SIBO stands for “small intestinal bacterial overgrowth”, and occurs when there is an abnormal increase in the overall bacterial population in the small intestine — particularly the types of bacteria that are not commonly found in that part of the digestive tract.

Causes of a bacterial overgrowth are many and varied, and can include;

• Abnormally high amounts of stress / trauma
• High consumption of refined carbohydrates / sugary foods
• Consumption of animal proteins that have been given antibiotics eg. chicken, pork, grain fed beef
• Consumption of products made with non-organic white flour eg. breads, pasta, cakes

Bacterial overgrowths can remain undetected for many years, and may only give light symptoms that are often brushed aside, as just something bad that was eaten. They can even occur from c-section births, as the baby had no exposure to the bacteria in the birth canal, or if the mother used anti-biotics during the pregnancy or during the period of breast feeding. Any situation that disrupts the normal flourishing of the digestive system with healthy bacteria, can cause an imbalance to occur.

Symptoms

The symptoms of SIBO are very similar to Candida, and include a hunger for carbohydrate type foods, or being hungry a lot of the time. One of the biggest most telling signs however, is extreme bloating, often quite painful, especially after eating something sweet or high in refined carbohydrates. This creates a lot of gas, as the bacteria digest the carbs and release their gases. This gas can become trapped, causing distention in the gut (bloating) and pain.

Another common symptom is alternating loose stools, and constipation. For some, it’s just one or the other. This is often diagnosed as IBS (Irritable Bowel Syndrome), when in actual fact, the problem is this imbalance of healthy and unhealthy bacteria, that is causing major disruption in the small intestine. In the case of constipation, often patients are told to increase their fibre intake, but this actually can make the situation worse, depending on the pathogens that are residing in the small intestine, as these can feed off the fibre.

Definitive diagnosis can be complex, and testing can be expensive and difficult to do. One rule of thumb, is to look at the location of the abdominal pain and distension. If it is higher in the abdomen, as in under the ribs, this is the area of the colon, so the problem may be more Candida related. If however, the bloating is lower in the abdomen, this is the small intestine area, and therefore, more likely to be SIBO.

Of course, as with any symptom, bloating can come from other areas of imbalance, such as food intolerances, or even hormonal imbalances, and sometimes from medications. This means that a diagnosis is not always found immediately, or without thorough medical history investigation. With doctors appointments generally only lasting 10-15 mins, this is generally not ascertained, and patients are often left wondering what is wrong with them or who to turn to for help.

Help is available however, and treatments require some extensive supplementation and a specific diet, to rid the body of these pathogens. There are a range of bacteria species that can form in the small intestine, causing all the symptoms and disharmony in the digestive system. These include, but are not limited to;

Streptococcus spp.; Bacteroides spp. ; Klebsiella spp. ; Staphylococcus sup. ; E. Coli ; Blasocystis hominis ; Candida albicans ; Clostridium spp.

Foods that make it worse

Many types of carbohydrates, sugars even artificial sweeteners, will be digested by these pathogens, resulting in gas, bloating and potentially digestive pain. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, and are basically a collection of short-chain carbohydrates (sugars) that aren’t absorbed properly in the gut, causing IBS type symptoms. These include;

• fructose, simple sugars commonly found in fruits and some vegetables, honey, and agave nectar
• lactose, a sugar molecule in dairy products
• fructans, a sugar compound found in gluten products, fruits, some vegetables, and prebiotics
• galactans, a compound found in some legumes
• polyols, a sugar alcohol often used as a sweetener

Foods high in FODMAP that can create symptoms include;

high-fructose corn syrup	honey
agave nectar	soda and soft drinks
garlic	onions
asparagus	butternut squash
cauliflower	artichokes
beans	apples
dried fruits	sausage
flavoured yoghurt	ice cream
sweetened cereals	barley
rye	whole grains
peas

• Note that many of these foods are healthy foods, and ordinary should form part of a healthful whole food diet. Several of these foods are actually Pre-Biotics, meaning a food source for healthy bacteria eg. onions, artichokes, wholegrains, garlic

Is a Low FODMAP Diet the answer?

Many suffers will resort to a Low FODMAP diet, and this is often prescribed by medical professionals who specialise in digestive issues, or patients will seek solutions using Google. While this diet will relieve the symptoms considerably, often patients struggle to maintain such a strict diet over the longer term. The other problem is that the diet does not resolve the issue, but simply avoids the triggers.

The foods that are acceptable in this diet, leading to symptom relief include;

meat	fish
eggs	oatmeal
gluten free crackers	leafy greens
unsweetened cereal	broccoli
carrots	rice noodles
olives	peanuts
potatoes	pumpkin
quinoa	seeds
berries	citrus fruits

Long Term Resolution

While using a specialised diet is necessary in the short term, long term restriction of other whole foods can be detrimental to colonic microbiota and can lead to other undesirable alterations of pH balance in the colon. Low FODMAP diets should only be used for a period of 4-6 weeks, alongside treatments to rid the small intestine of these pathogens, and a recolonization with healthy bacteria. So basically a three tiered approach;

Low FODMAP Diet + destroy the pathogenic bacteria + repopulate with healthy bacteria.

Post treatment, the diet should continue to be a healthful whole food based diet, that includes loads of fresh vegetables, fibre, and small portions of animal meats. Reverting to junk foods, processed foods, and refined carbohydrate type foods will only see these pathogenic bacteria return, as the food source for these pathogens returns. As FODMAP foods are re-introduced, these should be done slowly and only one at a time, to ensure symptoms do not return. It is often difficult to know 100%, if the bacteria are gone, and sometimes the recurrence of symptoms is the only clue. If symptoms persist, a different anti-bacterial treatment may be required, before re-introducing again.

Research has also concluded that patients should avoid constant grazing throughout the day, allowing at least three hours between snacks/meals, with a minimum of 12 hours between the evening meal and breakfast. This is due to the migrating motor complex (MMC) in the small intestine functioning, to move intestinal contents along, approximately 90-120 minutes into fasting. This is especially important for those who suffer with constipation issues.

In Summary

SIBO (bacteria based), like Candida (yeast based), is most likely far more prevalent in today’s modern western world than we actually realise. Our world is high in stress, high in toxicity derived from water, food, air, and diets that high in refined carbohydrates. You only need to drive past a bakery, and see all the queues of people, waiting to get their tasty pastries, to know “we” have a problem! There has also been an explosion of anti-biotic use in the most recent 30 years, leading to more and more imbalances of the human microbiota. Couple this with food sprayed with the weed killer glyphosate, which is actually an antibiotic, and animals grown for food, in small tight spaces, who are fed anti-biotics, is it really a wonder that our digestive systems are suffering?

The digestive system is the key to good health. It supports our immune system, our brain health, and our nutrient absorption capabilities, and quite simply, without a healthy microbiome and gut, health starts to suffer in many ways. Seeing a natural health professional is a great start, as they will generally complete a full health history, review standard bloods and use gentle but effective treatments. Testing can be beneficial, but not absolutely necessary, as there are usually enough symptoms to allow a diagnosis.

As treatments are not harsh on the body, there is no harm done with the use of probiotics, specific gut powders, pathogen elimination techniques and short term dietary restrictions.