Dr. Paul Deglmann
Meghan Feir Walker
Have you been experiencing uncomfortable symptoms like intense bloating, gas, abdominal pain, nausea, and other gut-related symptoms? Small intestinal bacterial overgrowth (SIBO) may be to blame. SIBO symptoms can significantly affect your life, but you don’t have to continue suffering.
In this article, I’ll cover what SIBO is and highlight the most common symptoms, causes, and risk factors associated with this condition.
What is SIBO?
You need a diverse microbiome to properly absorb nutrients and have a healthy digestive system. But while you need specific microorganisms in different areas of your digestive system, sometimes certain types can become unbalanced, or unwelcome intruders can cause issues.
When bacteria from the colon enter the small intestine, SIBO can occur. But what is SIBO? Small intestinal bacterial overgrowth simply describes an overgrowth of bacteria in your small intestine. You need the right balance of bacteria to support digestion, but symptoms can arise when certain bacteria grow or invade the small intestine from the colon. This can also lead to further complications, like inhibiting your body’s ability to digest and absorb nutrients from food.
How SIBO impacts nutrient absorption
An important role of bacteria in your gut is to properly digest carbohydrates in the small intestine and turn them into gas and short-chain fatty acids in the large intestine. But when you have an excess of bacteria, this can create even more gas and uncomfortable digestive symptoms.
Nutrient absorption occurs in the small intestine, especially in the last section of the small intestine called the ileum. Unfortunately, when SIBO occurs, the bacteria that are now present in the small intestine consume some of the nutrients before they can be absorbed, including protein (amino acids), vitamins, minerals, and bile salts. This can make it difficult for your body to digest fats and nutrients, leading to nutritional deficiencies.
These nutritional deficiencies can go on to cause several other symptoms, negatively impacting how your body functions and heals.
What happens in your gut doesn’t stay in your gut. The state of your gut can affect numerous functions in your body, including the health of your bones and nervous system.
SIBO Symptoms
What does having SIBO feel like? Some people describe it as dull knives stabbing them throughout their abdomen. Others say they’re so bloated they look like they’re 6 months pregnant.
While SIBO can present in numerous ways, the most common SIBO symptoms include the following problems.
Common SIBO symptoms:
- Bloating/gas (especially after eating)
- Abdominal pain
- Constipation
- Diarrhea
- Heartburn
- Indigestion
- Nausea
- Fatigue
- Brain fog
- Malnutrition
- Sense of fullness after eating
- And More
Many of these symptoms occur from the bacteria in the small intestine feeding on and fermenting undigested foods or specific carbohydrates.
These bacteria produce certain gases (such as hydrogen and methane) and cause inflammation, contributing to worsened symptoms.
Recognizing SIBO Stools
One way to tell if something is off with your digestive system is to pay attention to the consistency and frequency of your stools. For example, constipation can produce small, rabbit-like stools—once you’re actually able to go. One of the many problems this can indicate is that your body may be dehydrated.
Just as dehydration can be reflected in the toilet bowl, SIBO can also cause some alterations in stool consistency.
Potential indications of SIBO in stools:
- Stools may float and be more oily due to fat malabsorption. You may need to wipe excessively and see some streaking in the toilet due to fat content in the stool.
- Stools may also contain mucus.
- Stools may also be thin and pencil-like or soft, loose, and watery
- Stools may also be hard and lumpy
Common SIBO Causes
There is a reason for everything and several reasons why SIBO can occur, including structural abnormalities in the small intestine, slow motility (constipation), low stomach acid production, immune system disorders, antibiotic use, and gastric surgeries can all be potential causes of SIBO.
Structural abnormalities in the small intestine
From diverticulosis or previous surgeries, structural issues can create pockets that trap bacteria, leading to an imbalance in the small intestine.
SIBO can also be caused or exacerbated by problems with the function of your ileocecal valve (ICV), a sphincter muscle that regulates the passing of digested food from the small intestine to the colon.
When the ileocecal valve isn’t shutting properly, bacteria are allowed open entry from the colon to the small intestine. However, both problems can cause each other. SIBO can also cause the ileocecal valve to remain partially or totally open. So whether it’s a malfunctioning ileocecal valve leading to SIBO or SIBO causing the ileocecal valve to not shut properly, this can be an ongoing cycle of distress.
Slow motility/constipation
Many patients suffer from slow motility or constipation. Constipation causes bacteria to stay in the small intestine longer than usual, encouraging more bacterial overgrowth and more severe symptoms.
This is why staying regular is important for your overall health. However, it can be difficult to have regular bowel movements when digestive problems are occurring. Once again, one problem can cause another.
