SIBO: A Beginner’s Guide

We often take our digestive health for granted. It’s one of those things that most of us ignore until we’re forced to admit it. Upset stomachs can be debilitating, and it’s something we don’t often talk about as it’s embarrassing. 

Perhaps this is part of the problem. Our shyness works against us, so we tend to suffer in silence. But what happens when it’s not a temporary problem? 

A quick search on the internet will leave you confused. There are many chronic digestive problems, which all share similar symptoms. This makes it difficult to tell them apart, and therefore, treatment becomes a cumbersome effort. 

One of the problems which is often overlooked entirely is SIBO: a disorder of the small intestine. It could be a symptom of an underlying problem, so it deserves some of our attention. 

Here’s what you should know about it. Hopefully, the following will make it easier to diagnose so that if you suspect you have it, you can get appropriate treatment. 

Sibo: A Beginner’s Guide Index

1. What Is SIBO?
2. SIBO Symptoms
3. SIBO Diet
4. SIBO Test
5. SIBO Treatment
6. SIBO Probiotics
7. More SIBO & Paleo Resources

What Is SIBO?

SIBO stands for Small Intestine Bacteria Overgrowth. Even though your small intestine is the longest part of your digestive tract, it normally has very little bacteria in it. Its purpose is to absorb nutrients into our bloodstream; an important part of nutrition and health. 

In SIBO, the bacterial in your large intestine begin to migrate to the smaller intestine and cause an overgrowth of bacteria. This causes the small intestine to malfunction, and nutrient absorption is interfered with. 

What happens is that the bacteria feed off of your nutrients instead, meaning you receive much less than you ought to. SIBO not only affects your overall well-being because of this, but it brings about unpleasant (and even dangerous) side effects. 

Even though SIBO can be treated, it’s considered a chronic illness. A diagnosis is usually made if the measurement is greater than 100,000 organisms per milliliter (normal is 10,000 organisms/liter).

Recurrence is not uncommon even after treatment, and curing it can be difficult and frustrating. The good news is that if it’s seen soon enough, treatment could be as simple as a round of antibiotics, and simple changes in diet. 

Symptoms

How do you know if you might have it? Well, the symptoms are not fun – not fun at all. Truthfully, you’ll probably end up feeling like the lady in the picture below.

Not every symptom of SIBO will be immediately apparent. If it’s severe and it’s affecting your overall health, you might not notice until you’re well into your struggle with it. Still, it has some obvious physical symptoms. The problem is that they’re exactly the same as most other digestive disorders. 

It’s all too easy to confuse SIBO with problems like IBS, lactose intolerance, or other food allergies. These symptoms will vary in intensity from person to person. It includes:

• Bloating
• Constipation
• Cramps
• Diarrhea
• An excess of, or uncomfortable gas
• Indigestion
• Nausea
• Stomach pain
• Unplanned weight loss

You might also experience a regular, or even constant feeling of being full, regardless of how much you eat. 

Who Is at Risk of SIBO?

SIBO can affect anyone, but some people are more prone to it than others.

First and foremost, you are most at risk of SIBO if you have or contract any of the illnesses that could lead to it. 

The most common perpetrator in this is IBS. The problem is that those symptoms of IBS are so similar, that SIBO often goes unnoticed. 

You are also at increased risk of developing SIBO if your diabetic, or have HIV, Parkinson’s disease, fibromyalgia, or scleroderma. Hypothyroidism (or any thyroid troubles for that matter) could also make you more susceptible to SIBO. 

As mentioned above, you’re at higher risk of SIBO after surgery, particularly gastric procedures. Medications that you take can also leave you vulnerable to it, namely narcotics and those that slow down your gut. 

Lastly, there are lifestyle factors that put you at risk too, for example, unhealthy eating habits and alcohol consumption. 

Diagnosing SIBO

Since SIBO is so tricky to identify, self-diagnosis is impossible. The only way to be sure that you’ve developed SIBO is to receive a diagnosis from your doctor. Depending on the circumstance, diagnosis may be as simple as an abdominal exam and an interview about your symptoms and medical history. 

Sometimes it’s more complicated than that, though. If the interview and examination bring about unclear results, you may be subject to further testing. In extreme cases, this could involve blood, urine, or even fecal tests. 

The most common test, however, is the breath test. Bacteria in your gut will produce hydrogen and methane. These substances will enter your bloodstream through your small intestine, by which they will enter your lungs and therefore your breath. 

If there is a high concentration of hydrogen and methane in your breath, it will prove indicative of SIBO. There is one catch if a breath test is ordered: you will have to fast for 24 hours before you take it. 

The test itself is not at all painful or difficult. All that you will have to do is breathe into a device at regular, timed intervals. Though breath tests are the most effective way to detect SIBO, the results might still be inconclusive. If that’s the case, you’ll have to undergo further testing, in which other samples might be necessary. 

Treating SIBO

Treating or managing SIBO won’t be difficult, but it might prove to be slightly inconvenient or frustrating. The bright side to this is that with some patience and determination, you can eliminate SIBO as a problem. 

The most efficient way to not only treat but also prevent a recurrence is to manage SIBO with a combination of antibiotics and dietary changes. 

Antibiotics

If you have any hope of fighting SIBO you will have to resolve it at the source. Antibiotics will kill unwanted bacteria in your small intestine, which will naturally cure the bout of SIBO within it. Typical antibiotics, in this case, include ciprofloxacin, metronidazole, and rifaximin. 

Though you’ll be prescribed a course of antibiotics, in extreme cases you might require IV therapy to boost your fluids or treat malnutrition—a common complication of SIBO.

