Understanding SIBO: A Closer Look at Small Intestinal Bacterial Overgrowth

In the realm of gastrointestinal health, one term that has garnered attention in recent years is SIBO - Small Intestinal Bacterial Overgrowth. This condition, while not widely known, can significantly impact one's digestive system and overall well-being. Let's delve into what SIBO is, its symptoms, causes, diagnosis, and treatment options.

What is SIBO?

Small Intestinal Bacterial Overgrowth refers to an excessive growth of bacteria in the small intestine. Normally, the small intestine contains relatively few bacteria compared to the large intestine. However, when the bacterial population in the small intestine becomes imbalanced or overgrown, it can lead to various symptoms and complications.

Symptoms of SIBO

The symptoms of SIBO can vary widely and may overlap with other gastrointestinal disorders, which can make diagnosis challenging. Common symptoms include:

• Abdominal pain or discomfort: Often felt in the lower abdomen.

• Bloating: Feeling excessively full or swollen after eating, especially after consuming carbohydrates.

• Diarrhea or constipation: SIBO can disrupt normal bowel movements.

• Gas and belching: Excessive gas production is a hallmark of SIBO.

• Nutritional deficiencies: Malabsorption of nutrients due to bacterial interference with normal digestion and absorption processes.

These symptoms can significantly impact quality of life and may vary in severity from person to person.

Although these are typical symptoms, you can have unexplained symptoms elsewhere that may directly relate to SIBO. In other words, you could have anxiety or depression that is from gut inflammation. The underlying cause could be SIBO and you may not even have any gut symptoms. This makes it a tricky diagnosis but luckily, you can test for it. We’ll dive into that later. 

Causes of SIBO

Several factors can contribute to the development of SIBO:

• Impaired motility: Conditions such as irritable bowel syndrome (IBS) or scleroderma can slow down the movement of food and bacteria through the intestines. Decreased motility from GLP-1 agonists such as semaglutide may contribute and there is some emerging anecdotal evidence to suggest this correlation. 

• Structural abnormalities: Surgery or conditions that alter the anatomy of the gastrointestinal tract can predispose individuals to SIBO.

• Certain medications: Proton pump inhibitors (PPIs) and antibiotics can disrupt the balance of bacteria in the gut, potentially leading to SIBO.

• Underlying conditions: Disorders such as diabetes or immune deficiencies can create an environment where bacterial overgrowth is more likely.

• Hypochlorhydria: Low stomach acid can cause food to be undigested, feeding the bacteria in the small intestine. See below:

Diagnosis of SIBO

Diagnosing SIBO typically involves a combination of clinical evaluation and specific tests. Breath tests are commonly used to detect the presence of certain gases produced by bacteria in the small intestine. These tests involve drinking a solution of lactulose or glucose and then measuring breath samples over a period of time to detect elevated levels of hydrogen and methane gases.

Treatment Options

Treatment for SIBO aims to reduce bacterial overgrowth, alleviate symptoms, and prevent recurrence. Common treatment approaches include:

• Antibiotics: Specific antibiotics targeting the overgrown bacteria are often prescribed for a period of time to reduce bacterial load.

• Probiotics: In some cases, probiotics may be recommended to help restore a healthy balance of bacteria in the gut.

• Dietary changes: Following a low FODMAP diet or reducing intake of fermentable carbohydrates can help alleviate symptoms.

• Managing underlying conditions: Addressing any underlying causes or conditions that contribute to SIBO is crucial for long-term management.

Small Intestinal Bacterial Overgrowth (SIBO) is a complex condition that requires careful diagnosis and management. If you suspect you may have SIBO based on symptoms like bloating, abdominal pain, or irregular bowel movements, let’s get on a call and see if we can help you out. 

B12 Deficiency and SIBO

We routinely send our clients out for bloodwork, and one of the most common deficiencies we see is B12. There are a number of reasons for this, and in this blog we’ll cover the most common ones.

B12 (cobalamin) is a water soluble vitamin and is part of the methylation cycle, and as such is important for DNA synthesis and repair. It plays a role in nervous system development and in neurologic functions, as well as formation of red blood cells. Deficiency can cause anemia,  tingling in the hands and toes, and has been correlated with dementia. 

B12 interacts with homocysteine and folate in the methylation cycle, so when homocysteine and folate are high, that usually indicates deficiency in B12. It’s an inverse relationship.

Humans cannot synthesize B12, so it has to be acquired in the diet. B12 is high in liver, red meat, eggs, and seafood. You may read that B12 can be found in plant foods such as algae, but that is a myth. B12 is cobalamin, and algae contains cobamides, which is pseudo B12 and can actually inhibit the absorption of B12. So this is one of the most common reasons for B12 deficiency, inadequate intake. 

Another common reason for B12 deficiency is malabsorption. This comes in two forms, hypochlorhydria and SIBO. Hypochlorhydria means low stomach acid. Stomach acid helps break down our foods and if it’s too low, you won’t get the appropriate amount of nutrients out of your food. Several factors can influence low stomach acid. It naturally decreases as we age, but certain things can influence that. Excess alcohol intake depletes stomach acid. Also, use of PPIs (omeprazole) reduces it almost to zero in some cases. If you are concerned about reflux, read this blog on the correlation between low stomach acid and reflux. 

If the food is not fully digested, it moves into the small intestine. This is where B12 is usually digested by the body. There is a natural balance of microbiota that occurs within our guts. Most of the beneficial bacteria should be in the colon, and only a small amount in the small intestine. When stomach acid is low, food is inappropriately broken down, and the small amount of bacteria in the small intestine get a crack at that food and then they proliferate. This is what is known as SIBO (small intestinal bacterial overgrowth) and has a laundry list of possible symptoms. The over represented bacteria also gobble up the B12, so B12 deficiency may be a sign of SIBO. 

Typical symptoms of SIBO include gas, bloating, fatigue, skin issues, brain fog, constipation or diarrhea, halitosis, and muscle aches. So the symptoms are not confined to the gut. SIBO can also negatively impact fat absorption, so some of the fat soluble vitamins may also be deficient such as D, K2, and A.

The good news is that there is a breath test for SIBO that is cheap and easy. It will determine what type of species of bacteria that have become overgrown. There are specific botanical protocols to correct it based on the results of the breath test.