Low stomach acid (Hypochlorhydria)
Stomach acid plays a vital role in your body. It has many tasks, including keeping harmful bacteria at bay by helping kill microbes in your saliva or the food you ingest. But when the parietal cells in your stomach lining aren’t producing enough stomach acid, these microbes can make their way to the small intestine, contributing to bacterial overgrowth and symptoms.
Three of the main causes of low stomach acid production are chronic gastritis, the use of proton pump inhibitors (PPIs), and H. pylori infections.
Ironically, doctors often give patients antacids/PPIs to manage symptoms caused by low stomach acid. Since that can contribute to the problem, these medications may not help many acid reflux sufferers who are experiencing low stomach acid production.
Gastric bypass surgery can also contribute to low stomach acid production.
Immune system disorders
Certain immune system disorders can make it more difficult for the body to balance bacteria in the gut. This increases the risk of developing SIBO.
Some conditions that most commonly cause SIBO include:
- Celiac disease
- Scleroderma
- Inflammatory bowel disease (IBD)
Other conditions that can increase the risk of SIBO include:
- Crohn's disease
- Diabetes
- Hypothyroidism
- Cirrhosis
- Gastroparesis
- Radiation enteritis
- HIV
- Parkinson's disease
Use of antibiotics
Along with killing harmful bacteria, antibiotics can also wipe out beneficial bacteria. This allows opportunistic bacteria and other microbes to flourish, causing dysbiosis (an imbalance of bacteria) in the gut.
This is why it’s often recommended to take certain types of probiotics when taking an antibiotic is necessary. They can help restore balance to the affected microbiome. However, when patients have SIBO or other conditions, it’s especially important to take the right kinds and amount of probiotics.
History of gastrointestinal surgeries
Past gastrointestinal surgeries that could have impacted the stomach, small intestine, ileocecal valve, and colon can also increase the risk of developing SIBO.
Risk Factors and Complications
Certain conditions and structural issues can make the occurrence of SIBO more likely.
Risk factors for SIBO include:
- Low stomach acid
- Slow motility
- History of gastrointestinal surgery
- Structural ICV problems
- Diverticulosis of the small intestine
- Crohn’s disease
- Ulcerative colitis
- Radiation to the abdomen
- Several chronic inflammatory conditions including Celiac disease, diabetes, IBS, etc.
- Older age
- Certain medications
- And more
Complications can also arise from the presence of SIBO, causing further problems.
Some complications of SIBO include:
- Chronic malnutrition/nutritional deficiencies, which can lead to several other symptoms and conditions
- Other chronic digestive issues due to long-term dysbiosis
- Dehydration
- And more
Foods that trigger SIBO
Certain foods can trigger SIBO symptoms. Most of these food triggers are from different forms of carbohydrates. The biggest category of carbohydrates that trigger SIBO symptoms are high-FODMAP foods.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are short-chain carbohydrates (sugars), and the small intestine can have a difficult time digesting them. These different sugars/carbs provide fuel for the bacteria, leading to an increase in symptoms.
While lists can vary a bit from one clinic to the next, here is a list of commonly accepted high and low-FODMAP foods.
Examples of high-FODMAP foods:
- Some processed and marinated meats
- Garlic
- Onions
- Apples
- Avocados
- Dried fruit
- Other fruits and vegetables
- Certain beans and legumes
- Fermented food and drinks
- Certain nuts like cashews and pistachios
- Certain grains like wheat, barley, and rye
- And many others
Examples of low-FODMAP foods:
- Eggs
- Fresh and frozen meat/fish
- Bell peppers
- Lettuce and other greens
- Yams
- Zucchini
- Grapefruit
- Berries
- Other fruits and vegetables
- Certain nuts and seeds like walnuts, Brazil nuts, hazelnuts, pecans, macadamia nuts, pine nuts, etc
- Certain grains such as oats, rice, millet, teff, etc
- Pseudo-grains like buckwheat and quinoa
- Certain dairy alternatives
- And many others
The RHS approach to SIBO
You don’t have to continue suffering from SIBO. If this article has hit home for you and you suspect you have SIBO, accurate and thorough testing should be done as soon as possible.
While the gold standard for testing SIBO is the breath test, the reliability of this test is questionable. This test may be susceptible to false positive and false negative test results.
At RHS, we use other tests to look at a more comprehensive picture of your health. We test food allergies, food sensitivities, stool testing, organic acids, nutritional deficiencies, adrenal/cortisol panels, and more.
Although we can’t diagnose SIBO with a stool test, we can look for findings that suggest bacterial overgrowth. The additional testing can help us personalize your diet, supplement, and lifestyle protocol.
Take control of your gut health
At RHS, we believe in a one-size-fits-one approach, not a one-size-fits-all approach. If you suspect you may be experiencing symptoms of SIBO, a professional consultation can provide clarity and guide you toward effective options. Schedule a free consultation with Dr. Deglmann today to discuss your symptoms and explore tailored solutions for your digestive health.
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