Underlying Causes of Small Intestine Bacterial Overgrowth (SIBO)
Over the past year, I have seen and treated more cases of SIBO (Small Intestinal Bacterial Overgrowth) than I have in my entire tenure as a physician. Some might ask: “Is it becoming more prevalent?” or “Why are so many people suffering from this condition?” The truth is, there is a laundry list of reasons why a patient may develop SIBO.
SIBO is defined as an increase in the number of bacteria present in the small intestine, that is, an increase in the number of bacteria that should not be there. Often, bacteria from the large intestine migrate into the small intestine where they are not welcome, causing many digestive issues including gas, bloating, GI distress, constipation, and diarrhea, and the list goes on.
Although the prevalence seems to be increasing, we are also dedicating more time and resources towards researching this chronic condition, which can help naturopathic physicians like myself give you the most impactful remedies possible. The more studied SIBO is, the more natural treatments and protocols become available as options to help you heal.
If you’re suffering from any of the following conditions, it may be time for you to meet with your physician to rule out SIBO:
- Bloating
- Gas
- Constipation
- Diarrhea
- Abdominal Pain
- Brain Fog
- Fatigue
- Food sensitivities (increasing or worsening)
- Skin issues (Rosacea, rashes, eczema, dry skin)
- Headaches/migraines
- Pain or gas after eating
- Pain not relieved with passing gas
Now that we know what some of the symptoms are, you may be wondering: “What are some of the underlying conditions that contribute to SIBO?” Let me preface this by saying that there are many underlying conditions. However, here are some of the most common conditions that I’ve seen contribute to a SIBO infection.
1. Leaky Gut
You know when naturopathic physicians say, “everything starts with the gut”? Well, it’s true. Leaky gut is one of the most significant predispositions to SIBO, according to recent research. When you have a permeable gut wall, your body classifies certain foods as “foreign invaders.” Eventually, one can develop food sensitivities to foods that, at one point, never caused a reaction. I’ve seen many patients become sensitive to foods that aren’t commonly causes of sensitivity in a healthy human being, such as lettuce, cucumbers, blueberries, cantaloupe, and even spices. The goal is to work with a physician in getting to the root cause of Leaky Gut (and SIBO) by running a delayed IgG and IgA food sensitivity panel.
2. Prior Use of Antibiotics
For years, people thought antibiotics were the only way to cure or treat a health condition, whether it be a cold, sinus infection, yeast infection, or SIBO. However, in naturopathic medicine, we utilize a variety of other herbs, blends of herbs, foods, and lifestyle changes to create an environment of “healing” in your body. If you’ve ever used antibiotics (which most of us have) and have any associated SIBO symptoms, I would recommend working with a physician to test for various bacterial overgrowths. (2)
3. Past Incidence of Food Poisoning
Who remembers that one time they ate questionable grocery store sushi and ended up regretting it at 2:00 am in the morning? Most of us have experienced food poisoning at some point but brushed it off after we’ve felt better. We move on with our lives. It’s common, but it doesn’t mean that it’s benign. Research presented by Dr. Mark Pimentel and the Mount Cedar Sinai Center and Hospital at the Annual SIBO Symposium suggests that types of harmful bacteria are released when a person experiences food poisoning. These bacteria can have long-lasting detrimental effects on the gut. (6)
(Excerpt from Better Gut, Better Health) – “At the third SIBO symposium in Portland, Oregon last month, the research presented indicated that E. Coli, Salmonella, Campylobacter Jejuni, and Shigella all produce a toxin known as cytolethal distending toxin B (a neurotoxin). Sounds pretty threatening, and it is if you are one of the 10 percent of people who don’t necessarily recover from the food poisoning.” (6)
4. Low Stomach Acid
According to this study by the Journal of Gastroenterology and Hepatology, “Diminished acid production (hypochlorhydria) is a risk factor for SIBO, and can develop after colonization with Helicobacter pylori…. Inhibition of acid secretion via histamine type 2 receptor blockers (H2RAs) or proton-pump inhibitors (PPIs) may predispose to SIBO.” (2) Stomach acid is essential to breaking down your food and properly digesting your meals. Many of my patients dealing with SIBO have, at one point in their lives, been on a Protein Pump Inhibitor (PPI), such as Omeprazole, to inhibit their hydrochloric acid (HCL) production. As we’ve learned, this often does more harm than good, and it allows infections like SIBO to manifest.
5. Slowed Bowel Motility
One study of many suggests that chronic constipation, a symptom of SIBO, is caused by excess methane gas. According to the Journal of Neurogastroenterol Motility, “A patient with slow transit constipation [is] associated with high methane production both in fasting state and after ingestion of glucose, whose constipation improved after treatment with non-absorbable antibiotic, rifaximin, which reduced breath methane values.” (5)
In constipation-dominant patients, most don’t have proper and frequent bowel movements, which causes a back-up of food, bacteria, waste, and gas. This slow bowel motility must be addressed before resolving SIBO, or a relapse can be expected.
6. Underlying Co-Infections and Disease
More times than not, SIBO is never the root cause. Did you have SIBO when you were two years old? Probably not. SIBO is the effect of one or more underlying causes that have manifested in the gut. Many times, SIBO is present alongside another co-infection or disease, such as H. Pylori, EBV, parasites, autoimmune conditions, adrenal fatigue, etc. It’s imperative that you, alongside your physician, dig deep to find the root cause(s) to put SIBO in remission successfully. Dr. Alison Sibecker has a list of associated co-infections and diseases on her website, SiboInfo.org, alongside a plethora of other informative material.
Don’t be discouraged if your SIBO relapses. It’s relatively common. The most crucial part of healing SIBO is keeping your mind right. It can be discouraging. It can be very challenging. But healing from any chronic disease or infection starts by getting your mindset right. Finding a naturopathic physician (or “wellness team”) that is encouraging, supportive, knowledgeable, and ready to walk this journey with you is invaluable to your success.
If you’re interested in a Part II on this topic, let us know by leaving us a comment, tweeting us, or posting a comment on Facebook. How do you treat SIBO? How do you prevent a relapse? What else can I do to decrease my risk of developing SIBO? These are all important and valid questions, especially for those of you in the midst of treating an overgrowth.
If you’re interested in chatting with one of our physicians, call 480-588-6856 to schedule a FREE brief meet and greet with a naturopathic doctor, to learn how we can help you heal.
In health,
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