What's SIBO & do I need to worry about it?
SIBO (pronounced ‘sea-bow’) is an acronym which stands for small intestinal bacterial overgrowth and I’ve been getting more and more questions about it lately so thought it was time to share some info about it with a blog post!
So what is it? Well, SIBO refers to the condition where an abnormal # of bacteria take up residence in the small intestine that normally would inhabit the large intestine (colon). The outcome of these bacteria living higher up the digestive tract than they are meant to – remember anatomy here for a second, the small intestine is above and leads to the large intestine – enables carbohydrates to be available for these bacteria to digest and it’s the digestion of these carbohydrates that leads to symptoms similar to those experienced by irritable bowel syndrome (IBS) – abdominal bloating, distention, pain, gas, flatulence, diarrhea etc.
How do I know if I have it? There are 2 ways to go about determining if you have SIBO. The first is a rather invasive means which would involve your doctor obtaining a sample of the contents inside your small intestine via endoscopy to perform a microbial investigation on the contents found inside– not the easiest method of diagnosing, so typically option two is the route. The second option, is what’s referred to as a breath test. Remember I mentioned with SIBO bacteria are able to digest carbohydrates in the small intestine? A product of this digestion is the release of gases including hydrogen and methane. A breath test is performed by measuring the amount of gases in your breath, then having you ingest a beverage which contains sugar (lactulose or glucose) as this substrate would get the bacteria (if there are any) in your small intestine really excited. After you ingest the substrate, your breath is analyzed over a period of time to see if and by how much the gases in your breath increase. From this, your doctor can diagnose whether or not you have SIBO. Although less invasive than option 1 for diagnosing SIBO, the breath test is not without flaws of it’s on including the fact some cases are missed and can be missed if prep instructions for the test are not followed.
What if I am positive for SIBO? Treatment involves antibiotics that target the bacteria in your small intestine. If the antibiotics do their job, the symptoms of SIBO should disappear however, symptoms can return and this seems to be especially true if the reason why you had SIBO in the first place has not been identified or addressed where possible. Research is still pretty new in this field, but there does seem to be some suggestion that SIBO can be an outcome of an abnormal motility in the digestive tract – say for example, in someone with diabetes or someone who takes medication which can alter digestive motility. It also looks like anatomic abnormalities that can result from conditions such as diverticulosis or from surgical scarring can play a role in making some folks more susceptible.
Do I need a special diet if I suspect I have SIBO, or to prevent SIBO from coming back after treatment? Here’s the $1 million question and where these seems to be lots of differing opinions. There is research looking at the role of probiotics in prevention of SIBO as probiotics are known for their ability to “get things moving” and thus help with a motility issue. There is also research looking at omega-3s and other anti-inflammatory foods and their role. Finally, there is lots out there on the role that carbohydrates play suggesting a modified carbohydrate or low FODMAP diet may be indicated – with the idea here that altering the types of substrate you ingest would alter the ability of these bacteria to survive and thrive in your small intestine. But here’s the thing, there is no gold standard yet and before you jump the gun and make modifications to your diet you should speak with your physician and consider working with a Registered Dietitian who can guide you through the process to ensure your diet is balanced to support a healthy you.
I suffer from digestive health issues – should I get tested for SIBO? Here’s the second $1 million question and my answer here is it depends! Breath testing can be $$ and time consuming to do but confirming a diagnosis and then proceeding to treat SIBO can really improve symptoms. Your family doctor might not know a whole lot about SIBO, so bringing up testing with him/her might not get you far but working with a gastroenterologist who specializes in digestive health could be a step in the right direction. In my practice I work with a lot of clients who are under the care of gastroenterologists, and many have gone for testing for SIBO – but not all. Again, your doctor(s) will use clinical assessment and judgement before suggesting a test or treatment plan for you with your health in mind!