Small intestinal bacterial overgrowth, or more commonly referred to as SIBO, is much more common than many healthcare providers are acknowledging.  According to Dr Axe, ” It’s more prevalent than previously believed, and it occurs in many people suffering from IBS and certain other underlying conditions.” [1] [2]  In fact, for me, I came to question “if” SIBO might be the cause of many symptoms I was having.  You see, I had already identified a host of food sensitivities that had brought on leaky gut syndrome and I’d dealt with my adrenal function and I’d made lifestyle changes to reduce stress.  Basically, I should be feeling amazing, but I wasn’t.  I was still having bloating, gas, burping and generally feeling unwell digestively. So I got a lactulose breath test (out of pocket, of course) and discovered, yes, it was SIBO.

SIBO Causes

SIBO is having too much bacteria and other critters in your small intestines where they don’t belong.  And it’s true, you’re supposed to have bacteria in your gut, just not in your small intestines. Your upper small intestine, duodenum, is not supposed to have any bacteria — think sterile.  Your small intestines below the duodenum called the jejunum has a little bit of bacteria.  Your lower small intestines, ileum, has a larger bacterial population, but much lower than what is found within your colon.  On the other hand, your colon is loaded with bacteria to protect you.  In fact, half of your stool volume is made up of bacteria debris.  The problem with SIBO is that the bacteria that belongs in your colon has moved up into your small intestine and is growing uncontrollably.  However, the blame game would say it’s the bacteria, but instead, you should be blaming the “stuff” that is allowing the bacteria to overgrow in the first place.

Possible triggers for SIBO

• Stress indirectly causes SIBO by creating conditions that lead to SIBO
• Antibiotics are designed to kill bacteria, good and bad.  Thus your gut flora, microbiome, is upset and unbalanced.  You don’t have enough good guys to keep the bad ones in check.
• Low gastric acid means that your food cannot be broken down adequately and allows undigested food, particularly carbohydrates, to feed the hunger bacteria.  Stomach acid plays an essential role in the immune system by killing harmful bacteria and parasites that are ingested with food. As well, stomach acid signals the activation of pepsin for protein digestion and signalling when the food is ready to leave the stomach and move into the small intestine for continued digestion.
• Poor immunity means you are unlikely to have the necessary defences to protect your body from invaders and allowing disease to take root.  Your immune system should secrete protective immunoglobulins that keep everything in check.  However, if your immunity is low for whatever reason, this dysfunction will allow the bad bacteria other critters to win the battle to allow symptoms and disease.
• Dysmotility means that you have an impairment of your digestive muscles and your intestines don’t empty efficiently.  This allows bacteria to proliferate and feed off the residue hanging out and not moving to be excreted.  In a later blog post, I’ll talk about migrating motor complex (MMC) and peristalsis, which are both needed for your system to clear and remain healthy.  MMC dysfunction is often linked to SIBO and requires prokinetics (also to be discussed in a later blog post).
• Heavy metal toxicity
• Carbohydrate malabsorption simply gives the bacteria a feeding frenzy because it allows “sugars” to feed the bacteria which produce a byproduct of hydrogen and methane gas.  Neither of these gases are supposed to be expired by humans, but those with SIBO do and sometimes both.
• Ageing usually results in the digestive tract slowing down. According to Dr Axe, “It’s generally accepted that non-hospitalized adults over the age of 61 have a 15 percent prevalence rate of SIBO, in contrast with just under 6 percent in individuals 24 to 59. A study published in the Journal of the American Geriatric Society also found that over 30 per cent of disabled older adults have SIBO.” [3] [4]

Quotable: Diagnosing SIBO doesn’t diagnose the root cause. 

SIBO Testing

Regardless of the testing used to diagnose SIBO, the diagnoses doesn’t diagnose the cause of the overgrowth.  Figuring out the root of the overgrowth is the biggest challenge of the whole process.

• Stool testing cannot diagnose SIBO because it reflects what’s in your colon and not what is in your small intestines
• Urine organic acid tests can only indirectly tell you if you have a bacterial overgrowth.  It cannot tell you where that overgrowth is occurring.
• 3-hour Lactulose Breath Test is the gold standard for diagnosing SIBO.  In Alberta, the lactulose breath test must be ordered by a gastroenterologist, which requires a very long wait — think 18-24 months — and it is no longer covered by Alberta Health (changed fall of 2020).  Alternatively, you can choose to do this test “out of pocket,” which is what I chose to do.

Lactulose Test Explained

After eating a specific diet prior to the three-hour breath test, you breathe into a test tube to get a baseline reading and then you drink a lactulose solution. Humans can’t absorb lactulose, but bacteria have an enzyme to break it down for consumption. When the bacteria consume the lactulose, they produce gas.  This gas is diffused into your blood and expired from your lungs.  Remember hydrogen and methane are produced by bacteria NOT by humans.  Humans produce carbon dioxide.  So for the next three hours, you breathe into test tubes every twenty minutes.  The test tubes are packed off and sent to a lab to be processed and analyzed.  I used Dr Jennifer Bunzenmeyer in Calgary, who requisitioned the test from Sage SIBO Centre in Vancouver.

What’s your next step?  Are you suffering from reflux?  Digestive issues?  Why not connect with Brenda by email to schedule your free no-obligation Discovery Chat.  I know how difficult this journey to wellness is because I’m still on it.  Let’s talk.

Resources

[1] Dr Axe, “Do You Have SIBO? Here Is All You Need to Know!” Dr Axe Food Is Medicine Blog

[2] Andrew C. Dukowicz, MD, Brian E. Lacy, PhD, MD and Gary M. Levine, MD “Small Intestinal Bacterial Overgrowth: A Comprehensive Review,” Gastroenterology Hepatology (NY) 2007 February; 3(2): 112–122. pubmedcentralcanada.ca/pmcc/articles/PMC3099351/

[3] Axe

[4] A. Parlesak, B. Klein, K. Schecher, JC Bode and C. Bode, “Prevalence of small bowel bacterial overgrowth and its association with nutrition intake in nonhospitalized older adults.” Journal of American Geriatrics Society, 2003 Jun;51(6):768-73.  ncbi.nlm.nih.gov/pubmed/12757562