SIBO and Digestive Health

Written by: Dr Ingrid Pincott ND

There is a new diagnosis in the field of naturopathic medicine that is helping a lot of patients resolve complex health issues.  It’s called SIBO (which stands for small intestinal bacterial overgrowth). For many years naturopathic doctors have been very successful at treating dysbiosis which is an imbalance of yeast overgrowth in the gastro-intestinal tract; dysbiosis can cause gas, bloating and digestive upset. SIBO is often suspected after a patient has diligently followed a dysbiosis protocol for the suggested three months but has not seen any improvement.

SIBO symptoms can arise due to any number of causes and risk factors.  It’s not uncommon for SIBO to develop after a food poisoning incident, a head injury which affects the vagus nerve, or a gastroenteritis infection.  When SIBO is determined, most patients have difficulty tolerating certain foods such as apples, pears, mangos, avocados, asparagus, cauliflower, sweet potatoes, products with lactose and any fibrous grains, or fiber and sugar that bacteria can feed on. Contrary to what some people think, probiotics often make SIBO symptoms worse!

SIBO symptoms include heartburn, burping, sensation of fullness and slow digestion and minimal bowel sounds. Some patients with SIBO can be constipated, others can have alternating constipation with diarrhea.  Many doctors recommend what’s called a FODMAP diet for SIBO patients, which assesses how fermentable foods are and recommends them based on that scale.  Many SIBO patients cannot come off their FODMAP diet without getting serious symptoms.

The best strategy to assess whether you have SIBO or not is with a SIBO breath test. This test is not available through provincial labs.  Most NDs in BC use a three-hour breath test kit. A positive result for hydrogen and/or methane producing bacteria in the small intestine confirms the SIBO diagnosis and a three to six-month protocol is developed to help alleviate symptoms.

One question patients might ask is if there is not supposed to be any bacteria in the small intestine how does it get there?  Many factors are at play, such as: An infectious process caused by campylobacter, E. coli, Shigella and Salmonella; or trouble with the ileocecal valve (at the junction of the small and large intestine); or the migrating motor complex aka MMC; all of these can result in bacteria growth in the small intestine. If the MMC is not functioning optimally SIBO develops. The MMC are small peristaltic movements in the small intestine that occur over three-hour periods throughout the day that move bacteria out of the stomach and small intestine into the colon. If a person snacks too often the timing of the MMC is impacted. Part of the SIBO treatment is to space meals three hours apart to recalibrate the MMC.

A standard SIBO treatment program is usually divided into four parts:

1.A two-week preparation phase which reduces side effects of treatment as well as making treatment protocols more effective.

2. A six-week eradication phase using antibiotics and/or herbal remedies to kill off the bacteria and stimulate normal digestion.
3. A two-month phase of repair and recovery, when the anti-SIBO diet is introduced, along with stimulation of the MMC with medications. This is critical until the healing and repair of the gut lining is completed.
4. Finally, a prevention phase includes treating gastritis quickly using homeopathic remedies as well as appropriate probiotics, fish oils and digestive aids such as gallbladder drainage remedies.

If you have been treated for systemic candida for three months or more without a positive outcome, ask your naturopathic physician about getting tested for SIBO.