If you’re constipated or struggle with gas or bloating you’ve probably already done your fair share of googling things, such as, “What foods cause bloating?”, “How to stop diarrhea”, or “Will taking probiotics stop gas?”
But now you’re confused—you’ve cleaned up your diet, stopped taking antibiotics, and are taking probiotics regularly, but the symptoms aren’t getting any better. In fact, you actually think your irritable bowel syndrome (IBS) symptoms are getting worse.
It may be that the cause of those symptoms is not IBS, but an underlying gut imbalance called SIBO or small intestinal bacterial overgrowth. Studies show that over 70% of patients diagnosed with IBS actually have SIBO, and there’s a good chance you fall into this camp if healthy diet and probiotics aren’t clearing up your symptoms.1,2
What is SIBO?
You’ve probably heard before that our gut houses both beneficial and pathogenic bacteria. The beneficial bacteria aid in digestion and, when in balance, work to keep us regular. When your gut microbiome is in balance, you shouldn’t have problems with gas, bloating, indigestion, diarrhea, or other digestive problems.
However, those helpful bacteria only maintain good gut health if they live in the right portion of our gut and if they are in correct proportion to other bacteria. The majority of our gut bacteria should be in the colon. When the bacteria migrate backward into the small bowel, or when there is low stomach acid or poor pancreatic enzyme production, bacteria in the small bowel can overgrow and cause those yucky bathroom symptoms you’re sick of dealing with, such as diarrhea, gas, or bloating. That imbalance, or bacterial overgrowth, is known as SIBO.3
So how do you know for sure if you have SIBO?
Eight Signs and Symptoms of SIBO
- Eating fiber makes your symptoms worse.4 If your doctor recommended upping your dietary fiber, but you find that your cramps, diarrhea, or other symptoms haven’t improved, this could be a sign of bacterial overgrowth in the small intestine.
- Antibiotics actually seem to improve your IBS.5 This is a compelling sign that you might be suffering from SIBO. The antibiotics are actually helping to fight the excess amount of bacteria in your gut, so you probably experience some relief when taking antibiotics.
- Your gas and bloating increase when you take probiotics, especially if they contain prebiotics.6 Prebiotics stimulate the growth of bacteria which is why those with leaky gut are often encouraged to supplement with them. However, if you already have an overabundance of bacteria in the wrong places (like your small intestine), prebiotics will exacerbate your symptoms.
- You eat a gluten-free diet, but the symptoms still persist.7 If you have celiac disease or suffer from non-celiac gluten sensitivity, your doctor may have recommended a no-gluten diet. This should help your IBS symptoms dramatically— but if it doesn’t lessen your symptoms, it’s time to test for SIBO.
- You suffer from chronic symptoms of gas, bloating, constipation, or diarrhea after recently taking medication.8,9 If the symptoms appeared after a recent surgery, or you were on pain medication (such as opiates) lately, ask your doctor about being tested for SIBO, as these medications often lead to bacterial overgrowth.
- You can’t shake your “brain fog.”10 Maybe you’ve improved your diet, are getting adequate amounts of sleep, and have learned to manage or reduce the stress in your life. But you still can’t seem to concentrate, have difficulty with short-term memory loss, or just feel “foggy.” Recent studies have found that patients with SIBO have a higher likelihood of struggling with brain fog.
- You’re losing weight but aren’t sure why.11 Weight loss, malnutrition, and nutrient deficiency are all connected to SIBO. Due to bacterial overgrowth in your small intestine, absorption of critical nutrients and calories is stunted which can cause unexplained weight loss or lead to a serious nutrient deficiency.
- Your blood work shows chronically low iron or ferritin with no known cause.12 Anemia is known to be one of the clinical manifestations of SIBO. If your doctor can’t pinpoint the root cause of your low iron levels and you are experiencing other symptoms of bacterial overgrowth, it could be SIBO.
How Do I Know This Isn’t Just Leaky Gut?
While SIBO usually manifests with local gastrointestinal symptoms, a leaky gut will manifest with systemic complaints that affect the immune system. Keep in mind that it is not uncommon to have both SIBO and leaky gut simultaneously and having SIBO for a long period of time often leads to a leaky gut.13
Systemic signs of a leaky gut include:
- Multiple food sensitivities
- Skin rashes, acne, or rosacea
- Respiratory symptoms, such as asthma
- Allergic symptoms or increase in seasonal allergies
- Brain fog or poor concentration, especially after meals
- Any autoimmune disease
- Joint pain or arthritis
- Headaches or migraines
Remember, SIBO can cause leaky gut syndrome, but not everyone with SIBO has leaky gut. Usually, once the overgrowth is treated and the patient continues to follow a healthy diet, the leaky gut will heal itself!
