This is a guest post written by Amy Nett, MD.
The normal small bowel, which connects the stomach to the large bowel, is approximately 20 feet long. Gut microbiome bacteria are normally present throughout the entire gastrointestinal tract, but in varied amounts. Relatively few bacteria normally live in the small bowel (less than 10,000 bacteria per milliliter of fluid) when compared with the large bowel, or colon (at least 1,000,000,000 bacteria per milliliter of fluid). And, the types of bacteria normally present in the small bowel are different from those in the colon.
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Why You Should Thank Your Small Bowel and the Beneficial Bacteria That Live There
The small bowel plays an important role in digesting food and absorbing nutrients. It is also an important part of the immune system, containing an impressive network of lymphoid cells (cells of the immune system that help fight infections and regulate the immune system).
Are you at risk for small intestinal bacterial overgrowth? Find out what the most common risk factors and symptoms are.#SIBO #SIBOsymptomps
The normal (beneficial) bacteria that are an essential part of the healthy small bowel also perform important functions. These beneficial microorganisms help protect against bad (i.e. pathogenic) bacteria and yeast that are ingested. They help the body absorb nutrients, and also produce several nutrients (such as short chain fatty acids) and vitamins like folate and vitamin K. These bacteria help maintain the normal muscular activity of the small bowel, which creates waves that move the contents of the intestine, like food, through the gut.
What Is SIBO?
SIBO, small intestinal bacterial overgrowth, is defined as an increase in the number of bacteria, and/or changes in the types of bacteria present in the small bowel. In most patients, SIBO is not caused by a single type of bacteria, but is an overgrowth of the various types of bacteria that should normally be found in the colon (1). Less commonly, SIBO results from an increase in the otherwise normal bacteria of the small bowel.
SIBO has been shown to negatively affect both the structure and function of the small bowel. It may significantly interfere with digestion of food and absorption of nutrients, primarily by damaging the cells lining the small bowel (the mucosa). Additionally, this damage to the small bowel mucosa can lead to leaky gut (when the intestinal barrier becomes permeable, allowing large protein molecules to escape into the bloodstream), which is known to have a number of potential complications including immune reactions that cause food allergies or sensitivities, generalized inflammation, and autoimmune diseases (2).
These pathogenic bacteria, whether too many or the wrong types, can lead to nutritional deficiencies on top of those due to poor digestion or malabsorption. In particular, the bacteria will take up certain B vitamins, such as vitamin B12, before our own cells have a chance to absorb these important nutrients. They may also consume some of the amino acids, or protein, that we’ve ingested, which can lead to both mild protein deficiency and an increase in ammonia production by certain bacteria. (We normally produce some ammonia daily from normal metabolism, but ammonia requires detoxification, so this may add to an already burdened detoxification system.) The bacteria may also decrease fat absorption through their effect on bile acids, leading to deficiencies in fat soluble vitamins like A and D.
What Causes SIBO?
The body has several different ways of preventing SIBO. These include gastric acid secretion (maintaining an acidic environment), waves of bowel wall muscular activity, immunoglobulins in the intestinal fluid, and a valve that normally allows the flow of contents into the large bowel but prevents them from refluxing back into the small bowel. (This is called the ileocecal valve because it’s located between the ileum, or terminal end of the small intestine, and the cecum, a pouch forming the first part of the large bowel.)
The cause of SIBO is usually complex, and likely affects more than one of the protective mechanisms listed above. A number of risk factors for SIBO have been identified, with some of the more common risk factors listed below. For a more complete discussion of associated diseases and risk factors check out this study and this study.
Risk Factors for SIBO
- Low stomach acid
- Irritable bowel syndrome
- Celiac disease (long-standing)
- Crohn’s disease
- Prior bowel surgery
- Diabetes mellitus (type I and type II)
- Multiple courses of antibiotics
- Organ system dysfunction, such as liver cirrhosis, chronic pancreatitis, or renal failure
Moderate Alcohol Consumption and Oral Contraceptive Pills (OCPs) Also Increase the Risk for SIBO
Heavy alcohol use has long been recognized in association with SIBO (3). This study also found an association between SIBO and moderate alcohol consumption, defined as up to one drink per day for women and two drinks per day for men. Alcohol appears to have effects on several of the normal protective mechanisms, including causing injury to the small bowel mucosal cells, contributing to leaky gut, and decreasing the muscular contractions. Additionally, alcohol may “feed” a few specific types of bacteria contributing to overgrowth (4).
Overall there appears to be a moderate association between OCPs and inflammatory bowel disease (IBD) such as Crohn’s disease (5). Though no studies to date specifically correlate the use of OCPs with SIBO, given the known relationship between IBD and SIBO, it is likely that this association holds true for SIBO as well. However, once patients stop taking OCPs, this risk appears to reverse.
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How Do You Know If You Have SIBO?
