A woman with a stomach ache in bed

All about SIBO (Small Intestinal Bacterial Overgrowth)

What is SIBO?

SIBO stands for Small Intestinal Bacterial Overgrowth.

It is normal to have bacteria in your small intestine. But if there are too many or the wrong kind of bacteria, they can upset the balance in your gut which can cause intestinal complaints.

There is not much awareness of SIBO yet. Here in the Netherlands, not many doctors know about it yet. In the United States, more and more studies are slowly being done on SIBO.

Studies show (see an example here) that SIBO is common in people with IBS (Irritable Bowel Syndrome).

The study mentioned above looks at 25 studies where people have IBS. Among other things, they look at how often SIBO occurred in people with IBS and in healthy people in the control group.

These studies showed that someone with IBS was more than 5 times more likely to have SIBO than a healthy person.

They indicate in these studies that there may be a link between IBS and SIBO, but more research is necessary to prove this.

These studies do indicate that it would be good if SIBO became better known to doctors and practitioners.

And that more attention is being paid to whether SIBO might be the cause of the complaints in people for whom the FODMAP diet does not lead to a sufficient reduction of the complaints. Then the complaints can be handled better.

Groenten in een mand

What are the symptoms of SIBO?

The tricky thing about SIBO is that the symptoms of SIBO are similar to other intestinal problems, such as IBS. That makes it more difficult to distinguish.

Symptoms of SIBO can include:

  • Extreme flatulence
  • Abdominal pain and cramps
  • Sticky stools
  • Gas formation
  • Fatigue
  • Food hypersensitivity
  • Bad digestion
  • Nausea
  • Unwanted weight loss
  • A full feeling

In addition, it is often the case with SIBO that complaints occur quite quickly after a meal.

Do you suffer from abdominal pain, cramps, and flatulence soon after eating? Then that could indicate SIBO.

Een bord met wortel, avocado en kruiden

What is the origin?

The origin of SIBO is not very clear yet. More research needs to be done on this.

But it is already known that people with any of the following conditions or symptoms are more likely to develop SIBO:

  • If you have had food poisoning.
  • If you have had a parasite in the intestines.
  • If you have reduced stomach acid or have been using antacids for a long time.
  • If you have inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
  • After surgery on your small intestine or an intestinal infection.
  • After prolonged use of medication, such as antibiotics. Or the abuse of drugs or alcohol.
  • If you have IBS (according to the research I cited above).
  • If you have diabetes.
Iemand aan een behandeltafel die een vragenlijst beantwoord

How can SIBO be diagnosed?

I have mentioned several times in this blog that more research is needed with regard to SIBO and unfortunately, that is also the case with regard to the diagnosis.

There are currently a few methods by which SIBO can be diagnosed. In the Netherlands, a breath test is the most commonly used method:

  • Glucose/lactulose breath test: with this test, you drink a drink containing glucose or lactulose and then do a breath test. The exhaled air is then measured for hydrogen, methane, and CO2.

    Which of the two breath tests is best depends on the complaints you have.

    The only drawback of these tests is that they sometimes give a false positive or false negative result at SIBO, which means that the test is not always reliable.
  • Determination by a dietician or practitioner: your dietician or practitioner can also determine that you probably have SIBO by extensively discussing your complaints, asking questions, and possibly having an analysis list completed.
  • Stool test (fecal examination): a stool test shows which microorganisms are present in the intestines and in what quantity.

    And whether, for example, there is an excessive amount of these micro-organisms present, which can cause complaints.

The stool test can also show other substances that can tell you something about the health of your intestines.

The disadvantage of a stool test is that it cannot show whether the bacteria that are found are in the large or small intestine.

For me personally, it has been determined that there is a good chance that I have SIBO through a stool test and on the basis of a description of the complaints I have.

At the moment, I know that the breath test in the Netherlands is the most reliable method to determine SIBO, but it is always good to discuss with your practitioner what is the best option for you.

Source: the book SIBO by Joyce Bijl and Jacqueline Gerrits

Supplementen op borden en op een blad

How can SIBO be treated?

There are several ways to treat SIBO. But the treatment of SIBO is still in its infancy.

The recovery process can take quite a long time and the treatment depends very much on the type of complaints you have.

You need to take a good look at how you respond to a certain treatment and the next steps can be adjusted on the basis of this.

An elimination diet is often part of a SIBO treatment, just like supplements.

But it is also possible, for example, that antibiotics are used or prokinetics (drugs that stimulate the muscles of the gastrointestinal tract).

I think I have SIBO, now what?

Do you suspect you have SIBO? Then I recommend looking for a doctor, dietician, or practitioner who has experience in treating SIBO.

SIBO is still relatively unknown and not all doctors and dietitians are therefore familiar with SIBO.

Because the treatment of SIBO is difficult and can take quite a long time and because the treatment differs per person, it is important to do this under the guidance of a specialist.

I strongly advise against experimenting with supplements and, for example, the SIBO diet without the guidance of a professional.

This is because the approach and supplementation must really be tailored to your personal situation.

And if you try something yourself, there is a good chance that it will not work and that you will not get the necessary nutrients that you need.

Were you already familiar with SIBO? Or have you been diagnosed with SIBO? I’m very curious about other people’s experiences. Feel free to leave a comment in the comments below!

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  • Jan Coate says:

    Hi Karlijn, I appreciate your emails, even though here in Australia we are always in a different season to you.
    I had never heard of SIBO. I have Fructose Malabsorption, IBS, a super sensitive gut, and before the low FODMAP diet, I always seemed to have wind and diarrhoea. After my second bout of Covid, I am now also Lactose Intolerant. Crazy huh??
    As I read through all the symptoms of SIBO, I am relieved to see I do not have it. Phew. Good luck to you in recovering from it. And please keep on sending recipes, I do enjoy them. Thank you. Jan Coate

    • Karlijn says:

      Thank you, I will do! Crazy that you got a lactose intolerance after Covid indeed, I didn’t even know that was possible

  • Cath says:

    Hi Karlijin
    I was diagnosed with SIBO about 5 years ago, breath tests and history. Was put onto a very strict diet and lost 5kg in 5 days, was very unwell and the practitioner quickly ceased the diet !
    I remain on a low fodmap and gluten free diet as was unable to maintain wt on the SIBO diet.
    I still get symptoms and sometimes feel awful but much better than I was.
    Any tips greatly appreciated and thanks for your great recipes.

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