For millions of Americans, upset stomach, irregular bowel movements, and sensitivity to foods are a regular struggle. And while conditions like IBS (irritable bowel syndrome) and Crohn’s disease are fairly well known, there’s another digestive disorder that’s been gaining more attention recently: SIBO, or small intestinal bacterial overgrowth.
SIBO is defined as the presence of excessive bacteria in the small intestine, which is the longest section of the digestive tract. The small intestine is where food meets digestive nutrients so that they can be broken down and their nutrients absorbed into the bloodstream. However, abnormal bacteria levels can affect the small intestine’s ability to function properly, leading to poor absorption of nutrients—particularly fat-soluble vitamins (vitamin A, vitamin D, vitamin E, and vitamin K) and iron. It can also contribute to other issues.
If you’ve been experiencing digestive upset but aren’t sure of the culprit, SIBO might just be behind it. Although SIBO is a serious condition that can have damaging effects if left untreated, once you pinpoint it as the cause of your woes, it can be remedied with dietary and lifestyle changes.
Signs You Have SIBO
It’s normal to have some bacteria in the colon—it actually helps with digestion. However, when bacteria invades the small intestine, it inhibits nutrient absorption and can damage the intestinal lining, causing symptoms that are similar to those of IBS.
Some of the most common signs of SIBO include:
- Nausea and vomiting
- Weight loss
- Joint pain
- Skin issues like acne, rashes, eczema, and rosacea
- Mood changes (particularly low mood)
If left untreated, SIBO can lead to serious complications, particularly nutrient deficiencies. People with SIBO may become deficient in iron, vitamin B12, calcium, vitamin A, vitamin D, and vitamin K. They also may not properly absorb protein, fats, and carbohydrates. This then contributes to everything from weakness to reduced cognitive function.
Causes of SIBO
So, how does SIBO become a problem in the first place? Several underlying conditions may be linked to it, including:
- Celiac disease
- Dysmotility (when muscles in the digestive system don’t work properly)
- Chronic pancreatitis
- Injury or defect in the small intestine
- Intestinal lymphoma
- Scleroderma (excessive growth of connective tissue)
- Blind loop syndrome (when the small intestine forms a loop)
Aging is also a major risk factor for developing SIBO because the digestive tract slows down as we age, which allows for increased bacterial growth.
Even certain medications are linked to excessive bacterial growth in the small intestine, including:
- medications for immune system disorders such as lupus, rheumatoid arthritis, and multiple sclerosis
- proton pump inhibitors, which are used to reduce stomach acid
How to Address SIBO
SIBO is often treated with antibiotics, which may be necessary in some cases, like when the condition is caused by blind loop syndrome. However, research indicates that SIBO treated with antibiotics has a high recurrence rate. Plus, antibiotic treatment kills both the good and bad bacteria throughout your gut, which can possibly contribute to even more digestive issues.
The good news is that there are many natural ways to ease SIBO symptoms and reduce the presence of bacteria in your small intestine.
1. Eat Smaller Meals
Eating larger meals can exacerbate SIBO symptoms. Because your food sits in your stomach for longer, it reduces gastric juice production, which then means that food particles aren’t broken down properly when transferred to the small intestine, where they can then promote the production of bacteria.
Instead, eating smaller (perhaps more frequent) meals throughout the day allows you to digest foods properly before it travels to the small intestine, which helps ward off excess bacteria production and improves your ability to absorb nutrients.
When eating, make sure to chew each bite thoroughly to stimulate the digestion process and help with the absorption of nutrients.
2. Emphasize Probiotics
Research suggests that using probiotic supplements works to improve the balance of beneficial and harmful bacteria in the digestive tract. Look for a daily supplement that contains the strains Lactobacillus, Streptococcus, and Bifidobacterium—the combination found to be helpful in that aforementioned research.
In addition to taking a probiotic supplement, eat probiotic foods like fermented vegetables and kefir daily to naturally support bacterial balance.
3. Try An Elimination Diet
The first dietary change to make when addressing SIBO is to eliminate FODMAPs for two weeks. These foods contain specific sugars, including fructose, lactose, fructans, galactans and polyols, which aren’t fully absorbed by the body and can then feed bacteria in the digestive tract. So, cut out fruit juices, honey, processed foods (like baked goods and cereals), processed sugars, dairy products, wheat, garlic, onions, asparagus, leeks, artichokes, broccoli, cabbage, Brussels sprouts, soy, legumes, and “sugar-free” products made with artificial sweeteners.
What can you eat during these two weeks, then? Focus on high-quality proteins like wild-caught salmon, grass-fed beef, and free-range poultry and eggs. From there, incorporate quinoa, sprouted nut butters, leafy greens, carrots, cucumbers, tomatoes, and almond or coconut milk. You can also eat certain fruits, including blueberries, bananas, strawberries, cantaloupe, honeydew, and pineapple.
The goal here is to reduce inflammation and repair the intestinal lining by avoiding triggering, inflammatory foods.
4. Take a Multivitamin
If you have SIBO, you’ll need to ensure that you get enough nutrients while your digestive system works to function properly again, so taking a multivitamin is important. Look for a product that contains high amounts of vitamin B12, vitamin D, vitamin K, iron, and zinc.
5. Move Your Body
Research suggests that exercise helps to improve microflora diversity and improve the development of beneficial bacteria. So, to support a balanced gut, you want to keep your body moving, even if it’s with light exercise like yoga, barre, tai chi, and walks outside. If you’re used to more vigorous exercise, then keep it up as long as you listen to body cues to go shorter or less intense—especially while following an elimination diet. The key here is really to avoid being sedentary for long periods of time, so get up every hour or so and move your body.
6. Reduce Stress
Since stress can lead to inflammation and digestive problems, focusing on managing stress can improve SIBO symptoms. Try to set aside some time every single day to get outdoors, garden, take a walk, practice yoga or meditation, read an inspiring book, spend time with loved ones, and get some much-needed rest.
The Bottom Line On SIBO
Since SIBO can lead to serious nutrient deficiencies, it’s important to make an appointment with your doctor if you notice any signs of it. They may then refer you to a gastroenterologist, a doctor who specializes in treating digestive disorders.
Throughout this process, you may undergo some bloodwork to confirm any nutrient deficiencies, which your healthcare provider will then help you address properly.
Once you’re sure that SIBO is, in fact, the cause of your digestive woes, keep in mind that it will take time to repair your small intestine and really experience improvements. Dedicate at least four weeks to the healing process so that you can stick to that FODMAP elimination diet for two weeks and follow it up with another two weeks of anti-inflammatory eating.
Dr. Josh Axe, D.N.M., D.C., C.N.S., is a doctor of natural medicine, clinical nutritionist, author, and member of The Vitamin Shoppe’s Wellness Council. Dr. Axe operates one of the world’s largest natural health websites, sharing healthy recipes, herbal remedies, nutrition and fitness advice, and information on essential oils and natural supplements. Dr. Axe founded one of the largest functional medicine clinics in the world, in Nashville, TN, and has served as a physician for many professional athletes.