What is SIBO?


Small Intestinal Bacterial Overgrowth, SIBO, is an overgrowth of bacteria within the small intestine often due to a change in the microbiome, which is the environment of the bacteria that reside in the intestines.

The small intestine is the longest part of the digestive system. Within the small intestine, food mixes with digestive enzymes and as the food is broken down into smaller particles, nutrients are able to be absorbed into the bloodstream. Most of the beneficial bacteria are meant to be located in the large intestine and in the colon where they help break down food, manufacture vital energising B vitamins and also help to detoxify acids and toxins. If these bacteria begin to thrive in the small intestine, the result is SIBO. The excess bacteria then feed off the undigested food especially sugars, carbohydrates and starches.

So what happens in SIBO?

As the bacteria feed in the small intestine, the carbohydrates begin to ferment releasing excess amounts of hydrogen which can result bloating. Within the intestines, there are single cell organisms that reside called archaea. These micro-organisms use hydrogen which they convert into methane. This means that the when the beneficial bacteria have overgrown within the small intestine, both hydrogen and methane are released within the region which results in bloating, gas and abdominal pain.

The symptoms of bloating may also be accompanied by either constipation or diarrhoea. If hydrogen is the dominant gas, then bloating may be accompanied by diarrhoea whereas if methane is more dominant then it may be accompanied by constipation.

The overgrowth of bacteria interferes with nutrient absorption often resulting in nutrient deficiencies. Usually antibiotics are prescribed for chronic cases of SIBO but these are not usually without side effects and often relapse rates are high.

Causes and symptoms of SIBO

Digestive enzymes help break down food whilst the muscles through a series of neurotransmitters work to move food along through the digestive tract from the stomach to the small intestine and finally to the colon. Damage to the muscles and nerves surrounding the digestive tract can increase the risk of developing SIBO. Diabetics and those suffering from some immune disorders such as scleroderma are more likely to suffer from SIBO.

Physical obstructions, scarring from surgeries, inflammation in the gut and those suffering from diverticulitis all are factors that may make one susceptible to Small Intestinal Bacterial Overgrowth, SIBO.

The symptoms of SIBO mirror those of other inflammatory bowel concerns including IBS and include:

  • nausea
  • bloating
  • diarrhoea
  • constipation – less common that diarrhoea
  • food intolerances to gluten, lactose and fructose in fruits

Tests for SIBO include a breath test which is the usually the preferred route even though it is cumbersome. The breath test measures the amount of hydrogen and methane within the body because these gases can only be produced by the bacteria in the intestine.

Treating SIBO

Treating SIBO requires patience because like candida overgrowth, relapses can be common. The standard treatment for SIBO is the use of antibiotics to destroy all of the bacteria in the small intestine but of course these do destroy the beneficial bacteria in the colon too.

Initially, it would be prudent to consider the use of a natural remedy which enhances the production of stomach acid. This is important because stomach acid helps to break down food into smaller particles so that it does not stagnate in the small intestine. This is important to tackle small intestinal bacterial overgrowth because stomach acid kills off bacteria in the small intestines. A supplement that increases the amount of hydrochloric acid is Betaine HCl with Pepsin by Lamberts Healthcare. This supplement is not suitable for people with peptic ulcers and if you do suffer from peptic ulcers then please use Enhanced Super Digestive Enzymes by Life Extension which simply works to break down food into smaller particles. Enhanced Super Digestive Enzymes are not suitable for those who are lactose or gluten intolerant.

There are natural herbal remedies that may prove to be equally useful at eradicating bacteria – although their role is the same as antibiotics, their use does not increase the chances of antibiotic resistance which is clearly on the increase. The herb Goldenseal contains a chemical called berberine which displays potent antimicrobial properties and may prove to be effective treatment for SIBO. Eclectic Institute’s Goldenseal Tincture provides a strong extract of goldenseal.