The number of people with SIBO in the general population remains unknown. Some studies suggest that between 6 to 15% of healthy, asymptomatic people have SIBO, while up to 80% of people with irritable bowel syndrome (IBS) have SIBO (6).
Complicating this, the most commonly used tests (breath tests measuring levels of hydrogen and methane gas) still have fairly high rates of false negatives (meaning the test results come back as negative but you actually do have the disease) (7).
The most common symptoms of SIBO include:
- Abdominal pain/discomfort
- Bloating and abdominal distention
- Diarrhea
- Constipation (generally associated with methanogens as Chris discussed in his recent podcast)
- Gas and belching
- In more severe cases, there may be weight loss and symptoms related to vitamin deficiencies.
Is SIBO Contagious?
Unlike many other bacterial infections of the gastrointestinal tract, SIBO is not contagious, and there is no evidence that exposure to any single microorganism increases the risk for developing SIBO. SIBO occurs due to a complex interplay of many different factors and is not passed on between individuals. However, some evidence suggests that there is an association between Helicobacter pylori and methane production, suggesting that H. pylori plays a role in gut dysbiosis. (8)
Why SIBO Can Be Difficult to Treat
Antibiotics are often used to treat SIBO. However, studies show that despite treatment with antibiotics, recurrence develops in almost half of all patients within one year. One study comparing treatment with rifaximin (the most commonly used antibiotic for SIBO) and botanical antimicrobials showed slightly better outcomes with the botanical protocol, but still with successful treatment in close to only half of all patients after one course of treatment.
These finding suggests that treatment of the overgrowth alone is not enough for most people. An additional piece of successful treatment must include addressing the underlying cause, or predisposing factor.
Though there are many identified associations between SIBO and other diseases as described above, abnormalities in gut motility are recognized as one of the most common associations. One study published this month demonstrated that patients with SIBO do have significant delays in small bowel transit time (the amount of time it takes something to move through the small bowel). This finding suggests that patients with SIBO, who do not recover after a standard course of antibiotics, or botanical antimicrobial protocol (which we prefer), may benefit from the addition of a prokinetic agent, which increases the muscular contractions of the small bowel. Octreotide and low dose naltrexone are two such options that are being investigated, and may help treat some cases of SIBO that don’t respond to antimicrobials alone. Other options may include prucalopride and low-dose erythromycin, as well as lubiprostone. (9)
As research into SIBO continues, we are increasingly understanding the complexity of this disease, and how treatment must be tailored to each individual to maximize success.
If you need support in dealing with SIBO, consider working with the California Center for Functional Medicine. CCFM offers a membership-based health transformation service that excels at helping people with chronic conditions make the changes necessary to reclaim their health. Find out more about what CCFM has to offer.
About Amy: Amy Nett, MD, graduated from Georgetown University School of Medicine in 2007. She subsequently completed a year of internal medicine training at Santa Barbara Cottage Hospital, followed by five years of specialty training in radiology at Stanford University Hospital, with additional subspecialty training in pediatric radiology.
Along the course of her medical training and working through her own personal health issues, she found her passion for Functional Medicine. She works with patients through a Functional Medicine approach, working to identify and treat the root causes of illness. She uses nutritional therapy, herbal medicine, supplements, stress management, detoxification and lifestyle changes to restore proper function and improve health.
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Hello,
Can you recommend any integrative/ holistic doctors in the Santa Barbara area for treating a possible case of SIBO?
Thank You!
Tom Matteucci naturopath
Hi, I am a SIBO sufferer. I believe my SIBO is hereditery. I came to this conclusion after seeing a photograph of my late Father taken when he was about 50 yrs of age. The photo was taken in the garden and showed my Father minus his shirt. His stomach was swollen exactly the same as mine and thinking back to when I was a child ( I am 70 yrs of age ), I remember he always had excessive Flatulance and Burping and Indigestion as I now do, back then ( 50’s-60’s) SIBO was unheard of.
My SIBO is constant. Antbiotics (AB) will reduce it noticeably but never cure it. So, about every 15-18 months I visit my GP for a course of AB. Whilst this helps enormously I also take daily four tablespoons of “KEFER”.
For those who are not aware of KEFER it is a Probiotic that originally came out of the Eastern Urals. It can be bought in a satchet, the contents of which are mixed with HRT milk. After mixing it, it is then placed in a warm cupboard. It requires a constant temperature of 21 deg Celsius which give the best results for fermenting. After approx 24 hours ( I let mine go for 28-30 ) it is removed from the warmth and placed in the fridge to stop the Fermentation. 24 hours later it is ready to drink.
I take four Tablespoon full of Kefer every morning approx 30 minutes before eating my breakfast.
I have been taking KEFER for approx three years now and can eat virtually anything . I rarely get indigestion although because I don’t restrict my diet at all I do get Flatulence, although greatly reduced compared with not taking KEFER.
