I have SIBO – Small Intestine Bacterial Overgrowth. It’s been causing me issues for years now and I want to scream from the rooftops now that I have a diagnosis and a path forward. One of my goals is always to share things I learn so that others can benefit without having to pay the price in time, energy and money. Also, I have seen a bunch of “gut health protocols” being marketed to women lately and I can assure you that these cookie cutter plans can actually make things worse if you have SIBO. If you are experiencing symptoms like abdominal pain and distension, bloating (especially after eating), nausea, indigestion, gas, diarrhea or constipation, unintentional weight loss OR weight loss resistance, fatigue, and joint pain, you may be experiencing the same issue that I am.
For me, my symptoms are joint pain, fatigue, constipation, weight loss resistance and bloating. In fact, I wake up with a relatively flat tummy and by nighttime I look like someone could throw me a baby shower. I’ve been working with a functional medicine provider for my perimenopausal symptoms and despite being on hormone therapy, some of the symptoms were not getting better (often SIBO symptoms can overlap with perimenopausal symptoms). In addition to this, my bloodwork showed that my protein levels were going down, meaning that I was not absorbing protein. This was really perplexing because I try to eat a relatively large amount of protein to maintain and build muscle mass in midlife.
So, what is SIBO?
SIBO stands for Small Intestine Bacterial Overgrowth, and it is literally as the name suggests – an overgrowth of bacteria in the small intestine. Now, you might be saying to yourself, “I am pretty hip to gut health Steph and we SHOULD have bacteria in our guts, duh!” And you would be partially correct. In the gut, certain bacteria produce gasses as a byproduct of their growth and reproduction, so yes, we should have bacteria in our gut. BUT, they should live in the large intestine, not the small intestine. When these bacteria take up residence in the small intestine and start to overgrow in the place where our nutrients get absorbed, we can have these uncomfortable symptoms of SIBO as well as nutrient deficiencies because we will compete with these little critters for the food we eat.
Okay, lets dive into SIBO a bit more. There are three types of SIBO, each defined by the gasses the bacteria produce: Hydrogen, Hydrogen Sulfide, and Methane. People with hydrogen dominant SIBO typically have an issue with diarrhea. Methane dominant SIBO is not actually caused by a bacteria, but a similar organism called archaea. Archaea are similar to bacteria but are evolutionarily distinct. High levels of methane have been linked with obesity in humans because archaea have been shown to impact the number of calories your body can absorb. One of the most commonly known methane producers is called Methanobrevibacter smithii which (stay with me here) uses HYDROGEN to make methane. SO, it is not uncommon to have both hydrogen and methane present in methane dominant SIBO (or it can be called “mixed type SIBO”). People with methane dominant SIBO typically have issues with constipation due to methane slowing down transit time in the intestines. In hydrogen sulfide dominant SIBO, the bacteria produce hydrogen sulfide (the gas that smells like rotten eggs). Hydrogen sulfide is the new kid on the SIBO block and scientists are learning more about it every day. People with hydrogen sulfide SIBO can have a range of symptoms including diarrhea, constipation, abdominal pain and fatigue.
How is SIBO Diagnosed?
The most common mode for diagnosing SIBO is by breath test. Physicians may also recommend taking an aspirate (removal of fluids) from the small bowel; however, this is an invasive method of diagnosing SIBO and breath testing is not. I made a video of my experience with SIBO breath testing and plan to blog about it soon. The day before you test, you will need to eat a very limited diet. The day of the test, you drink a sugary solution and breathe into test tubes to determine the potential level of the gasses we talked about earlier in this post. Results usually take about a week or so and your practitioner will talk to you about next steps if SIBO gasses are found.
What Causes SIBO?
Okay, this is where I geek out on the science a bit. Dr. Mark Pimentel, the pioneer of SIBO research out of Cedars-Sinai Medical Center says that one of the causes of SIBO could be a bad episode of food poisoning. Food poisoning can damage our migrating motor complex (MMC), the “housekeeping wave” that sweeps the bacteria and food from the small intestine into the lower intestine where it belongs. If the MMC is impaired, it’s like leaving the dishes in the sink. We all know how gross that can be after a few days – our small intestine is no different! Additionally, Dr. Pimentel has discovered that the bacteria that can cause food poisoning contain a toxin called Cytolethal Distending Toxin B, or CdtB. CdtB proteins look like an important protein in our bodies called vinculin, which is critical to the MMC working properly! We know that when our bodies detect something that it thinks is harmful, it creates antibodies to protect against it. In this case, our bodies think that vinculin is CdtB and creates anti-vinculin antibodies, thus impacting our gut function. Yikes!
