Causes and Alternative Treatments for SIBO

Small intestinal bacterial overgrowth can cause a range of symptoms but there are safe and natural treatments

Ezume Images/Shutterstock

Small intestinal bacterial overgrowth (SIBO) has a reputation for being significantly underdiagnosed as many of its symptoms are similar to other health issues.

Research suggests that up to 60 percent of irritable bowel syndrome (IBS) is caused by SIBO and that it affects at least 6 to 15 percent of healthy, asymptomatic people. The actual number of people who suffer from it is unknown.

“SIBO is not as well known as other gut issues,” Dr. Onyx Adegbola said in a recent interview with me on “Discovering True Health.” Adegbola noted that many people with SIBO have symptoms that significantly undermine their quality of life.

Adgebola is a physician-scientist who now specializes in gut issues such as SIBO. She started her private practice after a recent family member suffered from debilitating gut problems. This made her realize there aren’t a lot of products and resources out there for those suffering from these types of conditions.

The good news is that research is now showing that there are several natural treatments that may work even better than the standard antibiotic treatment that’s usually prescribed for those suffering from SIBO.

What Is SIBO?

There are several types of SIBO, but this article will focus on hydrogen-dominant SIBO, which is characterized by an excess production of hydrogen in the small intestine and is frequently associated with diarrhea.

Another common form of SIBO is methane-dominant, and it’s frequently associated with constipation.

All forms of the condition occur when bacteria migrate upward from their proper place in the colon and invade the small intestine. The bacteria accumulate and start leading to a variety of symptoms.

SIBO Symptoms

• Abdominal pain after a meal
• Diarrhea
• Weight Loss
• Gas
• Indigestion
• Constipation
• Cramps
• Bloating

Nutrient Deficiencies

While many SIBO symptoms are impossible to miss, others are more subtle, especially nutrient deficiencies. The small intestine’s key role is absorbing nutrients from our food, and a bacterial invasion can disrupt this key function, Adgebola says. The consequences can be significant:

• Vitamin B12 deficiency: This causes muscle weakness and tingling and numbness in hands and feet. In advanced cases, there can be central nervous system damage and mental confusion. It can also lead to anemia.

• Calcium deficiency: SIBO leads to fat malabsorption. Excess fat binds calcium, reducing its absorption. This can lead to osteoporosis.

• Lactose intolerance: SIBO can damage the gut lining and people with the condition can become intolerant to dairy products.

• Other nutritional deficiencies: Deficiencies in zinc, iron, and vitamins A, D, E, and K are all possible outcomes.

Testing for SIBO

If your doctor suspects you have SIBO, they will order a hydrogen and methane breath test.

When taking the test, you’re first given a sugar drink and then required to blow into a tube. If anaerobic bacteria in your small intestine break down those sugars, they will produce hydrogen. The test measures the amount of hydrogen (or methane) in your breath.

If hydrogen and methane increase by more than a certain amount after consumption of the drink, this means there are excess gas-producing bacteria in the small intestine.

Treatment Overview

“Treatment of hydrogen SIBO is generally divided into phases,” Adgebola said. You want to eradicate the bacteria overgrowth and then treat the root cause.

In the first phase of eradication, the goal is to kill off the excessive bacteria in your small intestine.

Doctors usually use the antibiotic rifaximin to kill the excess bacteria, but many people don’t tolerate the drug well.

Some practitioners prefer to use herbal antimicrobials such as enteric-coated peppermint oil to kill the bacteria. These treatments are less aggressive than antibiotics and have been shown to be effective.

“While there are other herbal antimicrobials like oregano oil capsules, garlic, and olive leaf extract, peppermint oil is more commonly used,” Adgebola said.

“Also, while you wait for peppermint oil to eradicate your SIBO, you can use a low-FODMAP diet to control your symptoms and help starve the bacteria.”

Scientific literature also shows that the use of probiotic supplements and an elemental diet are also effective in reducing SIBO symptoms and eradicating excessive bacteria.

“The elemental diet is a liquid meal replacement diet that offers a complete nutritional profile broken down into its most ‘elemental’ form,” explains Cleveland Clinic.

