Small intestinal bacterial overgrowth is a condition categorised by overgrowth of bacteria in the small intestine causing symptoms of bloating, abdominal pain or cramping, food intolerances, diarrhea or constipation.
Symptoms of Small Intestinal Bacterial Overgrowth
- Bloating (typically 15-30 minutes after meals)
- Abdominal cramping/pain
- Gas
- Constipation
- Diarrhea
- Brain fog
- Food intolerances
- Fatigue
- Unexplained weight loss
How does this occur?
The small intestine is sensitive to a variety of internal and external imbalances, yet the most common trigger of SIBO is food poisoning as this disrupts the microbiome and allows bacteria to migrate and overpopulate causing the symptoms mentioned above. Other causes or contributions include slow gastrointestinal motility, low stomach acid, poor bile flow or enzymatic activity, immune dysfunction and medications or lifestyle choices.
The challenge with SIBO is that recovery is highly individual. It’s important to remember that everyone responds to treatment differently; while some see progress almost immediately, for others reducing or eliminating the overgrowth is a gradual process that can take months or even years of persistence.
How we treat SIBO naturopathically is still highly individualised but follows two main protocols. Most commonly the bi-phasic diet protocol, with phase one focusing on starving the bacteria and addressing underlying causes while phase two uses antimicrobials to further eradicate the bacteria. Secondly naturopaths use the elemental diet which is a liquid based diet made up of a collection of amino acids and carbohydrates. This is recommended only in extreme cases as it is extreme in nature and difficult to follow, although has a high success rate.
When treating SIBO conventionally rifaximin antibiotic is most used, this has a 70% success rate. This antibiotic is generally better tolerated than most broad spectrum as it has shown to not disrupt the microbiome and in some studies has contributed to increasing lactobacillus species in the gut.
The Low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet is a short-term therapeutic intervention designed to be used alongside conventional or naturopathic SIBO treatments. By reducing the intake of fermentable carbohydrates, the diet helps starve the bacterial overgrowth and alleviate symptoms. Because this restrictive protocol carries a risk of nutrient deficiencies, it should only be implemented under the supervision of a qualified health practitioner.
Below are some examples of high FODMAP foods:
- Pears
- Apples
- Garlic
- Onion
- Gluten
- Beans
- Lentils
- Milk
- Soft cheese
Steps to Take if You Suspect SIBO
If you are experiencing symptoms of Small Intestinal Bacterial Overgrowth (SIBO), follow these steps to ensure an accurate diagnosis and effective treatment.
1. Identify Potential Triggers
Reflect on your health history. Did your symptoms begin following a bout of food poisoning, international travel, or the introduction of a new medication (such as PPIs)? Identifying the root cause or triggering event is essential for long-term recovery.
2. Consult a Qualified Practitioner
Seek guidance from a healthcare professional experienced in gastrointestinal health, such as a naturopath, nutritionist, or functional medicine practitioner. They can provide the specialised oversight necessary for SIBO as it is multifaceted.
3. Undergo Targeted Functional Testing
To confirm SIBO, your practitioner may order specific diagnostic tests. This typically includes a SIBO breath test (lactulose is preferred) or a comprehensive microbiome map to assess your digestive health.
4. Follow a Personalised Protocol
Once SIBO is confirmed; your practitioner will design an individualised treatment plan. This protocol usually involves a combination of dietary modifications, antimicrobial herbs, and prokinetic support to restore proper gut motility.
5. Review and Reassess
Healing is rarely linear. If your symptoms persist after completing the initial protocol, your practitioner will reassess your progress and may order follow-up testing to identify stubborn overgrowths or underlying co-infections.
