Uh-oh . . . SIBO

SIBO.  That acronym strikes fear into my heart.  It stands for Small Intestine Bacterial Overgrowth.  SIBO happens when bacteria (and sometimes yeast & fungi too) that would not normally be in the small intestine show up there and throw a giant party.  According to Dr. Allison Siebecker, "Simply put, Small Intestine Bacterial Overgrowth is a chronic bacterial infection of the small intestine.  The infection is of bacteria that normally live in the gastrointestinal tract but have abnormally overgrown in a location not meant for so many bacteria."  (You can go to Dr. Siebecker's SIBO website here, to get all the in-depth details behind everything mentioned in the post.)

There are lots of theories on how and why these bacteria show up in the wrong place, in the wrong numbers.  One is that decreased gastric acid leaves foods not well digested before they reach certain points in the digestive tract, which gives the bacteria something to feed on.  Another is that motility (muscular activity) of the small intestine decreases, making it hard for the small intestine to do one of its jobs . . . sweeping bacteria into the colon.  Soooo, guess who is especially at increased risk for SIBO infections?  Yep.  Peeps with digestive system diseases.  Celiacs (lucky me), those with Crohn's, those with Chronic Pancreatitis, etc.  Another group that has a greater risk are those with diseases that can affect the muscles or nerves that operate the digestive tract, like Diabetes or Scleroderma.  

The reason SIBO is so serious is that it messes up normal digestion and absorption of nutrients while it is busy damaging your small intestine lining.  That damage leads to or exacerbates intestinal permeability (leaky gut).  And once you can't get proper nutrients from your food and you're leaking bacteria and food particles into other parts of your body, you've got LOADS of new issues to tackle.  Here's the other thing, SIBO is painful.  Really painful.  Symptoms can vary, but there is generally extreme bloating, constipation, and cramping.   

Now the bad news.  I have a SIBO infection again.  (Come on!  Universe!  What the bleepy-bleep-bleeped do you want from me?)  I have recently undergone a whole series of tests as part of my one year post diagnosis follow-up for Celiac Disease.  My GI doc practices some pretty serious functional medicine (lucky me), so he tested the heck out of me (not lucky me).  He wanted to know what was up with my old frenemy, so he ordered a SIBO test.  

There are three kinds of breath tests used to detect potential SIBO.  Last year, around this time, I did the Lactulose Breath Test.  You drink a sugary drink that the bacteria respond to and use to begin creating hydrogen and methane gases.  These gases are measured over three hours while you basically blow them out of your mouth into a tube.  Last year, when I got positive results, I took a course of an antibiotic called Metronidazol.  Metronidazol is Awful with a capital A.  Each dose would give me a headache and reduced me into a blubbering emotional wreck.  This was a very noticeable reaction, because at the time I had just begun AIP and one my first huge improvements was mood stability.  My husband coaxed me through the full course, but even he was shocked at how extreme the antibiotic was on my emotional state.   

SIBO is very difficult to treat and people often have chronic infections.  I was luckily eating AIP and adapting to the Paleo lifestyle, so one course of the antibiotics worked.  I had no symptoms of SIBO until very recently.  So what changed?  Why did my SIBO return?   

My theory is that it was a combination of things.  First, I take a pancreatic enzyme to help aid digestion.  It is a prescription enzyme and I ran out.  I called my primary care doc for a refill.  The request wasn't answered.  I called again.  I finally spoke to her nurse, but then there was apparently a series of extrodinary miscommunications and the doc's office became completely incapable of indentifying what pharmacy I use (same one the whole time I've been your patient, duh) and the pharmacy became completely incapable of identifying me (What do they need beyond my name, DOB, and address?  Do these people need a flipping DNA sample?).  The result?  No enzymes for well over a month.  At the same time, I was, probably unwisely, trying to cut back on my use of apple cider vinegar to aid stomach acid, in an effort to understand if my own acid production was normalizing.  My digestion  practically ground to a halt.  Dang.  

