Bloating has become your norm. Embarrassing and excessive belching or gas is on the daily. You experience abdominal pain and discomfort regularly. The frequency and intensity make you think something is not right! Other symptoms you might experience are diarrhea, constipation, nausea, as well as indigestion and heartburn. You thought it might be food allergies or food sensitivities. You’ve tried to eliminate everything, but sometimes, it seems like every food causes a problem.
Symptoms of Small Intestinal Bacterial Overgrowth: SIBO
Small Intestinal Bacterial Overgrowth (SIBO) can cause a variety of digestive and systemic symptoms, primarily due to the excessive growth of bacteria in the small intestine. These bacteria ferment undigested food, producing gas, and potentially causing inflammation. The digestive symptoms make sense with this understanding, but it can also cause systemic symptoms like:
1. Fatigue: Due to the nutrients going into your body not being digested and absorbed as well as inflammation in the gut, people with SIBO may feel unusually tired.
2. Unexplained Weight Loss: Not absorbing nutrients (also called malabsorption) can lead to unintentional weight loss in severe cases.
3. Food Intolerances: Sensitivity to certain foods, especially carbohydrates or fiber, due to the fermentation process in the small intestine.
4. Joint Pain or Muscle Aches: Some people report muscle or joint pain that may be linked to systemic inflammation or nutritional deficiencies caused by poor absorption.
5. Skin Issues: Conditions like acne or rashes can sometimes pop up, possibly related to nutrient imbalances or inflammation.
6. Brain Fog: Cognitive issues like difficulty concentrating or memory problems, often linked to nutrient deficiencies (e.g., B12 deficiency) or systemic inflammation.
Maybe you didn’t connect your digestive disturbances to some of these other things you’ve been feeling. It’s possible that you and your doctor have just assumed it’s another gastrointestinal problem like IBS since many of the symptoms overlap. There are ways to distinguish SIBO apart from other issues (while they might be side lying) and as functional medicine practitioners, we will approach your healing as a whole picture, addressing the root cause of the SIBO. Once we discover the root cause, your healing plan can be a more personalized, tailored approach to not just alleviate symptoms, but restore your body.
Holistic Testing and Assessing for SIBO
The conventional methods of diagnosis are using these tests to help with a proper diagnosis of SIBO.
- Hydrogen Breath Test: This test measures gases (hydrogen and methane) produced by bacteria during the fermentation of certain carbohydrates like lactulose or glucose.
- Small Bowel Aspirate: This is collecting a direct sample of small intestine fluid to count the bacterial load (though this is invasive and less commonly used).
- Imaging or Endoscopy: In cases where there are anatomical issues (e.g., structures or diverticula) or when a different condition is suspected, doctors may recommend imaging or an endoscopy.
While these tests can be enlightening, a functional medicine practitioner like myself will take a more holistic, individualized approach to addressing SIBO. We’ll also dive deep in these areas:
- Gut Motility Issues: Conditions like hypothyroidism, diabetes, or nervous system dysfunction can contribute to SIBO by impairing the normal movement of food through the small intestine.
- Leaky Gut or Inflammation: Chronic inflammation or intestinal permeability may allow bacteria to thrive and migrate into the small intestine.
- Dietary and Lifestyle Factors: Functional medicine doctors often focus on the person’s overall lifestyle, stress levels, sleep patterns, and diet to understand the root causes.
- Advanced Testing: In addition to breath tests, functional medicine practitioners may use:
- Comprehensive Stool Analysis: To assess gut flora and potential infections or imbalances.
- Food Sensitivity Tests: To identify possible triggers or intolerances that could exacerbate SIBO symptoms.
- Gut-Health Panels: Including tests for markers of inflammation or intestinal permeability.
Holistic Healing through Gut Motility and a Biphasic Diet
While antibiotics, which are usually prescribed in a conventional SIBO diagnosis, might be used, it’s preferable by functional medicine providers to include herbal antimicrobials along with other targeted diet and lifestyle changes. Diet and gut healing will be a large focus of the recovery process. While there are several approaches in diet and gut healing, I want to highlight how utilizing a biphasic diet can help to restore the gut and support healthier gut motility. Both of which are crucial in addressing SIBO.
The biphasic diet for SIBO is designed to control bacterial overgrowth by cycling periods of restricted food intake (starving the bacteria) with periods of refeeding, where a nutrient-dense, low-fermentable food intake supports gut healing and motility. This approach is intended to reduce symptoms, improve gut function, and help manage the underlying bacterial imbalance. However, it should be done under the guidance of a healthcare professional, as dietary restrictions and fasting can affect different individuals in varying ways.
How and Why the Biphasic Diet can Help with SIBO
1. Phases of the Diet intended to Starve Bacteria:
- Reduce and Repair: Phase 1 (Fasting or Caloric Restriction): During this phase, food intake is limited or restricted, giving the small intestine a chance to clear out excess bacteria. Since bacteria thrive on food (particularly fermentable carbohydrates), reducing or eliminating food intake for a period may help starve the bacteria, potentially reducing their numbers.
- Remove and Restore: Phase 2 (Normal or Increased Calorie Intake): When food is reintroduced in Phase 2, it’s typically a carefully curated diet that minimizes the intake of fermentable carbohydrates (such as those found in certain grains, fruits, and dairy) and focuses on more easily digestible foods. This phase provides necessary nutrition while avoiding feeding the bacteria in the small intestine.
2. Improving Gut Motility:
- The bacteria growth causes the motility of the small intestine to be sluggish or work improperly, causing further fermentation and the ensuing symptoms. Restoring proper motility in the small intestines is a major focus of eliminating SIBO for good. The biphasic diet includes fasting periods (in Phase 1) which give the gut a chance to “reset” and enhance motility through processes like the migrating motor complex (MMC), which is responsible for sweeping out food and bacteria that could contribute to overgrowth. By reducing food intake periodically, the biphasic diet may help support MMC function.
3. Limiting Fermentable Foods:
- In Phase 2, the diet often excludes or minimizes high FODMAP foods (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols), which are known to ferment in the gut and feed the bacteria. A low FODMAP diet, when paired with a biphasic eating pattern, can reduce bacterial fermentation and symptoms associated with SIBO like bloating and gas.
4. Reducing Inflammation:
- SIBO often leads to inflammation in the gut lining. By alternating between fasting and controlled food intake, the biphasic diet can give the intestines a break from constant digestion and potential irritation from fermentable foods, helping to reduce inflammation over time.
5. Supporting Healing:
- While the fasting periods (Phase 1) might help reduce bacterial overgrowth, Phase 2 ensures that the body receives adequate nutrients to heal the gut lining, replenish beneficial gut flora, and support overall digestive function.
The biphasic diet can be an excellent, healthy protocol for addressing SIBO. It’s not the ONLY way of addressing it and will produce even better results when it is supported by other lifestyle changes. If you have been diagnosed with SIBO or you suspect this might be your problem, please schedule a free consultation so we can work together to get to the bottom of the problem and get your health back on top!
https://www.ifm.org/articles/managing-sibo-nutriton-interventions
https://www.sciencedirect.com/science/article/abs/pii/S0889855317301206?via%3Dihub