Researchers have also found that probiotics may be of great benefit in helping to get rid of small intestinal bacterial overgrowth. A study which used a four strain probiotic supplement to half the people and antibiotics to the other half showed greater clinical improvements in the probiotic group. The study used specific strains of bacterial species which can be found in Bio-Kult Advanced Probiotic supplement.

Additional measures:

Start with a FODMAP elimination diet for two or three weeks. FODMAPS are foods that are not fully absorbed in the body and may end up fermenting in the small intestine. Typical examples include broccoli, legumes, soya, some fruits, fruit juices and dairy products. More details may be obtained online and it is absolutely important to avoid these completely in the first two or three weeks.

Eat smaller meals so that food does not get time to stagnate in the small intestine. Chew food thoroughly because partially chewed food requires more work by the digestive system and is liable to ferment in the intestine.

Eat high quality clean proteins such as lean poultry, grass-fed beef and wild caught tuna or salmon.

Incorporate coconut oil to cook with because this is a source of medium chain triglyceride which is easy to digest and is naturally antibacterial.

SIBO is more prevalent than previously believed and occurs in many digestive disorders such as IBS and also in patients using proton pump inhibitors. Proton pump inhibitors reduce acid production in order to alleviate the symptoms of acid reflux and this group are more likely to suffer from SIBO since optimal acid production inhibits bacteria from thriving in the small intestine. Those with metabolic disorders such as long standing diabetics may also have SIBO. Your gastrointestinal concerns may simply be a case of SIBO and perhaps tackling this issue will greatly improve the symptoms.

This content is not intended to replace conventional medical treatment. Any suggestions made and all herbs listed are not intended to diagnose, treat, cure or prevent any disease, condition or symptom. Personal directions and use should be provided by a clinical herbalist or other qualified healthcare practitioner.

Gut Health, Shabir Daya | , , , , , , , , , , ,
  • Sharon

    Hi, not sure if I have SIBO but do have IBS but lately symptoms seem worse and further up in stomach area as well as belly. I am already taking pro-biotics and taking linseeds daily. Is it safe to take those plus Betaine HCI, Super digestive enzymes and L-Glutamine all in one day?
    I haven’t been to the GP yet as thought would try this route first.

  • http://www.victoriahealth.com/ Victoria Health

    Dear Sharon, I would recommend that you start firstly with the Enhanced Super Digestive Enzymes to break down food more efficiently and the L-Glutamine to calm any inflammation. Evaluate the efficacy of these two for a couple of weeks. It might also be prudent to see your GP to negate any other GI disorder.
    Best wishes,

  • Ruth

    Hi, I was diagnosed with Diverticular some years ago and I have periodic bouts of Diverticulitus and the symptoms can vary from mild to quite excruciating and can be quite debilitating
    Having read you article on SIBO I was wondering whether I would benefit from taking Betaine HCI with peptine and Enhanced Super Digestive Enzymes and if so which do you think would be more beneficial, or would you recommend an alternative
    Many thanks

  • http://www.victoriahealth.com/ Victoria Health

    Hi Ruth, many of the symptoms of SIBO are linked to other GI concerns which is why I believe that the first supplement to try would be the Betaine HCl which will help us determine whether this is also present or not.
    Best wishes,

  • Zoe Haydon

    HI Shabir. V interesting article. Thank you. I was diagnosed with SIBO when I lived in Australia over 5 years ago having suffered with IBS type symptoms for years. It was dealt with very effectively (they were very advanced in their knowledge of the condition and diagnostics) but I have had relapses since then and it was only recently that I was offered the hydrogen breath tests on the NHS at Guys, where they were just introducing it. The Dr prescribed a ‘kill-all’ antibiotic which was not my favoured method of eradication, so I have been consulting with a naturopathic nutritional therapist who put me on a course of Oregon Grape Root and Neem, together with the Similase enzymes for a long period of time (natural antibiotics take a lot longer to work as you know) then introduced Symprove pro-biotics to repopulate the gut and bone broth with L-Glutamine powder as a gut healer. The various methods of attack worked extremely well and allowed my gut to heal in a way where my life-long low levels of zinc and iron, the source of my hairloss, were returned to good levels. This condition is very common and is often passed off as ‘IBS’ but can have a massive impact on the rest of your system, particularly when it comes to absorption, as you know. Anyway, there is a cure out there and, whilst my guts aren’t perfect, they are so much better than they used to be.
    Thanks again!

