Small intestinal bacterial overgrowth — commonly referred to as “SIBO” — can be thought of as a four-letter word for bloating, excess gas, abrupt changes in your bowel patterns and general digestive misery. Because the condition is often mistaken for irritable bowel syndrome, or IBS, people can suffer with SIBO for months — if not years — before the condition is properly diagnosed and treated.
[See: Foods That Cause Bloating.]
With each passing year, I see more and more patients affected by this condition, and I’ve noticed that many of them arrive in my office with similar misconceptions about it. As I realized while writing an entire chapter on SIBO for my upcoming book, “The Bloated Belly Whisperer,” there are four facts about SIBO in particular that prevailing internet lore continues to get wrong. Allow me to set the record straight.
1. SIBO is not an infection, and it’s generally associated with an underlying condition.
There’s a popular misconception that SIBO is an intestinal bacterial infection — something you can “catch” in a way similar to food poisoning or come down with as the result of having too much “bad bacteria” in your digestive tract. It is neither of these things. SIBO typically develops as the result of something else gone awry in your system that renders your small intestine too hospitable to the normal, friendly bacteria that typically stay put in your large intestine (colon) where they belong.
In other words, SIBO is a case of having too many benign bacteria living in the wrong neighborhood of your gut. Therefore, if you have developed SIBO, you’ll want to talk to your doctor about identifying and, when possible, treating the underlying cause. If you can treat the thing that’s making your small bowel so hospitable to bacteria in the first place, you can prevent the condition from coming back.
2. SIBO can absolutely be cured.
One particularly troubling myth about SIBO is that it always comes back, even when treated with antibiotics, so there’s no point in even taking medication. In reality, SIBO is routinely cured and often stays away for prolonged periods of time, if not for good. It’s true that there are a few predisposing factors for SIBO for which no remedy is available, and the unlucky people with these risk factors are at high risk for chronic recurrence. But many risk factors for SIBO can be addressed, meaning that recurrence is not a given if the underlying cause can be corrected.
But what about recurrent SIBO, you ask? Indeed, many people suffer from it, and I have a few guesses as to why — and none of them are because the condition isn’t treatable. First, not everyone responds to the first antibiotic medication their doctor prescribes, and often, these patients aren’t offered another course of antibiotics. Among patients who are offered another course of antibiotics, it’s often the same drug that didn’t work the first time. This means the initial overgrowth was never fully treated, and it persists over time. Second, many doctors do not follow through with the diagnostic detective work to identify and resolve SIBO’s underlying risk factor, making recurrence likely. And finally, many people choose to take bacterial probiotic supplements for SIBO under the mistaken impression that their condition resulted from an imbalance of “good versus bad” bacteria. In theory, these probiotics could actually be what’s causing SIBO to recur.
[See: 10 Lessons From Empowered Patients.]
3. Probiotics for SIBO may be part of the problem — not part of the solution.
There is no research-based answer as to whether probiotics for SIBO are helpful. But despite this lack of evidence, the internet is full of self-proclaimed experts advising all manner of probiotic supplement protocols claiming to treat or prevent SIBO. Consider this: If SIBO represents an overgrowth of normal (aka benign or “good”) bacteria in a neighborhood that’s too hospitable to bacteria, isn’t it possible — and even likely — that these supplements are actually “seeding” the recurrence by delivering concentrated doses of bacteria day after day? In the gastroenterology and nutrition practice I work in, my colleagues and I have come to believe this may be the case for many of our patients with SIBO, particularly those whose SIBO results from having low stomach acid or slow motility in their small intestines.
For this reason, patients in our practice who have a history of SIBO are advised to limit probiotic use to yeast-based strains like Saccharomyces boulardii (commonly marketed as Florastor) that cannot overgrow in the small bowel.
4. Diet has not been shown to cause or cure SIBO.
Patients who are medication-averse are often looking for natural treatments for SIBO, and routinely ask me how to cure SIBO with diet. I wish I could say that there is evidence for a SIBO diet that cures or prevents the condition, but to date, there isn’t. The role of diet for SIBO is to help manage your symptoms until you are able to be treated — and a few diets have indeed been shown to be remarkably effective at doing so.
The low-FODMAP diet, for one, is arguably the least restrictive way to get maximum symptom control — or the best bang for your dieting buck. It’s the approach I recommend in my clinical practice. So-called elemental diets — or diets consisting exclusively of powders or drinks that contain pre-digested nutrients — are also effective at symptom control, but they are extremely costly and incredibly unpleasant to drink. You may feel relief while limiting your diet to these powders, but you’ll tire of them quickly, and as soon as you resume a normal diet, the SIBO symptoms will be back in short order.
[See: 8 Food Trends Nutrition Pros Pray Will Never Return.]
The idea circulating online that restricting your diet when you have SIBO can somehow “starve” the bacteria and cure SIBO naturally has not been demonstrated in scientific studies. You can certainly suppress bacterial populations in all segments of the gut — small intestine and colon alike — to a modest extent with diet restriction, but you’ll never come close to eradicating them. Furthermore, staying on these restricted diets once your SIBO has been treated has not been demonstrated to be an effective strategy for prevention of recurrence — at least not to date. Be aware that diet restriction affects all bacterial communities in the gut; its effects cannot be limited to those communities overgrowing in the small intestine alone. For this reason, prolonged adherence to a highly restricted diet could have unintended adverse effects on the healthy diversity and balance of your colon’s microbiota.
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4 Facts About SIBO the Internet Keeps Getting Wrong originally appeared on usnews.com
