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Bacterial Overgrowth of the Small Intestine (SIBO)

How to Treat Small Intestinal Bacterial Overgrowth.

The two most common treatments for small intestinal bacterial overgrowth or SIBO among patients with Irritable Bowel Syndrome are oral antibiotics and probiotics, the live bacteria that, when ingested by an individual, result in a health benefit. The most common probiotic bacteria are lactobacilli (also used in the production of yogurt) and bifidobacteria.(as quoted from Medicine.Net)

Both of these bacteria are found in the intestine of normal individuals. There are numerous explanations for how probiotic bacteria might benefit individuals. However, the beneficial action has not been identified clearly. It may be that the probiotic bacteria inhibit other bacteria in the intestine that may be causing symptoms, or it may be that the probiotic bacteria act on the host's intestinal immune system to suppress inflammation.

Several antibiotics either alone or in combination have been reported to be successful. Treatment success, when measured by either symptom improvements or by normalization of the hydrogen breath test, ranges from 40-70%. When one antibiotic fails, the doctor may add another antibiotic or change to a different antibiotic. However, the doses of antibiotics, the duration of treatment, and the need for maintenance therapy to prevent recurrence of SIBO have not been adequately studied. Most physicians use standard doses of antibiotics for one to two weeks. Probiotics may be used alone, in combination with antibiotics, or for prolonged maintenance.

When probiotics are used, it probably is best to use one of the several probiotics that have been studied in medical trials and shown to have effects on the small intestine, though not necessarily in SIBO. The commonly sold probiotics in health-food stores may not be effective. Moreover, they often do not contain the bacteria stated on the label or the bacteria are dead.

Commercially available probiotics such as VSL#3, which are mixtures of several different bacterial species, have been used for treating SIBO and IBS, but their effectiveness is not known. Bifidobacterium infantis 35624 (probiotic that is contained in OMX Probiotics & VSL#3) is the only probiotic that has been demonstrated to be effective for treating patients with IBS.

More Natural Recommendations

  • Diet - Limit intake of sweet and starchy foods. People usually experience a noticeable decline in bloating, gas, indigestion, diarrhea, and other digestive symptoms when they do this. A popular diet for bacterial overgrowth is the specific carbohydrate diet by Elaine Gottschall. This diet limits grains, starchy vegetables, and some legumes, and was created to address digestive disorders such as bacterial overgrowth, Crohn's disease, and ulcerative colitis.
  • Eradicate unfriendly bacteria in the small intestine using natural agents like grape fruit seed extract, oregano, & berberine.
  • Support Digestive Function: Digestive enzymes - digestive enzyme supplements can support the body's digestive enzymes until function is restored. They should be taken before meals. A typical dose is one capsule before each meal. Also see Intestinal Repair Capsules, & Glutamine.
  • Medium Chain Triglycerides - Medium chain triglycerides are often recommended for people with bacterial overgrowth or any type of malabsorption because unlike regular oils, which a person with bacterial overgrowth may not be able to assimilate, medium chain triglycerides are absorbed directly without the need for digestive enzymes. Coconut oil is a medium chain triglyceride.
  • Vitamins and Minerals that may be deficient in people with bacterial overgrowth include vitamin B12, magnesium, calcium, iron, zinc, copper, vitamin A, Vitamin D, Vitamin E & Vitamin K.

How to test for Small Intestine Bacterial Overgrowth SIBO?

Hydrogen breath test

Bacteria that live in the colon are able to digest and use sugars and carbohydrates as food. When the bacteria normally present in the intestine digest sugars and carbohydrates, they produce gas, usually mainly carbon dioxide, but also smaller amounts of hydrogen and methane. These are the types of bacteria found usually in the esophagus, stomach, and small intestine and produce little gas.

Most of the sugars and carbohydrates that we eat are digestible and are absorbed in the small intestine and never do reach the bacteria of the colon. Also, more than 80% of the gas that is produced by bacteria in the colon is used up by other bacteria. This means that relatively little of the gas that is produced remains in the colon and may be eliminated as flatus.

Although most of the hydrogen and methane produced by colonic bacteria is used up by other bacteria, small amounts of these gases are absorbed through the lining of the colon and into the blood. The gases circulate in the blood and go to the lungs, where they are eliminated in the breath. The gases may be measured in the breath. see more information on Genova Lab's Bacterial Overgrowth of the Small Intestine Breath Test.

Small intestine bacteria overgrowth SIBO & Irritable Bowel Syndrome (IBS)?

