What is SIBO?
Small Intestinal Bacterial Overgrowth or SIBO is the abnormal overgrowth of bacteria in the Small Intestine. These bacteria ferment the food you eat, produce Hydrogen and Methane gases that lead to the many symptoms typically found in Irritable Bowel Syndrome. In fact it is estimated SIBO causes about 60 - 70 % of IBS cases (1)
HOW IS SIBO DIAGNOSED?
SIBO is diagnosed by a Lactulose Breath Test. Hydrogen and Methane gas are produced by bacteria and measured on a breath test. The North American Consesus defines an increase in Hydrogen greater than 20 ppm from baseline within 90 min as positive and an increase in Methane greater than 10 ppm at any time as a positive SIBO test.
A positive Hydrogen breath test is more strongly correlated to IBS-D (loose stools). The overgrowth of Methane producing bacteria ( also referred to as Intestinal Methanogen Overgrowth) is more correlated to IBS-C constipation type. Methane CH4 has been shown to directly slow down intestinal transit time and cause constipation (2)
WHAT ARE THE SYMPTOMS OF SIBO?
The overgrowth of bacteria in the small intestine may produce many different symptoms. These commonly include (1)
Types of SIBO?
There are 4 main types of SIBO:
CLUES YOU MAY HAVE IT
If you notice you experience some of these symptoms, they could be clues you may actually have SIBO. If you answer yes to any of the questions below, discuss testing for SIBO with your health care practitioner.
It is diagnosed by a breath test. However, if you notice your symptoms get worse with pre or probiotics, worse with fiber, you feel better when you take antibiotics for another condition and sugar alcohols make you feel worse ( xylitol, erythritol etc ) you may actually have SIBO.
WHAT CAUSES SIBO?
There are many different reasons that may increase the risk of developing small intestinal bacterial overgrowth. The most common reason to develop Hydrogen dominant SIBO is having a history of food poisoning. Bacteria that have been associated with the development of SIBO include Campylobacter, E coli, Salmonella and Shigella.
Other reasons that may increase both Hydrogen and Methane SIBO include medical conditions that impair motility such as hypothyroidism, Traumatic brain injury, diabetes and chronic infections. Chronic stress, difficulties with bile flow, low digestive enzymes and low stomach acid levels may also increase the risk of developing the condition. Endometriosis and abdominal surgery may also affect intestinal flow and increase the risk.
OTHER CONDITIONS THAT MAY BE ASSOCIATED
Bacterial overgrowth in the Small Intestine and the inflammation that accompanies SIBO may lead to the malabsorption of certain vitamins and minerals. Iron deficiency or difficulties absorbing iron may result from having SIBO. These bacteria may also affect bile flow and lead to a deficiency in fat soluble vitamins including Vitamins A, D, E and K. This may result in symptoms such as dry skin, brain fog, getting colds and flus frequently, hair thinning, mouth ulcers, easy bruising, anxiety, depression and fatigue.
Medical Conditions that may be associated with small intestinal bacterial overgrowth include:
TREATMENT OF SIBO
At Vitalia Health Care INC in Vancouver, we take a comprehensive approach when treating SIBO. This may include:
TREATING LOWER COLON BACTERIAL OVERGROWTH
The bacteria found in SIBO are usually an overgrowth of bacteria that are normally found in the lower colon. If you are experiencing foul smelling gas, Hydrogen Sulfide producing bacteria may be to blame.
Hydrogen Sulfide gas may lead to more intense symptoms such as body pain, bladder irritation, tingling in the hands and feet, feeling unwell overall and worse food intolerances (you feel like you react to so many different foods).
Hydrogen Sulfide bacteria, Fungal overgrowth and Parasites can be tested with a PCR-DNA stool test
At Vitalia Health Care INC in Vancouver we take a comprehensive approach when treating digestive problems. Book an APPOINTMENT today with one of our Naturopathic Physicians. We are available for in-person, phone or video appointments.
Small Intestinal Bacterial Overgrowth (SIBO) is a digestive condition where there is an overgrowth of bacteria in the small intestine. These bacteria will ferment the food you eat and produce gases such as hydrogen and methane. These gases can lead to symptoms such as bloating, gas, diarrhea, constipation, belching, heartburn and abdominal pain.
✔ Gas, sometimes odorous
✔ Bloating, especially within 1✔2 hours after eating
✔ Belching
✔ Diarrhea or Constipation or Mixed bowel patterns
✔ Abdominal pain or discomfort
✔ Acid reflux
Yes, Small Intestinal Bacterial Overgrowth (SIBO) may contribute to symptoms outside of the digestive system. The toxins produced by the bacteria may contribute to symptoms such as:
✔ Brain fog and difficulty concentrating
✔ Fatigue and low energy
✔ Skin conditions such as eczema, psoriasis, and rosacea
✔ Bad breath (halitosis)
✔ Sinus congestion or chronic sinus symptoms
These body symptoms are one reason why proper SIBO diagnosis and treatment is important for overall health, not just gut health.
