Small Intestinal Bacterial Overgrowth a.k.a. SIBO is an abnormal distribution of your gut bacteria through your small and large intestine, and sometimes even your stomach. Your gut bacteria have gotten the chance to settle themselves in places of your digestive tract, where they aren’t supposed to be. And this could lead to symptoms. To improve symptoms, you can follow a SIBO diet, but how do you do that exactly?
The gut microbiota plays an important role in your immune system, metabolism, your bowel motility, and overall health of your gut. (For more information and my article about gut microbiota and probiotics, click here)
What Is SIBO?
SIBO means that your gut bacteria have translocated themselves into your small intestine. Usually, your small intestine has very little bacteria. And most of your gut bacteria are present in your large intestine.
It is important to keep this separated.
Your small intestine is the place where your food gets digested and where you absorb basically every nutrient from the foods you eat. This also means that there are loads of partially digested food in your small intestine. If you have too many bacteria in your small intestine, they will start digesting your food with you. And that’s where your symptoms start.
The bacteria that have settled themselves in your small intestine, produce gas and acids (if you want to read more about it, click here for my article) just like they would in your large intestine. The only downside is, that there is so much more food for them in your small intestine! Letting them produce so much more gas and acid than they would in your large intestine. All this extra gas is trapped in your small intestine and results in bloating (click for my article).
Are you having gut symptoms like bloating, diarrhea, or constipation? Schedule a free IBS-symptom assessment and I’ll show you how I can help.
The Cause of SIBO
SIBO does not just happen out of nowhere. Your body is perfectly designed to make sure your bacteria stay put exactly where you want them.
Your body does this by creating a certain environment that suits the bacteria that should live there and fence off the ones that shouldn’t.
For instance, your digestive tract has different pH (a.k.a. acidity) levels throughout. You probably know your stomach to be very low pH (very acidic) which is a bad environment for most bacteria and kills many of them. This is actually good because your stomach is the gateway from the outside world to your intestines, you don’t want harmful ‘outside’ bacteria getting into your intestines. The best pH for most bacteria to live in is a little higher and thus less acidic.
A little further down, in your small intestine, the pH starts to go up a little. But not enough to actually be nice for most bacteria to live in. But the further you go down, the less acidic it gets. Your body starts adding digestive juices, which have a high pH level. The further down through the digestive tract you go, the less acidic you will be. Resulting in more and more bacteria down the line.
The end part is your large intestine. That place is not acidic anymore and is swamped with bacteria! That is a good thing. Because you may have heard me say it before….. Your gut bacteria are your friends!
Your large intestine is the ideal environment for your gut bacteria to live in. It’s warm, has the right pH, it’s moist, and there’s very little oxygen which is ideal for most of your friends who definitely don’t want air. In fact, it is so crowded there, that your gut bacteria are in a constant fight to claim their place. This is beneficial because this way bad bacteria have a smaller chance to settle.
But now, how does the SIBO happen then?
If for some reason the pH of your small intestine will become too high or the food does not move through your digestive tract fast enough (for example because of stress, intolerances, or issues with the digestive tract), your bacteria will love to live there. With a higher pH, your small intestine is basically the same as your large intestine, but with way more food! Well, easy choice for the bacteria, right? So they’ll grab their belongings and start migrating to the food paradise. Too bad that this is not a good thing for you though.
Since SIBO starts when the pH in your small intestine is not low enough, the actual start point of SIBO is your stomach. Do you remember me telling you the stomach is the most acidic part? Well if something goes wrong there, and the pH gets too high, the rest of your digestive tract will suffer from that with less acidity.
The biggest known causes of disturbing the acidity levels in your stomach are either the use of gastric acid inhibitors or having a stomach ulcer (the ‘Helicobacter Pylori’ bacteria that causes this, produces base in the stomach to be able to survive better).
Both of these will alter your pH levels and leave you with less acidic stomach acid.
What also does not help, is that the older you get, the less acidic your stomach will be. But also, the older you are, the higher the chance you will be using a gastric acid inhibitor….. Well, that’s just double trouble then!
SIBO can be recognized by a few symptoms, which are closely related to Irritable Bowel Syndrome (IBS) symptoms (For my article on IBS, click here). And research even shows that bacterial overgrowth can be a trigger for IBS symptoms and vice versa.
