A: Most people have never heard of SIBO, which stands for small intestinal bacterial overgrowth, but many people may suffer from it. And many of those don’t even know they have it.
SIBO occurs when there is simply too much bacteria in your small intestine. Normally, only small amounts of bacteria should reside in your small intestine. In people with SIBO, however, bacteria from the large intestine have migrated into the small intestine, made themselves right at home, and multiplied. This bacterial overgrowth not only causes digestive distress, but it can also lead to myriad health problems.
Often mistaken for irritable bowel syndrome (IBS) because the symptoms mimic each other, SIBO can be easily diagnosed with a hydrogen breath test from a gastroenterologist. Often, patients with SIBO finally seek help from a doctor after years of stomach pain and discomfort, gas and bloating, constipation, diarrhea, bad breath, and other symptoms. People tend to put off a doctor’s visit because they attribute these symptoms to other causes, or have simply become used to them and regard them as “normal.” When SIBO is eliminated, they’re amazed at how good they feel.
Did you know...
SIBO is often mistaken for irritable bowel syndrome, as the symptoms mimic each other.
But beyond the discomfort of living with this condition, it is also a major health concern. SIBO interferes with digestion and nutrient absorption. As food passes through the small intestine, bacteria that shouldn’t be there munch on your meals before food is able to reach your large intestine.
The bacteria’s favorite nutrients include vitamin B12 (deficiencies of which can lead to nerve damage), vitamin D, and vitamin K (deficiencies of which can lead to osteoporosis).When it comes to nutrient deficiencies and potential health issues as a result of SIBO, the list goes on.
SIBO can also lead to something called leaky gut syndrome, a condition in which your intestines develop small tears that allow bacteria to “leak” into your bloodstream. This commonly leads to autoimmune diseases and other health issues.
What causes SIBO? There are numerous potential risk factors, ranging from chronic stress and anxiety, to long-standing celiac disease, diabetes, Crohn’s disease, slow bowel motility, a poorly functioning ileocecal valve (the muscle that separates the large and small intestine), or simply excess sugar or alcohol consumption.
Herbal Antibiotics for Treating SIBO
Antibiotics are a first-line treatment; however, prescription antibiotics aren’t a panacea. In about half of SIBO patients, symptoms return within a year after taking antibiotics. The new bacteria are commonly stronger than the ones they replaced. Herbal antibiotics are an alternative that have also been shown to be effective, and don’t become bacteria-resistant. A few to try: garlic, oregano oil, neem, and supplements containing berberine, which include Oregon grape, goldenseal, and barberry.
Eating the right foods is also important in SIBO. A FODMAP diet is commonly recommended, which is low in sugar and carbs (see ibsdiets.org for more information and a list of approved foods). Incidentally, I tell my patients to try eliminating milk and fructose before getting tested for SIBO, as intolerances of these foods are often a cause of symptoms that resemble those of SIBO. This protocol includes not consuming milk and fructose for 10 days, including eliminating anything with sugar such as soda. Lactose-free milk products are OK. With lactose intolerance, most people can have some milk. They just don’t have the enzymes to digest more than a certain amount, and then it causes gas (not dangerous—just a nuisance). Taking the missing enzyme (lactase) as a supplement may allow you to tolerate more dairy products.
Supplements for SIBO
- Magnesium: If constipation is a predominant SIBO symptom, increase fiber and water, and take 200–300 mg of magnesium a day.
- Peppermint oil caps: For gas pains, begin with enteric-coated peppermint oil caps (e.g., Peppermint Plus by Enzymatic Therapy), which eases the cramps.
- A Good Multivitamin: Taking a broad-spectrum multivitamin that contains a full spectrum of B vitamins can help to make up for many nutritional deficiencies.
- Probiotics: Take an enteric-coated probiotic to support healthy bowel function. Although it may seem counterintuitive to add more bacteria (even the “good” kind) to an already overcrowded system, research shows they are helpful for many people. Begin with a high-potency probiotic (50 billion CFUs, which stands for “colony forming bacteria”) once per day for one month. For maintenance, take a daily probiotc supplement containing 1 billion CFUs.
Underlying Causes of SIBO
SIBO-like symptoms may have other causes. For example, constipation may be caused by candida (yeast overgrowth), low thyroid, or inadequate fiber and water intake. I also recommend testing for and treating any food allergies.