Thousands of years ago, a wise doctor named Hippocrates stated that all disease begins in the gut. If one stops to think about this statement, at first, it may not make any sense. However, if one fully understands the science behind how the gut functions and which roles it takes on within the body, this old wisdom helps us to take control of our health and lead a fulfilled life.

What Is the Microbiome?

The microbiome is made up of trillions of microorganisms that can either give us life by supporting the immune system, decreasing inflammation, producing important hormones and neurotransmitters, and improving digestion or can create disease by contributing to a leaky gut, triggering an autoimmune attack, or causing issues such as depression or anxiety. Depending on the types and quantities of strains of these microorganisms (either good in the form of probiotics or bad in the form of gram-negative bacteria, for example), health or disease can develop.

What Is SIBO?

SIBO is the acronym which stands for Small Intestinal Bacterial Overgrowth. It is defined by an overgrowth of gram-negative bacteria within the small intestine. These gram-negative bacteria can exist happily in the large intestine, but when they overgrow in the small intestine, they can cause the classic symptoms that most of us associate with Irritable Bowel Syndrome or IBS. These include symptoms such as cramping, flatulence, bloating, reflux, diarrhoea, and constipation. According to Dr Allison Siebecker, SIBO expert, 84% of IBS cases are caused by SIBO.

Why is this relevant? Whenever good and bad bacteria within the gut are unbalanced, as is the case with SIBO, this creates a dysbiosis within the gut that causes the aforementioned symptoms. The gram-negative bacteria feed off of sugars in specific carbohydrates to cause issues such as increased flatulence and other undesirable gastrointestinal issues.

If these symptoms are present over a longer period of time, proper digestion is hindered, proper nutrients cannot be absorbed, inflammation begins, and more long term chronic issues such as the following can occur:

• Allergies or asthma

• Autoimmune Disease

• Increased food intolerances

• Acne or eczema

• Increased risk for weight gain or obesity

• Insulin resistance

• Anxiety and/or depression

How Can You Test For SIBO?

There are two kinds of SIBO – hydrogen-dominant and methane-dominant. What this means is that the gram-negative bacteria can either produce too much hydrogen gas or too much methane gas. Hydrogen-dominant SIBO is typically associated with diarrhoea and can be addressed by taking large doses of good probiotics. Methane-dominant SIBO is more associated with constipation and typically needs an approach in which the gram-negative bacteria are tackled with specific herbal antibiotics.

In order to assess what kind of SIBO you have, you will need to ask your functional medicine doctor to order a breath test. The right kind of test should look at how much hydrogen or methane is produced after ingesting a sugar solution. Knowing these results can help your doctor or health practitioner give a more targeted approach to your IBS issues.

10 Symptoms or Signs You Might be Suffering from SIBO

In the meantime, there are several ways to begin to understand if you have SIBO or not. Let’s take a look at a few:

You have IBS. As mentioned before, 84% of IBS cases are caused by SIBO. Therefore, it would be negligent not to explore the possibility of overgrowth when you have symptoms such as bloating, flatulence, diarrhoea and/or constipation.

Persistent Diarrhea. If you often have issues with diarrhoea, this can also be a sign that you have SIBO – specifically, hydrogen-dominant SIBO. This type of SIBO is usually alleviated by taking the right kinds of probiotics.

Persistent Constipation. If you have a hard time going to the toilet or you do not go to the toilet for days, you are suffering from constipation. In addition to this, if you have constipation and it does not get better by changing your diet, SIBO may be the cause of your constipation. In this case, it is more probable that you have methane-dominant SIBO.

Symptoms Get Worse with Fiber. If IBS symptoms get worse when you add more fibre to your diet, SIBO may be the culprit. High amounts of fibre are needed in a healthy gut to feed the good bacteria within the gut. These types of fibres are called prebiotics. However, if you eat more fibre or you supplement with more fibre and your symptoms get worse, there is a good chance that you have SIBO. This tends to be especially true in methane-dominant SIBO.

Symptoms get worse with probiotics. If you start to supplement your diet with fermented foods such as kefir or kombucha or you take higher-dose probiotics only to get worse cramping and bloating, this is a good sign that you may have methane-dominant SIBO. Probiotics will typically make the healthy individual feel even better, but when they are making you feel worse and causing more GI symptoms, SIBO is probably the main culprit.

Moderate alcohol consumption. This is defined as one drink per day for women and two drinks per day for men. If you enjoy your daily glass of wine at the end of the day, you may be feeding the bacteria that cause SIBO. Drinking every day also causes damage to the lining of the intestine, causes leaky gut, and slows down the motility of the gut. One of the biggest causes of SIBO is when the migrating motor complex or the “electricity” that pushes your food in a downward motion, is compromised. Drinking alcohol slows this natural function of the gut down, which ultimately leads to SIBO.

You feel full easily. If you eat a regular-sized meal and it makes you feel more full than normal, this can be a sign of low stomach acid. One of the functions of stomach acid is to protect the rest of the digestive tract from unwanted or harmful bacteria. Also, it helps break down food properly making it ready to get absorbed in the small intestine. If you do not have enough stomach acid, you allow more bacteria to overgrow and you do not break down food properly thus providing a feeding ground for these bad bacteria. If you have low stomach acid, there is a good chance you also have SIBO.

You have Inflammatory Bowel Disease or IBD. Having a chronic gut issue such as ulcerative colitis or Crohn’s disease is often associated with SIBO. In fact, there is a ninefold increase in the prevalence of SIBO among patients with IBD compared with other individuals.

You take or have taken oral contraceptives. There is not a direct link between taking oral contraceptives and SIBO. However, contraceptives have a moderate association with inflammatory bowel disease. Since SIBO is highly correlated with inflammatory bowel disease, taking oral contraceptives may indirectly contribute to getting SIBO.

You have a thyroid problem. Thyroid hormones contribute to the motility of the gut. If you do not have enough thyroid hormones or your cells are thyroid hormone-resistant, this can slow the digestive tract down, cause constipation, and create a feeding ground for the gram-negative bacteria responsible for SIBO. Therefore, if you have not found the cause of your IBS and constipation, make sure to get proper thyroid testing.

SIBO can be controlled with diet, however, you cannot get rid of SIBO with diet. Therefore, it is imperative to work with your naturopath or functional medicine practitioner to address SIBO in order to fundamentally tackle an important root cause of digestive issues and many other health conditions.

Article Author: Tina Christoudias Spyrou, Dietician and Functional Medicine Practitioner

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