What is SIBO (Small Intestinal Bacterial Overgrowth)?

SIBO stands for small intestinal bacterial overgrowth (SIBO) and is a type of dysbiosis or imbalance of healthy gut bacteria. SIBO is caused by an overgrowth of bacteria in the small intestine, which can cause a variety of IBS-like symptoms such as bloating, abdominal pain, diarrhea, gas, constipation, nausea, and malabsorption of nutrients. Generally, bacteria live in our digestive tract ecosystem harmoniously with the other bacteria that make up the gut microbiome. Stomach acid, bile flow, digestive enzymes, and motility (forward movement of the gut) normally help protect against bacterial overgrowth.

When SIBO is present, the body is communicating to you that you are not in alignment, resulting in the gut not absorbing vitamins and minerals properly or breaking proteins and carbohydrates down effectively. For different reasons, motility by the migrating motor complex (MMC) becomes sluggish which results in food not being swept through correctly which in turn ferments and feeds bacteria living in there. This can damage the small intestine’s lining and increase intestinal permeability, often called leaky gut. When this happens, protein molecules pass through the small intestine into the bloodstream, triggering immune reactions that can cause food allergies or sensitivities, chronic inflammation, and autoimmune diseases. If left untreated, it can cause unplanned weight loss, nutritional deficiencies, and bone loss.

There are three types of SIBO:

Hydrogen (H2)-dominant SIBO is associated with higher hydrogen gas levels and IBS-diarrhea.
Intestinal methanogen overgrowth (IMO) aka methane (CH4) dominant-SIBO is more strongly correlated with IBS-constipation.
The most recently discovered SIBO subtype is hydrogen sulfide (H2S)-dominant SIBO, characterized by excess bacterial production of H2S gas and diarrhea.

Symptoms

Symptoms are a way the body speaks to us. They are trying to get our attention that we may need to change how we are thinking, speaking, and/or acting. The overgrowth of bacteria can lead to various symptoms that are not isolated to just the gut, including:

Bloating
Abdominal pain
Diarrhea
Constipation
Burping
Gas
Malabsorption of nutrients
Skin problems: rashes, rosacea, eczema
Joint pain
Nausea
Depression
Anxiety
Vomiting
Acne
Fatigue
Weight loss

Root Causes

While the exact causes of SIBO are complex and multifactorial, there are several factors that may contribute to its development. Here's a brief overview of some root causes:

Medications: Proton pump inhibitors, such as omeprazole and histamine 2 receptor blockers, may promote SIBO when used on a long-term basis, such as 4 weeks. Antidepressants, antibiotics, birth control can all slow the digestive process down, alter gut bacteria diversity, and impact function.
Low Stomach Acid, Bile, or Enzymes: Stomach acid, bile, and digestive enzymes act as part of the body's first line of defense against infection by killing bacteria passing through the gut. Bacteria can overgrow within the upper digestive tract when there are deficiencies in stomach acid, enzymes, and/or bile. Aging reduces these protective barriers. Dysfunction in the liver that affects bile production can influence the balance of bacteria in the small intestine as well.
Chronic Stress: Stressful thoughts or perceiving something as always stressful impacts energy flow, digestive function, and motility in the gut. Slow or disrupted motility can contribute to the stagnation of contents in the small intestine, creating conditions favorable for bacterial overgrowth.
Meal Timing: Frequent grazing or eating and not allowing enough time between meals can contribute to SIBO.
Concussions or Head Trauma: Injuries to the neck or head can affect the vagus nerve, the nerve responsible for gastric emptying and motility.
Food Poisoning/Post-Infectious: When we are exposed to food poisoning, the body produces antibodies to fight the foodborne illness. These antibodies attack Vinculin which is an important protein for nerves. In turn, the motility in the small intestine is affected and this can lead to the development of SIBO. Previous infections affecting the gut can sometimes alter the microbiome and contribute to SIBO. Dental procedures such as root canals and tooth extractions can also affect the balance in the gut.
Emotions/Personality: Worry impacts spleen and stomach balance, reducing ability to digest life and food. Resentment, frustration, anger impact the liver and gallbladder which are important organs for bile production and bile flow. If there's impaired bile flow, it may lead to an environment conducive to bacterial growth in the small intestine. When we fear, lack trust, or lack an ease towards experiences in life, digestion and absoprtion of nutrients will be affected. Working on trust is vital in gut healing.
Low Fiber Diet: A diet that is low in fiber (fruits and vegetables) and high in refined carbs (flour and sugar) can lead to slower transit times through the gut. Fiber adds bulk to the stool and stimulates peristalsis (the muscular contractions of the intestines). Insufficient fiber intake can contribute to stagnation in the small intestine, providing an opportunity for bacterial overgrowth.
Mold/Mycotoxins: Mold from water damaged buildings and from foods (grains, dried nuts, cereals), can alter and impact digestive ability.
Surgical Interventions: Surgeries involving the gastrointestinal tract, such as those affecting the gallbladder or ileocecal valve, can alter the normal anatomy and function, potentially leading to SIBO.
Chronic Disease and Immunodeficiency: Younger children, older adults, and individuals with weakened immune systems are more prone to getting SIBO. Conditions that compromise the immune system, such as HIV/AIDS, cancer, or immunosuppressive medications, may increase the risk of dysbiosis. Hypothyroidism, diabetes, gastroparesis, inflammatory bowel disease (IBD), and celiac disease can all negatively impact intestinal immunity and motility.
Genetics: Anyone who has either a Blood type O, a homozygous recessive FUT2 genetic mutation, or has a Lewis A+, and Lewis B- blood type is more susceptible to bacterial overgrowth.