Second, I seriously think the sugary little drink I took on the day I did my repeat Lactulose Breath Test is what put the whole thing over the top.  That day the bloating returned.  I also followed the breath test with a camera endoscopy.  For those not familiar, it means swallowing a gigantic capsule with a tiny battery and camera in it, which transmits pictures of the full length of the GI tract back to a recorder which your doc can use to help evaluate you.  Totally.  Freaked.  Me.  Out.  I think it freaked my system out too.  I have autoimmune troubs, so any foreign objection is bound to send my body into "total annihilation" mode.  Double dang.

What to do now?  I think there are three ways to approach treating SIBO.  A)  Give up.  Putting on a pair of terrible ugly elastic waisted pants that accomodate the bloating and then sitting in my closet while drinking wine, crying, and composing hate mail to the universe (Dear Dirtbag . . . ) with a tiny flashlight, seems tempting.  B)  I can take another course of antibiotics combined with the strictest adherence to AIP and hope that it clears up as quickly as it did last time.  C)  I can tell my doc that it will be a cold day in hell before I take those nasty antibiotics again.  To which he will reply, "Okay, then I'd like you to take this blend of botanical extracts that act as antimicrobials and follow a low FODMAP diet."  And I'll go, "For real?  You had another approach for people that don't like poisoning themselves?  Aaaawesome."  
Obviously, I chose option C.  I am taking the botanical blend my GI doc recommends, I am going low FODMAP (avoiding complex sugars will help starve the bacteria) in addition to retreating back to very strict AIP, and I am getting back on enzymes and ACV.  I am also incorporating lots more bone broth and kraut, but I am laying off probiotic supplements, as they can sometimes make SIBO worse.  I'm also doing yoga for digestion, to help the muscular activity of my intestine pick up.  Last but not least, I am trying limited use of oil of oregano.  I say limited, because it is really powerful stuff and the die-off reaction is pretty intense.  In fact, Chris Kresser recommends people not use it without a professional's guidance.  My first exposure resulted in all over aches, pains, and increased anxiety.  I had to take a serious detox bath to calm everything down, so I tend to think he is right.
Am I a little depressed to be reaching my one year Paleo-versary and having to get even more strict to deal with an old adversary?  Yes.  I'm telling true stories here, so it would be a lie to say no.  However, there's a part of me that is celebrating anyway.  I know so, so much more than I did a year ago.  I already know what SIBO is, I know that there are alternative ways to treat it, I know I could further adjust my diet to beat it, and I know how to tell the doctors what I will and will not do to my own body.  Most importantly, I KNOW I am capable of healing myself.  I believe my body was designed to fight and knows just what to do if I will aid it in battle.  That's not depressing.  That's miraculous.   

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13 thoughts on “Uh-oh . . . SIBO

  1. I am asking my doctor about this for me...thank you!
    Is the Lactulose Breath Test the same as a lactose intolerant test. Back around 1999, I was asked to participate in a study for a new drug for IBS and the first test was where I drank something that tasted like watered down Tang and then I had to blow into a tube every hour or half hour for several hours. They said it was a lactose intolerant test. I tested positive, so I did not qualify for this test drug and was taken out of the test study. Do you know by chance if the test you took similar to this test I took?

    1. Hi Ashley-
      The test you took is exactly like the Lactulose Breath Test, which makes me think they were testing you for SIBO, not lactose intolerance. I could be wrong though. Definitely ask your doc about the test, if you feel that you have an unrecognized SIBO. Thanks for reading!

  2. I was wondering if you have an update on how the diet is working for you? I am having the breath test done tomorrow (I have celiac disease too). If the diet is working, I would definitely prefer that over the antibiotics.

    1. The diet did work for me, but I had to combine it w/ antibiotics at one point to squash the overgrowth enough that I could get control w/ the diet. Also, once I was sure the SIBO was controlled, I added a really high-quality probiotic. (Do not do that WHILE treating the SIBO.) Honestly, I think the probiotic is what really got me out of the woods long term.

  3. Amba

    Can you share the names of the antibiotic and the probiotic that you mention above? thanks for all that you do....

  4. Hi Amba! Thanks for reading! I don't usually publicly share product names, but a good probiotic is Prescript Assist. The antibiotic I used was Rifaximin. It is pretty much the antibiotic of choice for SIBO by all well-educated GI docs.

