SMALL INTESTINE BACTERIAL OVERGROWTH
SIBO stands for small intestine (or intestinal) bacterial overgrowth. The intestines are home to many millions and billions of microorganisms, but these organisms should be mostly limited to the large intestine. When bacteria accumulate and replicate in the small intestine beyond what is normally found there, we develop small intestine bacterial overgrowth. Intestinal bacteria normally digest and ferment the food we consume primarily in our large intestine, and provide us with all sorts of good things - like short chain fatty acids, vitamins, etc - in the process. In SIBO, the bacteria now ferment the food we consume in the small intestine, as well as the large intestine. This fermentation process produces gas – think yeast fermenting sugar to produce carbonated alcohol – and when fermented in the small intestine, this gas has nowhere to go! As the gas builds, it can cause pain, bloating or distention, and can contribute to diarrhea or constipation. These are also symptoms of irritable bowel syndrome or IBS. According to many studies, majority of individuals with the symptoms of IBS, also have SIBO.
Wait?! How do I know if I have Sibo?
One of the single most recognizable symptoms of SIBO is intestinal bloating - we are talking extreme, "like-I-am-10-months-pregnant" type of bloating that typically is better in the morning and worse as the day progresses. It can be anywhere from mildly uncomfortable to incredibly painful, and is often triggered by meals containing highly fermentable foods - think lactose-containing dairy, beans and legumes, brassicas, etc. While not everyone will have significant bloating, the complete absence of bloating often leads me to wonder what else might be contributing to patients symptoms. Folks with SIBO will also typically have some changes in bowel habits (diarrhea or loose stools are common, though constipation can occur). Check out this site for other signs and symptoms of SIBO, as well as associated conditions.
Aside from symptoms that may point you or your health care provider towards considering a SIBO diagnosis, in order to have the appropriate information to make an accurate diagnosis, you will want to get a breath test. The breath test measures hydrogen and methane levels exhaled in the breath that are byproducts of bacterial fermentation within the small and large intestine. I recommend a 3- hour Lactulose Breath Test. Contact your health care provider to order a test from one of the following labs:
You can also order one directly (for yourself) through Direct Labs.
There is an excess of information about SIBO out there on the internet. Instead of re-creating the wheel, I have decided to create a short list of resources that I trust to accurately inform you about SIBO and associated conditions.
SIBOinfo.com - the site of Dr. Allison Siebecker
SIBO SOS - a library of interviews and courses of SIBO from basics to advanced. Check out the SIBO Recovery Roadmap Course if you are wanting to understand the basics of SIBO
Nirala Jacobi, ND at The SIBO Doctor website and podcasts
Michael Ruscio, DC site and podcasts