What is SIBO?
National Center for Biotechnology Information defines small intestinal bacterial overgrowth (SIBO) as the presence of excessive bacteria in the small intestine. In most patients, SIBO is not caused by a single type of bacteria, but is an overgrowth of the various types of bacteria that are commonly found in the colon. The small bowel is meant to be a sterile environment. When bacteria make their way into the small intestine, it can be very destructive to your digestive health and your overall well-being.
SIBO is now thought to be a potential cause for Irritable Bowel Syndrome.
What Causes SIBO?
The cause of SIBO is usually complex, and is likely a combination of several events. In order to prevent SIBO, our bodies have protective mechanisms to defend ourselves against SIBO. Some of these mechanisms are gastric acid secretion and the presence of a valve between the large and small intestine (ileocecal valve) that are meant to prevent bacteria from refluxing back or making their way into the small intestine. Whether the issue is that these protective mechanisms fail or there is another trigger (e.g. stress, food), the underlying cause of SIBO is that the motility of the small intestine is slowed down to a level that allows more bacteria to grow in an area where they do not belong – the small intestine. Once this process occurs in your small bowel, you begin experiencing symptoms of SIBO.
What are the Symptoms for SIBO?
The most common symptoms for SIBO area:
- Abdominal pain
- Bloating
- Constipation
- Diarrhea
- Gas and belching
How Do I know if I have SIBO?
The most common test to assess for SIBO is the Hydrogen Breath Test. This test is performed by asking a patient to drink a specific sugar and then by measuring the amount of hydrogen gas produced and exhaled (to determine if bacteria are digesting the sugar). Unfortunately, this test is not entirely reliable. In my practice, I have elected to treat patients whom have clinical symptoms suggestive of SIBO with specific anti-microbial agents, which target the bacteria and have been shown to significantly improve symptoms. If the patient’s respond, we have treated their symptoms and made the diagnosis of SIBO.
How is SIBO Treated?
SIBO can be difficult to treat but treatment of SIBO consists of dietary changes and antimicrobial therapy. The FODMAP diet and an elemental diet can be very helpful because they eliminate the foods that the bacteria feed on. By essentially starving the bacteria, the symptoms of SIBO can improve. Both of these diets are difficult to follow for a prolonged period of time and most people are unable to completely control symptoms with diet alone.
A new natural product called Atrantil is now available to treat SIBO. This product can eliminate the bacteria associated with SIBO and has been shown to significantly improve their SIBO symptoms. This product does an excellent job of treating the bloating and decreased intestinal motility often associated with SIBO.
Another antimicrobial that has been shown to improve symptoms of patient’s with diarrhea predominant SIBO symptoms is rifaximin. This is a more expensive prescription medication but has significantly improved symptoms in many patients who suffer from diarrhea and bloating associated with SIBO.
During the first few days of treatment with either of these agents, some patients will experience increased or worsened symptoms of bloating and abdominal discomfort as well as fatigue and body aches. This effect is called the “die-off reaction”. These symptoms tend to quickly improve and patients generally feel much better after the initial “die-off” symptoms improve.
What is the Die-Off Reaction?
Die-off is an accepted nickname for the period where toxins from dying bacteria are being released all at once while they are being eliminated. During this die-off time period, you are susceptible to experiencing temporary discomfort. Some of the common symptoms experienced during the die-off period are increased bloating and abdominal discomfort, mild fatigue, muscle aches or even a low-grade fever.
While the symptoms during the die-off period can be mildly unpleasant, it is actually a good thing since it means that the unwanted bacteria in the small intestine are being eradicated. Not everyone will experience a die-off period while their SIBO is being treated.
Disclaimer: The information presented on this website is not intended to take the place of your personal physician’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your healthcare provider to determine what is right for you. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions.
