If you are undergoing treatment for a leaky gut and are not improving, you may be dealing with SIBO – small intestine bacterial overgrowth. SIBO (pronounced SEE-bo) is one of the causes of leaky gut, but the two vary a bit when it comes to treatment.

The most common symptoms of SIBO are abdominal pain or discomfort, bloating/distention, diarrhea and/or constipation, and extreme burping and passing gas. SIBO is under-diagnosed because it shares many of the symptoms of other gastrointestinal disorders.

A Bit Of Background

The small intestine is a big part of the digestive tract. More than 20 feet long, it takes up most of the space in the abdomen. Above it, the stomach’s job is to mix chewed up food with acid and break it down into smaller pieces of food. It than moves on to the small intestine where it is broken down even further. Nutrients can then be absorbed into the bloodstream. 

Normally, stomach acid limits the type of bacteria in the small intestine to only a few specific varieties. The main bacteria colonies are a little further down in the colon (large intestine).

Between the small and large intestine there is a one-way valve that is designed to keep things moving forward. If the valve gets damaged or stuck, digested material can reflux back into the small intestine. This allows colon bacteria to enter the small intestine. Their presence can set off an inflammatory cascade that causes multi-system problems. Digestive issues occur such as GERD, leaky gut, and IBS, as well as problems with hormone production, mood and brain function.

Many circumstances can lead to SIBO including decreased stomach acid production, food poisoning, a small intestine structural abnormality, medications (antibiotics, proton pump inhibitors, antacids) and slowed bowel transit. People with IBS, diabetes, celiacs, and hypothyroidism are more prone to develop SIBO. In all of these cases, beneficial bacteria from one area of the bowels relocate to another and cause symptoms. Damage caused by any of the above does not guarantee you will get SIBO. However, if your gut is damaged, intestinal function will be impaired.

The most common lab test used to diagnose SIBO is a 3-hour lactulose breath test. The test involves breathing into a small balloon, ingesting a precise amount of sugar, than rebreathing into the balloon over a timed interval. If methane gas is found on the breath test, it is extremely predictive for SIBO. Other tests that give clues towards SIBO include Organix Dysbiosis urine test or a comprehensive stool test. Other options are to treat for SIBO without testing since there is little risk with treatment and it is often cheaper than paying for tests.

Once diagnosed, treatment may include Rifaxamin pharmaceutical therapy or herbal antibiotics. The approach taken depends on the patient and the prescribing physician. Antibiotics can stabilize the gut microbiota by reducing the number of intestinal bacteria. Often more than one round of treatment is necessary to achieve 100% eradication.

A two-week elemental diet can be done in place of antibiotics or after antibiotic treatment is completed This effectively starves out the bacteria by allowing the broken down nutrients to absorb before the bacteria can consume them.

The bacterial culprits in SIBO live on sugar, starches, fermentable carbohydrates, prebiotics, and soluble fiber. The diet utilized is called low FODMAP which stands for Fermentable Oligosaccharides, Disaccharides, Monosacharides, and Polyols. The rational is to starve out the bacteria. This is a debatable approach as bacteria that are starved will go into hibernation mode and wall off making it difficult for antibiotics to do their job. Yet, many people cannot tolerate the full blown symptoms of SIBO bacteria. It is therefore suggested that people eat FODMAPS they feel they can tolerate while excluding those leading to excessive symptoms.

In the long run, those who have had SIBO will need to be mindful of the conditions that led to SIBO in the first place to prevent recurrence.