Feeling Bloated? you LIKELY have sibo

What is SIBO?

Have you recently been diagnosed with Irritable Bowel Syndrome or IBS? Did you know that up to 84% of IBS cases are caused by SIBO and a gut microbiome imbalance? It is now commonly known that our gut bacteria convey numerous health benefits, from supporting digestion to immunity and even mental health. But what if their numbers become too high? This is what we refer to as Small Intestinal Bacterial Overgrowth (SIBO), where even good microbes can go bad.

Symptoms of SIBO

SIBO usually involves symptoms such as alternating stool frequency, typically as episodes of diarrhea; constipation, indigestion; abdominal pain; bloating; flatulence; and belching. These are caused by fermentation, as bacterial populations consume carbohydrates and turn them into gas. This leads to flatulence and bloating which seems difficult to relieve.

SIBO symptoms are overall non-specific, so many people can go for years without being able to pinpoint their symptoms. You may be reading this after thinking it’s just stress, you’re just getting older, or after receiving a battery of tests that came back “normal”. You may have tried every common over-the-counter remedy from charcoal to probiotics, and nothing seems to work.

Excess Histamine and SIBO

An overgrowth of gut bacteria can increase histamine, a substance involved in some inflammatory immune responses. High histamine is linked to inflammatory bowel disease and irritable bowel syndrome (IBS), a condition that overlaps with SIBO.

Histamine excess, or histamine intolerance, can cause headaches, a racing heartbeat, high blood pressure, and anxiety. It’s more common in people with connective tissue disorders such as Ehlers-Danlos Syndrome, where controlling your histamine levels is even more important.

Even with normal connective tissue, high histamine is not your friend. It also widens the gaps in your blood vessel walls and digestive tract lining, leading to leaky gut syndrome. A leaky gut allows immune cells into the intestines and lets undigested food particles into the bloodstream. This leads to more inflammation and could trigger food intolerances.

How is SIBO Diagnosed?

SIBO is diagnosed based on your symptoms and testing for the bacterial fermentation of sugar. You ingest either glucose, fructose, or lactulose, and then you receive a breath test to detect any significant rise in hydrogen, methane and carbon dioxide. These are the breakdown products from bacteria-consuming sugars. One of the most reliable sugars is lactulose, which stays in the intestines because your body cannot absorb it quite reliable.

How is SIBO Treated?

SIBO can be treated with diet, medication, supplements, or preferably a combination of these. Herbal medicines such as goldenseal and Oregon grape, which contain berberine, are common additions as they can reduce excessive bacterial populations. These are used alone or alongside antibiotics like rifaximin, which stays in the digestive tract. Some patients take probiotics too, but they must be used carefully to prevent overgrowth from reappearing.

The best dietary treatment is a low-FODMAP diet. FODMAPs stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. They commonly include lactose, the fructans in grains such as barley and wheat, galactans from legumes, and sugar alcohols. It’s also a gluten-free diet by default and lower in dairy.

The low-FODMAP diet does not exclude any food group, just certain foods. For example, you can have aubergines, bok choy, kiwifruit, and pineapple, but not artichokes, apples, cauliflower, or onions. You can have feta and hard cheeses, but not milk. Plain tofu and quinoa are permitted, but not legumes.

But does it work? Studies on people with IBS symptoms driven by SIBO show that you can expect significant relief from diarrhea, bloating, pain, and flatulence. To maintain these results, we recommend that you gradually reintroduce higher-FODMAP foods after a few months and permanently exclude those that still cause symptoms.

SIBO may be common, but you don’t have to suffer. To learn more about the right treatment plan for you, click here to book an appointment.