Low-FODMAP Diet

FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are the scientific names for four types of carbohydrate molecules found naturally in a variety of fruits, vegetables, grains, legumes, and milk products.

FODMAPs are sugar molecules that can be used by bacteria and produce symptoms of SIBO such as excess water and gas in the gut.

“The purpose of a low-FODMAP diet is to restrict these carbohydrates so you are basically starving the harmful bacteria by giving them nothing to ferment, which in turn will reduce the symptoms of SIBO,” Adgebola said. Research has found that it reduces symptoms in up to 86 percent of people suffering from SIBO or IBS.

Some of the high-FODMAP foods she notes are the following:

• Garlic
• Onions
• Wheat or grains that contain fructans
• Dairy (lactose)
• Beans
• Some fruits
• Sweeteners

There are two apps that Adgebola recommends for those starting on a low-FODMAP diet. They are the Monash FODMAP app, and the FODMAP Friendly app.

“These apps have the serving sizes of foods per meal and they are more reliable than using the low-FODMAP lists you find on the internet because these companies are doing the testing and research,” she said.

Natural Treatments Versus Antibiotics

According to the 2017 Integrative SIBO Conference hosted by Natural Medicine Journal, the main natural treatment options for SIBO include dietary modification and herbal antimicrobials.

Research shows that herbal supplements may work equally well, if not better, than antibiotics in the eradication of bacteria.

For example, in a 2014 study published in Global Advances in Health and Medicine, 165 SIBO patients were divided into two groups. One group received rifaximin and the other received herbal therapy.

The results showed that 46 percent of the patients who received herbal therapy had a negative breath test (meaning their bacterial overgrowth was gone) compared to only 34 percent of the patients who received rifaximin.

The study also reported many side effects in patients who took rifaximin, which included the following:

• One case of a severe allergic reaction.
• Two cases of a mild allergic reaction.
• Two cases of diarrhea.
• One case of a C.difficile infection.

This was in contrast to only one case of diarrhea that was reported in the herbal therapy group.

Another review evaluated 18 studies on probiotic treatment for SIBO. Probiotics were found to be effective at eradicating excess bacteria, treating abdominal pain, and getting rid of excessive gas production that’s seen in SIBO.

Finally, a study looked at the role of an elemental diet in treating SIBO. In this study, 124 patients were treated with methane or hydrogen-predominant SIBO with an elemental diet for two weeks. By day 15, 80 percent of the patients had normal breath test results, which meant that the excessive bacteria in their small intestines were gone.

Most pharmaceutical antibiotics indiscriminately eradicate all bacteria in our gut, even the good ones that help digestion and other functions such mood regulation.

This can throw our gut flora into disarray, a condition known as gut dysbiosis that can lead to various health disorders such as depression, anxiety, diabetes, and gut problems such as SIBO.

Root Causes

Adgebola says it isn’t enough to just address the symptoms of SIBO.

“Because SIBO is a symptom of an underlying cause, once you’ve eradicated bacterial overgrowth, it’s important to treat the underlying cause of SIBO, because if you just get rid of the bacteria, it could seem to go away and then come back later,” she said.

There are several conditions that can increase your risk of SIBO or be a root cause.

• Complications of abdominal surgery: This includes an antrectomy to treat peptic ulcers and stomach cancer or a gastric bypass for obesity.

• Structural problems in and around your small intestine: This can include low motility (weak contractions), scar tissue, and bulging pouches of tissue that protrude through the wall of the small intestine (intestinal diverticulosis).

• Low levels of stomach acid: If you have low levels of stomach acid, you aren’t killing the bad bacteria and they can multiply more than they should, causing an imbalance.

• Alcohol abuse: This can result in damage to the intestinal wall and disrupt the natural gut flora.

• Certain medical conditions: Crohn’s disease, radiation enteritis, scleroderma, celiac disease, diabetes, or other conditions that can slow the movement (motility) of food and waste products through the small intestine.

“One thing that all these root causes have in common is that you have a proliferation of the gut microbiome, which results in an imbalance,” Adgebola said.