There are a number of possible reasons a person may develop SIBO. One of the most common reasons is having a history of food poisoning. Other possible reasons include:
✔ Poor gut motility (slow digestion)
✔ Low stomach acid or digestive enzymes
✔ Abdominal surgery or endometriosis
✔ even having a concussion may contribute to the development of SIBO
Different conditions that disrupt digestion may contribute to developing SIBO.
At Vitalia Health Care INC in Vancouver, we recommend either a lactulose or glucose breath test. This test measures hydrogen and methane gas levels produced by bacteria in the gut. Elevated gas levels within a specific time frame indicate a positive result. Your Naturopathic Doctor at Vitalia Health Care INC is experienced and trained in both testing and treatment of SIBO.
There are several types of SIBO based on the dominant gas:
✔ Hydrogen-dominant SIBO - often linked to diarrhea
✔ Methane-dominant SIBO (IMO) - often associated with constipation
✔ Mixed SIBO - may contribute to alternating diarrhea and constipation
✔ Hydrogen sulfide SIBO - may be linked to diarrhea, foul gas, and general systemic symptoms
Each type of SIBO may require a slightly different treatment approach. Your Naturopathic Doctor at Vitalia Health Care INC will develop a treatment plan customized for your based on your symptoms, health history and test results.
Yes. Research suggests that SIBO may be responsible for 60-70% of Irritable Bowel Syndrome (IBS) cases, especially those involving bloating and irregular bowel movements (Ref)
we take a personalized and comprehensive approach to treating Small Intestinal Bacterial Overgrowth (SIBO). Every treatment plan is tailored to the patient based on symptoms, medical history and test results.
Treatment options for SIBO may include:
✔ Antimicrobial therapy, including prescription antibiotics or herbal antimicrobials
✔ Personalized nutrition and dietary guidance. Our Registered Dietitian, Zahra Tromsness, is experienced in helping patients manage digestive symptoms through evidence-based nutrition recommendations.
✔ Digestive support therapies to improve overall digestion and help reduce the recurrence of SIBO symptoms. This may include the assessment and support for stomach acid levels, digestive enzymes and probiotics. As each person is unique, your SIBO treatment plan is personalized for your unique health needs. Digestive support therapies are not indicated for everyone. Your Naturopathic Doctor at Vitalia Health Care INC will recommend therapies appropriate for your digestive health.
✔ Herbal medicine and supplements designed to support healing of the intestinal lining and improve gut health
✔ The addition of a Prokinetic (pharmaceutical or herbal) to support and help improve intestinal motility and reduce the rate of SIBO relapse.
✔ Assessment and treatment of fungal overgrowth, including Small Intestinal Fungal Overgrowth (SIFO), when clinically indicated.
✔ Food sensitivity testing to help identify foods that may be contributing to inflammation, bloating, or digestive discomfort.
If you are experiencing symptoms such as bloating, gas, abdominal pain, constipation, diarrhea, or food sensitivities, our team of Naturopathic Doctors will work with you to help identify the root cause and create a personalized treatment plan to support long-term digestive health.
Yes, SIBO may recur. Research suggests that SIBO recurrence is common, with studies showing relapse rates of approximately 44% within 9 months after treatment if underlying causes are not fully addressed. Ref
Other digestive health concerns may contribute to persistent or relapsing SIBO. Some of these conditions include:
✔ Intestinal inflammation which may include Irritable bowel disease ( IBD)
✔ Bacterial overgrowth in the lower digestive tract ( lower colon dysbiosis)
✔ Yeast or fungal overgrowth including Small Intestinal Fungal Overgrowth (SIFO)
Yes. In addition to SIBO testing, there are other functional tests that may provide valuable insight into the root causes of your symptoms and help guide a more personalized treatment plan. We may recommend the following tests based on their initial assessment and treatment recommendations
✔ Comprehensive Stool testing such as the GI360 stool test
✔ Food sensitivity testing
✔ Cortisol testing (Since stress can affect gut motility and digestion, evaluating cortisol levels may help identify underlying factors contributing to digestive issues and symptoms)
If you are experiencing symptoms such as chronic bloating, gas, loose stools and / or constipation, heartburn and belching, consider getting tested for SIBO. Other reasons you may want to get tested for SIBO include:
✔ IBS symptoms that don’t improve with standard treatment
✔ Symptoms that worsen with probiotics or fiber
✔ You notice a temporary improvement with antibiotics
These can be strong indicators of bacterial overgrowth.