I became interested in the topic of SIBO when our readers began writing in and asking about stomach bloat. These weren’t the typical ‘muffin top’ or weight gain or hard to lose belly fat complaints. This was stomach bloat, occurring at any time of the month, often every day, and present even after intermittent fasting. Some women – although it happens to men too – were waking up in the morning just as bloated as at any other hour of the day.

What is SIBO? Small Intestine Bacterial Overgrowth. Also known as post-infectious IBS. An infection happens, the gut environment is ripe for further complications, and SIBO happens. It doesn’t end there however, it can turn into auto-immune disease.

Before you read further, understand that this post is not medical advice. The content within is not to be construed as my theory or opinion. This post is the result of notes taken while listening to Dr. Alison Siebecker as she was interviewed by Diane Kazer. The 1 hour long talk was part of the Primal 90 Sessions, February 12, 2014 and will only be available free for a few days.

These notes are further enhanced on SIBO as a result of listening again to Dr. Alison Siebecker, this time as interviewed by Donna Gates during the Healthy Gut Summit.

Providing my notes allows you to skim (saving yourself hours), bookmark (to read later), or share (with a friend who has questions about the topic). Plus you will always receive links to the originating website or field expert to follow up with when you need to know more.

Dr. Alison Siebecker specializes in SIBO. Recognized with a “Best in Naturopathy” award from the Townsend Letter for her article “Small Intestine Bacterial Overgrowth: An Often Overlooked Cause of IBS” (2013).

What is SIBO?

We have bacteria in our intestine. It is supposed to be there.

SIBO happens when bacteria is overgrown in our small intestine. The small intestine is where food is digested and absorbed – it is about twenty feet long. It follows the stomach in the digestion process and moves the remaining waste to the large intestine. The large intestine processes the indigestible parts of our food – fiber – converting the remainder to vitamins and short chain fatty acids.

Most of our intestinal bacteria is supposed to be in our large intestine. This is not bad bacteria – this is just a case of too much bacteria in the wrong place.

In healthy guts there is a valve that keeps the two intestines separate – but with SIBO the bacteria has moved too freely into the small intestine and colonizes it. Consider that if bacteria is feeding on our food then our body is not. Therefore we’re not experiencing proper digestion or receiving the full nutritional value of our foods.

SIBO Symptoms

Bloating is the largest complaint most weight loss experts hear. SIBO could be the cause. If so, bloating is the gas created by bacterial fermentation, especially where it is unwanted – in the small intestine. Gas created by bacterial fermentation in the large intestine isn’t as disturbing as that gas has a ‘back door’ of escape.

Pain – varying degrees.

Bowel movement irregularities.

Other symptoms include: Excessive farting or burping, acid reflux, dyspepsia (a vague discomfort in the upper abdomen or chest that may be described as gas, a feeling of fullness, gnawing, or burning), and fatigue. Food, supplement and medicine sensitivities are also considered symptoms.

Dietary Changes Needed

Special diets help with SIBO symptoms but doesn’t solve the problem. However, it is advised to take control of your symptoms through diet.

Foods that might aggravate the SIBO condition: Carbs! Plant, dairy (lactose), natural sweeteners.

The last thing you want to do is feed that overgrowth of bacteria in the small intestine. Carbs are the easiest food source (for our bodies and for bacteria). To lessen symptoms, cut back on carbohydrates.

Large intestine bacteria has a different food source: fiber. Examples of fiber are both soluble and insoluble, resistant starch, and sugar alcohols. The stuff that our bodies can’t digest, that’s the stuff our large intestine bacteria does. So decrease fiber too – because some of that SIBO symptom-causing bacteria in the small intestine will feed on and multiply on, fiber.

Special diets help with SIBO symptoms but doesn’t solve the problem. However, it is advised to take control of your symptoms through diet.

Legumes, garlic, apples, chickpeas – anything that causes gas is suspect. But you have to be careful whenever you cut back on a major food group. You still need the nutrition from greens, fruits, fiber.

What Causes SIBO? What Causes That Overgrowth of Bacteria?

Poor motility caused by nerve damage, acute or chronic disease, and perhaps stress (when coupled with other conditions).

Underlying causes are: structural problems. When your intestines’ protective mechanisms are out of whack, or you have an obstruction of flow such as a non-draining pocket (diverticulitis, etc.) in your small intestine.

What are the small intestines’ protective mechanisms? Stomach acid, enzymes, bile, the migrating motor complex, the ileocecal valve (the doorway between large and small intestines), and your body’s immune system.

Factors that put you at risk of developing SIBO: abdominal surgery (including but not limited to, C-sections), drugs, injury, altered anatomy (born with, genetic, or developed).

Surgeries that put you at risk of developing SIBO: abdominal surgery, adhesions (bands of scar tissue that attach to organs and may cause an obstruction). Note that pain medications given after surgery are also a culprit.

Disease/Illness that put you at risk of developing SIBO: gastroenteritis (food poisoning), scleroderma (aka systemic sclerosis, a chronic systemic autoimmune disease characterised by hardening of the skin), diabetes (nerve damage).

Drugs that put you at risk of developing SIBO: proton pump inhibitors, opiate narcotics (pain medications).

