This article was written by Dr. Courtney Ranieri, a Naturopathic Doctor who practices in the Toronto area who recently joined the HEAL team to host lunch & learns in the Greater Toronto Area. She is a graduate of the University of Western Ontario and obtained her Doctor of Naturopathic Medicine from Canadian College of Naturopathic Medicine in Toronto. Being highly experienced in helping clients get to the root cause of their digestive health conditions, we invited her to write about a topic we've been getting questions about recently: SIBO, or small intestinal bacterial overgrowth. We are so excited to have someone as passionate as her on our team. We hope you enjoy!

Have you been diagnosed with IBS or have gone through ultrasounds, testing or treatment and are still abdominal bloating or discomfort regularly? It may be time to consider SIBO.  

The saying 'too much of a good thing can be a bad thing' is especially true when it comes to bacteria in the digestive tract.

It's believed that each person has around 4-7 pounds of micro-organisms in and on their body! Humans have a symbiotic relationship with this bacteria. Gut bacteria protects us from pathogens, helps us digest food, metabolize hormones, synthesize nutrients like biotin (for healthy skin, hair and nails), and absorb minerals like iron. That's why probiotics can be great to establish a healthy microbiome. However, when the bacteria normally found in the colon starts to colonize the small intestine, it can quickly turn into SIBO.    

What is SIBO?

Small Intestinal Bacteria Overgrowth (SIBO) is exactly what it sounds like: an overgrowth of bacteria in the small intestine. Only 1-6% of all the bacteria in the digestive tract should be found in the small intestine, the rest is found in the large intestine. Digestive problems can occur when higher amounts of bacteria are found in the small intestine.

Symptoms of SIBO

SIBO symptoms look a lot like IBS symptoms, which is why it can difficult to diagnose. Many symptoms of SIBO arise due to the impaired digestion of food and absorption of nutrients.

Common SIBO symptoms are:    

• bloating
• gas/burping/flatulence
• heartburn
• sensation of fullness in the abdomen
• constipation and/or diarrhea
• abdominal pain or cramping
• food intolerances
• low vitamin B12 or iron levels
• loose or floating stools
• abdominal discomfort

What Causes SIBO?

Our bodies have mechanisms in place to prevent this bacterial overgrowth. SIBO is believed to arise when there's an issue with one (or a few) of these protective mechanisms. The major ones are:

1. Low Stomach Acid - Although a lot of people associate heartburn with stomach acid, low stomach acid might actually be to blame. We need optimal amounts of stomach acid (hydrochloric acid) to kill off bad bacteria, break down food and activate enzymes. When there isn't enough acidity, food isn't broken down fully. Bacteria feed on this undigested food and it can cause symptoms like bloating, gas, indigestion and abdominal discomfort. This can lead to the overgrowth of bacteria. Low stomach acid is very common and can be caused by stress, poor diet, aging, infections or medications (like PPI's and other heartburn medications).    
2. Slow or Sluggish Bowels - Our intestines are muscles that contract to push the contents along. When they're not contracting optimally, food and bacteria stay stagnant and bacteria can proliferate. Sluggish bowels may be caused by stress, thyroid disorders, medications (like PPI's, birth control and NSAIDS), and conditions like diabetes or neurological disorders.    
3. Medical History - Antibiotic use, food poisoning, bacterial infections, poor eating habits, low pancreatic output, and conditions that effect motility like diabetes, scleroderma, intestinal obstruction and heavy alcohol use may also contribute to the development of SIBO.    

How Do You Test for SIBO?

SIBO is under-diagnosed and often misdiagnosed.

The gold-standard for SIBO testing is a simple and non-invasive breath test. Patients are given doses of a lactulose drink over the course of 2-3 hours. Our bodies don’t normally absorb lactulose, therefore it should pass through the digestive tract untouched. However, when there is an overgrowth of bacteria, the bacteria eats the lactulose and produces hydrogen and methane gases. Testing the specific levels of these gases helps us determine if there is an overgrowth of bacteria in the small intestine.

Testing for SIBO is especially important if you experience IBS symptoms and treatments haven't provided relief.

How Do You Treat SIBO?

The first key to treating SIBO is to correctly diagnose SIBO and address the root cause. Treatment focuses around bringing bacteria levels down to normal, preventing them from proliferating and optimizing a healthy microbiome and gut. I focus my treatment on:

1. Optimizing nutrition to restore gut health
2. Moderating bacteria levels with medications or supplements
3. Rebuilding the microbiome
4. Repairing the digestive system
5. Preventing recurrence

Always check in with your Naturopathic Doctor or other health care provider before starting any treatments or making changes to your healthcare plan

In health,

Dr. Courtney Ranieri, ND

Courtney Ranieri is a Naturopathic Doctor in Toronto, Mississauga, and Vaughan who is passionate about optimizing her patients’ health. She has a clinical focus in hormonal health, digestion, nutrition and fertility. Learn more at: www.drcourtneyranierind.com.

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References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890937/    

https://www.ncbi.nlm.nih.gov/pubmed/17990113    

https://www.ncbi.nlm.nih.gov/pubmed/11151884

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/    

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/pdf/GH-03-112.pdf  

https://www.karger.com/Article/Abstract/201507

https://www.ncbi.nlm.nih.gov/pubmed/8881809/  

https://onlinelibrary.wiley.com/doi/full/10.1111/ijcp.12128