When patients list many of the below complaints, one of the first conditions we suspect is SIBO (Small Intestinal Bacterial Overgrowth). This condition is associated with a wide range of persistent symptoms, including:
- Bloating
- Gas, diarrhea, or constipation
- Iron, B12, or Vitamin D deficiencies unresponsive to treatment
- Persistent acne or rosacea
- Fibromyalgia
- Irritable Bowel Syndrome (IBS)
- Non-alcoholic fatty liver disease
- Restless legs
- Sleep disturbances
- Chronic fatigue
- Autoimmune diseases
- Anxiety
What is SIBO?
SIBO occurs when bacteria overgrow in the small intestine, where bacteria should be limited to low concentrations. Normally, less than 1,000 bacteria per milliliter of fluid are found in this area due to factors like stomach acid, intestinal motility, and the ileocecal valve. However, conditions like long-term use of acid-suppressing medications, abdominal surgeries, diabetes, a carbohydrate-rich diet, and frequent snacking can disturb this balance, leading to bacterial overgrowth.
These bacteria thrive on carbohydrates, starches, sugars, and alcohol, producing gases like hydrogen and methane, which cause discomfort. Increased hydrogen production may lead to pain and diarrhea, while excess methane can result in persistent constipation
Common Symptoms of SIBO:
- Gas, bloating, and diarrhea
- Abdominal pain or cramping
- Belching
- Constipation
- Brain fog
- Diagnosis of IBS, IBD, or restless bowel
- Food intolerances (gluten, lactose, fructose, histamine)
- Chronic conditions (fibromyalgia, chronic fatigue, diabetes, autoimmune diseases)
- Vitamin deficiencies (B12, A, D, E, iron)
- Fat malabsorption (pale, foul-smelling stool)
- Rosacea and skin rashes (46% of rosacea cases are SIBO-positive)
- Leaky gut
Associated Conditions:
- Hashimoto’s or hypothyroidism
- Seborrheic dermatitis
- Celiac disease
- Crohn’s disease or ulcerative colitis
- Non-alcoholic fatty liver disease
- Anxiety and depression
- Chronic bacterial prostatitis
- Interstitial cystitis
- Gastroesophageal reflux disease (GERD)
- Restless leg syndrome
How is SIBO Diagnosed?
SIBO is diagnosed using a breath test, which measures hydrogen and methane levels in your breath after fasting and following a specific diet. Breath samples are collected at intervals of 20, 40, 60, 90, and 120 minutes. The accuracy of this test ranges from 80-85%. Consult with your doctor about test suitability and preparation.
Treatment for SIBO:
SIBO treatment involves a comprehensive plan of diet, supplementation, and lifestyle adjustments.
- Antibiotics: antibiotics are commonly used, and in some cases, a second antibiotic may be added.
- Low FODMAP Diet: A temporary low FODMAP diet is often recommended to reduce symptoms. However, long-term use of this diet is not advised. Foods that trigger symptoms should be reintroduced gradually based on the patient’s tolerance.
The treatment period for SIBO typically lasts around six months, but this can vary depending on the individual. SIBO is a complex condition requiring a holistic approach, and with the right treatment plan, symptoms can be effectively managed, improving quality of life.