Conditions and Disorders Linked to SIBO
These conditions predispose you to have small intestinal bacterial overgrowth:14,15
- Hypochlorhydria (low stomach acid)
- Vagotomy (surgical procedure often used for gastric ulcers)
- Surgical bowel resection or bariatric surgery
- Food poisoning (post-infectious IBS)
- Nerve damage that affects the GI tract
- Drugs, such as opiates
- Pancreatic insufficiency
- Decreased motility in the small intestine (food not passing through properly)
- Bowel obstruction
- Gastroschisis (organs growing outside the body at birth)
- Diverticula (weak places in the wall of the colon or intestinal tract)
- Any disease that slows motility (diabetes, hypothyroid)
Other disorders that may be associated with SIBO include:16
- Rheumatoid arthritis
- Short bowel syndrome
- Ankylosing spondylitis
- Hashimoto’s thyroiditis
- Restless legs syndrome
- Pancreatic insufficiency
- Non-alcoholic steatohepatitis
- Liver cirrhosis
- Crohn’s disease
- Celiac disease
- Kidney failure
Digestive Health Testing: Diagnosing SIBO
Testing for SIBO doesn’t have to be hard or time-consuming. In fact, it can be as easy as asking your doctor to order a breath test.17 Popular breath tests include the lactulose breath test and glucose hydrogen breath test, which measure the gases produced by bacteria in your gut to determine if there is an overgrowth.18,19
You can also ask for a comprehensive stool analysis and urinary organic acids analysis. While this won’t directly test for SIBO, it will help the doctor pinpoint other causes of your symptoms and can help narrow down the root of the problem.
How Do We Treat SIBO?
Treatment of small intestine bacterial overgrowth must be thorough and address all causes and symptoms. If you have SIBO, your therapy will need to be individualized, and your doctor will need to help you find out what underlying disease led to the overgrowth in the first place.
From there, the doctor will work with you to treat the original disease through nutritional support, and possibly antibiotics, before your SIBO symptoms can fully be addressed.
SIBO Diet and Nutrition: What to Eat If You Suspect a Bacterial Overgrowth
Once your doctor has confirmed the overgrowth of bacteria in your small intestine, you’ll want to look at your diet to eliminate any foods or medications that could be contributing to the imbalance.
Low carb diets like the paleo diet or low-FODMAP diet can improve SIBO symptoms by eliminating the carbohydrates most bacteria feed on while maintaining proper nutrients in the patient’s diet.20 Following these type of diets has been shown to improve stool consistency, gas, bloating, and diarrhea in patients suffering from bacterial overgrowth.21
Foods to avoid (for the time being):
- Alcohol, including probiotic drinks, such as Kombucha
- Probiotics and prebiotics, except those authorized by your doctor
- Fermented foods, as they can increase histamine
My favorite antimicrobial herbs to supplement with include:
- Oil of oregano, which has powerful antioxidant and intestinal cleansing benefits
- Thorne® Berberine 500, which helps support the GI tract
- Biocidin, which support microbiome balance and promotes healthy elimination
SIBO Recurrence: Stopping the Cycle and Staying on Track
Treating SIBO successfully is not always easy and may involve major dietary changes, medication, or herbal treatment for an extended period of time. However, achieving a healthier gut microbe balance will likely prove to be the most important step in regaining your health and vitality!
This was especially true for me—if you’ve read my story, you know that gut health was one of the first things I focused on when healing myself. Maintaining a healthy gut is truly transformative!
As you work through your symptoms, diagnosis, and treatment, please know that SIBO recurrence is not only possible, it’s common. There are two main ways you can fight SIBO recurrence in your gut:
- Retest, using the same breath test you used before, a few months after your symptoms subside or at the direction of your doctor.
- Follow through with the dietary recommendations, at least for a few months.
- Take probiotics only as recommended by your doctor. Remember, probiotics could actually be causing some of your bacterial overgrowth, so ask your doctor before incorporating probiotics or prebiotics back into your diet.
By following the diet, nutritional advice, supplement recommendations, and lifestyle changes I list above and any recommended by your doctor, you’ll have your SIBO kicked in no time!
Now it’s your turn—have you had SIBO? Do these symptoms sound all too familiar? Let me know in the comments if SIBO is a health concern for you. If you’d like more great resources and articles like this one, subscribe to my newsletter by typing your name and email in the form at the top of this page. We’d love to have you join our community of like-minded individuals who are on the path to health and wellness!