Small intestinal bacterial overgrowth, or SIBO, has become a lot more common in the general population. Additionally, it is very common with those who have an autoimmune disease. It’s a huge pain to both live with and to treat. In this post I’ll cover what SIBO is, what causes it, why so many people with autoimmune diseases have it, and how to treat it.
What is SIBO?
The lower half of the gastrointestinal tract is divided between the small and large intestine. The large intestine is where almost all of our microbiome lives. It’s rich in bacteria and actually needs a healthy balance of bacteria to function. On the other hand, the small intestine does not have or need bacteria present to thrive. In fact, it has very little bacteria living in it. This is because food moves very rapidly through the small intestine. Also, bile (that comes from your gall bladder) also mixes with food and neutralizes bacteria.
SIBO happens when bacteria from either the mouth or the large intestine travel to the small intestine and proliferate. This overgrowth of bacteria causes a whole host of problems for the digestive process, including diarrhea, constipation, bloating, nausea and abdominal pain.
A hydrogen and methane breath test is the best way to diagnose this condition. Bacteria produce either of these gases, so when levels are higher than normal, it indicates that those bacteria are present in the small intestine.
What Causes SIBO?
There are a number of different factors that cause SIBO, including:
- Low stomach acid: this can prevent gastric acid from destroying bacteria found in food and the environment.
- Medications like antibiotics or gastric acid suppressants: antibiotics wipe out the gut microbiome and can cause issues with bacterial balance when it repopulates. Gastric acid suppressants have the same effect as having low stomach acid.
- Motility issues like gastroparesis or hypothyroidism: when digestion moves too slow, undigested food sits in the small intestine for too long and can grow and ferment bacteria.
- Intestinal obstructions: obstructions can slow down motility, causing the same issues as above.
- Stress, smoking and a poor quality diet: all three can disrupt the microbiome balance and increase inflammation in the intestinal lining.
Why is it Common in Autoimmune Diseases?
SIBO is very common among the autoimmune population for a number of reasons. One of the most obvious reasons is the immune system is not robust enough to clear bacteria from the intestinal tract. Also, many people with autoimmune diseases have intestinal permeability. This causes bacteria to flow in and out of the intestinal tract. It also increases inflammation in the gut lining, which alters the gut microbiome and may also cause overgrowth of harmful bacteria in both the large and small intestine. Lastly, SIBO may be a root cause for the development of autoimmune diseases.
How to Treat SIBO
Treatment for a small intestinal bacterial overgrowth is one of the most frustrating conditions to treat. One reason is because it is not straightforward, and in many cases it is not eradicated in just one round of treatment. There are a few options when it comes to SIBO treatment:
Antibiotics
Antibiotics are used to wipe out the bacteria so you can regrow a healthy microbiome. Rifaximin is commonly used because it targets the bacteria in the small intestine. This is usually taken for 10-14 days.
Herbals
There are a handful of herbal supplement combinations that have been shown to be just as effective as antibiotics. Most of these contain compounds like berberine, allicin, oil of oregano and neem, which are all potent antimicrobials.
Diet
A low FODMAP has decent research backing its effectiveness for helping keep SIBO from rebounding. However, it’s a challenging diet so it is important to seek help from a qualified professional to make sure it is done correctly
Elemental diet
When all else fails, and SIBO is not responding to treatment, an elemental diet may be needed. This involves drinking a special diet formula that has pre-digested carbs, proteins and fats. The formulaic diet allows your gut to rest, prevents food from contributing to the bad bacteria, and helps you absorb nutrients more efficiently. Most people stay on this for about 2 weeks. This should never be done without being under the care of a physician.
If you suspect you might have SIBO, the best thing to do is get tested. Then, seek treatment from someone who is qualified to handle this condition. If you need support, please contact me for help. Additionally, follow me on my socials (Instagram, Facebook and YouTube) for more tips on how to live better with your autoimmune disease.
