5 signs that you may have SIBO
SIBO stands for small intestine bacterial overgrowth. It sounds like its name: an accumulation of gut bacteria in the small intestine (SI). Up until 1999 there were less than 10 publications on SIBO whereas between 2019 - 2022 that now stands at over 300 publications, evidence of the increase both in the diagnosis and in the existence of SIBO. In this article expert nutritionist Sue Potgieter looks at what SIBO is, how it is diagnosed, and various symptoms associated with it.
What is SIBO?
The small intestine is not designed to house a lot of bacteria, unlike the large intestine. The body has various protection mechanisms in place to prevent the presence of bacteria in the small intestine. When bacteria accumulates in the small intestine instead of passing through, it is known as SIBO.
SIBO is not an infection, although it can behave like one. When the bacteria multiply within the small intestine, it can cause various health issues. The small intestine is designed to handle the movement of bacteria, but this only becomes a problem when the bacteria become stationary.
The function of the small intestine
The main function of the small intestine is the digestion of food and the absorption of nutrients into the body. When there is an overgrowth of bacteria in the small intestine, the bacteria compete with your body for these nutrients. The bacteria are hungry, and as they feed on our food, it can lead to malabsorption of nutrients and damage to the lining of the small intestine.
The different types of SIBO
There are two types of SIBO: hydrogen sulphide type SIBO and methane dominant SIBO (now being called Intestinal Methanogen Overgrowth). They are differentiated by the types of gas that SIBO bacteria produce.
Hydrogen sulphide-type SIBO leads to diarrhoea or constipation and gas that smells of sulphur (rotten eggs). Methane-dominant SIBO causes bloating and increased flatulence due to the production of methane, which slows down transit time. This leads to constipation.
Symptoms of SIBO
The main symptom of SIBO is bloating, which may worsen in the evening or at night. This is due to an increase of gas in the small intestine as the bacteria digest food throughout the day. The bacteria especially love feeding off carbohydrates and sugar, which can exacerbate symptoms.
Other symptoms may include:
- Nausea
- Brain fog
- Anxiety
- Acid reflux
- Fatigue
- Excessive burping
- Joint pain
- Depression
- Abdominal cramps
The majority of symptoms experienced by someone with SIBO are triggered by eating, and therefore food intolerances may develop and restricted dietary habits develop.
Malabsorption of nutrients may also lead to weight loss and anaemia, mainly vitamin B12 or iron deficiency.
Due to the fact that IBS presents with the same symptoms as SIBO, recent studies have found that many patients with IBS symptoms may also have SIBO.
How do I know if I have SIBO?
The diagnostic test for these types of SIBO is a breath test. Speak to your GP or a nutritionist if you suspect that you may have SIBO.
Who is at risk of developing SIBO?
If you’ve already been diagnosed with Crohn’s disease, Parkinson’s disease, GORD, or hypothyroidism, you may be more at risk of developing SIBO. Rosacea, restless leg syndrome, interstitial cystitis, psoriasis and rheumatoid arthritis may also be signposts to possible SIBO.
SIBO can also develop from a bout of food poisoning (even from years ago) or from living in a mouldy house. PPI treatments for acid reflux and GORD such as Omeprazole, Nexium and Lansoprazole have been shown in recent studies to be a significant risk factor for SIBO.
For more information, read our guide on how to deal with SIBO.
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