The gut is home to many types of bacteria that belong there and play important roles in keeping your body running optimally. But when too many of the wrong types of bacteria start to populate the small intestine it can cause problems, including persistent and uncomfortable bloating. Small intestinal bacterial overgrowth (SIBO) occurs when, for one reason or another, certain strains of bacteria go unchecked and are allowed to overpopulate the small intestine. Here, we’ll dig into some of the scenarios that may lead to SIBO, how it is diagnosed, and what you can do to get rid of SIBO bloat for good.

What Is SIBO?

Food leaving the stomach enters the small intestine, where digestion continues as food is broken down and nutrients absorbed. Digestive juices and muscular contractions do much of the work of digestion, but bacteria living in the small intestine also play a large role.

When conditions in the small intestine are less than optimal, the population of bacteria can become imbalanced. There are a number of factors that may cause the wrong kind of bacteria to overgrow within the small intestine. When this occurs, it can cause symptoms such as abdominal pain, gas, diarrhea, nausea, constipation, fatigue, and serious bloating. (Source)

Why Does SIBO Cause Bloating?

One of the primary jobs of bacteria in the small intestine is to help break down carbohydrates into fatty acids. This process normally produces a certain amount of gas as a fermentation byproduct. But when there is an overgrowth of bacteria in the small intestine, excess gas is produced, leading to uncomfortable bloating. (Source)

Major Causes of SIBO

Determining the cause of SIBO can be tricky, as there are a variety of scenarios that can promote overgrowth of bacteria in the small intestine. When all the parts of the gastrointestinal system are working together optimally, growth of beneficial bacteria is supported and harmful bacteria is kept in check. Let’s take a look at some of the common causes of SIBO. (Source)

Motility Issues

Motility refers to the muscular contractions of the digestive tract, known as peristalsis, that move food along. Your nerves and muscles need to be well-coordinated and consistently do their jobs in order to keep food and waste moving. If peristalsis is impaired or overall motility is otherwise reduced, food is not able to pass through the intestines at the normal rate. Impaired peristalsis can cause a buildup of bacteria in the small intestine. (Source)

Anatomic (Structural) Irregularities

Sometimes food can’t pass through the digestive tract efficiently because of structural irregularities. One example of a structural irregularity that impacts digestion is called a bowel loop, formed when scar tissue from surgery, trauma, or inflammatory disease ties off a loop of intestine. In these cases, surgery may be necessary to create a clearer path for food to pass through. (Source)

Additionally, some people with SIBO discover they have an issue with the ileocecal valve that connects the small intestine to the large intestine, or colon. If it is not closing properly, bacteria that are supposed to live in the colon can migrate into the small intestine. (Source)

Hypochlorhydria

Hypochlorhydria refers to low stomach acid. Hydrochloric acid in the stomach is crucial for breaking down food, absorbing nutrients, and keeping bacteria in check. When stomach acid is too low, bacteria are able to thrive. (Source)

Not having enough stomach acid can also lead to other digestive symptoms, such as reflux and indigestion. People often treat these symptoms using drugs known as proton pump inhibitors, which reduce the symptoms of heartburn and reflux by lowering stomach acid. If you have low stomach acid, this isn’t the right cure for reflux, and can make it worse. (Source, Source)

Immune Deficiency

Secretory IgA is the antibody responsible for protecting the mucosal integrity of the intestine. It also serves a role in maintaining the correct balance of gut bacteria. A deficiency in IgA can be genetic, in which case it is tough to address from a root cause standpoint. But knowing that you have this deficiency can be useful in learning to offset the damage by supporting your gut health in a variety of other ways. (Source)

Other Factors that Contribute to SIBO

• Irritable bowel syndrome and other digestive disorders are highly implicated in the development of SIBO. Conditions like these often result in nutrient deficiencies that can affect gut motility and the production of stomach acid and bile. Impaired motility and lack of stomach acid encourage bacterial overgrowth. (Source)
• Celiac disease can contribute to SIBO, even when there is complete avoidance of gluten. This is because there are often motility issues connected to celiac disease. (Source)
• Overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) has a negative effect on gut health in a variety of ways, including a decrease in the diversity of good bacteria in the gut. (Source)

Chronic stress can be at the root of motility issues and low stomach acid, and can even directly affect the balance of “good” to “bad” bacteria in the gut. For this reason, when addressing SIBO it is always important to consider stress as a root cause. (Source)

Diagnosing SIBO

There are several different methods of pinning down a SIBO diagnosis, some more invasive than others.

