Small Intestinal Bacteria Overgrowth, or SIBO, occurs when the bacteria in our gut gets out of balance. Bacterial overgrowth is an often-neglected disorder that can severely impact nutritional status and quality of life. Symptoms may include nausea, bloating, vomiting, diarrhea, malnutrition, weight loss and malabsorption.
SIBO is often a secondary illness that occurs because the intestine has in some way been damaged by another disease, so it is important to keep chronic diseases properly treated and under control as best as possible. Some people with SIBO may be misdiagnosed with IBS, and may have developed other chronic diseases like fibromyalgia, chronic fatigue syndrome, diabetes, neuromuscular disorders and autoimmune diseases. SIBO overlaps with irritable bowel syndrome patients quite a bit (affecting somewhere between 30 and 85%), but it’s not known how common it is in the general population.
Food intolerances like gluten, casein, lactose, fructose and others may also indicate a case of SIBO. Illnesses and diseases that affect the body’s defense mechanism can put a person at risk for SIBO. The majority of people develop SIBO however, because of an intestinal motility (movement of food quickly along from small intestine to large intestine) problem. These may include complications from gastric bypass surgery, bowel strictures and adhesions that can lead to intermittent bowel obstructions, diverticula or outpouchings of the small intestine, and tumors. Bowel motility can be also affected by neurologic diseases like Parkinson’s, and people with diabetes with autonomic dysfunction (nerve damage) may also develop dysmotility.
SIBO is sometimes treated with an elemental diet or antibiotics, which may be given in a cyclic fashion to prevent tolerance to the antibiotics. This is sometimes followed by prokinetic drugs to prevent recurrence if dysmotility is a suspected cause. The Elemental diet consists of foods that are essentially “predigested.” Gerard Mullin, M.D., an integrative gastroenterologist at Johns Hopkins Medical Center in Baltimore, prefers to treat the condition with oregano oil, wild garlic and berberine (the active constituent of Oregon grape root and other plants used as GI remedies), which can help reduce the excess bacterial growth. Dr. Mullin goes into more detail in his book The Inside Tract.
If you think you might have SIBO, let food be thy medicine! A diet low in carbohydrates and free of refined flours, sugars and alcohol is your best bet to keeping your gut healthy. Add in some probiotics to help build up the good bacteria too. Medium chain triglycerides like the ones found in coconut oil are often recommended for people with bacterial overgrowth or any type of malabsorption. Getting adequate nutritional, correcting nutrient deficiencies (particularly B12 and fat-soluble vitamins), and maximizing adequate digestion to avoid overfeeding the microbes are key to maintaining gut health. Three to five hours between eating to allow the body’s cleansing actions to kick in may also prove helpful.
For people that have SIBO, prevention of recurrence is generally a multi step approach, which may utilize one of a few dietary approaches. These all seek to feed the person but starve the bacteria which primarily eat carbohydrates. The only carbohydrate that bacteria do not eat much of is insoluble fiber. Some established SIBO diets are the Specific Carbohydrate Diet (SCD) which eliminates all grains, dairy products, processed sugars and canned vegetables, and the Gut and Psychology Syndrome Diet (Gaps Diet). Researchers suggest that following these diets may help protect the body against developing SIBO in the first place.
Following the GAPS Diet, which is used as part of a treatment protocol for SIBO, may be helpful. This one page sheet shows which foods are allowed and which should be avoided. Beware, the foods to avoid list contains many of your favorite foods that are considered healthy.
On any SIBO prevention diet, you’ll want to avoid “fermentable foods” which basically are foods that can begin fermenting in the gut if they’re not moved along quickly enough. These include:
- Starch- grains, beans, starchy vegetables
- Resistant Starch- whole grains, seeds, legumes
- Soluble Fiber- some grains, beans, nuts/seeds, vegetables, fruit
- Sugar- some fruit, sweeteners
- Prebiotics- inulin, FOS, MOS, GOS, arabinogalactan found in agave, some beans, vegetables, roots/herbs, supplements
One more tip-ditch the Splenda. Splenda has been shown to reduce beneficial gut bacteria in animal studies and increase fecal pH, so eliminating this sweetener from the diet may also be useful.