What is SIBO?
Small intestinal bacterial overgrowth, or SIBO, is an imbalance of bacteria affecting the small intestine – the portion of our digestive tract that lies between the stomach and the large intestine.
Throughout our digestive system, but primarily in our small and large intestines, we have trillions of bacteria. These make up what we call our microbiome and are just like a fingerprint; the balance of bacteria that can be found there is thought to be unique to each person. From the moment we are born, the balance of bacteria is influenced by the choices we are making: from our diet to the use of medication.
Although it is quite normal for different strains of bacteria and yeast to reside throughout our system (and it is quite natural for some strains which are considered ‘bad’ to be present), we need sufficient levels of good bacteria to help keep everything in check.
Bacteria are opportunistic, so if levels of good bacteria dip or bad bacteria are given the opportunity to thrive, then we can be left out of balance - a state called dysbiosis - and can experience nasty symptoms as a result. SIBO is one type of dysbiosis. The main proportion of our microbiome is thought to exist in our large intestine; but if these migrate back into the small intestine this may also contribute to symptoms of SIBO.
SIBO may affect both the structure and function of the small intestine. The small intestine is an important site for the absorption of nutrients from our diet and, if this process becomes disrupted, it can lead to nutrient deficiencies. The balance of bacteria present in the small intestine can also influence the structure of the gut wall, which could contribute to conditions such as leaky gut. This could potentially contribute to other issues such as food intolerance, chronic inflammation, and an increased risk of autoimmune conditions.
What are some of the common symptoms of SIBO?
Some of the common symptoms of SIBO include:
- Abdominal discomfort, especially soon after eating
- Nausea or feelings of fullness
- Persistent bloating and/or flatulence
- Altered bowel habits including constipation or diarrhoea
- Weight loss
Please note: many of these symptoms could also be linked to other conditions. Unintentional weight loss, changing bowel habits or blood in your stools should always be investigated immediately by a doctor.
What factors put us at risk of SIBO?
1. Diet
Changes in diet, including excessive consumption of sugar, artificial sweeteners, alcohol, processed foods or the presence of food intolerance, have all been linked to an increased risk of SIBO.
2. Medication
Overuse of certain medications such as antibiotics or antispasmodics (often used to manage the symptoms of IBS) could contribute to an imbalance in gut bacteria or SIBO. There is also some reason to believe that the contraceptive pill may negatively impact digestive health; however, more evidence is needed in this area. Painkillers are notorious for causing digestive problems, as are conventional iron supplements containing ferrous sulphate.
3. Weak stomach function
Insufficient stomach acid secretion (common as we get older, in times of stress and with the long-term use of antacids medication) can affect nutrient absorption and the internal pH of the digestive tract, and can contribute to an imbalance in gut bacteria.
4. Physical issues
Structural issues within the small bowel may mean that food waste isn’t moving through our system properly, which could contribute to the proliferation of bad bacteria.
5. Constipation
Long-term constipation can give rise to slow-moving waste, and can contribute to an imbalance of gut bacteria. Diet, dehydration, medication or bile insufficiency (for example after gallbladder removal) may contribute to a sluggish bowel.
6. Depleted immune function
Up to 80% of our immune cells are found throughout our digestive tract. These immune cells are responsible for detecting the presence of pathogens, so, if these functions become depleted, opportunistic bacteria or yeast may take hold.
What can be done to help?
1. Consider how you eat
It isn’t just what we eat, but also how we eat that can impact our digestive system. Concentrate on eating slowly and chewing thoroughly in order to activate the production of sufficient digestive enzymes and to help prepare your digestive system for processing an incoming meal.
It’s also important to consider how you pair your meals with drinks. Drinking plenty of water is certainly important to help maintain digestive health and you should aim for at least 1.5l of plain, still water daily. However, be sure to separate your water from your meals, leaving at least 20 minutes either side to help avoid diluting your all-important digestive juices.
Avoiding caffeine and alcohol as much as possible is also helpful as this can risk irritating the digestive tract and upsetting the balance of bacteria that reside there. If you do want to include these elements in your diet, be sure to have them in small amounts and avoid having them on an empty stomach; again, sticking by the 20 minute rule can be helpful.
2. Also, what you eat
Complex carbohydrates and wholegrains such as brown pasta, quinoa, lentils and beans, are preferable to white varieties that contain more refined carbs and less fibre and nutrients. However, managing your portion size when it comes to carbohydrates and starchy vegetables such as potatoes and parsnips can also be helpful. Swap them for more non-starchy vegetables, including leafy greens, asparagus, green beans, beetroot, leeks, onions and garlic. These are also classed as prebiotic foods which can help support the good bacteria in your gut. Avoiding yeast-containing products such as bread and Marmite is also recommended.
The low FODMAP diet may also be helpful in the initial stages of treatment, but this should be conducted under the guidance of a practitioner. Lactose found in dairy products is also considered a FODMAP component, so reducing dairy consumption may be helpful. Fermented dairy products may be a more suitable alternative.
You can include lean cuts of good quality meat (red meat preferably no more than once per week), oily fish (aim for 1-2 portions per week), and also sources of healthy fats including avocados, olive oil, coconut oil, nuts and seeds. Including sufficient fats in the diet will help to encourage the proper movement of bile and therefore help to stimulate peristalsis. Sources of omega-3, in particular, are also considered to be anti-inflammatory and can help support the repair of the gut lining. Avoiding highly processed foods (which are considered pro-inflammatory and often full of hidden sugars and unhealthy fat) is also recommended. 
3. Support your immune system
Before tackling your digestive system directly, it can also help to consider what other underlying issues could be contributing to your symptoms. An undermined immune system is one area to consider.
Firstly, aim to reduce stress and prioritise getting a good night’s sleep as these lifestyle factors could be undermining your immune function. If you suspect you need a little help to get your immune system back on track, an extract of Echinaforce could help to do just that. This herbal remedy is antibacterial and antifungal in action so can help support gut health, plus, your immune system more generally.
4. Support your stomach
Supporting gastric and pancreatic secretions with the help of some herbal bitters remedies can often help in the overall managment of SIBO.
Strong acidity and the sufficient secretion of digestive enzymes will not only help you to digest your latest meal properly, but will also help to keep pathogenic bacteria at bay. Bitter-tasting herbs such as Yarrow or Centaurium can help to support these processes. Take something like Yarrow 5-10 minutes before meals, in a small splash of water (5-10mls is sufficient so you can experience the true ‘bitterness’), three times daily.
5. Support your intestines
Whilst supporting the stomach is important, including dietary source of L+ lactic may also be helpful. Combine this with a good-quality probiotic for maximum effects.
Taking pre or probiotic supplements can help to support the balance of bacteria in your gut. A study in 2010 found that probiotics proved more effective than antibiotics at treating SIBO. (1) A more recent study in this area cast some doubt and the results for probiotics in the management of SIBO were inconclusive. (2)
However, we know that, if the pH or internal gut environment of the gut isn’t quite right to start with, probiotics may struggle to become established and have significant benefits. Providing a source of L+lactic acid allows friendly bacteria to settle happily in the gut.
Research has backed the idea that a combination of pre and probiotics, called synbiotics, may help to manage the symptoms of SIBO. (3)
Please note that a course of antibiotics may be administered by your doctor in a bid to get any suspected overgrowth of bad bacteria under control initially. It’s important to be aware that antibiotics may also upset the balance of your good gut bacteria, so taking a probiotic supplement alongside this may be helpful.