There are 3 ways to diagnose SIBO:
First. SIBO can be diagnosed by doing a hydrogen breath test (although this is not a 100% reliable way to test it). This is similar to the one I describe in my article about Lactose Intolerance (Click the link). But in this case, you would drink a mixture of water with glucose or lactulose. The bacteria would produce hydrogen when they digest the glucose or lactulose and this can be measured in your breath. This can give you some information on whether or not the bacteria are high up in your digestive tract.
Second. Doing a highly invasive test with a ‘stool’ sample from your small intestine. But because it is very invasive for the patient, this is hardly ever done.
Third. A trial and error with antibiotics. If you’re symptoms ease with antibiotics, chances are they are being caused by bacteria. But I would never recommend this to any of my clients because antibiotics also just kill all your good bacteria!
But with SIBO, doctors and scientists are still trying to decide on the best way to diagnose and treat it. So most people will base their dietary plan upon the symptoms they are experiencing.
Can SIBO Cause Weight Gain or Weight Loss?
SIBO can have an effect on body weight. One of the symptoms is nutrient and vitamin deficiencies, and therefore that could actually influence your body weight. If you have nutrient or vitamin deficiencies that basically means your body is being deprived and thus functioning on its reserves. This makes it likely that you lose weight.
The deficiencies start to form because the bacteria in your small intestine are making it harder for you to absorb all the nutrients from your food because they compete with you for the nutrients and they inhibit the function of digestive juices. Leaving you with less nutritional value of your own.
Apart from that, if you have SIBO symptoms like bloating, stomach aches and diarrhea, chances are that you’re not feeling like eating too much anyway. Which would lead to weight loss.
SIBO and Weight Gain
SIBO has 2 types that can be taken into account. And both these types can have different effects on the body. The H2-producing (hydrogen) SIBO and CH4-producing (methane).
Both of these can be clinically tested with breath tests. And in general, the CH4-producing type causes constipation and the H2-producing type does not.
A study in adults tried to find a link between SIBO and body weight. In that study, the people with H2-producing SIBO generally had a lower body weight than the people without SIBO. Their conclusion is that H2-producing SIBO is not leading to obesity.
In the article describing the study, they do mention that CH4-producing SIBO (with constipation) has been related to weight gain in other studies. But these findings have not been consistent and need to be researched more.
Multiple other studies have found SIBO to be about 2x more common in people who have obesity. This does not prove that the SIBO causes obesity, but does show a link between the two. The question remaining is, what came first? SIBO or obesity? Most researchers seem to expect obesity first, SIBO after. If you want to read more about imbalances in the gut and weight gain, check my article.
SIBO is related to malabsorption and maldigestion. This means that the food you eat isn’t being digested properly. You won’t absorb as many nutrients from the food you eat if you have SIBO, in comparison to someone who doesn’t have SIBO. This is because the bacteria are eating with you. SIBO is therefore mostly related to weight loss and malnutrition.
On the other hand, if you would start eating more because you feel like you’re not getting enough nutrients from the food that you’re eating. You could end up eating too much for your energy usage, and thus gain weight. In this case, the SIBO isn’t necessarily the cause of the weight gain. But it does promote a feeling of inadequate intake which stimulates higher food intake and results in weight gain.
Conclusion: SIBO and Body Weight
As you can read above, there is not a strong YES or NO answer to the question if SIBO can lead to weight gain or weight loss. A lot of research is still being done on SIBO and its relation to body weight and health. In general, SIBO is more likely to lead to weight loss, than weight gain.
A way to get rid of bacteria in your digestive system is antibiotics (click for my article about probiotics and antibiotics). Too bad though, this kills all your bacteria and is not always 100% effective. Making it a bad idea, unless strictly necessary.
So we’re gonna have to deal with the SIBO in a more natural way. Remember though, if you have physical complaints that are worrying you, always consult your doctor! The information I’m providing is not specific to your personal situation.
Looking for a personalized SIBO plan? Schedule a free IBS-symptom assessment and I’ll show you how I can help.
Treatment of SIBO is done mostly by ensuring that the stomach acid is getting back to its original acidity and helping your gut recover its proper motility.
