A Nutritionist Explains This Little-Known Condition That Can Cause Major Gut Issues

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Digestive health and gut bacteria are intimately connected: from the grocery store advertisements of food products with probiotics to the infinite pains of bloating, people are used to casually discussing their digestive health. But sometimes, the gut bacteria that keeps you healthy can also cause you pain: Small Intestinal Bacterial Overgrowth (SIBO) can cause a lot of gut pain, but it can also be prevented and treated.

According to Certified Holistic Nutrition Consultant Stephanie Papadakis, the most important thing is to find the root cause of your SIBO. “There are many root causes that contribute to bacterial overgrowth,” she says, which don’t always include diet. Understanding the basics of gut bacteria is helpful in identifying these root causes.

When experts talk about the trillions of bacteria in your gut being essential to promoting digestive system integrity and gut health, they're typically not talking so much about the small intestine. Sure, the small intestine hosts bacteria, as well: but most of those trillions of helpful little ones live in the large intestine and the colon. There, the mass of health bacteria lining your gut provide essential assistance with nutrient absorption, digestion, and even immune health.

However, sometimes a migration occurs in which that normally healthy bacteria travels to the small intestine, and that’s when SIBO occurs. And too much gut bacteria in the small intestine can wreak havoc on the body’s digestive processes. This excess of bacteria growing in the small intestine is often due to lack of movement in the small intestine.

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This lack of movement can be caused by a range of nerve or muscular damage (such as from diabetes mellitus), physical obstructions (such as from surgical scarring or inflammation from Crohn's disease), or medications (such as antibiotics, steroids, and anti-blocking drugs). As a result, SIBO can lead to uncomfortable symptoms like bloating, diarrhea or constipation, nausea, abdominal pain, and fatigue.

These symptoms are shared by people experiencing Irritable Bowel Syndrome (IBS), so testing for SIBO checks for unique markers. Noninvasive testing for SIBO includes the Hydrogen and Methane Breath Test, since these are the gasses that are typically generated by the overabundance of bacteria in the small intestine.

In order to prepare to take this breath test, people are encouraged to avoid taking antibiotics or probiotics up to two weeks before the test; avoid high carbohydrate meals within 48 hours of the test; and avoid eating, drinking, smoking, or exercising within 12 hours of the test, according to Irritable Bowel Syndrome expert Dr. Barbara Bolen writing for VeryWell Health. The test itself may last two or three hours, with people being asked to blow air into a balloon every 15 minutes.

Once you know you have SIBO, your doctor will likely prescribe a regiment of antibiotics, as antibiotics remain the principal treatment for SIBO. And, depending on the suspected cause of SIBO, doctors may also encourage patients to take vitamin and mineral supplements or, if appropriate, small surgery to correct bowel anatomy.


Papadakis recommends considering multiple treatment options. In addition to a breath test, for example, she recommends seeing if you can see a functional medicine doctor or naturopath. These experts “can also do a GI map that actually locates where the SIBO is densely populated. From there,” she tells Bustle, “you can work with your doctor to decide whether you want to take traditional antibiotics — usually Xifaxan or Neomycin — or natural herbal antibiotics.”

Papadakis also recommends starting a food journal to document your symptoms. Take the time to jot down notes anywhere from one to three hours after you eat. Recording information like what foods you've eaten and how you're feeling (e.g. tired, energetic, bloated, gassy, etc.) can help identify patterns in your gut's relationship to the foods you're eating.

After a few days of recording these notes, Papadakis says, “you’ll begin seeing patterns of foods that trigger your symptoms, and can begin to eliminate them to start the healing process (you’ll be able to add these back in when the bacteria are gone).”

This journaling can provide vital information for you and your doctor in determining the root cause of your SIBO. And by finding the root cause, you will be that much closer to having a healthier, happier gut.

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