It is important to note that these factors are often interconnected, and someone may have a combination of them contributing to the development of SIBO.

Testing

There is no validated gold standard diagnostic test for SIBO yet. A carbohydrate breath test is a noninvasive, fast, and inexpensive test that has become a common way of assessing the amount of bacteria present.

Treatment and Management

A holistic healthcare professional can help identify the specific factors contributing to SIBO and develop an individualized plan that may include addressing the root causes along with symptom management. Dr. Cresencia Felty is a gut healing specialist who focuses on getting to the root cause of health issues by supporting the whole person - mind, body, and spirit. She believes the mainstay of therapy for SIBO needs to be holistic - antibiotics, diet, meal spacing, stress management, nervous system regulation, and prokinetics to reduce (rather than eradicate) small intestinal bacteria. In addition, some people may require treatment of underlying nutritional deficiencies, hormone imbalances, nervous system dysregulation, emotional trauma, and associated inflammation.

Herbal antibiotic therapy has been shown to be just as effective as antibiotic therapy in the treatment of SIBO. Antibiotic therapy such as Rifaximin is dosed for a minimum of two weeks and sufficient in treating hydrogen-SIBO, but it is usually paired with neomycin or metronidazole to treat IMO or bismuth to treat hydrogen sulfide-SIBO. Herbal antibiotic therapy is most effective when two antimicrobial herbs are dosed together for at least four weeks. Oregano, berberine, and neem are effective in the treatment of hydrogen-SIBO. Adding allicin (garlic) to one of the above herbs appears more beneficial in treating IMO.

The elemental diet (ED) is the most extreme, but most effective, option for treating SIBO. An ED formula consists of pre-digested nutrients that nourish the patient while starving microorganisms in the gut. Diets that reduce the intake of fermentable carbohydrates can effectively provide SIBO symptom relief. The low FODMAP, Specific Carbohydrate (SCD), Bi-Phasic, GAPS, and Cedars-Sinai diets are all clinically effective options. Strict elimination diets should be followed for as little time as needed, with the goal of reintroducing variety back into the diet as SIBO and leaky gut are treated.

Meal spacing can encourage proper motility and provide relief. It's best to space meals during the day by 3-5 hours, eating the last meal two hours before bed, and fasting overnight for 10-12 hours.

Stress management is key in healing any digestive problem. Some practices for stress management include: meditation, journaling, walking in nature, gratitude, faith, trust, talk therapy, and somatic therapy.

Nervous system regulation improves digestive functioning, motility, and bacteria diversity. Nervous system regulation can be a daily practice of creating intentional feelings of safety and joy within the body. Yoga, breathwork, inner child healing, spirituality, time in nature, therapy, and community can help regulate the nervous system.

SIBO management and prevention should always include a prokinetic agent, such as ginger, which enhances motility and digestion. You can take this in a supplement form (an example is called MotilPro) or have this in the form of ginger tea. Other preventive strategies include ileocecal valve massage and managing underlying diseases interfering with intestinal defense mechanisms. It is important to work with a qualified holistic practitioner to develop a personalized plan tailored to individual needs. Dr. Felty is committed to empowering individuals on their healing journey, and if you are struggling with SIBO symptoms, she is here to help.

Book a discovery call with Dr. Felty to explore personalized approaches. With her extensive expertise in natural medicine, mind-body healing, and holistic therapies, you can gain valuable insights and tailored recommendations to address the root causes of SIBO. Discover the possibilities of healing and the freedom to live life fully with Dr. Felty's support.