Approximately 60 to 70 million people in the United States are affected by digestive diseases each year. This category includes constipation, diverticular disease, gallstones, heartburn, ulcers, infections, hemorrhoids, inflammatory bowel syndrome/disease, and more. One study found that in those who had GI complaints and underwent a breath test, over 30% were diagnosed with SIBO. In those who have other bowel diseases such as irritable bowel syndrome, one out of two people may have SIBO. The true prevalence of SIBO is unknown, but it is more common than most people think.
What is SIBO?
Small intestinal bacterial overgrowth (SIBO) was discovered in 1939 but wasn’t brought to the forefront of medicine until 2000. It is caused by bacteria from the large intestine getting into the small intestine. Symptoms that might point to abnormal bacterial growth include bloating, flatulence, or chronic watery diarrhea. General abdominal discomfort combined with bloating, excess gas, or chronic watery diarrhea may indicate SIBO. There can also be fatty stools and weight loss due to malabsorption.
Having enough stomach acid and digestive enzymes prevents this dysbiosis from occurring. Also, having an intact ileocecal valve (separates the small and large intestine), and adequate peristalsis (food moving through the GI system) is protective against GI concerns. SIBO is more likely to occur in those who have irritable bowel syndrome, intestinal motility disorders, and chronic pancreatitis. It is also more common in females and elderly people. Additionally, if you have gastroesophageal reflux disease (GERD) and use PPI (proton pump inhibitor) therapy, you are at a higher risk of developing SIBO.
Do You Have SIBO?
First, see your doctor to have your symptoms professionally evaluated. Currently, there is no gold standard diagnostic test. Having a positive carbohydrate breath test and symptoms makes SIBO very likely. A breath test is easy, fast, and inexpensive. An upper endoscopy can be used to test the bacterial concentration in the small intestine, but it is expensive and invasive. A biopsy is rarely needed. Overall, testing for SIBO can be extensive if there are no specific risk factors for SIBO. Labs checking for vitamin deficiencies, abnormal GI motility, pancreatic insufficiency, and immune dysfunction, as well as endoscopies and imaging, can be performed to rule out other causes.
What Do You Do If You Have SIBO?
Conventionally, the first-line therapy is antibiotic use to eliminate the excess bacteria in the small intestine. If the breath test results indicated more hydrogen-producing bacteria, rifaximin for two weeks is typically an effective treatment choice. If methane-producing bacteria are more dominant, then neomycin is combined with rifaximin, again for two weeks. Another tool used conventionally is the elemental diet. This diet can be difficult and isn’t recommended for everyone; it doesn’t taste great, is high in carbohydrates, and can cause detox symptoms. It provides essential nutrients in a predigested form to starve the bacteria while letting the gut rest. Some companies offer it premixed, or it is available in powder form.
Natural SIBO Support
Here are a few options to consider to support your gut health naturally.
Nutrition. It’s important to make sure you eat a well-rounded diet full of vitamins and minerals. SIBO can cause vitamin deficiencies, including iron, B vitamins, and vitamin K and E. You can reference the low FODMAP diet if you are looking for specific foods that may help reduce symptoms.
Herbal Therapy. Some small studies indicate that herbal therapy may be as effective as antibiotics in managing SIBO. Several different options on herbs and herbal supplements may be helpful including herbs like goldenseal (Hydrastis canadensis), garlic (Allium sativum), milk thistle (Silybum marianum), echinacea (Echinacea purpurea and Echinacea angustifolia), and black walnut (Juglans nigra). See a qualified holistic health practitioner for specific recommendations.
Abdominal/Visceral Manipulation. Currently, research is ongoing to determine if physical therapy or visceral manipulation is helpful for functional digestive disorders. Manual therapy may help improve intestinal motility and reduce any fascial tension in the abdominal cavity.
Most importantly, work with your doctor or holistic health practitioner to help find the best options to support your health goals. SIBO can be debilitating for some people, so professional evaluation is crucial. Never add supplements or change your lifestyle without seeking advice from your doctor first.
Resources:
Akers, Alicia Sparks. 2023. “Can the Elemental Diet Reduce SIBO Symptoms?” https://www.medicalnewstoday.com/articles/elemental-diet-sibo#side-effects
Efremova I, et al. 2023. “Epidemiology of Small Intestinal Bacterial Overgrowth.” World J Gastroenterol; 29(22): 3400-3421. doi: 10.3748/wjg.v29.i22.3400. PMID: 37389240; PMCID: PMC10303511.
Goldenberg M, Kalichman L. 2024. “The Underlying Mechanism, Efficiency, and Safety of Manual Therapy for Functional Gastrointestinal Disorders: A Narrative Review.” J Bodyw Mov Ther.; 38: 1-7. doi: 10.1016/j.jbmt.2023.10.005. Epub 2024. PMID: 38763547.
Min M, Nadora D, Chakkalakal M, Afzal N, Subramanyam C, Gahoonia N, Pan A, Thacker S, Nong Y, Chambers CJ, Sivamani RK. 2024. “An Oral Botanical Supplement Improves Small Intestinal Bacterial Overgrowth (SIBO) and Facial Redness: Results of an Open-Label Clinical Study.” Nutrients; 16(18): 3149. doi: 10.3390/nu16183149. PMID: 39339748; PMCID: PMC11435404.
National Institute of Diabetes and Digestive Kidney Diseases. 2014. “Digestive Diseases Statistics for the United States.” https://www.niddk.nih.gov/health-information/health-statistics/digestive-diseases
Redondo-Cuevas, L., et al. 2024. “Do Herbal Supplements and Probiotics Complement Antibiotics and Diet in the Management of SIBO? A Randomized Clinical Trial”. Nutrients; 16(7), 1083. https://doi.org/10.3390/nu16071083
Sorathia SJ, Chippa V, Rivas JM. N.D. “Small Intestinal Bacterial Overgrowth.” Revised Apr. 2023. StatPearls Publishing, Treasure Island (FL). https://www.ncbi.nlm.nih.gov/books/NBK546634/