Let’s talk a little bit more about the MMC because I think that it is SUPER important for people with SIBO. The MMC works when we are NOT INGESTING CALORIES. So, if we are constantly grazing and giving ourselves “latte pick me ups” in between meals, our MMC is like “yeah, can’t do my job over here!” So, without realizing it, we are causing problems for ourselves. Even a stevia in our black coffee is going to “shut er down”…. So, if you are struggling with SIBO, make sure to leave 3-4 hours between ingesting calories between your meals. I like to drink water and tea without cream and sugar between meals to support my MMC. Be sure to read your labels on your teas too because many tea brands have added stevia to their recipes! Man was I pissed when I figured that out! LOL
Other issues can impact the MMC too. Stress can be one of them! Think about it this way – when we are in sympathetic or “fight or flight” mode (a tiger is chasing us! or maybe our tiger is an email we need to write to senior leadership at work that we are super nervous about!), our body prioritizes whatever we need to do to SURVIVE. Digestion is not one of those things that our bodies prioritize! When we are in “rest and digest” mode (parasympathetic), our bodies feel safe to chill and digest. So, it is really important to find ways to make our bodies feel safe, such as breath work (taking a few deep breaths before we eat), humming (I know, it is weird, but it activates our vagus nerve), focusing on the food we are eating and intentionally eating slowly and mindfully can all be ways to signal to our brain that there are no tigers behind us. There are many other great ways to reduce our stress levels like going to therapy, doing yoga or mediation (shout out to my new fave – sound bath meditation), reading, snuggling with a pet, or spending time with a friend that you love.
There are other possible reasons for SIBO such as adhesions from surgery (scar tissue forming in the area of the intestines) which could create issues with the function of the gut due to impaired mobility. The way my practitioner explained this to me is that it’s like scar tissue creates a “kink in the hose”. I was also told that this scar tissue does not have to be directly near the small intestines to cause problems. In fact, I saw a lymphatic massage therapist recently who thought that the scar tissue from the removal of my breast implants in 2019 could be contributing to my issues due to the scar tissue impacting the myofascia of my torso (think of a sheet being pulled and knotted at the rib cage – the lower end of the sheet (the intestines) gets pulled too!).
How is SIBO Treated?
The way that SIBO is treated is different from practitioner to practitioner. The first option many practitioners opt for is a two- or three-week regimen of antibiotics—specifically rifaximin, the first and only U.S. Food and Drug Administration–approved IBS drug for SIBO, or a combination of rifaximin with either neomycin or metronidazole for methane dominant SIBO, since archaea resist rifaximin alone. If insurance doesn’t cover these medications (or if you don’t have insurance), practitioners may prescribe herbal antimicrobials such as allicin, oregano, berberine, neem, and cinnamon for four to six weeks. Some practitioners may suggest dietary changes such as the low-FODMAP diet (you can read about that here), a low fermentation diet, the specific carbohydrate diet or in some cases, the elemental diet, a liquid formula of predigested nutrients that gives the digestive tract a break, starving the bacteria or archaea in the process. Once the bacteria or archaea are addressed, practitioners usually suggest taking some form of prokinetic – a prescription or herbal agent that stimulates the MMC so that the housekeeper wave keeps the bacteria from subsequent overgrowth. Examples of prokinetics are low dose Naltrexone, ginger, HT-P and Iberogast.
I look forward to sharing all about my journey and what I have been taking and doing to get rid of methane dominant SIBO. It has been quite the learning experience! But for now, I just wanted to make sure you are armed with this information so that if you are experiencing these symptoms, you can talk to your doctor about SIBO. An important note on that; it’s important to be an advocate for yourself – not every doctor is fully up to speed on the latest research on SIBO. If you are having trouble getting your doctor to test you for SIBO, it may be necessary to find a provider that will or to seek out a functional doctor to help you get the breath test that you need to find out if this is what you are dealing with. Hang in there and reach out with questions via the comments. We are in this together!
