people it's cauliflower, others honey, and for many in the long term they can happily return to eating all the FODMAP foods.
Embracing the FODMAP diet under the guidance of a healthcare professional ensures it is done correctly and carefully managed to your personal needs.
The Challenge of Eradication – Why SIBO Can Be Stubborn
The complexity of the gut ecosystem and the factors that initially led to the overgrowth—such as impaired gut motility or previous dietary habits—can persist, inadvertently inviting a return of the condition. We see this in the clinic often after a client has done a course of antibiotics. It has helped in the short term, but once the bacteria proliferate, the same imbalance remains, This resilience underscores the importance of a holistic treatment strategy, tailored to address not just the symptoms, but the root causes and the environment that allowed SIBO to thrive in the first place. Achieving lasting relief from SIBO demands patience, persistence, and a dedicated approach to rebalancing the intricate microbial landscape of the small intestine.
Preventing Recurrence – The Efficacy of Antimicrobials
The natural world provides us with a plethora of antimicrobials - garlic, sage, thyme, honey, tea tree oil just to name a few. We use a whole range to treat SIBO, as they naturally target the undesirable bacterial overgrowth in the small intestine, significantly diminishing the chances of a relapse, whilst not causing any disruption to the rest of the gut. Collaborating closely with your healthcare provider to craft a bespoke maintenance regimen that incorporates antimicrobials can be instrumental in sustaining the health of your gut. This proactive approach not only aids in keeping SIBO in check but also fortifies the gut's defence against potential future disturbances.
If you would like to discuss anything you've read in this blog in relation to your own concerns around gut health, or suspect you have SIBO, please book a call with one of our IBS and Gut Health specialists. We'd love to help!
Kelly is the founder of The Natural Balance. As a Nutritional Therapist she focuses on positive physical and mental wellbeing, achieved through diet, lifestyle, sleep and exercise. Having struggled for years with IBS and hormonal imbalance, and increasingly frustrated with the lack of support and helpful advice from conventional healthcare, Kelly began her own journey of healing the body from the inside out. After seeing huge improvements in her conditions following nutrition and functional medicine advice, she quit her job to retrain as a therapist and focus on harnessing the healing powers of food to help other people in similar situations.
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