Bloating, gas, pain, constipation or diarrhoea………Could it be SIBO?

SIBO or Small Intestinal Bacterial Overgrowth is a condition where we see bacterial overgrowth in the small intestine, the area that does most of our digestion and absorption. A healthy small intestine normally has small numbers of bacteria, especially when you compare it to the large intestine, which has a huge number and variety of bacteria.

In SIBO there is an overgrowth of bacteria that are naturally found in our body in other areas. These can be bacteria that migrate from another place like the bowel, where they perform very important functions. But once they start to reside in the small intestine they start to cause trouble. Symptoms can include gas, bloating, tummy cramping, fatigue, nausea, nutrient deficiencies, constipation, diarrhoea, reflux and joint pain.

These symptoms are very similar to other digestive conditions and this is why it can take many years for some people to get a diagnosis. It is now thought from clinical studies that up to 84% of cases of IBS may actually be caused by SIBO. Patients with Coeliac disease and Non coeliac-gluten sensitivity that don’t feel completely better once commencing a gluten free diet, could look at SIBO testing. Other conditions that SIBO has been linked to are Fibromyalgia, Gastroenteritis, Diabetes, IBD (Inflammatory Bowel Disease), Hypothyroidism, Scleroderma, Diverticulitis, Liver Disease and chronic constipation. It has also been linked with the long term use of some medications like antibiotics, opiods and proton pump inhibitors which are used for acid reflux.

Once SIBO is suspected, it can be tested for with a breath test. It is not widely known about with GP’s and other health professionals, but one day this will change. I have met gastroenterologists who are aware of SIBO and conduct testing to rule it out for patients with symptoms of IBS. In Adelaide they would refer you to the Women’s and Children’s Hospital for testing. While other health professionals for example nutritionists or naturopaths like me, can order the testing for you via testing laboratories.

I highly recommend going through a health professional, as they can recommend a laboratory that uses a proven test, interpret the results for you and assist you with all phases of treatment. SIBO is a very complex condition and you want to know you are with someone who has extensive training and knowledge on the condition. I have completed all the SIBO Mastery course taught by Dr. Nirala Jacobi, arguably Australia’s foremost expert on SIBO.  I was so excited to meet her in person, along with other leaders in this field, including Dr. Alison Siebecker at Australia’s first SIBO Symposium in 2016.

Testing involves a preparation diet for 24 hrs prior to testing. Then drinking a special sugar drink and performing breath samples into a small tube every 20 minutes for 3 hours. Not all testing laboratories measure methane and hydrogen gases. This is one of the reasons I choose to use Sibotest.

To effectively treat SIBO there are a number of areas you must treat & this is why it is worth engaging the help of a practitioner that has a real interest in SIBO. First the cause needs to be investigated, without addressing the cause you are much more likely to have relapses. Please note that some causes may not be able to be overcome, but you can still do a lot of things to minimise the return of SIBO. Some of the causes include a severe bout of gastroenteritis, medication, altered anatomy due to scarring or adhesions possibly from surgery, chronic stress which can alter the amount of stomach acid (which would normally defend us against certain bacteria) and poor gut motility.

Treatment also needs to include antimicrobials to kill the bacteria causing the problem in the small intestine. These can be herbal, specific antibiotics or a combination of both. Restoring the motility/flushing of the small intestine that naturally occurs every 90 minutes in the small intestine of healthy individuals, is essential. This flushing or sweep clean, helps to move bacteria down the road into the large intestine and helps to prevent overgrowth. Following a diet designed specifically for SIBO patients also forms part of the treatment, by starving the bacteria. It is also very important to improve digestion and absorption and replace nutrients that can be very low due to years of poor absorption.

Addressing all these areas is paramount if you want the best results and you wish to have lasting improvement. That is why I believe it to be very difficult to treat and manage on your own. You will need the support, treatment and guidance that only a qualified health practitioner can provide.

If you have any questions about SIBO or SIBO testing please get in touch.

Danielle Elliott

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Article written by:
Danielle Elliott

Adv Dip (Nat & WHM)

Danielle Elliott is a naturopath, herbalist & homeopath with a special interest in digestive complaints. She has been in clinical practice for 15 years and began specialising in gut health 9 years ago. Since then, Danielle has published a book entitled "Gluten Free and Happy", which helps educate people with Coeliac Disease and Non-Coeliac Gluten Sensitivity on how to optimise their digestive health and overall wellbeing. Danielle also does a lot of work with patients with SIBO and functional digestive disorders as well as running “Tummy Rescue”, an online community for patients with GI disease (see www.tummyrescue.com.au).