SIBO stands for small intestine bacterial overgrowth. The majority of bacteria in our gut should live in the large intestine. Commonly caused by a loss of tone in the valve that separates the small and the large intestine. This is the result of multiple stressors placed on the body.
The most common symptoms of SIBO are bloating, gas, and diarrhea. Heartburn and indigestion are be secondary components. It is the driver of many IBS diagnoses. These symptoms typically worsen after a carbohydrate rich meal or any of the foods below.
Causes of SIBO
Slowing of the digestive tract will leave foods to ferment and microbes to proliferate. With decreased motility comes a loss of tone in the ileocecal valve (ICV) that separates the small and the large intestine. This normally acts as a physical barrier to help keep the microbes in the large intestine from spreading into the small.
Things that can cause a lack of tone and decreased motility include anything that will drive that sympathetic side of the nervous system. This commonly includes stress hormones, inflammation, low blood sugar, and even a low thyroid output.
Addressing Stress Hormones
Stress hormones are called such because they increase due to some stress response. That can be from emotional (family, job), chemical (low blood sugar, inflammation), or physical (pain).
Avoid rapid fluctuations in blood sugar. People in this category should focus on eating 3 meals spaced 5 hours apart with no snacking in between.
Get your emotional baggage under control with meditation, therapy, or some low intensity exercise like yoga.
Work on resolving chronic pain issues with a good manual therapist like a chiropractor, physical therapist, or qualified professional.
Consider adding an adaptogenic herb like Ashwaganda, Tulsi, or Rhodiola. Other supplements to consider would include Magnesium, Vitamin B6 (P5P), and Zinc.
Inﬂammation is generated by the immune system. Inflammation is a natural part of regeneration, but left uncontrolled will drive degeneration. This will deplete vitamins, minerals, and macronutrients over time causing deficiencies.
Reducing Inflammatory Triggers
- Trying an anti-inﬂammatory or elimination diet can be helpful. Many times just cutting the biggest offenders can have a drastic impact (sugar, dairy, gluten).
- Use caution as you reduce problem foods! You must increase the foods that you can eat, in order to avoid worsening a potential blood sugar issue. Eat plenty of good protein and fat with each meal.
- Reduce inﬂammatory “accelerators.” Things that further drive inﬂammation include stress hormones like cortisol, insulin, and excessive NSAID use.
- Consider adding in supplements that help reduce inﬂammation like Turmeric, Resveratrol, and Fish Oil, Magnesium, Vitamin B6 (P5P), and Zinc also help your body make more ﬁsh oil from omega 3’s.
Addressing (low blood sugar) Hypoglycemia
Whether you’re diabetic and have trouble with high blood glucose (over 100) or low blood glucose (under 85) then this can be a common offender to your ability to get past chronic pain.
Generally, cut sugar out completely and focus on eating either 3 meals – 5 hours apart with around 30g of protein and a third of your calories for the day. If you’re on the low blood sugar side of things, then I’d avoid intermittent fasting in the morning. You need to shift away from your dependency on stress hormones to stable your blood sugar. You can do 6 small meals, but timing is much more difficult to hit every 2-3 hours.
Low FODMAP Diet
Going on a low FODMAP diet is very helpful in reducing symptoms. It also gives more confidence that you have SIBO.
FODMAPs are a collection of short-chain carbohydrates that are poorly absorbed in the small intestine. They are readily fermented in the bowels by bacteria, which produces gas and bloating. This diet is used as a temporary intervention to help bring homeostasis back to the gut. Below are the 6 general categories of foods included on the diet. Most people only have discernible problems with some of the FODMAPs – not all of them.
Oligoosaccharides (Fructans and GOS – Not absorbed by anyone.)
Monosaccharides (Fructose in excess of glucose)
Polyols (Sorbitol, Mannitol, Maltitol, Xylitos and Isomalt)
Reducing the Overgrowth
Medically, antibiotics are use to reduce the overgrowth with. The potential issue with that would be the overgrowth of other microbes like fungus. The advantage of using natural antimicrobial herbs is that many of they actually work against both fungus and bacteria.
Avoid a probiotic. This is not the time to try and support the growth of bacterial and in most causes will worsen the overgrowth.