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SIBO is a syndrome of bacterial overgrowth in the small intestine. Symptoms of SIBO are primarily abdominal pain after a meal, excessive gas, severe diarrhea or constipation. If these symptoms are familiar to you, see how you can reduce your symptoms with diet. What other treatments are there for this condition?

SIBOis an excessive growth of bacteria in the duodenum and small intestine. These bacteria can grow in these places for a variety of reasons, including migration from the large intestine to the small intestine. In a he althy person, the number of bacteria in the small intestine is not too high. The vast majority live in the large intestine, where it has an important role to play - to break down the remains of food and produce butyric acid beneficial for the body, produce B vitamins and vitamin K, and eliminate pathogens. The problem occurs when bacteria from the large intestine have entered the small intestine. Then, unpleasant ailments from the digestive system may appear.

What are the symptoms of SIBO?

The byproducts of bacterial metabolism are methane, hydrogen and hydrogen sulphide, gases that do not cause problems in the large intestine. However, if the bacteria from the large intestine passes into the small intestine, these substances are the reason:

  • flatulence,
  • coll,
  • abdominal pain.

In a he althy person, there are no gases in the small intestine, only digested food. That is why the sudden overgrowth of bacteria in the wrong part of the gastrointestinal tract is so difficult and causes discomfort in the abdominal cavity.

The ailments of people suffering from SIBO can be so embarrassing that patients often withdraw from social life, because each consumption of food that is unfavorable for them (feeding bacteria in the small intestine) ends with a visit to the toilet or excessive gas emission .

Diet with SIBO - Low Fodmap diet

One of the diets recommended for SIBO is the Low Fodmap diet, which limits the amount of over-fermenting oligosaccharides and those substances that can significantly increase the growth of bacteria in the duodenum and small intestine or lead to too much fermentation in the large intestine .

When following this diet, avoid:

  • sugar and sweets consumption,
  • products abundant in wefructans, e.g. onions, garlic, inulin,
  • legumes, as they contain galactose-oligosaccharides,
  • dairy products with lactose (lactose is milk sugar whose digestion is impaired with SIBO),
  • fructose (it is present not only in fruits, but also in many food additives containing glucose-fructose syrup, e.g. sweet drinks, cheese, sweets. Honey and molasses should also be avoided),
  • Sweeteners, e.g. in chewing gums because they contain polyols.

The Low Fodmap diet should not be used all the time, although many patients find it very relieved to eliminate the products that cause constant gas and gas. The aim is to avoid all prohibited products inI phaseof the diet (lasting about 6 weeks), then inII phaseto include products with individual groups and observe how the body reacts to them.

It is very important to establish your individual food tolerance. It may turn out that we react badly to only one of the fructose-containing products, e.g. only honey, and fruit is not a problem for us.

InPhase IIIthe diet is extended to as many products as possible. It's best that the Low Fodmap diet goes hand in hand with herbal or pharmacological treatment, because only then can it give real results in the form of SIBO reduction.

The products prohibited in the 1st phase of the Low Fodmap diet are:

  • Products containing fructose, such as: pears, apples, peaches, mangoes, watermelons, fruit in syrup, dried fruit as well as sweetened with glucose-fructose syrup, fruit concentrates, carbonated drinks, honey, agave syrup, asparagus , artichokes, sugar peas.
  • Products with lactose, such as: milk, powdered milk, condensed milk, sweet cottage cheese, e.g. mascarpone, cream ice cream, milk-based ice cream.
  • Products with GOS (galacto-oligosaccharides): beans, peas, broccoli, onions, soybeans, lentils, dry legumes.
  • Products with FOS (fructo-oligosaccharides): asparagus, Brussels sprouts, broccoli, chicory, artichokes, garlic, onion, leek, rye, couscous, durum wheat, inulin-based prebiotics.
  • Products containing polyols: avocado, cauliflower, sweet corn, cap mushrooms, watermelons, peaches, apples, pears, apricots, plums, dried plums, cherries, sweeteners such as xylitol or sorbitol.
  • Processed meats with additives: we reject canned goods, meats in ready-made marinades, cold cuts, sausages.
  • Wheat and rye bread, including breakfast cereals, croissants or biscuits.

Products allowedin the 1st phase of Low Fodmap:

  • Lactose-free products, e.g. lactose-free milk, cheese, vegetable drinks.
  • Fruits such as: strawberries, blueberries, raspberries, kiwi, currants, citrus, pineapple.
  • Vegetables: all but those mentioned above in the prohibited list. Therefore, e.g. carrots, parsley, celery, spinach, cucumbers, dill, tomatoes, butter lettuce, zucchini, Chinese cabbage, peppers, potatoes are allowed.
  • The following nuts are allowed: Italian, macadamia, peanuts.
  • Meat without additives, eggs, seafood.
  • Spelled bread, gluten-free bread, corn flakes, millet flakes, oat flakes.
  • Quinoa, millet, buckwheat, rice, oats, potato flour.