I should have stated earlier that my SIBO was so bad before I discovered it that it affected my breathing to such a point that I found it hard to breath.
A search on youtube has many video’s on KEFER.
Hey
Found the post really intersting.
I have a hiatus hernia along with Barrett’s esophagus and was treated for the same two years back.
Since the tratment I have had severe bloating and gas.
I asked my doctor but he puts in the bag of IBS with absolutely no help.
I believe I had low stomach acid prior to the treatment (mostly ppi’s) for hiatus hernia, which decreased the acid level even more.
Just wanted if this theory is correct and if yes then how do I treat SIBO without increasing the acid level as it may affect the barrett’s and hiatus hernia.
Is weight loss not a symptom in everyone?
It certainly was the opposite for me. I am actually malnourished but overweight, by about 50 pounds. I am doing the Specific Carbohydrate Diet now and have lost 15 and have a better overall composition and clearer thinking but I have a long way to go to kill the bugs that made me sick.
I’m at a loss for an explanation of how treatment would work. I know that a specific diet plays a part in treatment, but I still can’t understand why sibo is treated with antibiotics when antibiotics put me in this situation in the first place?
Ashley, all general antibiotics give me horrid diarrhea except Cipro which makes me able to eat anything without diarrhea. I’ve heard a recent theory that we have bacteria specific just to us so everyone responds to certain antibiotics differently. Rifaxamin did nothing for my SIBO but maybe because Cipro kills my specific bacteria it works. I think there is a Ted Talk about this but they call them microbes. You’d think with all the ppl suffering more money would go into research. There is a new drug on the market that starts with a V. Can’t remember the name. Google it. I’d rather do natural but when I need more I’d like options.
Does anybody know if being on a SIBO-friendly diet already will/can impact an Organic Acids Test? My test came back with no indicators of bacterial overgrowth, and I’m trying to sort out if that is definitely a trustworthy result, or if there’s a potential for my dietary absence of bacteria-feeding foods to have influenced the test. I’m not entirely sure how the bacterial byproducts work.
There is a SIBO breath test that Genova and biohealth have (I’m sure other labs too) that is more accurate in detecting SIBO than an organic acids test- that one can have false negatives regarding bacterial markers.
Over the last 6 years I’ve seen 7 specialists (GI) , I’ve had ct’ s, mri’ s, barium, double hernia repair, I changed my diet, tried elemental diets. Every test, blood,urine, biopsy, fecal, all completely normal. I tried antidepressants (used to slow the gut in small doses) , probiotics and a total sibo diet. Nothing worked. I had recurring sibo for the last 3 yrs. I took ciprofloxacin and flagel every 2-3 months for years with good results for month or so then back again it came.
My fix : a hida scan. It showed nothing, again but was extremely painful when the stuff was injected to contract the gallbladder. My surgeon gave me a 70% removing the gallbladder was going to fix me. Sceptical I had it removed. Prior, my digestive tract had no issues and now once again I’m feeling normal. No one could seem to know what was wrong. I really thought that I’d be dead in short order..
Don’t give up! I’m feeling optimistic now. If I found out anything it’s doctors really have no clue . My doctor still doesn’t believe it was my gallbladder.. but I sure FINALLY feel better.
I’m happy for you that it seemed to fix things for you. I wish you the best of luck that this truly is the end of suffering with SIBO for you. Unfortunately, that’s the first thing did in my case was test gallbladder and said I should have it removed, so I did. When I came back saying I was worse than before, I went through all the MRIs, CTs, tons of labs, breath tests, and the only thing that flagged positive was SIBO that has not responded to antibiotics.
Hi, Steve, did you ever have pains on your right side? What prompted removing your gallbladder?
I had mine took out too and felt great started gaining wait back a year later almost to te date started feeling fatigue losing appetite being very emotional depressed sleep deprived pain in my stomach diarrhea I’ve been dealing with it almost two years I’m tired I wish u the best and pray it doesn’t return but seeing all these posts scares me will it ever go away ?
A woman tried an Elemental Diet for SIBO and writes about it here: http://www.hollywoodhomestead.com/elemental-diet/
It sounds extreme but she said all else has failed for her and this worked.
There also was a multi-center clinical trial that Chris referred to in his article that showed herbal antibiotics worked as well as the prescription for treating SIBO, without any side effects. Here are the herbals that they used http://www.siboinfo.com/herbal-antibiotics.html I ordered these products from Amazon and the reviews on there were very encouraging.
dr ruscio and dr siebecker often use the elemental diet. They have said it can work in many cases but that the adherence is hard. most people can adhere to antibotic courses and diet change better. so they try that first. they consider the elemental diet very effective. seriously check out these amazing experts on SIBO. I am sure we have all had days we would do anything to feel better. but two weeks of no solid food its pretty extreme. it is safe if confirmed that you are okay by DR. If you have done fasts before maybe it would be easier. If my case was more complex it would easily be worth the flight to see DR ruscio.
