Small intestine bacterial overgrowth is just what it sounds like from the name. Bacteria normally live in the large intestine, if fact there are trillions of microorganisms that colonize the colon. Many help humans and provide nutrients, immune function, and even detoxification roles. Others are commensal and do not have specific roles that we know of. A third category would be the dysbiotic bacteria or the types that could cause inflammation and become invasive to our good flora. Any of these types of bacteria can migrate in a retrograde fashion and colonize the small intestine. The lining of the small intestine has the very important function of extracting and absorbing nutrients from food. When bacteria populate the lining, inflammation occurs and the absorption process is affected. Since bacteria release gasses just as humans exhale carbon dioxide, these gasses accumulate and can lead to a long list of symptoms. Bloating, flatulence, belching, heartburn, acid reflux, diarrhea, constipation, fatigue, headaches, skin conditions and even auto-immune diseases might be traced back to SIBO. 

The most commonly reported symptom is bloating. Some people will bloat with any meal, others notice with onions, garlic, cauliflower and broccoli. Food poisonings and traveller’s diarrhea can initiate the start of SIBO because of the trauma that occurs to the gut lining. Others may report becoming reactive to foods that could normally be consumed without a response. Methane gas production by SIBO typically leads to constipation and hydrogen gas can lead to diarrhea. This is not always the case but is more common than not. Because the gasses travel, heartburn and acid reflux along with excessive flatulence are also common symptoms. 

With inflammation in the digestive system, there can be many symptoms outside of the gut to watch out for. Fatigue, headaches, skin conditions such as acne and eczema, joint and muscle pain, low mood, painful periods, difficulties with weight gain or loss are just some. If nutrients are not properly absorbed into the body, signs of vitamin or mineral deficiencies might be observed. A main cause of iron deficiency is poor absorption, and symptoms might include dizziness, fatigue, shortness of breath, hair loss and heavy periods. Some may also experience Vitamin B12 deficiency which can have nervous system symptoms such as numbness, tingling, tiredness or irritability.

This is the big question, how do people get SIBO? One of the main causes is a traumatic event to the gut. This could be food poisoning, traveller’s diarrhea, abdominal surgeries such as C-sections, appendicitis, gallbladder removal or ovarian cyst removal. It can also be a result of requiring multiple antibiotics or taking long term antibiotics for conditions such as acne. Low production of stomach acid can also initiate SIBO. Stomach acid triggers digestive enzymes to break down food into small enough components to be absorbed into the blood. If enzyme levels are too low, larger pieces of food travel further down the small intestine and can feed any outlying bacteria that managed to make it past the large intestine and thus colonies grow. Low stomach acid can occur from periods of prolonged stress, use of proton pump inhibitor drugs, part of the aging process and in rare instances due to an auto-immune condition.

Absolutely. Testing for SIBO will provide information on the severity and the type of bacteria present. This guides treatment as different pharmaceuticals and herbs can be used for hydrogen and methane-specific SIBO. Just assuming that a person has SIBO and treating it with broad-spectrum herbs or drugs will often not get rid of the condition long-term. For the best protocols, a retest after the final 2 weeks of treatment is advised so that eradication can be confirmed.

Yes, and really it should be done at home. It is possible to take the kit into work and do the breath samples discreetly every 20 minutes for 3 hours if that is what works best. SIBO tests are not offered in a laboratory setting or clinic office.

There are 3 types of gasses found related to SIBO. Hydrogen, methane and hydrogen sulphide. At this point in time, only hydrogen and methane can be identified in the breath sample tubes. Bacteria of different families and classes release these gasses and elevated values are highly correlated to overgrowths of bacteria in the small intestine. Hydrogen sulphide SIBO can be inferred using SIBO breath results and specific symptoms.

Lactulose is a type of simple sugar. Humans can’t absorb it into the bloodstream but bacteria can use it to survive and produce gasses as a byproduct. The importance of only choosing lactulose and not glucose breath tests has to do with absorption. Glucose will easily be absorbed into the body mid-way through the small intestine. Thus tests using glucose will show low levels of gasses in the second aspect of the small intestine because the food provided to the bacteria is no longer available. Lactulose moves in its entirety through the digestive tract and feeds bacteria all the way through. It is a safe sugar to consume, but in some individuals it may cause mild side effects such as gas, bloating and loose stool.

Yes. If the diet isn’t followed strictly, the results may look normal when in fact SIBO is present. If the bacteria have been fed regularly without a break, gas production will not peak and results can show negative for SIBO.

The instructions in the test kit are very clear. Rice, white bread, eggs, poultry, fish, salt, pepper and oil are allowed. No seasonings, vegetables, fruit, nuts, seeds, legumes or sugar can be eaten. Making a huge chicken and egg fried rice with coconut oil and salt and pepper might just be delicious to eat all day long!