Elementary diet at SIBO

One of the dietary proposals for people suffering from SIBO iselemental diet , which is usually used in infants or seriously ill people in hospital, unable to chew food on their own . It consists in providing ready-made nutritional mixtures that contain a balanced proportion of proteins, fats, carbohydrates, minerals and vitamins.

Elemental diet is used with SIBO, because it is assumed that well-composed mixtures are better and faster absorbed than food that chews on its own. So they can better nourish emaciated and malnourished people with an overgrowth of bacterial flora.

Accelerated absorption can also cause the absorption of nutrients so quickly that the bacteria living in the small intestine cannot keep up with the food leftovers (and thus they will not grow and create excess gas).

Faster digestion of food may also activate an important intestinal cleansing mechanism, namely -migrating myoelectric complex (MMC) . His handicap is often one of the reasons for the appearance of SIBO. In turn, its improvement and sweeping food debris from the intestine may improve the condition of a patient with an overgrowth of bacterial flora.

Although studies show that patients who used elemental for 14 days (this is how much it should be used) there was a significant reduction in hydrogen, and that this type of nutrition was as much as 80-84% effective in reducing bacterial gas production, however, one should consider whether the average person is able to stay on such a diet for 2 weeks. If not, it doesn't even make sense to start a diet.

SCD diet

Another diet that may have benefits in improving bowel function with SIBO is theSCD diet . It excludes the consumption of carbohydratescomplex such as:

  • polysaccharides,
  • starch,
  • or disaccharides.

It allows the consumption of products with the content of simple sugars, such as:

  • fruit,
  • some vegetables,
  • or honey.

An important element of this diet isresignation from lactose-containing dairy products , but fermented dairy products are valued.

However, with SIBO, the consumption of yoghurt can cause a problem and exacerbate ailments. The issue of probiotics recommended in this diet can also be troublesome, as most multi-strain products make the patient's situation worse.

Sometimes single-strain probiotics with Bifidobacteria work, but it is a very individual matter.

What is definitely beneficial in the SCD diet is the emphasis on the consumption of anti-inflammatory omega-3 fatty acids, which can help the body regenerate.

The texture of the food served is also beneficial to the he alth of the intestines. As SCD aims to relieve the gut, many dishes are blended and mixed to aid nutrient absorption.

To sum up: in the SCD diet, cereal products are abandoned, but the following are allowed:

  • fruit,
  • vegetables,
  • honey
  • and lactose-free dairy.

You can also eat:

  • eggs,
  • meat,
  • nuts,
  • butter
  • and oils.

You completely give up processed, canned food.

SIBO - treatment methods

Diet alone is not enough to get rid of excess bacteria from our gut. The main factor that can make our symptoms disappear is the use of appropriatedrug or herbal treatment .

However, it must be supervised by a specialist, because both the implementation of drugs and herbal preparations is associated with the risk of side effects resulting from the wrong dose or wrong combination.

SIBO pharmacological treatment

Depending on what form of SIBO we are dealing with (whether it is constipation, diarrhea or mixed), different types of treatment are used.

When diarrhea predominates, the most common drug is an antibiotic called rifaximin.

In constipation and in a mixed form, it will be rifaximin combined with neomycin or metronidazole.

After the end of pharmacological treatment, the doses and duration of which are determined by the doctor, prokinetics can be used to prevent recurrences of SIBO and to implement probiotics appropriate for this disease.

Prokinetics, or substances that speed up emptying of the stomach or intestines, can be pharmaceuticals or natural over-the-counter remedies.

The best known prokinetic drugs include erythromycin, itopride, and the natural ones, e.g. ginger.

When it comes to the use of probiotics, you should be very careful with SIBO, often only preparations with Bifidobacteria and the Saccharomyces boulardii strain are involved.

Herbal treatment SIBO

If someone does not want to decide on pharmacological treatment, they can try herbal treatment. However, it must be carried out under the supervision of a dietitian or doctor to avoid side effects or even poisoning.

There are many herbs that can help with bacterial overgrowth. The following can be distinguished here:

  • berberine,
  • oregano oil,
  • thyme oil,
  • caprylic acid,
  • alicin (garlic),
  • pau d'arco,
  • Canadian goldenseal,
  • Indian honey,
  • neem,
  • triphala,
  • ginger,
  • cinnamon.

In the case of SIBO constipation, a combination of allicin and berberine can be used.

In the case of diarrhea, e.g. berberine plus oregano oil, and when mixed:

  • allicin,
  • berberine,
  • oregano oil combined with Indian honey.
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Gastrology