SIBO: a primer

On a scale of 1 to pregnant, how bloated do you feel after a meal?  Do you wind up clutching your stomach and moaning about your digestive discomfort? (no judgement.)  Suffer from lots of gas?  Deal with regular bouts of constipation and diarrhea?

She looks like a pregnant!  For real tho...

She looks like a pregnant!  For real tho...

Meet my frenemy, SIBO.

SIBO is like your adult sibling staying over in the guest room.  Everything's going great; he/she tells funny jokes, loves your dog, and even washes the dinner dishes on occasion.  Until suddenly one evening you realize that he/she has inexplicably relocated the air mattress to YOUR bedroom and, to make matters worse, invited their friends.  And friends of friends.  Talk about crowded and awkward.



Bacterial colonies live all throughout our digestive tract.  Generally speaking, the large intestine is the most populated and acts as home base for most types.  A few others live peacefully in the small intestine while maintaining a relatively low population density.  This is all good and healthy.

But sometimes bacteria is that crazy sibling and, against all things good and natural, moves up into the small intestine to start a new life.  With a few billion friends.

Things get rowdy.  As the bacteria move further up the digestive tract, they gain access to sugars and nutrients that should've been absorbed into our blood stream.  Now they're feed the growing colonies, instead.  To add insult to injury, the bacteria tend to ferment these sugars, causing the gas and bloating that ruins every good meal.  Meanwhile, your friendly large intestine bacteria, trying to make a good, honest living further down the GI road, find their food sources drying up as their greedy cousins push north.  Some of the good guys have no choice but to pull up stakes and leave, further disrupting gut function.

The result is a long slide into a bunch of shitty symptoms (<-- there I go with one of those digestive puns).  Aside from the aforementioned physical discomfort, low grade inflammation caused by the bad bacteria and their byproducts gradually damages the intestinal lining.  This can result in partially digested food molecules moving into the bloodstream before they should, causing an immune reaction, more inflammation, and a range of symptoms from acne to nausea to fatigue as the body works to cleans up the mess.  This state is known as leaky gut, or gut permeability.  It's present to some degree in a surprising number of us and is linked to the development of more serious conditions like depression, food allergies, and autoimmune disease in genetically susceptible individuals.

SIBO's why.

SIBO can be triggered by many factors.  One of the most common ones is the overuse of antacids.  Without a highly acidic stomach environment, bacteria that should be killed off are able to make there way into the relatively cozy, food-rich environment of the small intestine, where they thrive at the expense of our health.  

Antibiotic use is another potential cause.  Although very necessary at certain times, they disrupt and clear the natural balance and can set the stage for an overgrowth of aggressive, pathogenic bacteria.  If you've ever turned over soil in preparation for garden planting and watched an abundance of weeds spring out of nowhere to take advantage of the chaos, you know what I mean. 

A diet high in refined carbohydrates is also guilty.  The carb-loving bacteria, the gut deplorables, if you will, are usually kept in check by an army of fiber-loving good guys in the land of the large intestine.  But if these carb munchers slip past into the small intestine, it's game-on!  Here they're better able to feed their sweet tooth with the refined carbs that are typically absorbed earlier in the gut.  This means pasta, bagels, donuts, frosting, and 99% of delicious snack foods available for purchase.

Is this me?

Diagnosing SIBO can happen on a few levels.  Symptoms and health history alone are often enough for a soft diagnosis.  For a more definitive answer, breath tests are used.  These measure the amount of hydrogen that is exhaled, a sure sign of improper bacterial fermentation going on in the small intestine.  Methane is checked as well, as its presence can indicate an overgrowth of archea, an organism that digests that hydrogen into methane.  Methane production can cause both constipation and diarrhea, but -luckily for your social life- the gas is odorless.  So there's that.

Great.  Now what?

If you suspect that your small intestine is a fixer-upper, don't despair.  You've got options.  And none of them are based on a 30 year commitment.

In extreme cases, antibiotics may be the best choice for knocking these pathogenic bacteria back.  Before you scroll up to confirm that I did, indeed, list this same item as a cause, let me explain.  Antibiotic use followed by an improper or careless diet is an open invite for pathogenic bacteria to have the run of the land.  Antibiotic use to wipe out something like SIBO, followed by a strategic diet and probiotic support, is an entirely different story.  With a much happier ending.

Alternately, you can explore treatment with herbal antibiotics, such as a blend of oregano oil, cinnamon oil, neem oil, and other potent essentials.  

But my favorite approach -effective for most mild to moderate cases- is straight from the Medieval Times: starve 'em out.  Pathogenic bacteria, as a rule, are lovers of sugar and refined carbohydrates.  Eliminate these strictly for a month and see how you feel.  For the most effective and speedy results, cut out all added sugar, grains, legumes, and dairy during this time.  Limit fruit as well, especially the sugary types like bananas, apples, and pears (berries are cool).  If you think I'm trying to sneak a paleo template diet on you, rest assured that we're merely controlling for certain types of carbohydrates.  But if paleo guidelines appeal to you or make it easier to follow, take advantage of the abundance of resources on the diet.  You don't need to get Grok about it to use it.

To help support the good bacteria -those friendly, large intestine-dwelling folk- eat loads of fiber from vegetables.  The addition of a high quality probiotic can also help the cause.  In this case, choose one with soil-based organisms to uproot some of the bad bacteria, like Garden of Life's Primal Defense.

If you've given these measures a good, solid go-around and haven't experienced relief, consider removing FODMAPS from your diet for a spell.  Some of us wind up with bacteria that ferments very specific types of carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols of FODMAPs fame) that are found in a variety of otherwise delightful fruits and vegetables.  Cross your fingers this isn't you, cause it's an annoying diet to follow, but be aware that it's a possibility.  And if you ARE that guy or girl, don't despair; FODMAPs is usually only required temporarily for the flora to rebalance.

Happy gut healing, friend.