SIBO or Small Intestinal Bacterial Overgrowth occurs when bacteria normally found in the large intestine migrate to the relatively sterile environment of the small intestine. Think of excess bacteria in the small intestine as snow falling in Texas, the environment is not very well suited for it, and it creates a lot of problems! The small intestine is mainly responsible for absorbing our nutrients from food.
This translocation of bacteria to the small intestine can cause significant bloating after eating, foul-smelling gas, diarrhea/constipation, abdominal pain and other symptoms that are common to many people. These symptoms can be very difficult to live with on a day-to-day basis.
The causes of SIBO, which are often overlooked include low stomach acid (HCl), hypothyroidism, proton pump inhibitors/antacids, neurodegenerative disease, traumatic brain injury, uncontrolled diabetes and more. It’s important to understand the underlying mechanisms so recurrence can be avoided.
The bacteria in the small intestine that overgrow generally produce hydrogen, methane or hydrogen sulfide. Hydrogen SIBO tends to favor diarrheal symptoms whereas Methane SIBO tends to favor constipation symptoms. These gases can be tested for with special SIBO breath tests available from different labs. The only lab currently testing for hydrogen sulfide SIBO is Triosmart.
SIBO can manifest on a spectrum from asymptomatic overgrowth all the way to severe symptoms with significant malabsorption. It is significantly undervalued as a cause of malabsorption in many individuals. The environment of the small intestine in these cases is not conducive to the absorption of key vitamins and minerals such as iron, vitamin D and other fat-soluble vitamins, vitamin B12 etc. and lab deficiencies of these may be seen.
Early neurodegenerative diseases such as Parkinson’s can present as SIBO from dysmotility and this manifestation occurs years, sometimes even decades before a tremor is seen in a patient. Looking into this as a rare cause of SIBO is vital in picking up these obscure cases.
The treatment of SIBO involves consuming a diet low in fermentable carbohydrates essentially starving the bacteria of food and helping to reduce symptoms of bloating, gas, diarrhea/constipation. In addition, certain herbal or prescription antimicrobials are needed to wipe out the bad bacteria and get rid of the SIBO. These antimicrobial courses can sometimes take 2-4 weeks to be effective and at times multiple courses are needed to overcome these stubborn bacteria. Probiotics can also be effective in certain cases. After that, employing certain strategies that help improve the motility of the GI tract are needed to prevent relapse of SIBO.
Take home message: always try to identify the underlying cause of SIBO and have a comprehensive treatment plan encompassing diet and various antimicrobial tools from your toolkit.

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