SIBO is small intestinal bacterial overgrowth, excess bacteria in the small intestine. Bacteria naturally occurs throughout the gut. The small intestine usually has low levels, the colon usually has the highest. Most nutrients are absorbed into the bloodstream in the small intestine.
The problem
The overgrowth of bacteria can interfere with normal digestion and absorption of food and can also damage the inner lining of the gut allowing foreign particles to pass into the blood stream (leaky gut). This may trigger an immune response leading to food allergies/sensitivities. Bacteria entering the blood stream can lead to chronic fatigue and body pain.
When food passes through the small intestine, the bacteria consume some of the food causing symptoms of gas, bloating and pain. It may also ingest some nutrients, potentially leading to nutrient deficiencies, especially iron and vitamin B12.
After the bacteria have eaten the food, they produce gas within the small intestine leading to bloating, belching, flatulence, abdominal pain, constipation and/or diarrhoea.
The bacteria can interfere with bile, leading to improper fat absorption and potential deficiencies of vitamins A and D and fatty stools.
Protein may be consumed by the bacteria, this can lead to both mild protein deficiency and an increase in ammonia production. We normally produce some ammonia daily from normal metabolism, but ammonia requires detoxification, so this may add a burden to the liver.
Acids are excreted from the bacteria which may, in high amounts, lead to neurological and cognitive symptoms.
What can cause SIBO?
Antibiotics
Alcohol consumption
Aging
Contraceptive pills
Low stomach acid
Stress
Dysfunctional immune system
What to do
There's a 4 step programme that can potentially help with SIBO.
Step 1 - allow time between meals for your digestive system to relax. Eat three meals per day and try not to snack in between. Chew thoroughly.
Step 2 - Identify which FODMAP foods are causing reactions and eliminate these from your diet for two weeks. These foods aren’t fully absorbed and end up fermenting in the gut. The fermentation feeds the bacteria, making it more difficult to fight SIBO. You can use the Monash app to identify these and a food diary to track your symptoms.
FODMAP foods
Fructose — some fruit and fruit juices, honey, processed cereals, baked goods, maple syrup, processed sugars
Lactose — dairy and products processed with added lactose
Fructans — leeks, artichokes, broccoli, wheat, garlic, onion, asparagus, cabbage
Galactans — soy, legumes, cabbage, Brussels sprouts
Polyols — lactitol, maltitol, sorbitol, isomalt, xylitol and erythritol, found in sugar-free gum, mints and some medications
What to eat (be diverse)
A portion* of wild-caught oily fish (tuna, mackerel and salmon) at least twice per week
A portion of grass-fed beef and lamb max once per week
A portion of free-range poultry and eggs every second day
½ a portion of raw hard cheeses (unpasteurised) three times per week
¼ cup almond or coconut milk daily (V)
1½ portions of vegetables: leafy greens, squash, carrots, cucumbers, tomatoes every day (V)
A portion of fruits: bananas, blueberries, grapes, melons, pineapple, strawberries per day
A portion of quinoa every second day (V)
Sprouted nut butters (low sugar) 1 tablespoon, 3 times per week (V)
The goal of the SIBO diet is to repair the intestinal lining, ease inflammation, get rid of the bacterial overgrowth and eat a diet rich in the essential nutrients that your body may be lacking.
Eat pineapple (rich in bromelain), this may help lower inflammation whilst helping digestion. Bromelain helps with digestive disorders and joint pain. Bananas help improve digestive health and boosts energy levels.
Step 3 - Reintroduce eliminated high FODMAP foods one at a time each day and track reactions.
Step 4 - GAPS Diet (Gut and Psychology Syndrome Nutritional Protocol) after 2 weeks of FODMAP elimination. The GAPS diet may help repair leaky gut syndrome, rebalance bacteria, prevent toxins entering the bloodstream, reduce food sensitivities, improve neurological function, boost the immune system, improve mood and help with irritable bowel symptoms.
Foods to avoid
Grains
Processed sugars
High-starch foods
Processed foods
Non-organic meats and dairy
Guidelines
Drink one cup of bone broth with each meal
Introduce probiotic-rich foods slowly (fermented vegetables: kombucha, sauerkraut, kimchi, etc.) ½ portion every second day
Consume raw dairy, 2 portions every second day
Supplements
Here are some suggested supplements for SIBO, but it is best to obtain the advice of a practitioner on what is best for you.
Garlic
Oregano
Berberine
Neem
Cinnamon
Lifestyle
Drink 2 litres of filtered water daily
Manage stress with meditation, yoga and regular exercise
*A portion is 80grams