Brief Facts about SIBO
SIBO or to give it its full name, small intestinal bacterial overgrowth is an intestinal complaint which is often linked to another underlying illness. During the early stage of the condition, symptoms tend to be non-specific but may include abdominal pain, indigestion, bloating and diarrhea.
However, when the disease progresses further, the body becomes incapable of absorbing the nutrients from food which can lead to vitamin deficiencies and malnutrition.
Diagnoses are often done by exclusion but sometimes biopsies, blood testing or tissue samples are required.
The Causes of SIBO
In healthy people, the small intestine is kept relatively clean. Food is received in the stomach where it is mixed with acid and other digestive juices, which transforms your food into a clean substance. This slurry gets pushed through the small intestine where the body absorbs nutrients. The waste gets dumped into your large intestine where it absorbs water making the feces more solid before they are expelled from the body in a bowel movement.
Our gut is full of bacteria, much of which is good for us, this intestinal flora is vital to the efficient healthy workings of the digestive system. Intestinal flora helps us to digest important vitamins such as vitamin K and folic acid while also protecting the intestine against invasion by harmful bacteria, the type of bacteria that causes disease.
However, if normal intestinal functions are compromised then an overgrowth of bacteria can occur. There are several reasons why this could happen; it may be caused by insufficient stomach acid or result from intestinal damage from alcohol or toxins for example. It could also be caused by the small intestine transferring waste material to the large intestine (or colon) less efficiently.
As I mentioned in the introduction, SIBO is often linked to underlying illnesses which affect the way in which the small intestine functions. Bacterial growth is generally kept in check through a number of bodily protective mechanisms such as intestinal mobility i.e. the way in which it moves contents through the digestive system, and also stomach acidity. Our body’s bile content also hinders bacterial growth while our ileocecal valve prevents stools from refluxing out of the colon into the small intestine.
An illness or a disease of some kind which harms the body’s defensive mechanism can put a person at a greater risk of SIBO. However, it is most often a motility problem of the intestines that lead to a person developing SIBO. Examples of this include complications following a gastric bypass operation, tumors and bowel strictures or adhesions.
Certain neurological diseases such as Parkinson’s disease and myotonic dystrophy may also affect bowel motility as can diabetic neuropathy.
Other diseases linked to an increased risk of SIBO are:
- Celiac disease
- Crohn’s disease
- Alcohol abuse and liver cirrhosis
- Achlorhydia (a chronic inflammatory condition which prevents the stomach from producing acid)
Symptoms and Diagnosis
A SIBO diagnosis is difficult because there are no actual specific symptoms that can lead to a direct diagnosis. Instead, SIBO is considered as one of a variety of unspecific symptoms which put together can lead to a diagnosis.
The initial symptoms affecting the digestive system and stomach include one or more of the following:
- Abdominal pain
- Bloating and flatulence
Longer term symptoms
As the condition continues to progress, the overgrowth of bacteria prevents the body from being able to effectively absorb the nutrients from food. This can lead to a range of problems such as protein deficiencies, vitamin deficiencies, electrolyte imbalance and problems with absorbing fat.
The body’s inability to properly absorb vitamin B 12 can lead to a variety of symptoms associated with anemia including peripheral neuropathy and decreased red blood cell numbers. A reduced level of vitamin A can cause night blindness while a deficiency in vitamin D can cause metabolic diseases that lead to spasms and bodily twitches.
The malnutrition symptomatic of SIBO is likely to result in dramatic weight loss and muscle wasting. The body’s difficulty in absorbing fats from the diet can cause a condition called steatorrhea, a condition characterized by an excess of fat in you feces which in turn leads to oily and foul smelling stools and possible anal leaking.
SIBO is commonly treated with antibiotics but antibiotics alone tend to be very ineffective in treating the disease. Sufferers of SIBO may require many antibiotic rounds to gain control over their intestinal bacterial levels. Indeed, even after completing several rounds of drugs, SIBO may still return. It is possible for bacteria to repopulate the intestine within a few weeks of completing the course of antibiotics.
