Living Low Fodmap with SIBO (Small Intestinal Overgrowth)
SIBO what is it? The steps I took and still take daily to live with SIBO.
Tip
I am serious about taking good care of my skin, using safer skincare products, keeping my hormones balanced, eating non-inflammatory foods, (see my skincare routine here) and washing my makeup brushes is a huge part of me keeping my acne at bay. Since they can get pretty nasty, I HIGHLY recommend cleaning your brushes, at least, one time per month. Blog post here.
I’ve been through so much the past 5 years of finally figuring out why I felt so poopy (pun intended!) I remember, after my first son was born in 2003, that something was off digestively. I went to numerous doctors only to have all my symptoms be diagnosed as IBS.
I’ve been an athlete, runner, gymnast, and personal trainer since 1999, I’ve been teaching group exercise classes since 1991! With having a huge passion for working out every single day, running half-marathons, planning to run Boston, and one morning I woke up and literally had a panic attack. My joints were hurting, my stomach was distended, I was constantly constipated, and the anxiety I was experiencing was OFF the charts. By this point, I had been through over a decade of digestive woes, and I knew something was really off. I had NO energy to move, everything hurt from my feet up. I kept pushing my body, because my motto was suck it up and just deal with it. That was THEN. This is not the case so much anymore. I would sit and watch Netflix and have neuropathy in my legs and hands, then a scratchy feeling inside my small intestine, like something was inside there. Furthermore, I also had way more than occasional tooting, it was ALL the time.
Once I started to put the physical pieces together—the outward bloating with the inward distress—I decided to see a functional medicine doctor for candida, because at the time, I hadn’t heard of SIBO. The diagnosis I received was, in fact, SIBO: small intestine bacterial overgrowth.
I quickly fell down the internet wormhole, and what I discovered about SIBO changed my entire understanding of gut health. To be honest, up until this point, I ate a very traditional body building diet, consisting of a lot of eggs, which actually were a trigger food for me, proteins and carbs. I had no idea what fodmaps were, and boy was I in for a BIG diet change!
Researchers have estimated that over 60 percent of IBS cases are actually being caused by SIBO. The issue is not necessarily the ratio between good, beneficial bacteria and bad, pathogenic bacteria (though that could be part of it too) rather, the location of the bacteria.
Though bacteria colonize all sections of our alimentary canal, the majority of it is found in the large intestine (also known as the colon). There, it assists in the final step of our digestive process and prepares waste matter for evacuation.
The small intestine has three parts: the duodenum, jejunum, and ileum. It helps to further digest food coming from the stomach. It absorbs nutrients (vitamins, minerals, carbohydrates, fats, proteins) and water from food so they can be used by the body. The small intestine is part of the digestive system.
If you have SIBO, the excess bacteria often cause diarrhea and may cause weight loss and malnutrition.
There’s no one approach to treating SIBO, which is what often makes patients so confused. I know I was.
Your SIBO roadmap, at least I know mine was, it was not streamlined. It was a lot of detours, and steep uphill climbs that often lead you to exactly where you started, which can feel so frustrating and defeating all at the same time.
IT’S IMPORTANT TO KNOW WHICH BACTERIA YOU ARE TREATING FOR AN
EFFECTIVE TREATMENT PLAN.
The main test for SIBO is a hydrogen-methane breath test. After drinking a synthetic sugar solution (bacterial fast food), you breathe into a series of tubes at various timed intervals. The lab then measures any rises in hydrogen or methane gas in your breath. The timing is what indicates whether they are in your small or large intestine, i.e. whether their presence is normal or an indication of SIBO.
Symptoms
Signs and symptoms of SIBO often include:
Loss of appetite
Abdominal pain
Nausea
Bloating
An uncomfortable feeling of fullness after eating
Diarrhea
Unintentional weight loss
Malnutrition
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Why small intestinal bacterial overgrowth (SIBO) develops
The small intestine is the longest section of your digestive tract, measuring about 20 feet (6.1 meters). The small intestine is where food mixes with digestive juices and nutrients are absorbed into your bloodstream.
Unlike your large intestine (colon), your small intestine normally has relatively few bacteria due to rapid flow of contents and the presence of bile. But in SIBO, stagnant food in the small intestine becomes an ideal breeding ground for bacteria. The bacteria may produce toxins as well as interfere with the absorption of nutrients. This is why I felt a scratchy sensation with my higher than normal numbers of methane and hydrogen.
Find Your Root Cause
SIBO gets a bad rap for being a notoriously difficult, chronic condition. But often the main reason it returns is that you haven’t dealt with the physical defects, lifestyle issues, or nutrient deficiencies that caused your SIBO in the first place.
