High Risk of SIBO With Inflammatory Bowel Disease
High Risk of SIBO with IBD
SIBO is a manageable, treatable condition. It frequently goes undiagnosed. It can create symptoms such as bloating, fatigue, brain fog, digestive symptoms, joint pain, mood disorders, and more. If you suffer from Crohn’s disease or Ulcerative Colitis and are experiencing any of these symptoms, these symptoms may be confused with a flare and invite unnecessary medications. If you have IBD and are suffering these symptoms, you may want to consider being evaluated for SIBO.
What is SIBO?
SIBO stands for small intestinal bacterial overgrowth. Normally, the small intestine has few bacteria. Most intestinal bacteria are contained in the large intestine. When there are too many, or they are the wrong type of bacteria in the small intestine, it is called SIBO.
- Stomach pain
- Weight loss
- Nutrient deficiencies and their associated symptoms: Vitamin B12, A, D, E, iron, other B vitamins, fat, protein and carbohydrate malabsorption
- Carbohydrate intolerance-symptoms such as bloating/pain/gas fatigue after eating
- Joint pain
Causes Of SIBO
To keep bacteria counts at a healthy low level in the small intestine, your body must have normal levels of stomach acid; properly functioning pancreas and gall bladder; normal intestinal motility (ability to move food through the digestive tract); normal mucosa (lining of the digestive tract); and structurally normal valves.
These medical conditions and treatments that affect one of the factors above can predispose someone to SIBO:
- Liver or pancreas disease
- Celiac Disease/Non-celiac GS
- Inflammatory Bowel Disease
- Chronic Constipation
- Chronic Antibiotic Use
- Immune suppressed states i.e. AIDS, Cancer, chronic steroid use
- Other chronic diseases
- Chronic use of acid-blocking medication
It is typically diagnosed using a breath test in which the patient drinks a sugar-containing drink and exhaled gases are measured. If there are too many bacteria, excess gases (hydrogen, methane or both) will be produced. It should be noted that the reliability of this test is less than ideal. Due to the poor reliability of the testing method, some physicians will treat based on symptoms. A direct sample can also be taken from the intestinal fluid to diagnose SIBO, but it is not routinely done.
The underlying cause of the SIBO must be addressed first or treatment will not be effective. For example, if SIBO is due to celiac disease it will never get better without first adhering to a strict gluten-free diet. After treating the underlying cause, the subsequent therapy will depend on a traditional or integrative approach.
Traditional SIBO treatment:
Antibiotics are the mainstay of therapy and are often used in conjunction with motility agents to prevent “build-up” of bacteria by moving things through the intestinal tract. Some physicians will also prescribe a low sugar diet. In severe cases, elemental diets are used. These are liquid diets in which all of the nutrients are broken down and don’t require digestion. The nutrients are absorbed so quickly that the bacteria don’t have time to act on them and produce symptoms. This is done for a short duration to effectively “starve” the bacteria.
Integrative SIBO treatment:
As mentioned above, the underlying cause must first be treated. From there, the following integrative therapies may be used:
- Probiotics +/-
- Diet/nutritional interventions
- Motility agents
- Digestive Enzymes
- Elimination Diets
- Relaxation Techniques
- Stress Reduction
- Addressing sleep disorders
- Herbal antibiotics
- Elemental Diets
Diets For SIBO
Many diets are used to treat SIBO. Which diet is used depends on the clinical scenario and the practitioner. Most of the diets have the same goal of reducing sugars that the bacteria would consume. Commonly used diets are Paleo, SCD, GAPS, Candida, Low FODMAP or a general low sugar/carb diet.
Long term outcome varies, but recurrence is common.
How do you best prevent recurrence?
You may be able to prevent or minimize the risk of recurrence by eating a “clean diet” of primarily plant-based whole foods; minimizing processed foods and sugar; reducing stress; exercising; and adopting good sleep habits. Some people will use a less restricted form of one of the above-mentioned diets on a long term basis; each person is different.
If you think you may be experiencing SIBO symptoms and you have IBD, please contact your health care provider. The symptoms can be confused with a flare. Your doctor can help you differentiate the two problems and get you on your road to recovery.
THIS ARTICLE IS COPYRIGHTED BY AMY BURKHART, MD, RD.
Dr. Amy Burkhart is a doctor (M.D.), Registered Dietitian, R.D., and fellowship-trained in integrative medicine. She specializes in treating chronic digestive disorders from an integrative/functional medicine perspective.