I am sure we can all agree there is no magic bullet to getting well. Although it seems, I am always on to the next “This-Will-Fix-It” protocol. I was seriously considering the Elemental Diet, but I found this article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1419567/
I have tested positive with E. Histolytica so this diet would not be a good idea for me until I am cleared. I would not recommend the E.D. to anyone w/ gut issues until they have ruled out parasites. The genetic testing (GI Map and DRG) are the best for finding the amoebas. Whereas the regular stool test (BioHealth 401H) would probably be a better bet for worms. That is just my take on this from the research I have done. I hope this helps
We are trying to verify that my 3 yr old has SIBO. Her SIBO is actually synthesizing B12, so wondering if anyone has experience with this. We are thinking Klebsiella, but not sure yet. Dr office is so slow, been going on for a year now. Scared to just give her herbal treatments since she is just 3 and I can’t tell whats going on from her perspective. She’s also allergic to penicillin. Do people usually know what bacteria is overgrown in them specifically? And does anyone have experience with Klebsiella or any other bacteria that would highly synthesize B12?
No, they can’t tell what strains are overgrowing, unfortunately. I have read that B12 deficiency often does occur in prolonged SIBO cases and/or leaky gut. I don’t have any answers for you, as I am still battling this myself. Antibiotics didn’t work for me and my doctor just basically sent me away saying he didn’t have any answers for me either. I am currently trying the herbal route along with an SCD/low FODMAP combo type diet, basically very low carb, high fat (which is sometimes an issue because i have no gallbladder), no dairy, no nuts, no raw fruits or veggies, and I have introduced fermented foods. I read a new study from abroad showing a four-strain high dose probiotic regimen could wipe out SIBO, so hoping that taking probiotics containing those strains along with fermented foods will help run the bad guys out and rebalance.
This might sound crazy, but the movie that came out “Miracle From Heaven” made me sit straight up! The girl named every diagnosis and pills that the doctor prescribed and said to me. There is a condition where the stomach stop sending signals to the intestines to digest food. I didn’t have a pen to write it down, but started with pseudo…something!!!
The diagnosis was pseudo-obstruction. I have had stomach issues for years and it can trigger depression or anxiety for which I have taken anti-depressants for. About eight years ago, my indigestion increased to a point where I couldn’t eat solid food. Naturally I lost incredible amounts of weight. Thinking my problem was structural, I had a diagnostic laparoscopy done. It showed nothing except that I couldn’t stop dryheaving. (I can’t vomit because of a fundoplication done in 1999.) I was subsequently told my problem was neurological. Fastforward to now, I have chronic fatigue syndrome, POTS, multiple chemical and food sensitivities, and hypothyroidism. So, for some of us, I think our condition is neurological in origin. Like the little girl in the movie. When she fell on her head, it likely “fixed” her problem. Don’t ask me how, it just makes sense if this condition is in part neurological. Plus, she was young and their bodies heal much quicker than adults. (Not to mention she had God on her side.) One theory floating around out there suggests CFS is not about the infection patients have but likely where the infection resides within the body. The theory is “what if the infection resides in the vagus nerve?” Again, a neurological hypothesis which correlates to my own digestive issues.
Hi Kris,
I reside in Australia and have had stool testing completed by BioScreen labs. They produce a full report that details the strains of bacteria and the approximate number of each type, as well as recommendations (diet, etc). Not sure what exists in other countries. You are totally right, “standard” medicine does not always take into account this type of information, but I think that Western medicine is changing. I have a holistic GP that uses these types of tests in conjunction with herbal and vitamin supplements as needed (as well as Western medicine). With the advent of so many diseases and new findings about the importance of gut flora and the immune system, it is slowly changing. I believe in a holistic approach, and incorporating as many healing methods as possible as we are multi-dimensional beings : so nutrition, exercise, spiritual practice – they all come into play and count in the whole of the being. I would say we have this incredible access to the Internet in our day and age, why not use it to educate yourself? Knowledge is indeed power 🙂
Yes, unfortunately, natural medicine is not well supported here. It is not covered by insurance at all. My GI has released me from care at this point, stating he doesn’t know what else he can do for me, never did a retest at all and refused to order one when I asked to see if or how much my numbers lowered, Even if I sent away for an expensive, out-of-pocket comprehensive stool test on my own, and another lactulose breath test, I wouldn’t be able to find a doctor who would take it seriously or know what to do with the results (no NDs near me), and doubt they would even look at tests done from a lab outside the one associated with our local health system. They’re a little stuck in their ways and behind the times here, unfortunately. That said, I have to question how testing stool from the colon that is going to tell what is overgrown in my upper small intestine or what’s causing the overgrowth to begin with?