Chances are that the antibiotics will work like a charm, but they won’t prevent recurrence or cure what caused the SIBO in the first place. If your SIBO is a side effect of another illness, you’ll have to seek treatment for it. If it’s a poor lifestyle that caused it, you might have to make a personal effort to ward it off for good. 

Diet

There is no evidence that any specific diet directly leads to SIBO, but many people experience relief (even permanent relief) once dietary changes are made. Food is often what causes SIBO to flare, as it won’t be digested properly and will seemingly make you sick. That is why the best kind of diet is one consisting of easily digestible foods.

This will allow your body to process the food early on in the digestive process and leaves minimal digesting for your lower intestine (the part affected by this condition). 

Remember, though it’s common to confuse SIBO with a food allergy or intolerance, they’re two different things. It’s recommended that you consult a doctor or physician before you commence a new or specialized diet, though chances are high that changing what you eat will help immensely. 

Before you begin a new diet though, there are other changes you can make to keep SIBO at bay. Eating a generally balanced diet is always promoted. Smaller meals will prevent SIBO attacks because they’re easier on your stomach and digestive tract. If you have started a different diet plan and have found that you developed SIBO, discontinue it. 

One study suggests that the elemental diet (in which foods are replaced with specialized diets) had a massive impact on SIBO. More research is needed, and you have to try this diet under the instruction and supervision of a doctor. 

Using Probiotics

Probiotics – as we already mentioned – can sometimes help alleviate the symptoms. These are commonly found in yogurts and help accompany the good bacteria you already have in your system. Their actual result is still a little uncertain, but it seems to work better for some people than it does for others.

Whatever you do, you’ll want to approach this carefully, there is some evidence that probiotics can actually make the symptoms worse!

What Should You Eat if You Have SIBO?

There is evidence to suggest that the bacteria you can blame SIBO for thrives on carbohydrates. For this reason, a low FODMAP diet is highly recommended to those who struggle with it. 

FODMAP stands for Fermentable Oligo-, Di-, Mono-saccharides, and Polyols and designates certain kinds of carbs. When you eat foods within this group (and a few outside of it too), rather than ingesting it, those pesky bacteria ferment instead it. This can amplify the excessive gas, bloating, and stomach pain that you experience. 

It’s not to say that reducing carbohydrates will cure your SIBO, or that a low FODMAP is the only diet you should into. There is insufficient research to prove that it’s the best. Regardless, it works for many people and is worth a shot. 

There are other diets that have worked for some people, but they’re not as effective in general and shouldn’t be attempted without a doctor’s consent. These include:

• Specific carbohydrate diet (SCD)
• Cedars-Sinai diet
• Gut and psychology syndrome diet (GAPS)

Keep in mind that you should consult a doctor before attempting the low FODMAP diet anyway, just to be safe. 

Foods to Avoid

According to the National Institute of Health (NIH), you should avoid (or reduce intake of) the following, while keeping a food journal to note any changes in correlating symptoms:

• Fruits including (but not limited to) nectarines, plums, cherries, apples, watermelon, blackberries, apricots, mangos, and pears in all varieties—fresh, frozen, juiced, dried, or canned.
• Vegetables such as cauliflower, mushrooms, artichokes, onions, sugar snap and snow peas, beans, garlic, cabbage, lentils, and even asparagus.
• Dairy
• Rye and wheat
• Foods containing high fructose corn syrup, such as processed honey and pancake syrup
• Candy, sweets, and all foods with artificial sweeteners

You should also limit the oils you take in, and you should avoid alcohol. 

Recommended Foods

When following a low FODMAP diet, fiber is important. It’s worth noting that bacteria don’t feed on insoluble fibers, so foods containing them are emphasized. Safe foods include:

• Five to six servings of vegetables every day, including carrots, cucumber, green beans, lettuce, pumpkin, and sweet potato.
• Four to six servings of bread, rice, pasta or cereal, with emphasis on gluten-free variations.
• Two servings of fruit per day, including oranges and other citrus fruits and bananas.
• Two to three servings of meat (including poultry and fish). White meat and eggs are a favorite. You can also replace this with nuts and seeds if you are vegetarian. 

There are many recipes available online if you’re unsure where to start. There is no reason for you to give up delicious foods, only to rethink them. 

Testing

There are several tests to determine if a patient is affected.

One – the D-Xylose test – a patient may be given a sugar that is not broken down by enzymes. It’s then measures the level of D-Xylose in the urine and blood after a certain time. If there is none – it shows the small intestine is having trouble absorbing it.

A breath test is also available where the patient is given a carbohydrate and the level of hydrogen metabolized over a certain period of time as

A patient is usually considered to have it if their organism count is higher than 10^5 per milliliter.

Sometimes, if a diagnosis can’t be made, treatment is given experimentally to see if it will alleviate the symptoms.

Conclusion

If you’re struggling with SIBO there are many solutions you can try, though there is no guarantee that they’ll bring you any relief at all. The most effective way to treat SIBO is to use antibiotics. 

You’ll have to be diagnosed by a doctor, but this shouldn’t be any trouble. You won’t be able to treat SIBO unless you’re sure that you have it. It could be other illnesses that you’ll have to correct. 

Though SIBO is painful, inconvenient, and generally unpleasant, you can combat it with simple dietary changes and lifestyle choices. It might be a frustrating process, but you can cure it. If left untreated, it can cause complications and become chronic. If you suspect you might have it, consult your doctor as soon as you can.

If you like this article, check out these others:

The Ultimate Guide to Celiac Disease

Paleo 101 Guide

Paleo Diet Meal Planning

Complete Guide to the FODMAP Diet