The gastrointestinal tract is the habitat of a huge number of bacteria, the community of which is regarded as an independent organ of microbiomes.
The composition of the normal microbiota of each biotope of the gastrointestinal tract has its own characteristics.
The small intestine is the largest part of the digestive tract.
In this area, food mixes with digestive juice and the absorption of essential minerals and vitamins into the bloodstream happens.
Small intestine bacterial overgrowth (SIBO) is characterized by the presence of an excessive number of bacteria in the proximal small intestine.
In a healthy person, the proximal portion of the small intestine contains 105 — 106 bacteria/ml of contents, mainly positive aerobic bacteria.
A sufficiently low bacterial content is ensured by normal peristaltic activity, secretion of hydrochloric acid, the production of mucus, IgA and the function of the ileocecal valve.
For various reasons, this balance of intestinal bacteria can be wrecked.
The intestinal bacteria can change not only in number but also in content.
Initially, it was believed that it occurs only in a small number of patients, but now it is obvious that this disorder is more common.
According to statistics, one out of four individuals faces SIBO at one or another time in their life.
SIBO is defined as excess bacterial growth in the small intestine.
Everyone knows that bacteria are normal in a healthy digestive tract.
All bacteria vary in type and concentration depending on the location in the digestive system.
Some bacteria, for example, probiotics are very useful for our body.
However, other types of bacteria that are useful in one place can do great harm in another.
This is what happens with SIBO syndrome when too many bacteria of the colon enter the small intestine.
These gut bacteria are essential for fighting bad bacteria, maintaining healthy immune functioning, improving nutrient absorption, and promoting the production of vitamin K.
It is well known that problems such as SIBR occur when bacteria in the large and small intestines mix or go out of balance.
But why this happens is a more complex issue.
This syndrome is still poorly understood.
However, you can take steps to first identify it and then take measurements to treat SIBO.
SIBO diet and probiotics are the main steps in this treatment process.
What is SIBO Symptoms?
You can find out if you have SIBR by paying attention to skin condition and general well-being.
If you constantly feel weak and notice digestive problems that are not related to any infection, you may need to take action.
The main danger of the syndrome is that the body does not receive enough micro and macro elements, as a result of which you can develop anemia, a chronic deficiency of B vitamins, especially B12, without which nutrients are not absorbed.
Therefore, in the presence of symptoms, of course, it is very important to undergo a full medical examination and pass all the tests.
Here are some symptoms of the SIBO condition:
- Weight loss due to insufficient absorption of protein and fat;
- Steatorrhea and polyfecalia
- Distensional pain syndrome (aching pain in the lower abdomen, umbilical region, decreasing after gas discharge or defecation)
- Formation of oxalate kidney stones
- Deficiency of vitamins A, D, E, K
- Macrocytic anemia due to increased consumption of vitamin B12 by the bacterial flora
- Chronic endotoxemia syndrome (weakness, increased fatigue, decreased productivity, sleep disturbance, headaches)
- In advanced cases, peripheral edema due to progressive protein
- Weight loss due to insufficient absorption of protein and fat;
There are several reasons that can cause SIBO syndrome.
These can include the following:
- Functional diseases and motor impairment – the main mechanism for removing the contents of the small intestine – phase III of the migratory motor complex (MMC). With IBS, drug use, diabetes, pseudo-obstruction of the small intestine, radiation enteritis and scleroderma a decrease in MMC activity may be observed
- Anatomical abnormalities can lead to SIBO due to inactivity in the small intestine. The causes of abnormalities may be adhesions after surgeries, IBD, tumors, and others
- Metabolic and systemic diseases – during diabetes, SIBO can develop due to intestinal neuropathy. Diseases of the liver and pancreas lead to disruptions in the number of enzymes and bile composition, which can provoke SIBO
- Immune pathology – a possible mechanism of bacterial colonization is a decrease in local immune defense (including with HIV).
The goal of treatment of patients with small intestine bacterial overgrowth syndrome is to eliminate excess bacterial seeding of the small intestine, restore the intestinal microbial community, and normalize intestinal digestion.
In parallel, symptomatic treatment is carried out aimed at eliminating or reducing the severity of the main symptoms of the disease.
