Small intestine bacterial overgrowth (SIBO) is a condition that has been “the buzz” around gastroenterology offices over the last several years. It’s well-known that beneficial bacteria reside in our large intestine, but they become problematic once they outgrow their space and enter the small intestine.
What is SIBO?
SIBO earns its name when the bacterial count in the small intestine is greater than 105 CFU/ml (colony forming units per milliliter). The symptoms of SIBO are gas, bloating, distension, diarrhea, constipation, pain, fat malabsorption, body aches, nutrient deficiencies, fatigue, and malabsorption. Since these symptoms are associated with many other gastrointestinal disorders, it may take some time for a diagnosis, which is done by either taking duodenal aspirates during a procedure performed by a gastroenterologist or by using a lactulose hydrogen breath test.
One of the most important things to remember about SIBO is that it is not a disease, but a symptom of some other problem. The problems that may trigger this bacterial overgrowth include gastroparesis or slow transit time, insufficient stomach acid, celiac disease, inflammatory bowel disease, immunodeficiencies, diverticula, recurrent antibiotic use, and inadequate enzyme activity.
How is SIBO treated?
Once diagnosed, SIBO treatment starts with antibiotics. After the antibiotics have run their course, the root cause of the condition is addressed. The low-FODMAP diet is recommended after the antibiotic therapy to limit the fuel source for the bacteria, but this therapy has not been fully studied for effectiveness and may not work on everyone. It is important that the dietary interventions start after the antibiotics have been taken so that the maximum number of bacteria is exposed to the antibiotic.
The dietitian can be very helpful with patients suffering from SIBO and, with proper dietary interventions, may be able to keep the bacteria in check long-term.