Hi Kris,
I know it must be difficult when there is no one in your area to help. But I truly believe we are all our own best healers, if we just trust and listen and pay attention to our bodies. You can also check out functional doctors that work via Skype, I have used them in the past for my adrenal fatigue and they worked wonders. The absolute best medicine is to switch to a natural diet filled with whole foods and eliminate processed foods, as Hippocrates said “Let food by thy medicine and medicine by thy food”. As far as the bacteria identification in stool, to my knowledge it is conducted via DNA testing. They have been able to ID bacterial DNA and can test for differing strains…check out Ubiome’s website – they can test and ship internationally as well. I have not used them yet, but may at some point in the future. I really do look forward to the day that Western medicine is more holistically focused, and not so focused on drugs. That being said, there are quite a few functional doctors out there that you can find out about online….
Hi
Please know that stool testing can only test for bacteria in the colon and lower/large intestine. The hydrogen/methane breath test is the standard test for bacteria in the upper/small intestine.
Depending upon where you go, you can indeed be stool testing for the predominant types of bacteria you have in your gut. Science in this area is changing so very much, and is being reflected with things like the Microbiome Project and the recent Microbiome Summit online. Mainstream Western doctors have not 100% caught on to this, but there are many Western MDs and Functional Medical Drs that exist that you can find online. Do your research!! We are so blessed to have the Internet in this day and age, it allows us to research and to learn so much!
I have gotten a ton of information on Siboinfo.com, Dr Seibecker is amazing at describing all of the elements of this problem, as is Chris Kresser, but her information gets straight to the point, if you are just dealing with SIBO anyway. We have a skype call scheduled with her in June and July this year.
I finally found a Naturopathic Doctor (ND) in our area and she is going to try and help us treat our 3-year-old herbally. We are probably going to start with Allicin at first and see if we get any results. She is moving forward cautiously at this point, because she doesn’t’ have experience with children especially this young. I guess finding a doctor with sibo experience in kids is rare. Taking botanical antibiotics takes longer than pharm antibiotics and at this point we haven’t tried the pharm path, mostly because we think this is partially why we are in this position in the first place.
I have heard probiotics can make Sibo worse and I have heard they can help. The most important thing I guess is to be sure you are taking the right strains (Chris Kresser talks about these). Also, I will give them to her a week and take her off when I notice they become too much. Seems to work well that way.
I have also discovered that it’s all an individual basis, what works for one may not work for another, so you have to just accept the ride and do the best you can. Don’t give up and keep trying to figure it out. Unfortunately, you will be alone, except these forums and an occasional lucky person who finds a good Sibo expert. But, just keep educating yourself and try, try, try. Keep learning, and eventually, I believe there will be more help out there from the medical community.
For me it is Proteus Mirabilis. Discovered because it somehow also got into my bladder. Still working through my issues
Hi My 7 year old special needs daughter was diagnosed with SIBO. It took us over a month to finally nail down that SIBO had to be causing her so much pain. She screamed daily. She had tons of gas. She can’t speak so I was not sure what was wrong and tested her for everything under the sun and finally they figured it out as SIBO. As soon as started taking Flagyl, she became better. We are currently still on Flagyl for another week. She is in a wheelchair. We take probiotics, she always has. I had to put her on formula, she used to eat a healthy fantastic vegan diet. I am not sure if we will have to continue to keep her on formula and I am petrified of the idea of SIBO coming back. It was brutal seeing her in so much pain. Any suggestions on future diet? I read carbs and sugars not good. Thank you.
If it hasn’t been suggested yet I would look into the low FODMAP diet. I haven’t had a confirmed SIBO diagnosis but I’m pretty sure it’s what I have and the low FODMAP diet has greatly reduced my symptoms. A lot of people with IBS have success with reducing symptoms through this diet as well. Hope this helps!
There’s actually a combination SCD and FODMAP Diet for SIBO that I am about to try. I also follow Paleo and don’t eat meat, so I will refine the food list found here: http://sibodietrecipes.com/the-sibo-diet/
Check out Norman Robillard’s website, Fast Tract Diet (for both heartburn and IBS.
http://digestivehealthinstitute.org/
I am doing my lactulose breath test 2 days from now. To the extent that I have already implemented some of his suggestions, I do feel better. Robillard, a microbiologist, claims to have taken the SC Diet to the next level by limiting consumption of 5 groups of carbs with fermentation potential. I think he’s on to something, he is clearly very intelligent and articulate at explaining the Fast Tract Diet.
I got Post-Infectious IBS-C after a bout of gastroenteritis,
I am 21 years old and I was diagnosed with SIBO almost two years ago after abnormally high results from a hydrogen breath test. I was given a couple rounds of antibiotics and then started taking a probiotic every day, which I have taken every day since. One year later, I did the test again and, again, had very high numbers and went on more antibiotics. Now, about 8 months later, I feel that I need to take the test a third time. I feel bloated and gasey constantly. I also have acid reflux and gluten and lactose intolerances, but these do not seem to be factors that increase the risk of SIBO from what I have read. It is very frustrating. Is there anything anyone recommends I do?