A therapy aimed at eliminating the underlying cause of the disease is of most importance.
Dietary requirements in patients with this pathology consist of recommendations for the use of products of natural origin.
The main elements of this therapeutic nutrition are products containing dietary fiber (food bran, etc.), bifidobacteria (bifid-containing kefir, yogurt), oligosaccharides from plants, dairy products and synthetic origin (lactulose).
The purpose of dietary fiber for this syndrome should be very individual (no more than 25-35 g/day) since their overdose can cause worsening of the symptoms (increased flatulence, pain, etc.).
Treatment of SIBO with Probiotics
Theoretical background for the effectiveness of probiotics makes them a very attractive way to treat SIBO.
In addition, the probiotic safety profile is much more favorable than antibiotics.
To date, a series of studies on the effectiveness of probiotic strains have shown conflicting results.
However, interesting data were obtained in a randomized study comparing the effectiveness of amoxicillin-clavulanate 1500 mg/d, norfloxacin 800 mg/d, probiotic Saccharomyces boulardii 1,500 mg/d and placebo.
The comparative research on the effectiveness of Saccharomyces boulardii and antibiotics in the treatment of SIBO results showed that in all randomized groups of patients with SIBO diseases who took antibiotics and probiotic, the intensity of diarrhea decreased compared with the placebo group.
In addition, hydrogen excretion decreased in all patients, and in 60% it was below normal.
Considering the safety of the probiotic Saccharomyces boulardii, its use, as well as the use of probiotics with similar effect, can be considered preferable for the treatment of SIBO in comparison to antibacterial drugs.
The main goal of diet therapy is to supply nutrients that will be absorbed as much as possible, without leaving energy for bacteria to reproduce.
Since bacteria in the intestines metabolize mainly carbohydrates and not fats, it is preferable to eat foods with a reduced content of non-absorbable carbohydrates.
The best option is a low-carb, high-fat diet with minimal inclusion of dietary fiber.
Patients with SIBO often have lactose intolerance.
It is advisable to conduct a hydrogen lactose test to confirm this condition and limit lactose-containing products when intolerance is confirmed.
In the presence of malabsorption, an additional amount of deficient nutrients is necessary.
Multivitamins with vitamins B12, D, K, zinc, and iron should be taken daily.
High levels of vitamins also help fight or reduce the chances of developing SIBO.
SIBO diet means small portions several times a day instead of three large meals.
An excessive amount of food limits the production of acid in the stomach, and, therefore, an appropriate environment will be created for the reproduction of bacteria in the small intestine.
In the beginning, one should follow a strict diet for about two weeks, eating and avoiding foods from the list below.
Gradually, foods rich in probiotics are introduced, but not yogurt bought at the supermarket, but homemade or organic, cultivated vegetables, natto, kombucha, and fermented foods, such as sauerkraut.
All grains, processed sugars, high starch foods, processed foods and inorganic meat dairy products should still be avoided for some time.
After SIBO syndrome is treated and a well-balanced diet is recommended.
Sibo diet recipes (sibo diet food list):
Foods to avoid:
- Sweeteners: agave, artificial sweeteners, high fructose corn syrup, sorbitol, mannitol, xylitol, maltitol, maple syrup, more than 2 tsp honey, coconut sugar
- Fruit: apples, apricots, boysenberry, blackberries, cherries, figs, dates, grapefruit, mango, persimmons, pears, peaches, plums, prunes, and watermelon
- Vegetables: onions, garlic, shallot, cauliflower, sweet corn, mushrooms, snow pea, soybean, Jerusalem artichoke, asparagus, sugar snap peas
- Grains/Starch: wheat, barley, rye, inulin, sweet potato, chicory root, beans, more than ½ cup chickpeas, arrowroot, tapioca, gums, corn starch, and maltodextrin
- Additional: teas (chamomile, fennel, oolong), sauces (tamari), rum, fermented foods
Foods to eat:
- Fibrous vegetables (greens, cucumbers, carrots, squash, tomatoes)
- Fresh fruits
- Tuna and salmon
- Beef and lamb
- Raw hard cheeses
- Almond or coconut milk
- Fresh berries (blueberries, strawberries, currants)
- Nut butter