  • http://www.victoriahealth.com/ Victoria Health

    Hi Zoe, thank you so much for sharing and I am glad that you have experienced the benefits of natural herbs and supplements.
    Best wishes,

  • David

    Shabir, I just wanted to thank you for writing this article. I read it when I saw it in the newsletter and must admit I hadn’t heard greatly of SIBO before. It did connect with a lot of symptoms I was experiencing and lead me to carry out the breath test which came back positive. I’m now gearing up to do the low FODMAPS diet combined with the natural anti-microbial route. I’ve been chasing my tail for a few years now trying to find out the reasoning for numerous symptoms and different tests coming back inconclusive. There might be more going on but researching more about SIBO and getting the test carried out feels as though there’s something more conclusive to work with initially to see if my symptoms improve.
    Having said this, I’m surprised SIBO doesn’t have more awareness out there given how common it seems to be and quite often just grouped under IBS. I did go to my GP to get their take on it and basically waited 5 minutes whilst they googled it in front of me and said they didn’t know what it was!
    Thank you once again.

  • http://www.victoriahealth.com/ Victoria Health

    Hi David, glad you found the editorial beneficial and it appears that you now might be on the right track in order to counter this. The whole idea of the editorial was to raise awareness because it is more prevalent than most people realise.
    Best wishes,

  • http://www.victoriahealth.com/ Victoria Health

    Hi Andrada, though many of these nodules may be benign, I

  • Khayam Ali

    I’ve been struggling with Sibo ever since I finished taking omeprazole as I had a case of gastritis and antacid worked. I’ve seen my gastrologist and he’s referring me for an breath test. I’ve been taking a complete probiotic that also contains betaine hcl which has improve my symptoms but it isn’t very strong (20MG of betaine per capsule). do you recommend I take a stronger hcl supplement? could I have low stomach acid?

  • http://www.victoriahealth.com/ Victoria Health

    Hi Khayyam, I am glad that you have experienced the benefits of Betaine HCl and yes for sure increasing its strength will be of great benefit. I am glad that you are having a breath test because this will maybe rule our or confirm helicobater infection.
    Best wishes,

  • Vic Adams

    Thanks for the great article :) I’ve read that a low protein meal doesn’t require much acid, so the betaine HCl can cause too much increase in acid. For those who don’t eat meals overloaded with protein, do you recommend decreasing the dosage of betaine HCI and if so, would around half the dosage do the trick? I’ve also read that apple cider vinegar before a meal will increase stomach acid, would you recommend this, especially for people not eating too much protein? Thanks

  • http://www.victoriahealth.com/ Victoria Health

    Hi, yes absolutely, the editorial is only a generalised guideline and for those with a low protein meal, it might be prudent to simply not take the Betaine supplement and to use the apple cider vinegar liquid prior to a meal.
    Best wishes,

  • http://www.victoriahealth.com/ Victoria Health

    Hi Donna, Raynauds is of course linked with numerous other connective tissue disorders such as scleroderma. I understand the logic behind taking Betaine HCL but there are other options open to you such as the use of Esophageal Guardian and perhaps this is where you might first start. This supplement is designed to neutralise any stomach acid that comes up the oesophagus without neutralising acid production by the stomach cells since this is crucial for nutrient availability. At the same time, the formulation contains a seaweed extract to form a raft to protect the oesophagus.

    With reference to Raynauds, you may wish to consider the use of pycnogenol supplements such as Bio-Pycnogenol – this extract from pine bark displays multiple benefits which may prove to be useful. It has a slight blood thinning effect easing circulation; it displays anti-inflammatory properties; it provides antioxidant benefits and generally protects the whole body of oxidative damage.

    Best wishes,