SIBO is not a disease, but it certainly is a sign that something is not working within the body, and for me, it was several things.
For me and with just under 5 years of being fully recovered from my eating disorder of over a decade, I knew my migrating motor complex needed work. How was I going to deal with my stress and anxiety now that I didn’t have my eating disorder to hide it with? It is known that, anorexia and bulimia have been associated with methane dominant SIBO, which is exactly what I had, with slight morph into hydrogen sulfide then back to methane dominant. You can see my healing journey was not linear.
A Few Reasons SIBO Happens
Insufficient stomach acid
Your stomach acid kills the bacteria that you swallow along with your food. If you don’t have enough, they can find their way into your small intestine and multiply (Source: PUBMED).
Low levels of bile
Bile is another substance your body uses to defend the small intestine against invading bacteria. Insufficient levels of bile can allow bacteria in the small intestine to get out of control (Source: NCBI).
Insufficient digestive enzymes
If your body isn’t producing enough digestive enzymes, your food can remain in your small intestine and instead of feeding you, feed your bacteria (Source: PUBMED), encouraging numbers to grow.
A compromised immune system
Many researchers have noted a link between SIBO and something known as post-infectious IBS (IBS symptoms that begin after a bout of food poisoning). There’s also evidence that people with SIBO and IBS have higher levels of inflammation in their guts (Source: NCBI), suggesting that an imbalanced immune reaction is at play.
If your immune system is weak, plus stress, plus other factors mentioned above, you’ve got a recipe that could result in SIBO.
A faulty ileocaecal valve
Your ileocaecal valve is the ‘door’ that sits between your small and large intestines. It’s designed to enable food to flow down from the small intestine into the large intestine, and prevent it from going backwards. For a variety of reasons, that doesn’t always happen.
If it doesn’t shut when it’s supposed to, the hundreds of trillions of bacteria in your colon can start to migrate to your small intestine (Source: NCBI).
A faulty migrating motor complex
To push your food through your GI (gastro-intestinal) tract—the ‘tube’ that runs all the way from your mouth to your anus—your body performs a complex, tightly coordinated series of events. In between meals, your migrating motor complex (MMC) happens approximately every 90-120 minutes to sweep what you’ve just eaten through your GI tract.
Several studies have demonstrated that abnormalities in your MMC make it more likely that you’ll develop SIBO (Source: PUBMED).
For me it was numerous things. My thyroid had tanked completely during treatment, I was barely producing any t3, which left with little to no energy, stress, migrating motor complex, low immunity, insufficient digestive enzymes (I had heartburn for YEARS), and elevated chronic infections like EBV (Epstein Barre Virus) and Lyme Disease.
How to Test?
The hydrogen breath test is a fast, easy, and non-invasive method for testing for SIBO. By measuring the gases in the small intestine, a hydrogen breath test can determine if you are suffering from excess bacteria, and if so, to what extent. The process is pretty simple, view a post here, of my last breath test I took at home.
If you decide to take a SIBO test, you’ll get a sugar solution to drink. Soon after you drink it, the solution hits your small intestine, where the bacteria there eat those sugars and produce gases. Small amounts of gas are normal, but larger amounts mean there are too many bacteria there, and you have SIBO. Make sure your test does measure both hydrogen and methane. Some only test hydrogen, and you want to measure both.
How to Treat?
Conventional doctors use antibiotics to treat SIBO, while a Functional Medicine Practitioner/Registered Nutritional Therapist will usually use a combination of antimicrobial herbs, along with other nutrients, digestive aids and methods to support gut healing and health. I used both including oil of oregano, berberine, neem and garlic. This was not all at once, but I really tried many modalities, with finally finishing with 3 rounds of Xifaxan and Neomycin.
How I Healed
My entire life changed. When I say this, I say it with grace and compassion because I fought it for a really long time and I needed to trust that someday I would get better and have energy again with no more achy joints, headaches, constipation and upper abdominal pain. It was terrifying and hard while I was in the middle of it, I remember feeling so lost and hopeless at times. I slowly started changing my daily habits, decreased my exercise, no more running or heavy strength training (I did this because my body could not recover and left me feeling even worse), to this day, harder workouts when I’m run down will affect my digestion, so I’m always careful. To be clear, I still workout, but the intensity of my workouts have drastically changed, and I’m okay with going for a walk especially if it’s in the woods! I also started to meditate every single day for 30 minutes or more, I needed to reset my central nervous system and improve my vagus nerve, which I knew meditating would be a great first start. I also worked in alternate-nostril breathing, cold showers, breathing deeply and slowly throughout the day, eat slow and really chew my food, connect with nature, I literally took forest baths, diaphragmatic breathing, the slower, the better and changed my diet to basically low sulfur & low fodmap.
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