The SIBO recurrence rate is very high; around 44% of sufferers will develop an overgrowth within 9 months of treatment. To ensure that you get rid of the condition entirely and to help it stay away for good, it is vital that you address any underlying problems that lead to the condition. One of the most important things to consider is your diet.
It is highly likely that you need to make dramatic alterations to your diet in order to prevent a recurrence of the sickness. There are a number of potential diets but they all have one thing in common….you need to discourage the bacteria by starving it.
So could your diet be causing SIBO?
The bacteria that inhabit our gut is not always harmful. There are a host of friendly bacterial strains often referred to as intestinal flora which perform a number of important bodily functions. These roles include a range of functions from aiding the digestive process to regulating your mood. And like any other living organism, bacterium needs to nourish itself and feed off something in order to survive. And the stuff they primarily like to feed off is carbohydrates
The standard modern western diet tends to be full of carbohydrates and not just any carbs, but typically simple carbohydrates like starchy and sugary foods. Your intestinal flora will dine out on these excess carbohydrates causing them to thrive, proliferate and causing you to have an overgrowth issue.
Another problem with the standard western diet id that it is rich in inflammatory food such as gluten which can damage the stomach’s lining and reduce the level of stomach acid necessary to regulate bacteria.
As I mentioned earlier, there are 5 generally accepted diets for SIBO which all aim to starve the bacteria and prevent it from overgrowing in the small intestine.
1. The low FODMAP diet
This is a very popular and effective diet for SIBO which was originally designed to treat irritable bowel syndrome but can easily be adapted for the purposes of SIBO.
The diet is based on getting rid of the food that contributes towards fermentation in the intestines.
Because it was designed for IBD and is also an excellent choice for IBD, the low FODMAP plan does not eliminate either polysaccharide or disaccharide carbohydrate sources such as starch, grain or sucrose. In most people these types of carbohydrates are easily absorbed but in the case of SIBO they should also be eliminated from your diet as bacteria enjoy feeding off them.
A comprehensive list on food allowed and not allowed on a low FODMAP diet can be found here, but remember it will need to be adapted for SIBO.
The SCD Diet
The SCD diet was originally created to treat Celiac disease before being popularized in a book written by Elaine Gottschall. SCD is an acronym for Specific Carbohydrate Diet and like the FODMAPS diet; it is designed to starve bacteria to prevent them from taking hold.
The SCD diet restricts complex carbohydrates, sucrose, lactose and other man made products. These types of carbohydrate are considered to be generally unhealthy and even somebody without SIBO would do well to follow it to a certain extent.
Carbs of this kind encourage bacteria to feed and can lead to bacterial as well as yeast overgrowth and other inflammatory conditions.
The SCD is a very popular and effective diet with excellent success rates. Estimates from surveys suggest the success rate is over 75% from following this diet.
Examples of food not allowed on the SCD diet include:
• Grains and cereal
• Canned vegetables
• Canned fruit
• Processed meat products
• Dairy products
• Fava beans
However, do not despair, there are plenty of allowed foods that allow you to have an interesting and varied diet including:
• Fresh meat products
• Kale and lettuce
• Mushrooms and peppers
Elemental Diet for SIBO
This is a far less popular diet and for good reason; it is intended only to be used in the short term for SIBO treatment. It is definitely not a diet that lends itself well to the long term because it starves the bacteria in the most stringent manner you can imagine and leaves no room for pleasure.
Basically you starve the bacteria by starving yourself. You do not actually eat a thing; instead you have to take a specific liquid containing the necessary basic nutrients to prevent starvation. It is effectively a feeding formula which you take to kill the overgrowth but just about sustain your body. While it should not be dismissed as a method of treating both Crohn’s disease and SIBO, it is certainly not an easy not a long term solution.
