Small Intestinal Bacterial Overgrowth (SIBO)

Bacteria live mostly in the large intestine where, in their healthy state, they are assigned specific jobs. They are collectively called The Gut Microbiome, Intestinal Flora or Intestinal Microbiota. The small intestine, however, is meant to be relatively bacteria-free as it has gastric juices to break down food, that can also break down bacteria, and intestinal wall muscles that move food through the digestive system and bacteria get pushed out. In a healthy body, everything that’s not useful should move effortlessly towards elimination.

But gut researchers have been finding colonies of bacteria and microorganisms that are migrating into the small intestine from the large intestine bringing along their metabolic waste. Just to be clear, the body is built to move food and its byproducts down and out of the body not up and into the blood stream!

What Dr. Google or an MD might say about SIBO:

Dr. Google provides a lot of hits on SIBO, but it’s all quite contradictory and you also have to roam around a lot (and understand medical terminology) to find useful and accurate information.

Typically, SIBO is described as an overgrowth of bacteria in the wrong place at the wrong time. The wrong place is the small intestine, and the wrong time is often in the middle of the night where hungry bacteria are eating up your undigested food, or even the meal you are trying to digest, and causing GI symptoms like gas, bloating, diarrhea, cramping and pain – a collection of symptoms that sound like IBS.

Some medical websites indicate that SIBO is a result of illnesses and conditions that interfere with the motility of the small intestine; meaning that someone with diabetes might have SIBO because their food and waste move more slowly through the small intestine causing bacteria to collect, multiply, and thus throw the system out of balance. Aging can decrease gastric acid which could increase risk of ineffective digestion and result in SIBO.

According to Dr. Google, overgrowth of bacteria can also be attributed to complications from certain surgical procedures that leave scarring, and illnesses like Crohn’s and IBS. This suggests that IBS or Crohn’s may be the cause of your SIBO. Yet other medical websites state that SIBO is associated with a number of illnesses, meaning that someone might have IBS or Crohn’s and SIBO all at the same time.

One medical website indicated that drugs used to treat IBS like antibiotics and proton pump inhibitors could be “at the root of SIBO”. But no further mention was found of this connection.

Medical Tests

• Your doctor may suggest a hydrogen breath test where you drink a solution of milk sugar which is like a smorgasbord to bacteria that may be living in your small intestine. As those bacteria feed on the solution, they excrete hydrogen and methane over a period of several hours like we excrete carbon dioxide in our breath. Those gasses are measured from your exhalation to determine your level of bacterial infestation.
• Another test involves the doctor putting a tube down your throat to collect material in the small intestine. That material is sent to a lab where the levels of bacteria will be measured. I tossed that off kind of nonchalantly, but it’s a pretty yucky test!

What I say about Small Intestinal Bacterial Overgrowth (SIBO)

Basically, the discussion on the bacterial microbiome in the mainstream medical community has led to the creation of a new “dis-ease” called SIBO. I never heard about SIBO in my medical or my naturopathic training. Now there are SIBO websites, SIBO Symposia, SIBO books, and unfortunately SIBO blind spots – because they overlook Yeast Overgrowth Syndrome. Even so-called SIBO experts are missing a big part of the picture.

We have people calling our Customer Experience Team saying, “I think I have SIBO,” and then they want to know what they should do. Their self-diagnosis is scary because, as I noted above, the whole topic is very new and very confusing. They don’t know enough about it and don’t know what to do about it. It’s no wonder people are confused by Dr. Google, which gives conflicting information, and their MDs who may never have heard of SIBO because they never learned about it in medical school.

Some Possible Answers

Dr. Sidney Valentine Haas had success with a grain-free, sugar-free, starch-free diet for celiac and IBD (irritable bowel disease) patients in the 1950’s. She believed that bacterial overgrowth could disrupt enzymes that normally attach to the intestinal cell surface and prevent proper digestion and absorption of carbohydrates.

We do know that a severe bout of diarrhea can impair disaccharide enzymes that break down sucrose, lactose, and starch, leaving them undigested and making them fodder for bacteria and yeast. Dr. Haas knew that these bacterial toxins and acids could injure the lining of the small intestine. Excessive mucus could be produced as a defense mechanism against the irritation caused by toxins, acids, and undigested carbohydrates and lead to the condition called mucus colitis, now called IBS.

The above explanation makes sense, but the problem is that the emphasis has always been on bacteria and now SIBO is called bacterial overgrowth, not both bacterial and yeast overgrowth. Because SIBO is a bacterial diagnosis, doctors, both MDs and NDs, unfortunately recommend antibiotic therapy, which of course will cause more yeast overgrowth, and SIBO treatment does not include natural antifungals.

The treatment for SIBO even includes Fecal Implants, which are incredibly expensive (and gross!) and quite over-the-top. Of course, something that expensive and that dramatic will have a great placebo response and may work for some people in the short term! It will be very interesting to see if they ever lead to long-term improvement.

Testing SIBO

As noted above, a hydrogen or methane breath test is used to diagnose SIBO, but it’s not actually measuring bacteria at all. It’s measuring whether or not you are able to digest a sugar drink of fructose, lactose, or lactulose. If you don’t digest these sugars they become food for intestinal bacteria, which produce hydrogen and/or methane as a result. Yeast also produces gas when they ingest sugars – mostly methane. This means that the hydrogen/methane is not just measuring bacteria.

SIBO Diets

The following diets can all be used to starve the intestinal organisms that are snacking on undigested sugars:

• The Specific Carbohydrate Diet (SCD)
• FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols)
• Yeast ReSet Diet

However, I find that the SCD and FODMAP are too strict and you are made to feel like you have to be fanatic about the diet for it to work. FODMAP is not the same as the SCD; it allows grains, fiber, sugar and other fermentable carbs, which will feed intestinal organisms. The Yeast ReSet Diet is less restrictive and therefore easier for folks to follow.

Treatment of yeast overgrowth and SIBO

My Yeast Overgrowth Protocol, which is described in detail in my book, ReSet The Yeast Connection, and my SIBO protocol are essentially the same.

• Begin with a yeast-free diet, which means, avoid sugar, fruit, gluten and dairy for 3 weeks.
• Stabilized ions of picometer silver: 1 tsp twice per day. Begin with 1 tsp per day for 1 week, then increase to 1 tsp twice per day. Can be taken straight or in a few ounces of water. Silver ions are antifungal, and they also mop up debris from yeast die off, so it can help neutralize or lessen Herxheimer reactions.
• Soil-based natural antifungal/probiotic: Begin week 2. Start slowly and take one a day. If you get die off, open the capsule and take ½ per day, and increase when you no longer have die off. Look for a soil-based probiotic that contains  S. boulardii, which is a type of yeast itself with antifungal and probiotic properties, and Humic/Fulvic, which is a soil-based probiotic.

Carolyn Dean MD ND
The Doctor of the Future