Hi Cailey,
I was recently diagnosed with SIBO and decided to get rid of it holistically. 8 years ago I was diagnosed with H Pylori followed doctors orders and took medication to get rid of it. Shortly after taking those very strong meds I developed a gluten allergy and acid reflux. Hope experience can help you seek other treatment then the traditional way.
Think about how Muslim fast for a week. I think I’m gonna give that a try because it makes sense. The SIBO won’t have any source of food and could just die by good bacteria feeding on them? It would also be cool if we could email each other since your only a year older than me?
I had my colon completely removed 56 years ago when I was 15. I think I might have SIBO. I have not found information on the effect or safety of taking probiotics with only a small bowel. Nor have I discovered what strains of probiotics to take either for normal digestive and immune health or for SIBO. It seems to me that taking probiotic strains that normally reside in the colon but not the small bowel would cause problems, might even cause SIBO, or at the very least they would be a waste if money. Does anyone have information shedding light on this issue? Or an educated opinion?
I was told by my provider to go OFF my probiotic immediately. My test results showed an overgrowth of a bacteria found in most probiotics (l-acidopholis) and she said the probiotic could me making me worse. To your point, I’d be careful about taking a probiotic after a SIBO diagnosis until you know exactly what kind of bacteria is in your system.
Just wondering. Is SIBO an overgrowth of comensal or pathogenic bacteria?
All bacteria are comensal – they live in balance in the proper context. They only become pathogenic when they are not being balanced properly by competing bacteria. In addition, the extended use of antibiotics for non-life threatening situations has caused bacteria to mutate into the more threatening forms (ie: MRSA, C-diff). Consequently, the forms of bacteria usually present with SIBO are generally those that are already normally found already in the gut. A great resource is the Microbiome Project (as well as the Microbiome Summit that recently took place online).
I was just diagnosed with SIBO. I don’t know what a lot of the terms in this article mean. They have me on Cipro.
Your food and diet choices up til now have resulted in your present condition. Are you willing to research to learn what you are eating that destroys the beneficial balance of gut bacteria. Learn about probiotics and how to make fermented veggies at home. And eat them. A pill from the doctor is not going to fix it.
Probiotics can be the WORST thing for sibo.
Nora, I wason here looking for info on weather or not I should continue my pro/prebiotics when I found your comment. Do u know WHY probiotics are bad for SIBO?
They can create byproducts that feed the overgrown bacteria causing sibo. I tested high on methane, low on hydrogen. The common lactobactilli strains in most probiotics create hydrogen which feeds the methane producing overgrown bacteria. This is why I tested low in hydrogen, high in methane.
My gastroenterologist told me that probiotics would feed the bad bacteria but that I should take probiotics to feed the good bacteria.
It just depends upon the situation. Every single person’s gut is different! Certain strains of probiotics could be very beneficial with SIBO – it all depends on what the overgrowth is (what types). Best to get tested to find out the types of bacteria that are present in over abundance and work from there-
I have to ask how you are determining what strains are involved in the overgrowth. From what I’ve researched, according to standard medicine they can’t tell. I have heard of some stool test, but that’s not accepted by standard medicine, so would not be covered by insurance. After all I have paid out already in testing and doctor visits, I can’t afford the naturopathic recommended tests labs. I’m having to go it on my own from internet research on using herbals, because they won’t cover ND treatment, period. Any ideas?
Probiotics, for me, makes my Sibo worse!!!! I can’t gain weight! Fat makes me ILL! Have had Sibo for three years. On a lowish fodmap diet. It has helped in ways. Knowing what you eat and how your body reacts to it is a long process. I give my body a break from food so it could heal when i have a flare up. I lovvveeee CHARCOPILLS. They relieve gas fast and remove toxins from colon. I also drink lemon with warm water first thing in the morning ( google benefits ), wait thirty minutes to eat. EAT SOLUABLE FIBER BEFORE EVERY MEAL and insoluable fiber after that. Salad after meals too. Drs did nothing but pills, pills and bills! Stay awayyyyyy from any ingredients that end in -ol. Cause bad bloating, flatulence and annoying pain. Eat organic. My grocery bill went wayyyy up!!! Keep stress down. Sleep when you can. Your brain doesnt effect your digestion like when you’re awake. These are things that I’ve learned, tried along the way. Im better (ish) than before only because of trial and error. If i feel my rectum is swollen from eating wrong stuff and straining ( Do not strain ), i insert a hydrocortisone suppository in it before i sleep. Meds are $$$ in the U.S.A and suggest getting overseas for chump change. I pray for everyone.
