SIBO, trend or epidemy?

What is SIBO?

SIBO means Small Intestine Bacterial Overgrowth. 90% of the microbiota of the intestinal tract is located in the colon and the large intestine. When the microorganisms living in the small intestine increase too much, they cause troublesome symptoms, and may be the cause of more severe health problems.

But bacteria are not the only organisms that can overgrow, since so do parasites and fungi. On one side, parasites usually cause an excess of methane ‒ in this case, the disease is called IMO‒, and an infection caused by fungi, which we call SIFO.

Once we take a specific diagnostic test, it is possible that the cause remains unidentified. Then, this disorder is called SIBO.

What about the symptoms?

The main symptoms are the same, regardless if we suffer from SIBO, IMO or SIFO:

• Slow digestion
• Smelly and persistent flatulence
• Bloating
• Constipation
• Alternance between explosive diarrhoea (sudden, completely water-like, and with abundant gas expulsion)
• Occasionally, heartburn and halitosis (in case of hydrogen sulphide-producing bacteria overgrow).

These are only the perceptible trouble it can cause, and are not exclusive of this disease. This is the reason we should never self-diagnose ourselves.

Moreover, if these symptoms are not treated, it is possible that we suffer from the following, in the long-run: 

• Intestinal malabsorption and deficiency in vitamins. 
• Intestinal hyperpermeability and inflammatory-type responses that may lead to skin problems, hormonal alterations, and other metabolic problems.
• Depression, memory loss, as well as mood and sleep alterations. 

Those who suffer from SIBO know how painful and uncomfortable it is. But, at the same time, it is important to understand the possible underlying sources, and take them out of the equation little by little. These are the possible causes:

·         Abdominal surgery resulting in alterations of the ileo-caecal valve. This valve opens in just one direction, to let the content of the large intestine into the small intestine. If this part of the intestine is somehow damaged, a small quantity of the contents from the small intestine pass into the large one. This produces an invasion of a place where these bacteria are not supposed to be.

• Hypochlorhydria. Chronic medication used to inhibit the formation of hydrochloric acid may induce a change in the pH of the digestive tract. This change can make the appearance of bacteria, parasites, and fungi easier.
• Diagnosed coeliac disease or intestinal inflammatory disease, that is not treated with an adequate diet. 
• Diabetes or resistance to insulin. 
• Diverticulosis.

Any pathology that can directly (hypothyroidism, for instance) or indirectly (some pharmaceutical drugs) trigger acute constipation.

All of the above means that, in addition to diagnosing and treat SIBO, people affected by it should suspect, dismiss, and fix previous anomalies.

Should I follow a specific diet?

The most extended recommendation is to follow a high fermentable, low-carbohydrate diet. This is also known as low-FODMAD diet (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols).

This type of diet reduces the symptoms, but it is not a treatment for SIBO by itself. This disorder should be treated with prokinetic antibiotics (herbal ones like milk thistle, chamomile or ginger root, since they act by improving the digestive tract motility, or pharmacological). At the same time, the treatment also includes specific probiotics, in order to reduce the inflammation of mucosae.

Ideally, one should ask a nutritionist and dietitian, who can advise and accompany you through the healing process, since it can be long.