Strictly speaking, SIBO has only been discussed relatively recently. The same goes for properly diagnosing the problem. Today, however, anyone who has encountered digestive problems has at least heard about bacterial overgrowth, i.e. SIBO.
What is SIBO?
SIBO (Small Intestinal Bacterial Overgrowth), as the name suggests, is an overgrowth of bacteria in the small intestine. Much is said about
the bacterial flora and its beneficial effect on the body. But what happens when excessive amounts of bacteria begin to settle in a place where they do not belong? Let's start from the beginning…
The vast majority of bacteria are found in the large intestine, while in other parts of the digestive system there are far fewer of them. This also applies to the small intestine. The key to a healthy body is balance. It is not only about specific types of bacteria, but also about their amounts in specific places. Maintaining the optimum in this regard allows, among other things, for the proper functioning of the immune system, digestion, and the absorption and assimilation of nutrients.
The small intestine is adapted to much smaller amounts of bacteria than the large intestine. Sometimes, however, there is excessive bacterial growth in the small intestine, which in medical terms is defined as a chronic bacterial infection, but without a strictly pathogenic basis. This is what SIBO is – bacteria from the large intestine move to other parts of the system, mainly to the small intestine, disrupting many important processes.
This state of affairs negatively affects the functioning and production of enzymes in the lining of our intestines. In SIBO, there is relatively often a significant reduction in or inactivation of enzymes responsible for digesting carbohydrates. Undigested carbohydrates, in turn, provide excellent nourishment for bacteria, creating a favorable environment for further overgrowth. In such circumstances, the breakdown of carbohydrates and increased fermentation contribute to digestive discomfort, including pain.
SIBO – where does it come from and what is the cause?
The fact is that SIBO is more a consequence of other problems than a primary cause. I mentioned the bacterial balance of the digestive tract. It can be said that each area is assigned a specific, optimal amount of bacteria. Everything is overseen by the so-called intestinal peristalsis, whose role is to transport food from the stomach, through the small intestine, to the large intestine and from there to the rectum for elimination. Weak intestines and impaired peristalsis mean trouble for the whole body.
Interestingly, other digestive problems put us at a disadvantage, which places us in a higher-risk group for SIBO. Most often, this involves problems with the functioning of the small intestine, digestive disorders, and a deficiency of stomach acid.
What else contributes to SIBO?
- use of PPIs, NSAIDs, painkillers and antibiotics,
- excess amounts of simple sugars in the diet,
- alcohol abuse,
- use of steroids,
- chronic conditions such as pancreatitis,
- diabetes, cirrhosis of the liver,
- food poisoning,
- celiac disease,
- intestinal infections and diseases leading to them.
It is worth keeping in mind that, according to experts, SIBO is to a greater or lesser extent associated with conditions such as diabetes, obesity, celiac disease, irritable bowel syndrome (IBS), hypothyroidism.
SIBO – symptoms and diagnosis
Symptoms of SIBO can be very different and do not necessarily have to be limited to the digestive system. What is more, the type of symptoms and the degree of their severity depend on the type and amount of bacteria that have moved into the small intestine.
However, it should be remembered that this is an individual matter. One person may experience constipation, another diarrhea, and yet another only bloating. That is why comprehensive action and a holistic view of the body are important. Namely: prevention, health-promoting measures, and in the case of a problem, eliminating the source, not just the symptoms.
The most common symptoms of SIBO include:
- persistent bloating (especially after meals, though not only),
- difficulty concentrating,
- bowel problems (diarrhea / constipation),
- nausea,
- heartburn,
- weight loss,
- food intolerances,
- deficiencies of fat-soluble vitamins (A, D, E, K),
- deficiencies of B vitamins,
- bad breath,
- muscle and joint pain,
- fatigue.
Symptoms do not necessarily have to involve the digestive system strictly – these include, for example, swelling, inflammation of the joints or liver. According to research, excessive bacterial growth in the small intestine is also associated with depressive states. A consequence of SIBO may be damage to and disruption of the integrity of the intestinal barrier, which is a good environment for the appearance of allergic conditions and infections.
Symptoms are only an auxiliary element. Due to their individual occurrence, they cannot serve as a diagnostic tool. For a proper diagnosis, a hydrogen–methane breath test is performed, using glucose or lactulose.
The test involves measuring hydrogen and methane in exhaled air. It is first performed on an empty stomach, and then after administration of glucose or lactulose. Several such measurements are taken over about three hours. An excess of hydrogen and/or methane will indicate SIBO.
It should be remembered that for the test to make sense, you need to prepare properly. A few days before the breath test, you should switch to easily digestible, non-fermentable foods. We also avoid antibiotics (even a month before) and laxatives. It is also a good idea to add an LPS test to the hydrogen–methane test, which allows for a more precise diagnosis and optimization of management in a given case.
Have any of you had experience with SIBO, or do you know someone who is struggling with it?