Breath Test

Diagnosing SIBO typically starts with a breath test. Beneficial bacteria populating your small intestine produce methane and hydrogen gasses as they break down the carbohydrates you eat. This kind of breath test can tell if more gas than normal is being produced, which would suggest a bacterial overgrowth. (Source)

Small Bowel Aspiration

It is also possible to take a fluid sample from the small intestine and test it in a laboratory for bacteria. This is, obviously, more invasive than a breath test. In order to collect the sample, an endoscope needs to pass through the mouth all the way to the small intestine. However, this type of test may also provide information about physical damage to the digestive tract and help rule out other conditions such as Crohn's or celiac disease. (Source)

Imaging Diagnostics

If you or your health care provider suspect anatomical irregularities are contributing to your SIBO symptoms, imaging diagnostics (X-Ray, CT scan, MRI) may be performed.

Blood Tests

While blood tests can’t tell if you have SIBO, your health care provider may want to run them to check on your nutrient levels. Nutrient deficiency is common with SIBO because bacterial overgrowth in the small intestine affects your body’s ability to absorb nutrients. A blood test could also identify an IgA deficiency, which could help narrow down the underlying cause. (Source)

How to Get Rid of SIBO Bloat for Good

Resolving SIBO bloat may involve prescription medications, herbal preparations, dietary changes, or more.

Antibiotics

If you are diagnosed with SIBO, the recommended treatment will likely include antibiotics and a focus on nutrient replenishment. Studies have shown rifaximin, an antibiotic commonly used to treat “traveler’s diarrhea,” is effective for treating SIBO. (Source)

However, there is reason to pause before starting an antibiotic to deal with SIBO. Antibiotics, while effective at killing the overgrown bacteria, are not discerning about which bacteria they wipe out and will also kill off beneficial bacteria. If you choose to use an antibiotic, you can help repopulate good gut bacteria by taking a probiotic and by eating a wide variety of fruits, vegetables, and fermented food. (Source)

Herbal Preparations

A 2014 study published in Global Advances in Health and Medicine suggested that herbal preparations with known antimicrobial properties, such as oil of oregano and sage leaf, may be as effective as rifaximin in treating SIBO. The study’s results were promising, but more research is needed. As with antibiotic treatment, nutrient replenishment remains an important part of managing SIBO with herbal preparations. (Source)

Find the Underlying Cause of SIBO

Treating SIBO with antibiotics has about a 45% recurrence rate, because SIBO is usually a symptom of another underlying issue. If you want to get rid of SIBO for good, you have to figure out what the underlying issue is that has allowed bacterial overgrowth in the first place. From there, treatment will vary from person to person. Perhaps you need to work on increasing stomach acid, or focus on nutrients that promote good motility. In the event your underlying cause is structural, you may need to explore surgical solutions. (Source)

Stop SIBO Bloat From Coming Back

If you have had SIBO, you will want to adopt some preventative measures to make sure you really get rid of SIBO bloat for good.

Here are some suggestions for keeping your stomach bugs happy:

• Avoid proton pump inhibitors.
• Try a probiotic.
• Consider nutrient supplementation, particularly B vitamins, calcium, and iron.
• Look into a low FODMAP diet or the elemental diet for SIBO.
• Drink plenty of water.
• Choose a natural alternative to NSAIDs.

(Source, Source)

The Bottom Line on SIBO Bloat

It can be unpleasant to deal with SIBO bloat, and finding a diagnosis can seem daunting. But if you are able to identify the underlying cause of your SIBO and the uncomfortable bloat that comes with it, you can start to make changes that will, hopefully, bring long-term relief. 

You don’t have to make this journey alone. ‍At WellTheory, you can work with a Nutrition Therapy Practitioner and a Health Coach to not only manage your SIBO but get to the root cause of your symptoms.