There is a striking similarity between the symptoms of Irritable Bowel Syndrome and Overgrowth of Bacteria in the Small Intestine or SIBO. Some say that Small intestine bacteria overgrowth may be the reason for the symptoms of at least some patients with irritable bowel syndrome - could be as high as 50% of those with with irritable bowel syndrome. Many irritable bowel syndrome sufferers are found to have an abnormal hydrogen breath test. Also, some patients with irritable bowel syndrome have improvement of their symptoms after treatment with probiotics, one of the primary treatments for small intestine bacteria overgrowth or SIBO.

What is Bacterial Overgrowth of the Small Intestine (SIBO)?

The small intestine is also known as the small bowel. This is the part of the digestive tract the joins the stomach to the large intestine. It's main function is to digest food and also absorb food into your body. This section of the digestive tract is about 21 ft long. It starts with the part called the duodenum, where the food from the stomach transfers. Then there is the part called the jejunum. And lastly there is the ileum, which is the part that transfers the food that has not already been digested, into the large intestine.

Everywhere in the gastrointestinal tract, including the small bowel, there is bacteria - good bacteria and bad bacteria. The largest number live in the large intestine. They say that there are at least 1,000,000,000 bacteria per milliliter (ml) of fluid. A much smaller number live in the small intestine, like less than 10,000 bacteria per ml of fluid. It is important to know that the type of bacteria that are present in the small intestine are different to those that are in the large intestine.

When you have a small intestinal bacterial overgrowth (SIBO) there is an abnormally large number of bacteria (at least 100,000 bacteria per ml of fluid) in the small intestine and also, the types of bacteria in the small intestine look more like the bacteria of the colon than the small intestine.

What causes small intestinal bacterial overgrowth?

It is important to think of the digestive tract as one continuous muscular tube. The food from the stomach is propelled through into the small intestine and then further into the large intestine by muscular activity. Interestingly enough, even when there is no food in the small intestine, muscular activity continues through the small intestine from the stomach to the large intestine.

This muscular activity is not only important for the digestion of food, but also is important to propel bacteria out of the small intestine and thus limit the quantity of bacteria in the small intestine. There are many things that may interfere with the normal muscular activity through the small intestine. This may allow the bacteria to stay longer and also proliferate in the small intestine. Lack of muscular activity may also permit bacteria to go backwards from the large intestine back into the small intestine.

Conditions that are associated with Small Intestinal bacterial Overgrowth (SIBO)

  • Diverticuli or out-pouchings of the small intestine that allow pathogenic bacteria to multiply inside diverticuli.
  • Partial or intermittent obstruction of the small intestine - adhesions (scarring) from previous surgery and Crohn's disease.
  • Neurologic and muscular diseases can alter the normal activity of the intestinal muscles.
  • Diabetes mellitus damages the nerves that control the intestinal muscles.
  • Scleroderma damages the intestinal muscles directly.

The symptoms of small intestinal bacteria overgrowth SIBO include:

  • bloating and distension,
  • excessive gas,
  • loose stools, and
  • pain in the abdomen.
  • there are a few sufferers who experience chronic constipation.

With severe and long lasting SIBO, the pathogenic bacteria may affect the digestion and/or absorption of food. This leads to deficiencies of vitamins and minerals.

Weight loss also may occur.

Sometimes symptoms are unrelated to the gastrointestinal tract like body aches or fatigue.

Very often SIBO will be chronic, the intensity of symptoms may fluctuate and may remain undiagnosed for months and even years.

What is the relationship between bacteria and the small bowel?

There are no bacteria in the gastrointestinal tract when a baby is born, but during birth, bacteria from the mother's colon and vagina are swallowed by the infant so that after a few weeks or months, they proliferate in the infant's gastrointestinal tract. These beneficial bacteria stimulate the growth of the intestinal lining as well as the immune system of the intestine. They also prevent the growth of pathogenic bacteria in the gut. They produce vitamin K, which is absorbed and used by the host. The beneficial flora (or bacteria) are important even for the muscular activity of the small intestine. So, without good bacteria, there is reduced muscular activity.

Its important to note that the intestine does not attack the beneficial bacteria, only disease-causing or pathogenic bacteria. Mucus that is secreted into the intestine lines the intestinal wall and prevents the bacteria from being in touch with the lining. Antibodies are secreted by the intestine that may block, and sometimes kill, bacteria as well as substances that prevent the growth of bacteria. The intestinal lining can also produce receptors for toxic bacterial substances and can prevent the substances from having their toxic effects and so result in small intestinal bacterial overgrowth


What Conditions cause increased production of gas?

  • Bacterial Overgrowth of the Small Intestine
  • Malabsorption of sugars and carbohydrates.
  • Rapid intestinal transit.