SIBO and what you need to know about Post-SIBO syndrome
Post-SIBO syndrome
Have you been treated for SIBO but you’re still not feeling better? Or you were feeling better on the diet, but now your symptoms are back that you’re trying to reintroduce foods? Post-SIBO syndrome is very common after completing treatment for SIBO and is something that we see often. Thankfully, this is also something that we can treat! Figuring out why you got SIBO in the first place is crucial so that we can treat the underlying cause to prevent your SIBO from coming back!
What is SIBO? SIBO is a gastrointestinal (GI) disorder that is characterized by Small Intestinal Bacterial Overgrowth. Your digestive tract is meant to have good beneficial bacteria. We need a certain amount of beneficial bacteria in our gut to help us digest and process food but also to help eliminate the bad bacteria and yeast in our gut. Most of these bacteria should live in the large intestine, not the small intestine though. When there is overgrowth of bacteria in the small intestine, this leads to multiple and frequent GI symptoms such as bloating, abdominal pain, diarrhea, constipation, gas, and indigestion.
What causes SIBO? There are many different contributing factors for SIBO, including:
Lack of stomach acid (also known as achlorhydria) which can be caused by long-term NSAID, PPI (proton pump inhibitors such as Prilosec) or long-term antacid use. Stomach acid is designed to digest and breakdown food as well as kill off bacteria so that it can’t get into the small intestine where it doesn’t belong. A lack of stomach acid causes food to sit in your stomach longer than it should (because your body can’t properly digest it) and can lead to a delayed transit time of ingested food through your digestive tract. These can both contribute to bacterial overgrowth in the small intestine.
Poor diet. Your diet plays an extremely large role in the balance of beneficial and harmful bacteria in your gut microbiome and in your overall digestive health. We need a large amount of beneficial bacteria to help us digest our food and crowd out the bad bacteria and without this, SIBO occurs.
A lack of fiber, probiotics and fermented foods in your diet leads to a lack of beneficial bacteria in your gut. Probiotics and fermented foods provide our digestive tract with beneficial bacteria and many of the beneficial bacteria in our gut rely on fiber as food. Fiber also helps keep food moving through our digestive tract (the reason why fiber helps with constipation) which helps prevent bacteria overgrowth.
Too much sugar and processed food leads to an increase of harmful bacteria in our digestive tract. Sugar and processed foods feed the bad bacteria and yeast that we don’t want in our gut. These bad bacteria are responsible for the SIBO symptoms that you experience.
Leaky gut. A damaged digestive tract and intestines means that bacteria (and other toxins) are not properly being contained in your digestive tract and are able to leave the digestive tract and get into places where they don’t belong.
Poor ileocecal valve health (ICV is the valve between your small and large intestine). This is a huge factor in SIBO and often overlooked by many physicians. You must address the ileocecal valve when evaluating SIBO. Your small intestine is designed for food breakdown and nutrient absorption. Your large intestine has the majority of the bacteria in your gut and that is how it is supposed to be. When your ICV isn’t working properly, the bacteria (both good and bad) from the large intestine are able to get into the small intestine where they do not belong. If this is happening chronically over time, all of those bad bacteria getting into the small intestine replicate and multiply leaving you with an overgrowth of bacteria in your small intestine, also known as SIBO. This can occur more quickly if you also have a lack of stomach acid (achlorhydria) to kill off the bad bacteria and a diet high in sugar and processed foods without enough fiber and probiotics.
Gut flora/microbiome imbalance which can be caused by chronic stress, eating too much sugar and/or processed foods, a lack of fiber and natural probiotics in your diet, repeated antacid use, and a history of antibiotic use, especially long-term or repeated antibiotic courses.
Stress. Chronic stress is known to affect your digestive tract and its bacteria. Chronic stress also leads to decreased immune function. This means that your bacteria balance is thrown off and your immune system isn’t working well enough to help fight off any infections or bacterial overgrowth that occurs.
Why am I still not feeling better? Studies have found a relapse rate of up to 44% following antibiotic treatment for SIBO. That’s a high relapse rate, so know you’re not alone! There are many reasons why your SIBO treatment hasn’t left you totally symptom free. There are many different causes of SIBO and so treating it with antibiotics (pharmaceutical or botanical) and diet are not always enough. Without addressing the underlying issues that led to your SIBO, you chances of relapse of high.
What can I do about it? Fix the underlying issue(s) that led to your SIBO in the first place. There are so many factors that need to be addressed in addition to eliminating the bacterial overgrowth. Taking a look at your diet in the past, your medication history, and what was going on when your SIBO symptoms began can help you figure out what underlying issues you need to address.
Do you have a history of indigestion, heartburn, gas and bloating? Restore your stomach acid and digestive enzymes.