That is garbage that food and lifestyle have caused sibo my son has a severe lung condition that he has to have antibiotics to keep him alive that is not his fault he also cant eat as it not safe so he has to have formula thru a tube thats not his fault and he did not choose to be like that so go and educate yourself
Agreed. I already was eating low carb paleo for about four years before I got SIBO. I wasn’t eating garbage, just whole foods, no sugar, no grains, etc. Now to do low FODMAP/SCD I’ve have to cut out a large part of the foods I enjoyed. I’ve started experimenting again since this diet still made little difference and, to be honest, many of the foods listed as no-nos do not seem to flare me up. I can eat cooked garlic and onion, green peppers, tomatoes and asparagus without exacerbation, so I’m not sure that is the answer – at least for me – either.
Fermented vegetables are awesome. But if you have SIBO, especially an overgrowth of yeast, eating fermented foods can make you feel worse and should be cut out. But that’s the rule of thumb. At the end of the day, everyone is too different for one diet or treatment to fit all. I was vegan and then went paleo. It’s amazing how, like you said, so much good health can be achieved just through a healthy diet.
I have had a first treatment with rifaximin and my symptoms actually got worse, parasite tests have been negative, but i’m beginning to suspect parasites, otherwise, why would i feel worse after taking antibiotics? i have read that parasites are often in a symbiotic relationship with bacteria, so that could be the cause
Hi Mary
I not long finished my treatment too and ended up worse off. What happened in my situation though is it made candida flare up, so now I’m on tablets to treat that.
I hope this helps and you figure out what’s going on
Katie
The first round of xifaxan caused my Candida to flare. I didn’t get meds for Candida even though I’ve had issues with it since I was a teen. So this time I cut sugars significantly unlike the first time and it seems I’m not having issues with it this time. This medication is really rough though.
I get Candida overgrowth every time I am on Rifaximin. I had about 5 rounds of Rifaximin (not consecutive) when I treated my SIBO. First time was a success. But ever since then every time I was on it, roughly 4th day into the treatment I would get Candida completely out of control. Small intestinal candida for me is much more difficult to treat and much more symptomatic than SIBO. I can usually control my SIBO with diet. With Candida I get symptoms no matter what I eat. I drink some water in the morning and I get an acid reflux and indigestion from it. I mean it’s horrible. I always get vaginal candida at the same time (never have it usually) and my stomach becomes itchy, so it’s no doubt that it’s SIFO and not just worsening of my SIBO symptoms. Thank you, Rifaximin! I am done with you!
Last year I was diagnosed with SIBO. After a course of Xifaxan and mostly following the FODMAP diet, I was able to hold off symptoms for about a year. I’m doing another course Xifaxan now and had this question when I’ve completed. For example, if I have beer and pizza will I feed/grow bad bacteria in my small intestine? Will the bad bacteria be at that higher lever permanently? Thank You.
I started on 1/4 capsule of Prescript Assist. It made my poo very stinky. Is this expected? Any thoughts?
It’s common. After awhile that goes away.
I am extremely surprised not to see scleroderma listed as a risk factor in this article, as it is a well-established association. In fact, a SIBO diagnosis has helped to diagnosis systemic sclerosis (scleroderma) for some people. Scleroderma can cause fibrosis, or a stiffening of the digestive tract (as well as other organs) leading to decreased intestinal motility. Up to 80% of people with systemic sclerosis are thought to have SIBO. If you are diagnosed with SIBO and also suffer from Raynaud’s phenomenon or have experienced skin changes, tightening, puffy fingers, or joint swelling or contractures, get a thorough work up by a rheumatologist asap.
You are absolutely right. I have a parent with scleroderma and I believe that is the issue they are having…you post validates my feeling.
That is interesting. Do you mean puffy fingers or skin tightening all the time? I get it occasionally. I get mild raynauds in my hands and feet occasionally and suffered with it in my nipples early on while nursing my twins. I was just diagnosed with SIBO a couple weeks ago. I have had symptoms for 3 years.
My two cents here in hopes that it may help. I do have systemic scleroderma only in my gut-(no skin issues or other systems involved). I do have Raynauds as well. I have been diagnosed for 13 years after having an emergency laparotomy for what my doctor believed was a bowel obstruction. Complete gut shut down, 2 week hospilization.
I have used:
Cipro-Flagyl combo weekly-awful, killed off everything on Monday when I took the drugs, by Friday I was miserable. I also took Reglan as needed until it was black listed.
Acupuncture/custom made Chinese herbal formulas-helped but still had episodes where I could not eat for a week (gas, intense bloating, abdominal pain, diarrhea)
Now I take Culturelle every day and occasionally S. Boulardii and this has been my most successful strategy. The number of episodes is maybe once a year but probably less, and my autoimmune markers for scleroderma are now normal.
I have never been formally diagnosed with SIBO but my gut transit times and other symptoms lead me to believe that I do have this and FOR ME this treatment plan is working.