The GAPS diet
GAPS is an acronym meaning Gut Psychology Syndrome and was first designed by Dr. Natasha McBride. The idea behind the GAPS diet is that nearly all diseases begin deep within the gut and damage or imbalances in intestinal flora may lead to a variety of complaints ranging from inflammatory complaints to autism spectrum disorder and emotional conditions such as depression.
On a practical level, the GAPS diet is very similar to the SDS diet that we have already talked about but there are some variations in the foods that are allowed or to be excluded. It is also a diet that requires discipline because it is set out in seven phases.
During the initial introductory phase, you are very limited in what you can consume and are limited to probiotic supplements and lukewarm water with very little in the way of actual food. As the diet progresses, you are allowed to expand your diet a little at a time by adding food like eggs and avocado and certain allowed vegetables. However, certain food remains off limits during any of the phases.
Food that you will always need to avoid if you follow the GAPS diet includes starchy and sugary foods such as:
• Dairy products
While the GAPS diet also attempts to starve the bacteria to prevent overgrowth, it does not completely eliminate certain high FODMAPS food. Because of this, it is generally recommended that you adapt the diet in order to effectively treat your SIBO.
The Cedar-Sinai Diet plan for SIBO
Unlike the 4 diets we have already spoken about which are designed to treat SIBO and other inflammatory conditions of the intestines, this diet is actually designed for those of you concerned about getting it in the first place.
This preventive diet which was designed by Dr. Pimentel is not as strict as the ones already discussed but it does follow similar principles. The essential idea is that you reduce your intake of food which your body finds difficult to digest thus ensuring that harmful bacteria do not use them to feed off.
As well as the dietary requirement, the doctor who devised the plan in the first place recommends that you eat infrequently because of the way in which this can affect the migration of food through the intestines which in turn affects bowel movement and cleanliness.
Food to avoid on this diet includes:
• Dairy products
• Artificial sweeteners
• Legumes such as beans and lentils should be limited
• Tea and coffee should also be drunk only in moderation
You should however:
• Drink at least 8 cups of water each day
• Eat proteins such as fish, beef and eggs but in moderate amounts
• Eat moderate quantities of fruit
• You can eat vegetables but only if they are the non-starchy variety
So which diet should I choose?
I don’t blame you for being a bit confused at this point. There are so many similarities and minor variations between the diets that it is difficult to know which one to opt for. Couple with the fact that many of these diets were originally designed with another condition in mind; it makes it an even more difficult choice.
Fortunately there is a specific SIBO diet plan that takes its lead from the diets listed above but tailors it towards the SIBO disease far more specifically.
SIBO specific diet
This specifically designed diet is basically a combination of the SCD diet and the low FODMAP’s diet that we have already discussed above. It is considered to be an especially effective diet for those with stubborn cases of the disease and when alternative diets have not proven successful.
Unlike the other recommended diets which were designed to treat similar conditions, this diet was created to treat SIBO in particular by Dr. Siebeckar who is a renowned SIBO expert.
Like the other diets, the aim is to starve and kill the bacteria which cause the overgrowth and the basic tenets of the diet are similar to the others that we have talked about.
This diet requires you to follow these rules:
• Starch must be avoided
• Low fiber
• You should eat only small amount of fermentable fruit and vegetables
• Avoid raw food and beans to begin with
• Be careful about the size of your portions
• Wait 4 hours at least between meals
The things that you can eat allow for a varied and enjoyable eating experience…
You can eat as much as you wish of certain foods including:
• All types of meat
• Dairy products as long as they are free of lactose
However certain types of food are restricted and based on a tier system including:
• Nuts and seeds
What you cannot eat on the SIBO specific plan:
• Grains including oats and quinoa
• Thickeners like gum and agar
• Corn and soy
• Beans (at the beginning of the regime)
• Mucilaginous food such as seaweed, astralagus, licorice and slippery elm
• Garlic and onions
Diet is absolutely vital to ensure that you can get rid of your condition and keep it at bay for good. We hope that the information provided has been of some help and that you can use it to make an informed choice. Please let us know if any diet in particular helped and good luck