Support your body’s natural digestive enzymes. Focusing on your diet (as listed below) can help with this by managing inflammation.
Supplementing with digestive enzymes and betaine HCl can also help with this while you heal your gut. Digestive enzymes and betaine HCl help digest your food so that you don’t have food sitting in your stomach or digestive tract for longer than it should. These are a key part of your digestive system and are required for digestion and nutrient breakdown and absorption.
Avoid NSAIDS, antacids, proton pump inhibitors, and other medications that decrease your stomach acid.
Do you have a history of eating foods high in sugar or processed foods? Does your diet lack fiber and probiotics? Fix your diet.
Address food allergies and sensitivities. Food sensitivities promote inflammation in the body. Food sensitivities indicate those foods that your body can’t properly process. When eating foods that your body doesn’t handle well, they can sit in the intestine longer, making your digestive tract work harder to break them down and allowing for bacterial overgrowth to occur. They also create an inflammatory response in the body due to the extra stress they create.
Avoid sugar and processed foods. Sugar will feed the bacteria leading to an overgrowth of (bad) bacteria.
Avoid artificial sweeteners, preservatives and other food additives. These negatively alter your gut microbiome, allowing for bad bacteria to grow and overcrowd the beneficial bacteria.
Eat fiber. Fiber helps to keep your gut microbiome in check by feeding the beneficial bacteria and helping maintain a good balance of flora. It also prevents constipation which helps keep things moving through your intestines.
Did your symptom begin after high stress, an infection, trauma, injury or glucocorticoid use? Repair gut damage.
Heal your gut with L-glutamine supports the intestinal walls and lining and improves gut absorption and decreases gut permeability. Stress (such as infection, malnutrition, trauma, injury, glucocorticoid use, and intense exercise) decreases L-glutamine and so supplementation may be necessary to replenish it.
Replenish nutrient deficiencies that may have occurred from your SIBO infection. SIBO can lead to fat malabsorption which can lead to a deficiency of fat-soluble vitamins such as vitamin A, D, and K. Vitamin B12 malabsorption can also occur due to the role of bacteria in vitamin B12 synthesis and utilization.
Has your diet been less than great? Have you traveled abroad? Did your symptoms begin after a highly stressful or emotional event or time in your life? Improve ileocecal valve (ICV) health. In addition to a poor diet (such as a diet high in sugar, processed foods and artificial sweeteners) and food sensitivities, parasitic infections and stress and emotions all play a role in the health and function of your ileocecal valve.
Follow the dietary advice above to treat the underlying dietary contributors.
Eliminate parasites. A simple stool test can identify whether or not you have a parasitic infection in your intestines. If you have traveled out of the country, swam in infected waters, or ingested contaminated foods, you may be at risk for an intestinal parasitic infection. Parasites can alter our nutrient absorption and the bacteria in our digestive tract. A parasitic infection can make you more susceptible to SIBO and so treating the bacteria without treating the parasite(s) can set you up for relapse even after treating your SIBO.
Treat the underlying stress and emotions. Stress has a large impact on our gut health. If we are under constant stress, have underlying emotions that we are not dealing with, or have poor adrenal function, your gut microbiome and ICV may be suffering. Make sure to address these while treating SIBO.
Did your symptoms begin after a course (or many courses) of antibiotics? Do you have a history of eating highly processed foods, not enough fiber, and a lot of sugar or artificial sweeteners? Rebalance your gut microbiome.
Probiotics from foods that you eat or in supplement form are beneficial in restoring and rebalancing your gut microbiome. They will help to increase the amount of beneficial bacteria while crowding out the bad bacteria that are creating your symptoms.
Garlic is a natural antimicrobial that can help eliminate bad bacteria overgrowth in the small intestine.
Oregano is a natural antimicrobial that can help eliminate bad bacteria overgrowth in the small intestine.
Berberine is an herb acts as a natural anti-microbial in the gut to help maintain a healthy balance of normal (beneficial) bacteria. It can also help balance blood sugar which can contribute to an altered gut microbiome.
Post-SIBO syndrome can be frustrating. You’ve taken the antibiotics, followed the diet and now your symptoms are back and you feel like it was all for nothing. Don’t despair! The antibiotics and diet were a great place to start, but now you need to get to the root cause of what caused your SIBO and treat it to eliminate your SIBO for good!
References:
Jan Bures, Jiri Cyrany, Darina Kohoutova, Miroslav Förstl, Stanislav Rejchrt, Jaroslav Kvetina, Viktor Vorisek, and Marcela Kopacova. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28; 16(24): 2978–2990. Published online 2010 Jun 28. doi: 10.3748/wjg.v16.i24.2978