As a healthcare consumer we really do have to do our own research…I was a patient of the top scleroderma doctors in the world and he told me my probiotic control of my scleroderma symptoms was a result of the “placebo effect”. Whatever! It works for me and defies your experience and I am ok with that. 🙂
I don’t have a mainstream physician. About 2 years ago my holistic chiropractor determined through muscle testing that a valve (now forgotten, presumably the ileocecal) was “permanently open.” He showed me a simple maneuver to perform daily involving the body meridians: press down firmly on a spot between my pelvic bone and navel while rubbing an area near my underarm with the other hand. I practiced this for a while, but because I didn’t fully understand GI dysbiosis nor the ramifications about my valve, I stopped the maneuver after a couple months. I couldn’t tell if it was accomplishing anything.
QUESTIONS: Can the ileocecal valve indeed be permanently open? Could it then cause SIBO? How to close the valve, or otherwise remedy it?
Other than receiving interpretation of a comprehensive lab (blood and urine) through the chiropractor’s office, I never had a stool or other test for specific pathogens. I believe I had bacterial and candida overgrowth from various indicators. Since that time and botanical treatments, I believe the bacteria (causing copious gas and rauchy odor) has subsided leaving stubborn intestinal candida with relatively mild symptoms but frustrating nutritional deficiencies it seems.
QUESTION: do you recommend a particular (affordable) test or lab so I know specifically what I’m dealing with at this point? Leaky gut has since been ruled out by one lab test through another practitioner.
Kris, you need to add adhesions to that list from C-Sections. I had a C-Section almost two years ago and began having pain and back up from adhesions near my cecum. My gastroenterologist told me I didn’t have them. I went to a physical therapist that is highly reputable nation wide. The GI I saw was uneducated at best. He said I didn’t have adhesions when even I could feel lumps pulling on my intestines. Anyways, SIBO can be caused by backflow, and no it’s not always constipation. Irritated intestines with partial obstruction will get backed up but will “dump” to compensate (consider the Chron’s patient in the beginning stages). That’s why I caught it early before it progressed to a worse obstruction, however I already developed SIBO by the time I self-diagnosed and got to the physical therapist. Therapy has improved my quality of life and my intestinal function because my rate of weight loss has slowed, but I still am receiving treatment. Anyone who’s had a c-section and developed dysfunction should see a GI asap and if they ignore your intestinal pain go to a physical therapist (one that doesn’t look confused but has EXPERIENCE when you bring this up).
Hi Tiffany, I am very interested in your experience and feel that it may finally explain what has been going on with me. I have had 2 c-sections and was diagnosed with SIBO 2 years ago (2 years after 2nd C-section). However, I have had abdominal pain and problems ever since my 1st. How does a physical therapist help? I have taken the antibiotics and manage it as best I can with diet. However, I just had to take an antibiotic for a sinus infection and now I am back to square one with being sick again. It is so frustrating and I am on my 3rd GI doctor. I will also add that I am B-12 and VIt D. deficient and have a very low ferratin level. This has definitely created serious problems for me in addition to weight loss. Any advice or help is much appreciated!
Antibiotics cause terrible problems to our guts! Physicians prescribe them but never do anything after to rebalance or repopulate our guts with the good organisms they killed. One in 4 people have parasites, 90 something % of parasites do not culture out in stool specimens. They eat up all your B12, Iron and Ferritin. Where parasites go, they carry toxic heavy metals with them. They cause malnourishment, weight loss, large appetites and carb cravings and fatigue. Diagnosis is difficult. majority of Medical Doctors do not believe in them, and treat you blindly because they don’t know what else to do. Please look at this as a possibility. Be your own advocate.
my daughter has had bacterial over growth along with short bowel syndrome for 11 years now same antibiotics cycled monthly… she has not gotten any better actually worse now because she is on TPN… do you know of any other treatments out there that she are a win ?
thx
XIFAXIN helped my SIBO
Currently healing my leaky gut with the AIP protocol. To minimize my risk of having to take antibiotics, I supplement with 10,000 units of D3 daily and I use ionic silver during cold and flu season (nasal spray of ionic silver 3x/day and swish with 1 Tbs of it for 3-5 minutes then spit it out, 2x/day). For years I struggled with sinus infection. Since starting this regimen four years ago, I’ve had no infections, not sinus, not respiratory, not any type.
Sam, sorry about this late reply. The scar tissue can be broken up mostly with hands on physical therapy. It cannot be broken up otherwise. Laparoscopy will make it worse if you scar up a lot like I do. Find one experienced. You might be able to get it through your insurance by telling your doctor about your history of pain. If not, call around and find a PT experienced treating women with c-sections. My PT told me to start doing yoga to encourage and maintain plyability of the scar tissue. I “think” that it will recur and worsen if not. My body is this way. Since November I’ve noticed a tightening because I’ve been using not feeling well as an excuse.
Are you saying that abdominal surgical adhesions can tug on the intestines, resulting in the backflow that ultimately produces SIBO? That would certainly make sense for me. My gut problems started a month or two after abdominal surgery.