Author: Alinda Coleman, BNat
Small intestinal bacterial overgrowth (SIBO) is just one condition that may cause your digestive system to get out of balance.
If your practitioner has diagnosed you with SIBO, it means there is an overgrowth and/or alteration in the type of bacteria in your small intestine.1 Bacteria are normally found in higher numbers in the large intestine, but in SIBO they find themselves in high numbers in the small intestine where they ferment the available food, producing gas (hydrogen, methane and/or hydrogen sulfide), causing non-specific symptoms and potential issues with the way you utilise and absorb nutrients.
Signs and symptoms of SIBO
• Abdominal pain or distension, especially after eating
• Altered bowel movements – constipation/diarrhoea
• Changes to nutrient malabsorption
• Weight loss
Causes and risk factors
The causes and risk factors associated with SIBO are varied and can include poorly coordinated contractions of the small intestine, certain medication use, lesions resulting from injury, trauma or certain health conditions (such as endometriosis), digestive disorders, anatomical abnormalities of the digestive tract, chronic stress and obesity.2,3
There is no one-size-fits-all approach when it comes to treatment of SIBO and your options are always best decided with your healthcare practitioner.
Essentially, the goal of SIBO treatment is not only to treat the bacterial overgrowth, as focusing exclusively on this aspect can lead to relapse which frequently occurs with SIBO. Instead, a comprehensive treatment plan is preferred, which includes herbal antimicrobials to manage the bacterial overgrowth, pre- or probiotics if indicated, dietary changes and addressing the root cause of SIBO and individual symptoms experienced.
Antimicrobial herbs offer a more natural alternative for the management of microbial overgrowth in SIBO. Ask your practitioner about herbal remedies such as4:
• Liquid tinctures including Allium sativum (garlic), Punica granatum (pomegranate) and berberine-containing herbs including Hydrastis canadensis (golden seal), Coptis chinensis (Chinese goldthread), Berberis vulgaris (barberry), Mahonia aquifolium (Oregon grape) and Phellodendron amurense (phellodendron).
• Essential oils including Origanum vulgare (oregano), Syzygium aromaticum (clove), Mentha x piperita (peppermint) and Thymus vulgaris (thyme).
Probiotics and prebiotics
Strain-specific probiotics (in the families of Saccharomyces boulardii (SB), Bifidobacterium lactis, Lactobacillus acidophilus and Lactobacillus plantarum5) may be recommended to reduce symptoms of SIBO including constipation, diarrhoea and to improve intestinal barrier function. The particular prebiotics indicated for supporting the management of SIBO depend on your individual symptoms and can be provided by your practitioner.
Gut healing nutrients
Gut healing nutrients that may be indicated for SIBO patients include zinc (including zinc carnosine), vitamin A, digestive bitters, L-glutamine, lactoferrin, quercetin and SB.
Any dietary recommendations need to be tailored to you, as what works for one person may not work for another. Diets that are commonly prescribed can include components of eliminating problematic foods (such as dairy or wheat products), modifying specific carbohydrate intake and focusing on digestion-supporting, anti-inflammatory foods.6 The optimal diet to look after your SIBO is best discussed with your healthcare practitioner.
The above guidelines provide a brief overview to the causes and risk factors, symptoms and potential treatment components of managing SIBO. Talk to your doctor if you think you may have SIBO or want to rule out any potentially serious conditions that may result in similar symptoms.
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1. Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol 2010;16(24):2978-2990.
2. Revaiah PC, Kochhar R, Rana SV, et al. Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors versus proton pump inhibitors plus prokinetics. JGH Open 2018; 2(2):47–53.
3. Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol 2007;3(2):112-122.
4. The SIBO Doctor. SIBO, IBS and Herbal Medicine with Dr Eric Yarnell [podcast], 2018. Viewed 22 Feb 2019, https://www.thesibodoctor.com/2018/04/28/sibo-ibs-herbal-medicine-dr-eric-yarnell/?v=6cc98ba2045f
5. Leventogiannis K, Gkolfakis P, Spithakis G, et al. Effect of a preparation of four probiotics on symptoms of patients with irritable bowel syndrome: association with intestinal bacterial overgrowth. Probio Antimicro Prot 2018. doi: https://doi.org/10.1007/s12602-018-9401-3
6. Dietary Treatments. SIBO – Small Intestinal Bacterial Overgrowth [online]. Viewed 23 Feb 2019, https://www.siboinfo.com/diet.html