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Calgary, AB / 587-437-3197 / jenna@simplynurtured.ca

2016 by Jenna Lessner 

  • Jenna Lessner, BSc, CHNC

Digestive Issues… Could it be SIBO?

Updated: Feb 12

Truth be told I’ve personally been struggling with digestive issues for a while now... called SIBO. I know what you’re thinkingwhat is SIBO?!

SIBO stands for Small Intestinal Bacterial Overgrowth. SIBO is defined as excessive bacteria in the small intestine, when bacterial population exceeds 105 – 106 organisms/mL. The condition is commonly characterized by extreme bloating, diarrhea, flatulence and abdominal pain.

But you thought gut bacteria was a good thing? And you’re not wrong. A healthy gut microbiome aids in digestion, improves immunity and lets not forget the gut-brain connection. However, there are many different types of bacteria in our gut. Some great and some not as great…. And when we have an overgrowth of bacteria it creates a dysbiosis in our digestive tract. Additionally, these intestinal bacteria should be housed in the large intestine not the small intestine.

There are two processes that are thought to commonly predispose one to bacterial overgrowth; diminished gastric acid secretions and dysfunctional migrating motor complex. Diminished gastric acid is a risk factor of SIBO because gastric acid suppresses the growth of ingested bacteria. Normal gastrointestinal tract motility is a tightly coordinated event designed to move material through our digestive tract known as peristalsis. Delaying gastric peristalsis can lead to SIBO due to the stasis of food and bacteria in the upper gastrointestinal tract. Meaning that, ideally the small intestine must empty itself between meals, however if it is not able to empty, the leftover bacteria are able to ferment residual carbohydrates producing various gasses such as hydrogen, methane and carbon dioxide. The likelihood of developing SIBO is also increased with disturbed gut immune function, anatomical abnormalities and a diet high in refined and processed foods. The bacterial overgrowth induces an inflammatory response in the intestinal mucosa furthering exasperating symptoms of SIBO.

It has been apparent in recent research that it is more prevalent than previously thought. Those with SIBO may have varying degrees of overgrowth and symptoms. We are just beginning to understand the ins and outs of SIBO. Many people have initially been diagnosed with IBS (irritable bowel syndrome) but with recent SIBO testing have found out that it was actually SIBO all along. A typical dietary approach to IBS is one of low FODMAPs, that is foods that are Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. FODMAPs are short chain carbohydrates that are poorly absorbed in the small intestine. The confusion in diagnosis lies in that SIBO also feeds on fibre or high FODMAP foods.

If you suffer from many of the following symptoms, it may be SIBO. Please consult your medical professional regarding your symptoms.

  • Extreme bloating

  • Abdominal distension

  • Abdominal pain or discomfort

  • Diarrhea, constipation or both

  • Flatulence

  • Weight gain after eating high fibre foods

  • Fibre worsens symptoms

Testing for SIBO

Your naturopathic doctor or medical doctor can order a breath test through SIBO Canada. The test measures levels of hydrogen and methane (gasses produced by SIBO) in your breath. If either hydrogen or methane levels are higher than 20 ppm of the baseline you are positive for SIBO.

Eradicating SIBO

I’ll be honest it’s not easy. And depending on the level of overgrowth it may take some time and money before it is eradicated.

  1. To begin with your naturopathic doctor or medical doctor will prescribe a combination anti-microbials or antibiotics (rifaximin) to initiate SIBO die off.

  2. This is followed by a gut healing protocol and the introduction of the anti-SIBO diet.

The anti-SIBO Diet

The anti-SIBO diet is quite restrictive being that we are essential removing all foods that feed SIBO bacteria aka fibre. That’s where I come in as a Certified Holistic Nutritional Consultant. A customized anti-SIBO meal plan can help you navigate what you can actually eat. It’s suggested that one has 4 hours between meals to allow the small intestine to empty completely.

In short, foods included on the anti-SIBO diet are:

*= in moderation

  • Banana

  • Bell peppers

  • Blueberries*

  • Bok choy

  • Broccoli*

  • Butternut squash*

  • Cabbage*

  • Carrots

  • Chives

  • Citrus

  • Collard greens

  • Cucumber

  • Eggplant

  • Endive

  • Fats and oils

  • Fennel

  • Grapes

  • Green beans

  • Kale*

  • Kiwi

  • Lettuce

  • Meat, fish, shellfish, eggs

  • Melons

  • Olives

  • Pineapple

  • Pomegranate*

  • Radish

  • Raspberries*

  • Rutabaga

  • Spinach*

  • Strawberries*

  • Swiss chard

  • Tomato

  • Zucchini*

Canny, G.O. & McCormick, B.A. Bacteria in the intestine, helpful residents or enemies from within. Infection & Immunity. 2008; 76(8): 3360-3373.

Dukowicz, A.C., Lacy, B.E., & Levine, G.M. small intestinal bacterial overgrowth:

a comprehensive review. Gastroenterology & Hepatology. 2007; 3(2): 112-122.

Furnari, M. et al. Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth. Aliment Pahrmacol. Ther. 2010; 32: 1000-1006.

Ghoshal, U.C. How to interpret hydrogen breath tests. J. Neurogastroenterol. Motil. 2011; 17(3): 312-317.

Ghoshal, U.C., Shukla, R. & Ghoshal, U. Small intestinal bacterial overgrowth and irritable bowel syndrome: a bridge between functional organic dichotomy. Gut and liver. 2017; 11(2): 196-208.

Morstein, M. SIBO. azimsolutions.com

Siebecker, A. SIBO Diet. Siboinfo.com