Small Intestinal Bacterial Overgrowth – SIBO. What it is and how to treat it.
May 28, 2018

This last week at the AutismOne conference in Chicago, I attended a few really informative workshops.  Here is a summary of information from Dr. Logan’s presentation on Small Intestinal Bacterial Overgrowth – aka SIBO.   We are dealing with SIBO and honestly, most of you probably are too to one degree or another.  It’s difficult to definitively diagnose so as with much that we have going on with our children, we have to take all of their behaviors into consideration to help us narrow down our focus.

Even if you’re not sure it’s SIBO that you’re dealing with, it’s clear that a clean and intentional diet is important for EVERY.LIVING.BEING.  Treating SIBO is not just about killing bugs, it’s about bringing balance to the GI tract.

These are some highlights from her presentation.  If any of this resonates with you, please do your own research and work with your practitioner on how to proceed.  None of the information presented here should be construed as medical advice for you – it is presented for informational purposes only.

  • SIBO is where the bacteria that normally live in the colon, make their way into the small intestine (sort like backwashing). These bacteria can be both ‘good’ and ‘bad’ varieties.  The point is, they are in the wrong place.
  • These bacteria interfere with our normal digestion and absorption of food and cause damage to the lining of the small intestine.
  • This damage impairs the small intestine’s absorption of food with leads to more food available to feed the bacteria and then the bacteria multiply exponentially.
  • They then hijack their favorite nutrients which over time leads to deficiencies in critical factors such as iron and B12 and then leads to many other health problems.
  • These bacteria produce gas within our small intestines. This gas causes pain, bloating, flatulence, constipation, diarrhea or both (symptoms of IBS).
  • They decrease the body’s ability to perform proper fat absorption.
  • IBS can be SIBO. It is estimated that 60-84% of IBS patients actually have SIBO.
  • Causes of SIBO: Food poisoning incident or  Impaired gut motility or Damage to the Brush Border.
  • Loss of intestinal enzymes is a major feature of SIBO. We naturally produce digestive enzymes but with SIBO, we lose this ability – particularly those that digest carbohydrates.
  • Pathogenic bacteria found in SIBO patients:   1) Hydrogen-producing bacteria (E. Coli, Klebsiella, Proteus, Aeromonas).  Produces hydrogen gas which most often leads to chronic diarrhea.  2) Methanogens – convert hydrogen to methane and most often leads to constipation.  Constipation slows motility in general so when added with SIBO the effects of the methane are compounded.
  • SIBO bacteria can develop biofilm which makes it difficult to kill them in their locations. They also blunt the intestinal villi and they are associated with the development of intestinal permeability (leaky gut).
  • How do you know if you have it?
    • More than 80% of people with IBS have SIBO.
    • Wake up with flat stomach which distends throughout the day.
    • GI symptoms are temporarily alleviated with antibiotics.
    • Probiotics and fiber make gastro symptoms worse.
    • Celiac patent that is not better on GF diet.
    • Chronic constipation after opiates.
    • Low Ferritin/Iron without any other known cause.
  • Testing: Invasive duodenal and jejunal aspiration (sounds fun, right?)  Comprehensive Stool Analysis (does not diagnose SIBO but will provide certain indicators), Urine Organic Acid Test (OAT) which also does not diagnose SIBO but identifies bacterial and fungal metabolites of bugs that don’t show up in stool cultures.
  • Breath testing for SIBO is helpful as it can determine whether you are dealing with hydrogen producing or methane-producing bacteria. It is NOT, however, a test that most kids can comply with easily as you are not supposed to use mouth air so the instructions are complicated and then if you have motor planning issues – it may be impossible to get a quality sample for the test.
  • Treatment options include:
    • Reducing bacterial load with prescription antibiotics and/or antimicrobial herbs and/or a biofilm protocol.
    • Address the carbohydrate maldigestion through a restriction of certain carbohydrates (which is why diets such as GAPS and SCD can be so helpful).
    • Improve gut motility with prokinetics (things to help the bowels move like magnesium citrate), vagal nerve therapies and/or chiropractic care and of course healing the gut lining.
  • The one constant in SIBO is carbohydrate malabsorption which leads to bacterial overgrowth. The best way to address this is to use a diet that limits difficult to digest carbohydrates (grains and some fruits)
  • Use binders such as activated charcoal, zeolites, burbur, bentonite clay, chlorella to help with die-off and to “mop up” the toxins sitting in the gut. The purpose of the binder is to sweep the toxins out before they can be reabsorbed into the bloodstream.
  • Rebuilding the gut is a very important step. Probiotics, Enzymes, bitters and supplements to heal the nerves and mucosa of the gut lining (Acetyl L-Carnitine, Glutamine and Butyrate).

My biggest “light bulb” was that the colonization of SIBO bacteria was not so much that they are the “bad type”, but rather they are in the wrong place.  I loved this presentation by Dr. Logan – so much good information in one place!!  If you are interested in watching Dr. Logan’s presentation, you can access it HERE.

My son was on the GAPS Diet for 18 months which proved to be tremendously helpful for eliminating behaviors and for improving his overall health.  It’s not an easy diet to start but it is possible – even for the pickiest of eaters!!  If you want assistance with creating a plan for moving to a healing diet, Amy Y. can help with that!  Consultation is available HERE.