SIBO: What It Is, Symptoms, and Treatment
Your gastrointestinal tract is a long tube that hosts a vast number of microorganisms—especially in the colon, or large intestine, where the greatest concentration of gut flora resides. However, when there is an overgrowth of bacteria that may be harmful to you, intestinal dysbiosis occurs, often leading to symptoms like abdominal pain and bloating.
What Is SIBO?
SIBO stands for Small Intestine Bacterial Overgrowth. It refers to an abnormal increase in the number of bacteria in the small intestine, particularly types that are not commonly found in that part of the digestive tract (Mayo Clinic, 2022).
Causes of SIBO
Several risk factors for SIBO have been identified (Anna Gudan et al., 2023):
Altered gastrointestinal secretions:
When enemy foods reduce your stomach acid and digestive enzyme levels, partially digested food remains in the gut. This feeds harmful microbes in the colon, which may overgrow and migrate into the small intestine.
Intestinal motility disorders:
If you suffer from constipation, there’s less turnover of gut microbiota. The bacteria can then overgrow and spread to the small intestine (Michalina Banaszak et al., 2023).
Abdominal surgeries or anatomical changes:
Structural changes—such as those from short bowel syndrome, diverticulosis, or bariatric surgeries like gastric bypass—can allow bacterial overgrowth in areas where these microbes normally shouldn't be (Karen Delbaere et al., 2023).
Symptoms and Complications of SIBO
Common signs and symptoms include:
- Loss of appetite
- Gastritis and upper abdominal pain (dyspepsia)
- Nausea
- Abdominal pain
- Bloating
- Feeling overly full after eating
- Diarrhea and irritable bowel symptoms
- Flatulence
- Unintentional weight loss
- Nutrient malabsorption and malnutrition
Diagnosing SIBO
According to the MSD Manual, the following tests can be used:
Breath tests:
They are based on the ingestion of a fixed amount of a substrate, a carbohydrate such as lactulose or glucose (typically 50–75 g of glucose or 10 g of lactulose in 200–250 ml of water). The most commonly used is lactulose, a disaccharide made up of galactose and fructose, which cannot be absorbed by the digestive system.
A breath sample is taken before ingesting the substrate. Then, the substrate is consumed, and exhaled breath is measured at different time intervals—every 15 minutes for glucose and every 30 minutes for lactulose. This test specifically measures hydrogen and methane gases.
The total duration of the test is 120 minutes for glucose and 180 minutes for lactulose, with samples taken at the specified intervals.
In healthy individuals, the ingested lactulose travels through the small intestine and reaches the colon, where it is metabolized by colon bacteria. This is reflected in the test graph by a late hydrogen peak after 90 minutes.
In patients with SIBO, there is an early rise in hydrogen or methane before the first 90 minutes. These gases indicate that bacteria are present in the small intestine and fermenting the ingested sugars.
Quantitative culture of intestinal fluid:
A sample of fluid from the small intestine is needed. To obtain it, a procedure called esophagogastroduodenoscopy (EGD) is performed. The fluid is placed on a special plate in the laboratory and monitored to check for the growth of bacteria or other microorganisms.
SIBO Treatment
Since your gut microbiota feeds on what you eat, dietary changes are essential—often starting with a low-carb or low-FODMAP diet.
Your best approach is to follow the 3R Immunonutrition Protocol, which focuses on feeding your friendly bacteria and improving digestion, absorption, and elimination:
- Digestion:
Support this phase with supplements like betaine HCl and pancreatic enzymes to help break food into absorbable nutrients. - Absorption:
Once food is properly digested, nutrients can be absorbed. Only indigestible fiber remains, which feeds your beneficial microbes. - Excretion:
Regular elimination prevents undigested material from fermenting in your gut and causing further inflammation.
NutriWhite’s 3R Protocol Approach:
- Remove enemy foods that are hard to digest and feed harmful microbes—especially sugar, grains, dairy, and ultra-processed products.
- Replenish with friendly foods that support your immune system and nourish beneficial gut bacteria.
- Recover your health holistically—gut, mental, and overall well-being.
We invite you to apply the 3R Immunonutrition Protocol and personalize it with our NutriWhite Ambassadors through an online consultation.
References:
- SIBO (SOBRECRECIMIENTO BACTERIANO EN INTESTINO DELGADO) Gemma Sesmilo León y Laia Pérez Tor, 2017
https://www.endocrino.cat/es/blog-endocrinologia.cfm/ID/8204/ESP/sibo-sobrecrecimiento-bacteriano-intestino-delgado-.htm - Sobrecrecimiento bacteriano del intestino delgado, Mayo Clinic, 2022
https://www.mayoclinic.org/es/diseases-conditions/small-intestinal-bacterial-overgrowth/diagnosis-treatment/drc-20370172 - Gudan A, Kozłowska-Petriczko K, Wunsch E, Bodnarczuk T, Stachowska E. Small Intestinal Bacterial Overgrowth and Non-Alcoholic Fatty Liver Disease: What Do We Know in 2023? Nutrients. 2023 Mar 8;15(6):1323. doi: 10.3390/nu15061323. PMID: 36986052; PMCID: PMC10052062.
- Banaszak M, Górna I, Woźniak D, Przysławski J, Drzymała-Czyż S. Association between Gut Dysbiosis and the Occurrence of SIBO, LIBO, SIFO and IMO. Microorganisms. 2023 Feb 24;11(3):573. doi: 10.3390/microorganisms11030573. PMID: 36985147; PMCID: PMC10052891.
- Delbaere K, Roegiers I, Bron A, Durif C, Van de Wiele T, Blanquet-Diot S, Marinelli L. The small intestine: dining table of host-microbiota meetings. FEMS Microbiol Rev. 2023 May 19;47(3):fuad022. doi: 10.1093/femsre/fuad022. PMID: 37193669; PMCID: PMC10246847.
- https://www.msdmanuals.com/es-ve/professional/trastornos-gastrointestinales/s%C3%ADndromes-de-malabsorci%C3%B3n/sobrecrecimiento-bacteriano-del-intestino-delgado-sbid
- https://medlineplus.gov/spanish/ency/article/003731.htm
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