SIBO (Small Intestinal Bacterial Overgrowth)
SIBO is a condition that is characterized by excessive bacteria in the small intestine, leading to multiple symptoms and complications such as malabsorption and intestinal permeability. Symptoms of SIBO are non-specific, including bloating, abdominal pain, flatulence, nausea, dyspepsia, constipation, and diarrhea.
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SIBO: Addressing and Managing Imbalances
Patients with digestive problems aren’t always taken seriously by primary care providers. Often cases are dismissed with the nebulous diagnosis of irritable bowel syndrome (IBS), when the problem hasn’t been adequately worked up and given the proper attention. A recent study in Scientific Reports found that up to half of patients diagnosed with IBS also have a treatable and consequential condition called small intestinal bacterial overgrowth (SIBO). SIBO in and of itself has many underlying causes, and can cause deficiencies in both macro and micronutrients.2 These deficiencies can slowly sap a patient’s health. We’re going to uncover what to look for, so that you can discover these deficiencies and correct them.
Patients with SIBO can present with a varied constellation of GI-related problems, such as diarrhea (which can present as steatorrhea), constipation, bloating, vitamin and macronutrient deficiencies, which we’ll outline below.2-4 Symptoms can vary from mild to severe, based on the species present, the duration of their illness, concurrent ailments, and individual factors including diet.2,3 Let’s look at some of the nutritional deficiencies that can develop from SIBO.
Because SIBO is an issue with overgrown bacteria, my experience has proved that reducing those bacteria with antimicrobial herbs often needed to get a patient’s symptoms under control. When those therapies are unable to get symptoms under control, or if patients are especially motivated, then trying a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet may help.5,6 This involves eliminating or drastically restricting foods that contain FODMAPs, for a period of weeks, and then slowly reintroducing them to see if they reproduce symptoms.5,6 Elimination diets like the low FODMAP, that impact consumption of fruits, vegetables, and whole grains also come with the risk of exacerbating nutrient deficiencies and must be used judiciously.5 In cases where steatorrhea is a particular problem, using medium chain triglycerides (often referred to as MCTs) might be helpful.6,7 Often with SIBO treatment, a combination of therapies are needed to help patients navigate their condition.
SIBO has multiple mechanisms that cause nutritional deficiencies, in carbohydrates, proteins, fats, and micronutrients, like vitamins and iron even before establishing a diagnosis of SIBO (since there could be other digestive causes for them).2 Once we’ve identified a deficiency we can correct it by supplementing nutrients, while concurrently addressing the causative bacteria, as the loss of these nutrients often creates a vicious circle wherein the bacteria worsen the deficiencies and the lack of nutrients make it more challenging to return to the gut microbiota to normal. To learn more about the workup and treatment of SIBO, contact the Integrative Wellness & Research Center, Inc at (901) 763-7006.
- Poon D et al. A systematic review and meta-analysis on the prevalence of non-malignant, organic gastrointestinal disorders misdiagnosed as irritable bowel syndrome. Sci Rep. 2022;12(1):1949.
- Bushyhead D et al. Small intestinal bacterial overgrowth. Gastroenterol Clin North Am. 2021;50(2):463-474.
- Quigley EMM et al. AGA clinical practice update on small intestinal bacterial overgrowth: expert review. 2020;159(4):1526-1532.
- Bures J et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978-2990.
- O’Brien L et al. What Are the Pearls and Pitfalls of the Dietary Management for Chronic Diarrhoea?. Nutrients. 2021;13(5):1393.
- Jacob A. Treatment and Management of SIBO – Taking a dietary approach can control intestinal fermentation and inflammation. Today’s Dietitian Website. https://www.todaysdietitian.com/newarchives/121112p16.shtml. Updated 12/2012. Accessed 5/31/2022.
- Fitzgerald K et al. Managing SIBO through dietary interventions. Institute for Functional Medicine Website. https://www.ifm.org/news-insights/managing-sibo-dietary-interventions/. Accessed 5/31/2022.