  5. Dina

    Thanks for your info on how you treated your SIBO. I am celiac and 100% gf for over 12 years. SIBO was diagnosed for me over the summer , one dose of Rifaximin worked at the time, then 2 months later another bout of SIBO, they put me back on the Rifaximin - this time it didn't help. My dr insisted it ALWAYS works - it didn't, and she threw me on a PPI (which makes SIBO worse) and when my nausea and gas pain got too intense to live with and function and I was taking multiple zofran a day she started sending me for gallbladder tests and having me take gas x (antacid which looks like from the drs page you recommend she says NOT to take that TOO!) . Finally I got in touch with the other dr in the practice and INSISTED that my SIBO did not go away and it was now about 2 months later - she gave me Flagyl & Cipro (I know there are alot of scary things with CIPRO) . Anyhow, yesterday was my last dose of those antibiotics- and in the meantime I also have been trying to find the RIGHT diet ( SO MANY inconsistencies out there!!) - I am basically wasting away. I am already underweight 5'4, 97 lbs. I am still not feeling great - although better - but I am eating virtually NOTHING. I am trying to find a new dr in Functional Medicine which of course Insurance doesn't cover at all, and trying to find a dietician to help too - I have been scowering the web to try to find help - how long do you think I need to wait after being off the antibiotic to start the Probiotic that you recommended?

    1. Angie Alt

      Post author

      Dina, what was the reason for Flagyl? I have taken it before, but it is not a normal drug for SIBO, more for parasites. Hmm? According to the recent SIBO symposium I attended via webinar, you can take the antibiotic & probiotics at the same time. Just take the pro at night, so there is plenty of space between it & the anti. Definitely consider the Low-FODMAP diet. Hang in there!! SIBO is tough stuff!

  6. Lisa S

    I am curious as to what your SIBO symptoms are? I was diagnosed with Celiac Disease in September and have been mainly okay - however I have had bouts of sickness that start with diahrea, include severe nausea and extreme exhaustion that last anywhere from 3-5 days. I haven't been able to pinpoint any certain food, or being "glutened" to these episodes. I just started taking a Probiotic - but even had one within the first week of that too.

    1. Angie Alt

      Post author

      Actually, Lisa, the extreme exhaustion & nausea seem like glutening to me. You are really newly diagnosed, so do you think it is possible that something non-GF is sneaking in? Like in medications, spices, teas, cosmetics or other body care products, or household cleaners? My SIBO symptons were extreme bloating, belching, & constipation. Diarrhea can be a SIBO symptom & there is even a good chance that as a Celiac you are also dealing w/ SIBO, but your immediate symptoms seem like glutening. Have you had your antibodies retested to see if they are decreasing? If they are not, it is likely you need to start w/ sleuthing out that gluten. The next step is to eliminate foods that cross react to gluten. You can find that list here: http://www.cyrexlabs.com/CyrexTestsArrays under the test labeled "Array 4." Good luck! And don't worry. You'll figure it out.

  7. Chris

    hi Angie,
    What kind of yoga or what poses did you do for your digestion? One big thing with SIBO is that the migrating motor complex (MMC) slows down, so the food doesn't move from your small to the large intestine as quickly as it should, giving bacteria the chance to feed and take up residence in the small intestine. I've seen that taking a prokinetic like ginger, motilpro, low dose naltrexone or low dose erythromycin are recommended to stimulate the MMC for people with sibo; this helps prevent relapses. But I'm also really interested if there are yoga, acupuncture, qigong or massage therapies that can help stimulate the MMC or support digestive health in general. What did you do and did you find it helped?


  8. Scared and Confused

    I have noticed in the past seven months I have lost a significant amount of body muscle (though the scale says I haven't lost anything). I have pictures to show the difference. My clothes no longer fit the way they used to. My primary doctor says nothing is wrong. However my GI dr is constantly treating me for sibo. Is this common for me to lose weight this fast? The scale has remained consistant at 154 (but visually I look a lot smaller). Until recently, now it says 148 in the time span of 1 1/2 weeks. Im scared and don't know what to do. I just need someone to let me know what is going on. I cry because I'm losing so much weight and no one knows whats wrong. I eat but keep losing weight.


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