The basics are:
1. Fixing the cause of the disturbance
2. Adjusting your nutrition
3. Treating the bacterial overgrowth
4. Treating nutrient deficiencies (if they exist)
5. Creating a healthy lifestyle
Fixing the Cause of the Disturbance
If the problem lies within the acidity level of the stomach acid, it is best to start there. If you’re using PPI’s, it may be wise to discuss the dosage of this with your doctor. In this case, the less the better! But never make that decision on your own!
Help your stomach a little by adding acidic foods to your diet. It’s best to add sour foods to every meal, to get a little extra acidity into your stomach. Examples are: lemons, kefir, pickles, sauerkraut, or even take a small shot of apple cider vinegar.
If you’re not a big fan of the sour flavor, you could also try to add a supplement to a meal that contains Betaine HCL. This adds extra acidity and digestive enzymes to your stomach to help you digest the foods and keep it out of the hands of the SIBO bacteria. Don’t use this with every meal, since the safety of long-term use is not yet evaluated.
The SIBO Diet
Since the SIBO bacteria are eating with you, it’s a good idea to make sure you give them as little food as possible. Don’t worry, I’m not telling you to stop eating…. Make sure you use several small portions of healthy foods throughout the day and chew properly. This way your body gets the chance to digest your food before it reaches the SIBO bacteria. And there are no large amounts of food in which your SIBO bacteria can feast alongside you.
Also, make sure you’re adding probiotic foods to your diet. The healthy bacteria from the foods will compete with the SIBO bacteria and making it harder for them to settle in the wrong places. Products containing probiotics are for example fermented foods (sauerkraut, kimchi, pickles), yogurt, kefir, or kombucha.
Often, it is advised to follow a low FODMAP diet (for my article, click here), but according to the Monash University FODMAP Blog, there is no actual scientific evidence for this. Still, with SIBO it is smart to avoid any food sensitivities or triggers since they could slow down the movement of your intestine. And SIBO is often related to IBS. So I’d say the FODMAP diet is definitely worth a try.
It’s recommended to follow a low FODMAP diet under guidance of a specialized dietitian. Schedule a free IBS-symptom assessment and I’ll show you how I can help.
And lastly, fill up on fiber! The more fiber you eat, the better your bowels are moving. Your bowels have to squeeze and push to get the fiber through, and the faster and better this goes, the less chance the SIBO bacteria have to settle down.
Are Food Intolerance Tests (IgG) Useful?
What I always get a lot of questions about are IgG food intolerance tests. You can often have these tests performed privately with blood samples. Personally, I wouldn’t recommend these tests. An IgG test shows whether you have been in contact with a certain food and does not say anything about a possible intolerance. So it has little added value and costs a lot of money.
A valuable food allergy test is IgE, which indicates immune responses a.k.a. food allergies. This is also a test that GPs often perform.
Treating the Bacterial Overgrowth
There are certain herbs and spices which help prevent the bacterial overgrowth, so use those in abundance while preparing your meals! The following herbs and spices are mentioned as being beneficial in the treatment of SIBO: oregano, berberine, black walnut, garlic, clove, and peppermint oil.
All of these can also be bought in supplement form.
Treating Nutrient Deficiencies with SIBO
In the recovery of SIBO, it is wise to start taking a vitamin supplement. Since you are competing with the SIBO bacteria for nutrients, it is best to make sure to just get enough of those. Especially vitamin B12, D, E, K and the minerals calcium, magnesium zinc, iron, and manganese are at risk for deficiencies. So either get a supplement with those or find a good multivitamin.
With multivitamins, you should really check the labels of what you’re buying. I will write a more extensive article on this later, but for now, make sure they are not a too high dose. About 100 – 150% RDA should be enough since you’re also going to be following a healthy and nutrient-providing diet alongside it.
Other supplements that could help you get more nutrients are digestive enzymes. These enzymes will help you digest your food, and make it easier for your body to absorb the nutrients.
Creating a Healthy Lifestyle
The movement of your bowel is highly dependent on the lifestyle you’re following. Physical activity and stress are the two main factors that could stop your bowel from moving properly.
Ensure that you get enough exercise and reduce your stress levels. Great ways of doing this are by doing yoga, hiking, cycling, pilates, or tai chi. But basically, everything that you like and gets you moving, will do the job!
Well, that’s it about SIBO for now! Do you think you have/had SIBO? Did you solve it with a SIBO diet? Let me know in the comments below!