• Do you have gas and bloating, belching, constipation or abdominal cramping?

  Do you have trouble focusing and often feel mentally foggy?

  Do your digestive symptoms occur no matter what foods you eat?

  If you answered yes to any of these questions you may have a digestive condition called Small Intestinal Bacteria Overgrowth, or SIBO.

What is SIBO?
Small Intestinal Bacterial Overgrowth is a condition where bacteria accumulates in the small intestine.  In a healthy digestive tract, most of the bacteria is found in the colon.  With SIBO, bacteria is overgrown in the small intestine and this bacteria can create a lot of digestive problems.  SIBO can impair digestion and absorption of nutrients, it can damage the lining of the intestine creating a leaky gut, and it can create a variety of symptoms, the most common being gas and bloating.

Symptoms
SIBO symptoms can vary depending on the type of bacteria or organism found in the intestine.

If normal bacteria overgrows in the intestine then bloating can occur 20 minutes to 3 hours after a meal.  Other symptoms can include abdominal pain, cramping and diarrhea.  Carbohydrate foods will cause more bloating than meats.

If there is an overgrowth of another organism called Archaea, then the symptom picture can be very different.  There can still be bloating, abdominal pain and cramping, but Archaea usually cause constipation, not diarrhea.  There can also be intense nausea and loud gurgling (borborygmus).  The Archaea bacteria slow transit time (the amount of time it takes for foods to get from digestion to elimination) so digestion feels sluggish.

Testing
A common test used to diagnose SIBO is the Lactulose Breath Test.  Humans can’t digest or absorb lactulose but bacteria can digest lactulose.  When bacteria consume the lactulose they produce gas which can be measured in the breath.  Both hydrogen and methane gases are measured in this test. If there is a significant rise in hydrogen or methane gases in the small intestine then SIBO is suspected.

The test requires a 12 – 36 hour preparation diet.  To take the test, the person will drink a minimum of 10 grams of lactulose and then blow into a tube every 15 – 20 minutes for 3 hours.  Gas from the bacteria is collected in the breathing tubes.  The 3-hour duration measures the amount and type of gas at different points along the small intestine.  The testing measures 3 types of gases:

1. hydrogen gas (made by bacteria),
2. methane gas (made by archaea)
3. carbon dioxide (made by humans)

By measuring all three gases, we can tell where the SIBO exists in the small intestine, what kind of organism is present and if the test is valid.  The doctors at Boulder Natural Health use the SIBO laboratory company called Aerodiagnostics because their testing meets all of these criteria.  Most insurance companies do cover the cost of SIBO testing.

Treatment
A positive SIBO with a high amount of hydrogen gas is the easiest to treat.  One or two rounds of the antibiotic Rifaximin, or an herbal antimicrobial protocol are very effective for treating SIBO.  A SIBO specific diet,  low FODMAPS or the Specific Carbohydrate Diet, are typically very effective for controlling symptoms while killing the overgrown bacteria.

A positive SIBO with a high amount of methane gas is much harder to treat.  A class of organisms called Archaea create methane gas and they are not as easily killed by standard antibiotics.  Additionally, Archaea make elaborate biofilms, or protective coverings, that prevent them from being killed by antibiotics of herbal antimicrobials.  For this reason it is necessary to use something called a “biofilm disruptor” designed to break through the protective covering.  A methane positive SIBO can be treated using a protocol that includes a SIBO-appropriate diet, herbal antimicrobials specific for Archaea, a biofilm disrupter, and a soluble fiber.

Even with proper treatment the re-occurrence of SIBO is nearly 60%.  Killing the microbe is only part of the equation.  It is also necessary to address the underlying reason that the SIBO developed in the first place.  Continuing to support digestive healing, nervous system balancing, and maintaining healthy microbiome in the gut are extremely important for full resolution of SIBO.

Questions?
If you have questions about SIBO and would like to learn more, please contact our office at 303-960-3920 and schedule a free 15-minute telephone consultation with one of our naturopathic doctors.

Brechmann, T., Sperlbaum, A., & Schmiegel, W. (2017). Levothyroxine therapy and impaired clearance are the strongest contributors to small intestinal bacterial overgrowth: Results of a retrospective cohort study. World Journal of Gastroenterology, 23(5), 842–852. http://doi.org/10.3748/wjg.v23.i5.842