SIBO (or small intestinal bacterial overgrowth) is an overgrowth of microbial species in the small intestine which would generally be living in the colon. This translocation of bacteria can alter digestive function, cause severe discomfort and lead to nutritional deficiencies. SIBO can lead to intestinal hyperpermeability, which can, in turn, trigger food intolerances and sensitivities. Many health conditions are associated with the presence of SIBO.
SIBO is common and yet it is frequently underdiagnosed, and not well understood or treated by conventional medicine.
Left untreated, SIBO can lead to chronic inflammation and other long term health conditions. Our functional medicine SIBO naturopaths use the functional medicine SIBO approach, which is a comprehensive, personalised natural SIBO treatment that gets to the root of SIBO naturally and effectively to restore digestive health for good.
SIBO is caused by microbial bacteria producing methane, hydrogen or a combination of both or sulphur-reducing microbial species residing in the small intestine. Symptoms can differ from person to person, although the most common SIBO symptoms can include:
Methane-dominant SIBO is usually associated with constipation, whereas hydrogen-dominant SIBO can present with symptoms of diarrhoea or loose stools. Less common sulphur reducing bacteria can produce a gas odour that resembles rotten egg.
SIBO symptoms can both mask and worsen symptoms of other digestive disorders such as coeliac disease, and IBS. SIBO is found in up to 60% of people diagnosed with IBS (irritable bowel syndrome) making diagnosis difficult (see our article on IBS and SIBO to find out more). And for patients diagnosed with inflammatory bowel disease (IBD), studies reveal they are 9.5 times more likely to develop SIBO.
SIBO can cause systemic inflammation and trigger intestinal hyperpermeability (also known as ‘leaky gut’) of the digestive lining by breaking the junctions between cells, allowing large proteins to cross over into the bloodstream. These proteins are detected by the immune system and can trigger new food reactions. A vicious cycle can occur where food reactions cause further inflammation, exacerbating SIBO symptoms.
Additionally, in all SIBO types, nutritional deficiencies can occur due to poor absorption of Vitamins B12, D, A and E and minerals such as iron and calcium.
Healthy digestion relies on a sequence of events occurring. Once the food is broken down by chewing and saliva in the mouth, it is further broken down by hydrochloric acid in the stomach and moves to the small intestines where most nutrients are absorbed. The timely movement of food occurs via a wave-like muscular constriction called ‘peristalsis’, and allows proper absorption of nutrients. The migrating motor complex (MMC) is a different and stronger wave-like constriction occurring around every 90 minutes and is a necessary ‘cleaning cycle’ of the digestive system. The disruption of any of these processes can lead to SIBO.
Common causes can include:
There are 3 main types of SIBO, with each involving overgrowth of different aerobic and anaerobic microbial species:
1. Hydrogen producing bacteria
The abnormal presence of colonic bacteria in the small intestines means that fermentation of foods is occurring much higher up the digestive system than it should be. The small intestines are very sensitive to the excessive production of hydrogen gas, predominantly from Bacteroidetes spp., which causes abdominal bloating and diarrhoea. Other low oxygen (microaerophilic) hydrogen-producing species are Streptococcus and Escherichia coli, along with anaerobic bacteria, such as Lactobacillus and Bacteroides.
2. Methane producing archaea
Constipation is a result of methane-producing species of non-bacterial, single-celled species called archaea, such as Methanobrevibacter smithii and Methanospaera stadmagnae. M. smithii and M. stadmagnae. These microbes feed on the hydrogen produced by species of bacteria, creating a methane gas byproduct which is also responsible for abdominal bloating and slows transit time or migrating motor complex of the GIT, leading to constipation or irregular bowel motions.
3. Hydrogen sulphide producing bacteria
The third type of SIBO is due to the hydrogen sulphide producing bacteria, commonly Desulfovibrio spp or Fusobacterium spp. This SIBO type is less common and tests negative on traditional breath testing which only tests for hydrogen and methane gas which these species don't produce.
The by-product of these species is hydrogen sulphide gas, which is highly toxic to the cells of the intestinal walls and is distinguished by the foul odour of rotten eggs. Hydrogen sulphide metabolisation is normal in the cecum and in the colon, but not when it occurs in the small intestine. These species reduce sulphate to hydrogen sulphide gas and are also referred to as sulphur reducing bacteria (SRB). High concentrations of hydrogen sulphide are involved in gut inflammation.
Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.
These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.
Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected.
Food hypersensitivity has been found to cause or exacerbate atopic dermatitis in 10-30% of cases, and 90% of these are caused by eggs, milk, peanuts, soy and wheat.
The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.
Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).
Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.
Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.
Diagnosis via conventional testing alone is imperfect and is made via either hydrogen and methane breath testing, or the gold standard is jejunal aspirate testing. This test extracts a small sample of fluid from the middle part of the digestive system called the jejunum via an endoscope. The limitations of jejunal aspirate tests are cost, the invasive nature of the testing, and potential for false negatives due to difficulties in growing cultures.
Conventional methods of SIBO treatment usually includes antibiotics such as rifaximin, and whilst it may kill undesirable species, it is indiscriminate and also kills beneficial species. This can allow opportunistic species to overgrow in much the same way as weeds that grow back in the garden when the ground is cleared. In addition, studies show that rifaximin is not effective at treating SIBO symptoms.
