It is important NOT to diagnose yourself but to instead work with a qualified practitioner. Afterall, you don’t want to be treating yourself for small intestinal bacterial overgrowth (SIBO), when in fact, you have IBD or a neoplasm (growth) in your intestines. Even though the scary things are much less likely to occur, they still need to be ruled out for your safety.

What is small intestinal bacterial overgrowth?

Small intestinal bacterial overgrowth (SIBO) is pretty much exactly as the name states, overgrowth of bacteria in the small intestine. Most of the bacteria in the human gut resides in the large intestine. However, things can sometimes get out of whack with our modern lives and make the small intestine not such a bad place to live for these little critters. The type of bacteria in the small intestine also plays a part, with species that metabolize bile salts or Klebsiella species causing more trouble.

Symptoms of SIBO

The main symptom to look for here is bloating and gas within 30-45 minutes of eating. This is the bacteria consuming the food you ate and producing gas.

  • Irritable Bowel Syndrome (IBS)- there is a HUGE correlation between SIBO and IBS patients!
  • Bloating/Abdominal gas—burping, flatulence
  • Pain, abdominal cramps
  • Diarrhea 
  • Nausea
  • Leaky gut problems—Food allergies, headaches, joint pain
  • Steatorrhea or fatty/oily stools
  • Non-direct GI problems such as asthma, eczema, etc.

Further, intestinal damage from inappropriate bacteria can cause malabsorption, vitamin and mineral deficiencies (especially fat-soluble vitamins A, D, E and K) and further increase associated symptoms such as night blindness, osteomalacia, increased bleeding, etc.

Testing

A physician will often run a glucose and/or lactulose breath test and/or a comprehensive stool analysis for patients suspected of having SIBO to have a basis for diagnosis and treatment. The breath test will check for the gas test the bacteria put off and the stool analysis will check for parasites, yeast, bacteria species, digestive enzymes and more. There are benefits and downsides to each test. So, make sure to discuss that with your doctor. Taking more than one type of test will help to cover your bases.

Treatment

It is my opinion that the best route for an otherwise healthy person with SIBO is the following:

  1. Ketogenic diet, atleast at the start (until the majority of symptoms subside), with weaning off to the GAPS diet for the duration of the issues plus atleast 6 months after all symptoms subside. This is essentially a diet of grass-fed meat, wild fish, organic fruits, vegetables and nuts. You know, the diet we are supposed to be eating!
    1. The reasoning for this is as follows: SIBO is bacterial overgrowth. Bacteria feed primarily on carbohydrates. Less carbs, less bacteria in the small intestine where they are not supposed to be (should be primarily in large intestine). If it were me, and I was able, I would even consider water fasting for the first few days before the ketogenic diet.
  2. Natural antibiotics for 30-60 days. Bio Vegetarian by Priority One is a great supplement that is widely used by practitioners.  
    1. You can take Bio Vegetarian as follows: 2 tablets 4/5 times a day for 1 week, followed by two tablets twice a day for three weeks.
  3. Take betaine HCL with pepsin with each meal- increased acid prevents bacteria from growing in the stomach and small intestines. If this should burn or hurt in any way, discontinue. If you have an ulcer, DO NOT TAKE betaine HCL!
  4. After you discontinue the Bio Vegetarian, start to supplement with fermented foods and probiotics that don’t have prebiotics. Many health food stores sell fermented sauerkraut, kimchee, etc. Eat several bottles from several different brands of the fermented foods to get a wider variety of bacterial strains. Here are two probiotics without prebiotics: Metagenics Ultraflora IB and Metagenics Ultraflora Restore

You should see a huge improvement inside of 30 days. However, don’t take this improvement to mean you’re cured! The problem will come right back and viciously. I would maintain the above program as stated.

If you don’t see a huge improvement within 30 days, AND YOU ARE FOLLOWING THE PROGRAM EXACTLY, you may want to then consider antibiotics treatment. There is no good proven course of antibiotics for treating SIBO. This will need to be discussed with your physician and is outside of the scope of this article.

References:

Andrew C. Dukowicz, G. (2007). Small Intestinal Bacterial Overgrowth: A Comprehensive Review. Gastroenterology & Hepatology, 3(2), 112. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/ 

(2019). Med.unc.edu. Retrieved 8 April 2019, from https://www.med.unc.edu/ibs/files/2017/10/Bacterial-Overgrowth-in-IBS.pdf