SIBO: Small Intestinal Bacterial Overgrowth
SIBO is attributed to many irritable bowel diseases and usually is diagnosed as irritable bowel syndrome. It’s not an infection but rather an overgrowth of bacteria in the small intestine which proliferates due to a slow metabolism.
The vast majority of your gut bacteria should live in the large intestine and only a small portion should be living in the small intestine. But with SIBO, your intestinal bacteria expands and colonizes in your small intestine which damages the cell lining. This is what can lead to leaky gut and allow large protein molecules to seep into the bloodstream. This stimulates inflammation and immune reactions which is how food sensitivities and autoimmune diseases begin.
The small intestine is extremely important as it’s responsible for nutrient absorption. It breaks down the food you eat using pancreatic enzymes and bile from your liver. With SIBO, its not uncommon to have nutritional deficiencies like iron, B12 and fat-soluble vitamins; A, D, E and K. This is because SIBO negatively affects both the structure and function of the small intestine therefore compromising nutrient absorption. If SIBO goes unresolved, it can lead to a carbohydrate intolerance, malnutrition, anemia, anorexia and/or hormone imbalances as the bacteria can change the way hormones are metabolized and excreted.
When your small intestine isn't able to function optimally, you will likely see your large intestine suffer shortly after as everything is inter-connected in the body.
Common Symptoms of SIBO:
Bloating (this is the main one)
As always, test don’t guess! We offer the GI Map test which gives clues to whether SIBO is present or not as well as insight into the rest of the GI tract. Additionally, we do offer SIBO breath tests in certain cases where we need to decipher the type but we do not diagnose.
What are The 3 Types of SIBO?
Hydrogen Dominant- more associated with diarrhea, abdominal pain and nutrient deficiencies
Hydrogen Sulfide Dominant- mainly associated with gas that has a rotten egg smell but also histamine intolerances, joint pain, altering constipation and diarrhea
Methane Dominant- more associated with constipation, acid reflux, weight gain and brain fog
Hydrogen Sulfide is not commonly tested for which is another reason why SIBO is under-diagnosed.
What is SIFO?
SIFO is a fungal overgrowth in the small intestine. It's not nearly as common as SIBO because it usually occurs after SIBO has been left untreated for too long. The treatments are very similar and both are addressed when doing our SIBO Eradication protocol. Antibiotics are unnecessary when treating SIBO or SIFO and are not recommended by us in any circumstance. Anti-bacterial and anti-fungal agents are strongly preferred so the overgrowth doesn't keep repeating itself.
What are FODMAP's? Do I have to go low FODMAP when treating SIBO?
You do not have to go full low FODMAP and you shouldn't. This is how SIBO will return in the future because you are further slowing your metabolism which is the reason SIBO has occurred in the first place. FODMAP's are short chain carbohydrates that are poorly absorbed in the small intestine. FODMAP stands for fermentable, oligosaccharides, disaccharides, monosaccharides and polyols. When a slow metabolism is present, these carbohydrates tend to be very slowly digested which is why they act as fuel for the bacteria in the small intestine. SIBO is a slow motility issue because the food you are eating is hanging around too long and fermenting. The bacteria in your small intestine is what causes these high FODMAP foods to ferment which leads to excess gas byproducts. Temporarily lowering SOME high FODMAP foods is needed to starve the gas producing bacteria and give your gut the time it needs to heal. However, if you go too low FODMAP and cut out all sugar/carbohydrates, your cells will have no energy to fight off this overgrowth. It's a tricky condition to overcome which is why we recommend following our SIBO e-book closely. We also only recommend reseeding and repopulating the microbiome with probiotics after you have confirmed SIBO has been resolved. We do not use probiotics during the treatment protocol, only after.
There is a strong connection between acne and all gut conditions but especially SIBO. One study showed SIBO to be 10x more predominant in people with acne. Why is this? Well it kinda makes sense if you think about how acne is dealt with from a western medicine standpoint. When you go to your doctor with acne, usually one of the first things they prescribe is oral antibiotics. Antibiotics are designed to destroy all bacteria. So if antibiotics are used to temporarily clear your skin, it's safe to say SIBO or some kind of gut bacterial overgrowth is at play when it comes to acne. This isn't the case for everyone but we see it often in our practice. Keep in mind, antibiotics will cause acne and SIBO to return with a vengeance. It is not a long term solution or even a solution at all. The main reasons SIBO can cause acne are due to the effects SIBO can have on your gut health as a whole. It causes microbial imbalances, leaky gut and a lot of inflammation. This has systemic effects on the entire body including your hormones and detoxification system.
Digestive issues like SIBO often cause hormonal acne due to the gut hormone connection. Women with SIBO usually have a bacterial imbalance with their estrobolome which is a collection of gut bacteria capable of metabolizing estrogen and balancing hormones. So if your estrobolome is imbalanced from SIBO, then all your estrogens, progesterone and cortisol will be imbalanced as well, leading to more acne. The bacteria in your estrobolome actually produce an enzyme called beta-glucuronadise. Its job is to turn your estrogens into their active forms and send a certain amount of free estrogen circulating. When your gut microbiome is balanced, then your estrobolome produces just the right amount of estrogen to support hormonal balance. When SIBO or any dysbiosis is present, beta glucoronadise will trigger an increase in free estrogen, throwing all hormones off balance and causing acne.
Overall, we are what we digest and that is exactly what the small intestine is responsible for. It's not about removing dairy and sugar to clear your skin. That is a band-aid approach that only works short term and causes severe imbalances long term. Overcoming acne is about digging deeper to address your hidden stressors so your body is able to digest all foods properly and utilize nutrients as fuel. We work on restoring metabolic and gut health so you can produce the lactase enzyme and be able to tolerate high quality dairy as its actually very beneficial for your skin. We then teach your body how to utilize glucose (sugar) as fuel as its the primary source of fuel for our cells. Our clients are very relieved when they can finally stop symptom chasing and enjoy all foods without their skin suffering.
If you suspect SIBO, it’s time to check out either our 1:1 Membership or our SIBO Eradication E-Book. Working with an experienced SIBO nutritionist can help eliminate the bacteria in your small intestine and restore your metabolism to create a healthy digestive system. This doesn't always mean eating "pro-metabolic" right away nor does it mean cutting out all FODMAP's long term. We offer in-person appointments in Toronto, ON and online worldwide! We also offer a skin clearing program that tackles gut issues like SIBO!