The small intestines are the part of the digestive system that helps further break down the food coming from the stomach.  In the small intestines is where nutrients and water are absorbed from the food you have eaten.  Small intestinal overgrowth, or SIBO, is a condition in which the bacteria in the small intestines become imbalanced. 

SIBO causes an abnormal increase in the bad bacteria in the small intestines.  This can happen when the small intestines don’t move food along quickly enough.  Bacteria will start to grow and stick around as food is kept in the small intestines for too long.  The good bacteria that helps digest food can’t keep up with the bad bacteria, which can cause the germs to multiply too fast causing the imbalance.  



Risk Factors

There are a few things that can put you at a higher risk of developing SIBO.  Anyone can develop SIBO.  Having a smaller or unusually shaped small intestine can cause you to be at a higher risk of getting SIBO.  The pH balance in the small intestines can also cause you to have a higher risk.  Being older, having diverticulitis, a gastric bypass surgery, scar tissue, injury, or buildup of amyloid can also raise the risk of SIBO. 

Conditions that may have SIBO as a side effect or symptom are diabetes, lupus, scleroderma, HIV, immunoglobulin A deficiency, or Inflammatory bowel disease.  About 80% of patients who have Inflammatory bowel disease also have SIBO. 

Medications like narcotics, Irritable bowel syndrome treatment medications, proton pump inhibitors, or antibiotics can also cause SIBO. 


Symptoms Of SIBO

Symptoms can range from mild to severe.  In some cases no symptoms may be present. 

Symptoms include pain especially after eating, bloating, cramps, diarrhea, constipation, indigestion, regular feeling of fullness, gas, unexplained weight loss, and fatigue.  



Diagnosing can be tricky because the symptoms are similar to so many other conditions.  There are tests that can diagnose SIBO.  Your doctor may want to do some kind of imaging test to look at the intestines to see if there is anything physically wrong with the digestive tract, such as CT scan, X-ray, or MRI.  Blood tests can check for anemia or other vitamin deficiencies.  A stool test can help your doctor determine how much fat your body is absorbing. 

A small intestine aspirate and fluid culture is a procedure where your doctor will use an endoscope to go into the small intestines, the endoscope will be able to take a sample of the fluid in the small intestines.  That sample will be sent to a lab to see what type of bacteria is growing. 

The hydrogen breath test is another test for SIBO.  Before the test begins you will be given a very sugary beverage to drink.  Then in the course of 3 hours you will blow into a balloon every 15 minutes to check the level of hydrogen or methane that is in your breath.  




If left untreated SIBO can cause some complications.  SIBO can cause malabsorption of fats, proteins, and carbohydrates.  Vitamin deficiencies like anemia or b12.  It can also cause poor calcium absorption which can lead to poor bone health, and kidney stones.  SIBO can cause an electrolyte imbalance.  

Treatment usually consists of antibiotics and diet changes. The first step is to control the bacteria that is out of control.  This can usually be done with antibiotics. If your SIBO is caused by an underlying issue, your doctor will want to start treatment on that as well so that your SIBO doesn’t return.

SIBO is not caused by specific foods, but there are foods that encourage overgrowth of bad bacteria.  Some foods can cause your SIBO symptoms to worsen.  Foods that have been shown to worsen symptoms are sugars and sweeteners, fruits, starchy vegetables, dairy products, and grains. 

Having a diet that is well balanced and nutritious is important.  Eating more meals that are smaller during the day can help you not overload your stomach.  Avoid gluten when possible.  Keep a food journal and figure out what your triggers are.  Avoid fiber supplements.  Try an elemental diet.  Add healthy prebiotic and probiotic foods or supplements into your diet.  If you have any vitamin deficiencies, try supplements.  



SIBO is usually caused by an underlying issue.  Once that underlying issue is found, treating SIBO can be done.  Changing your lifestyle, avoiding triggers, and eating healthy can help maintain a healthy bacteria balance in your small intestines.  It may take antibiotics to completely heal your SIBO.  If left untreated it can cause complications.  


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