Usually, SIBO takes a long time to heal, and requires a holistic approach to uncover the factors involved in causing or aggravating SIBO, along with a staged approach that patients are supported through.
Diagnosing SIBO accurately is essential for effective treatment. The most common diagnostic tool for SIBO is a breath test that measures hydrogen and methane gas levels. These gases are produced by certain bacteria and archaea in the small intestine.
Unlike a Helicobacter pylori test, which detects the presence of H. pylori in the stomach, the SIBO breath test is specifically designed to identify bacterial overgrowth in the small intestine. It involves collecting breath samples after consuming a specific sugar solution (e.g., lactulose or glucose) and analysing them for gas production over time.
Our functional medicine approach goes beyond breath testing to develop a comprehensive understanding of your condition. In addition to the SIBO breath test, we may also recommend:
These tests help uncover underlying factors contributing to SIBO and guide a personalised treatment plan. Our practitioners combine test results with a detailed health history to identify triggers such as antibiotic use, genetic predispositions, and lifestyle factors.
Through this holistic approach, we ensure that every aspect of your health is considered, leading to more effective and lasting relief from SIBO symptoms.
Our SIBO functional medicine naturopaths will identify the root cause of SIBO and treat these underlying causes. Our team of SIBO specialists have a holistic understanding of SIBO, with access to the most up-to-date scientific insights.
After interpreting SIBO breath test results and other functional testing, the functional medicine SIBO approach involves your practitioner identifying underlying issues causing your symptoms, and will tailor a treatment plan to suit you.
Your personalised natural SIBO treatment may include:
The benefits of herbal medicine as treatment for SIBO is their ability to target specific microbes, ensuring that the beneficial species are supported while the pathobiont species (those that are not beneficial when in the wrong location, or number) are suppressed. Optimising digestive function is an important part of a holistic treatment, as well as addressing any other conditions that you may have, in addition to SIBO.
In our healthcare program, your practitioner along with a health coach will provide you with all the support you need to overcome SIBO, empowering and educating you to implement the changes needed so you can feel happy and healthy in your body again.
(Jenny is a real patient but we’ve changed her name and image to protect her privacy)
Jenny came into the program with significant health concerns, which included bloating, constipation, brain fog, and migraines. These, plus other ongoing issues had severely impacted her ability to work, as she struggled with unpredictable health fluctuations. After finding little help from allopathic medicine specialists, Jenny turned to us as a last resort, hoping for answers and a path to recovery.
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SIBO can occur alone or alongside IBS, and both conditions have similar symptoms, making clear diagnosis difficult.
The most common symptoms of SIBO include bloating, abdominal distension/pain, loose stool/diarrhoea, constipation, excessive and/or smelly flatulence, belching/burping, nausea, reflux and heartburn.
Vitamin & mineral deficiencies due to poor absorption of nutrients can cause symptoms that may not appear to be connected such as skin, mood disorders, joint pain, and brain fog/memory problems can also occur.
Functional testing and detailed case taking can help to ascertain whether symptoms are due to SIBO or IBS, or both. This is the essence of the functional medicine SIBO approach.
Depending on the root cause, any other conditions and how long the symptoms have been experienced, it may take some time to heal SIBO.
Malabsorption and maldigestion as a result of SIBO may cause other conditions such as intestinal hyperpermeability which can then trigger new food intolerances and sensitivities.
Nutritional deficiencies need to be addressed to ensure your body has the cofactors it needs to restore healthy digestive function.
Our Melbourne SIBO specialists take the functional medicine SIBO approach, and treat each of the underlying issues in turn, with latest science-backed treatments to ensure your optimal recovery.
SIBO is a form of gut dysbiosis, where the presence of particular microbial species that normally live in the large intestines are located in the small intestines, causing fermentation of carbohydrates much higher up in the digestive process than it should.
This results in pain, bloating, diarrhoea, constipation, and a range of other symptoms.
If left untreated, other conditions can develop due to poor nutrient absorption, and depletion of vitamins and minerals and intestinal hyperpermeability (also known as ‘leaky gut’).
SIBO has a number of causes, from stress and anxiety, to medications, poor diet, surgery, and other health conditions.
SIBO testing by a specialist SIBO functional practitioner can help isolate the root cause of SIBO.
Poor digestion can be associated with skin symptoms such as acne, rosacea, psoriasis and eczema.
This can be due to inflammation of the gut, and malabsorption of nutrients essential for healthy skin maintenance and turnover.
SIBO can cause intestinal hyperpermeability which can also affect the cells of the skin surface, via food allergies or sensitivities.
Poor production of short chain fatty acids (SFCA) by disturbed gut microbiome species in the colon can also affect the ability of the body to repair damage to skin and cells that line the body (epithelial cells), whether they are on the outside or on the inside of the body.
No. Diagnosis of SIBO cannot be confirmed via stool testing.
Stool testing provides an assessment of the large intestinal environment only and does not provide any information regarding the small intestine.
In the presence of SIBO, digestive processes are compromised including insulin sensitivity and nutrient absorption.
The presence of SIBO may lead to the destruction of intestinal barrier integrity, increased intestinal permeability, increased endotoxin levels, activation of inflammatory responses, and translocation of bacteria from the colon to the small intestine.
This activity in the GIT influences the body’s ability to manage inflammation and obesity.
The presence of SIBO may lead to weight gain, but may also cause weight loss.
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