Injuries that put you at risk of developing SIBO: any nerve injury or disease that has the potential to injure nervous system.

Sometimes it takes two risk factors to bring SIBO on. The most common of this is food poisoning – when pathogenic bacteria arrive in the small intestine and the small intestine has existing scar tissue.

This is one of the most common causes and it begins with food poisoning and/or a pathogenic bacteria entering the small intestine. Usually our body fights off those pathogenic bacteria by expelling the food when it is still in the stomach (throwing up), or by killing the bad bacteria (through bile and stomach acids). What happens when those safeguards aren’t carried out – or carried out fully is that the bad bacteria then heads into the small intestine (the result of which is often diarrhea).

There are long term and damaging effects when this happens – the worst of which is our body’s autoimmune response. When our body fights off pathogens in our small intestine this happens: Acute infection leads to the autoimmune process, which leads to nerve damage, which leads to longer-term autoimmune processes, which negatively affects the migrating motor complex (the act of sweeping bacteria from the small to the large intestine) – the result of which is a backup of bacteria that leads to discomfort and potentially long term health problems.

Prevention: Worried About Food Poisoning?

Get to emergency or to a doctor. If you can’t right away, try an antibacterial agents: Berberine, Goldenseal, Oregon grape, garlic (although it is highly fermentable by bacteria – so seek out allimax, alliUltra, AlliMed), oregano oil, cinnamon bark capsules.

Acute symptoms and learning to live with SIBO

Symptoms are similar to IBS.

Long term consequences: mal-absorption of foods, malnutrition. Not just for micro-nutrients (B12, iron deficiency/anemia), but also of macro-nutrients (fat, carbs, and sometimes protein).

Somewhat an infection but not pathogenic. Overgrowth of bacteria burns out the immune system, the liver, (too much endotoxin – outer cells of bacteria).

Testing & Treatment

Three hour breath test for lactulose (not a spelling mistake) – through your doctor. Go to siboinfo.com and look for the testing links if your doctor won’t do it. All of it is covered by insurance. Go find a gastroenterologist if you can. Order a test yourself? Not always perfect but look for the Glucose Breath Test.

Treatment can be hard. Killing of bacteria makes you feel like you have the flu, headache, fatigue, or worse SIBO symptoms, or new digestive issues.

Best relief has been found by many SIBO sufferers through diet: “Low FODmap”; but also try “restrictive or low fermentation”, specific carbohydrate, or the GAPs diet. Dr. Siebecker has also created a diet.

Therapy protocols are standard 3 months on, a trial removal, and assessment.

Herbal antibiotics for SIBO, but that could take multiple rounds to get to a point of comfort.

Iberogast, ginger, MotilPro, Prokinetics, low dose erythromycin (50mg compounded), low dose naltrexone, Prucalopride (Resolor). Each one is best to treat specific conditions of SIBO – you’ll want to consult with a doctor first!

Try one of the diets. Don’t snack between meals (see below for a warning) especially if the underlying cause could be the migrating motor complex.

Get to a naturopath. Naturopaths study for 4 years, all the same training as MD but no surgery. STudy botanical, homeopathic, nutrition, hydrotherapy, naturopathic manipulation therapy (chiropractic), physiotherapy and primary care.

Looking after our families. Get healthy bacteria into children’s guts at a young age. It reduces the risk of later autoimmune processes. We are given far too many antibiotics at far too young of an age which causes many problems in a child’s gut.

Final Tips For SIBO Sufferers

Are you going to have SIBO forever? Perhaps – it would depend on the underlying cause. Everyone is different.

Best to practice prevention of re-occurence: strategies are a low carb diet and a prokinetic (drugs to strengthen the lower esophageal sphincter (LES) and cause stomach contents to empty faster). Low Carb diet helps starve out some of that small intestine bacteria – or at least not feed it! Prokinetics help move the migrating motor complex.

Probiotics have shown good results in studies, but not enough to say “yes, probiotics help everyone with SIBO.”

Be sure to visit Dr. Siebecker’s website as she provides a lot of great information, free diets, and links to testing. The best treatment is knowledge, know the condition and know how your body reacts to foods, medications, or treatments.

Try one of the diets. Don’t snack between meals – especially if the underlying cause could be the migrating motor complex. Try some of the natural interventions available on the doctor’s website.

An action step is to not eat every few hours. Better to eat every 4-5 hours as one of the symptoms is the mobility function: peristalsis. Two types of peristalsis happens in the intestines. The first is moving food out of small intestine to large intestine. The second is the sweeping motion of moving bacteria out of the small intestine to the large intestine. These occur individually of each other and if the small intestine always has food in it, the sweeping of bacteria cannot take place. This lifestyle change is not recommended for people with low blood sugar. The recommended dietary change is to go low carb and then – once blood sugar has stabilized – address the snacking problem.

Another action step: rest, reduce stress, and add a little exercise to your life.

Further Consideration and Study

Leaky Gut: 50% of people with SIBO have leaky gut and SIBO can cause leaky gut.

Autoimmune Diseases start with 3 criteria (genetic predisposition, environmental triggers, leaky gut).

What is a “Migrating Motor Complex“, “Prokinetic Agent“, “Motility“?

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