What Is SIBO?

Not to brag, but guess who has two thumbs and SIBO… again?! So, I decided to write about my experience with SIBO (Small Intestinal Bacterial Overgrowth), my treatment, diet adjustments, and how I am coping.

For a condition one can easily google, I hadn’t even heard of SIBO until a few years ago. That’s when I decided to test for it, and low and behold, I discovered I had it. One round of antibiotics back then seemed to do the trick, but that was then, and this is now.

SIBO is a condition which is known for its recurrences. It’s estimated that only 1/3rd of SIBO cases are cured the first time, and the other 2/3rds of people who have it wind up having multiple recurrences in their life.

SIBO has been under the radar, only recently getting more attention on the patient end. Even for doctors and gut health specialists, SIBO is a bit of a mystery. It’s not entirely clear if SIBO is a result or cause of other health issues. But either way, there’s a correlation. Even the protocol for treating SIBO varies widely among practitioners.

A little background on SIBO:

Our digestive system is filled with healthy bacteria which are responsible for breaking down our food, keeping up our immunity, balancing our emotional state of mind, and pretty much everything good in our lives. In fact, here are some fun stats on these friendly bacteria:

• roughly 90% of serotonin is produced in the gut with the help of these bugs

• over 70% of our immune system lives in our gut, which these bacteria help protect

• we are only 10% human, actually. The other 90% is all microorganisms

• the bugs in and on our body make up roughly 3-5 lbs of our body weight

• when it comes to digesting certain fibrous foods, our bodies themselves can’t do it—it’s the healthy bacteria in our gut that digest the foods! That’s why it’s so important to eat healthy, fiber-rich foods—to feed the bugs so they can do their magic (that is, unless you have SIBO…)

All the healthy eating habits and rules go out the window when you have SIBO. With SIBO, the healthy bacteria is overgrown, and in the wrong place, so feeding them is counterproductive.

You see, these magical bug creatures are supposed to live in your large intestine (a.k.a, the colon). The small intestine, by contract, is supposed to be mainly sterile, free of any bacteria.

When you have SIBO, it’s not that the bacteria is bad, but simply, misplaced. SIBO is an overgrowth of the GOOD bacteria, in the wrong place. Yep, the good bugs have moved from the large intestine into the small intestine, which is not designed to house them. This can cause a range of digestive symptoms—don’t make me name them, use your imagination (or google).

Having went through a stressful period in my life a few months ago, I have no doubt that the stress triggered the bug migration and brought on SIBO again. That’s one of the major contributors to SIBO—stress.

SIBO can also be caused by a dysfunction in the valve separating the large and small intestines, or a dysfunction in the MMC (migrating motor complex). The MMC is a natural bodily process that sweeps out residue in your digestive tract in between meals. If there is a dysfunction in the MMC, bacteria and food particles can remain in places they shouldn’t.

As someone with multiple food sensitivities, specifically foods that are high in fiber (certain fruits, veggies, legumes, wheat, dairy), I’ve been on a low-FODMAP diet for several years anyway. But when I realized I had SIBO again, that diet was not enough. I had to go on the bi-phasic diet, which is an even more extreme version of the low-FODMAP diet.

Note: Please do not attempt these diet changes on your own without consulting with your doctor or nutritionist. Diets like these are designed to “starve out” the bacteria, which should only be done when necessary. They are meant to be temporary, and if done incorrectly, can lead to malnutrition.

The low-fiber diet was not only a recommendation from my doctor, it was something I wanted to try to alleviate my discomfort. Some of my favorite foods that I was able to tolerate before SIBO include peanut butter, rice, avocado, sweet potato, and chickpeas. But all of a sudden, just the slightest amount of these foods would cause terrible pain in my stomach. And so, they had to go.

Speaking of bacteria, probiotics also had to go. For years I’d been taking daily probiotics to supplement the good bacteria in my gut (as most people should!), but now that I had an overgrowth of it in the wrong place, taking probiotics would be like adding fuel to the fire.

So that was my protocol as far as diet went:

1) stop the probiotics

2) restrict my diet to mainly lean animal proteins, simple sugars, healthy fats, and some vegetables

3) continue said protocol for roughly three months (yes, it can take that long to heal)

As for the rest of my treatment, I was prescribed an anti-microbial supplement called Atrantil, to help reduce the symptoms of SIBO.

Note: Some practitioners feel that before starting any anti-bacterial treatment, the patient should actually eat a lot of fiber-rich foods to “bring out” the bacteria, making them easier to kill when you start taking the antibiotics/antimicrobials—like laying out a steak to trap a bear. Others feel it’s better to starve them out. It’s very much trial and error, for patients AND doctors.

About two weeks into the treatment I was not impressed, and I was getting impatient. I was feeling low, in every way a person can feel low. My symptoms hadn’t improved, and my mood followed suit. Having SIBO, especially when it’s a recurrence can be emotionally disturbing. After struggling with digestion for so long, and finally getting some relief in recent years, it feels terrible to have that taken away from you. It can be devastating. All the progress you’ve made can seem insignificant and for naught.

Even though I knew the SIBO wouldn’t last forever, it was tough to be “back there” again. At first I became depressed, hopeless, frustrated. What was wrong with me? I thought. Why can’t I just get better and STAY better?

One thing that was helpful for me during these moments was remembering that, not only will this pass, but, it’s completely normal to feel emotionally shitty when your gut chemistry is off. Remember, our gut and brain are intimately connected. The gut bacteria helps produce almost all of our serotonin, so how could I possibly feel happy when I’m in the process of annihilating those bacteria?! It’s like firing your personal assistant and expecting to have an easier work load.

Even though I was down, I decided to make lemonade of it. I had always wanted to try removing grains from my diet anyway and see how I felt, so this was a good opportunity. At first it felt good. I felt less hungry and was able to cope just fine without them. It was one less thing I had to buy and cook, and frankly I didn’t miss them that much.

Aside from still having pain, bloating, and mild depression, my appetite and poop were in good standing, so I decided to stick to my regime, and give it some more time… that is until about three weeks into the treatment.

That’s when I started to really notice the absence of grains. My body had went into ketosis, a metabolic state which can be brought on by a low-carb diet. It’s not necessarily unhealthy, and for some, can result in feeling great, weight loss, and other health benefits. But for me, I noticed a very distinct weakness in my muscles and very low energy. The limited access to blood sugar was not sitting well with me.

Fighting SIBO, lacking probiotics, and not having enough carbs were all energy zaps. I didn’t like the way I felt. So I decided to listen to my body, and bring back rice and probiotics into my diet.

Within just a few days, I felt more energy and less weakness in my muscles. I do think I need grains in my diet, even if they “should” be avoided during SIBO treatment. This is one of those things you have to experiment with yourself, to get the right blend of what will work for you. Diets are supposed to be tweaked and used as templates, not gospel.

I still have SIBO, but it feels like it is getting better. I have to accept that, this is not my first time having SIBO, and it may not be my last.

It’s so important that if you have SIBO, you work with a qualified practitioner to diagnose and treat it, and decide for yourself what protocol you can reasonably follow without compromising your health.

Note: This blog was written in 2018. I’m currently SIBO-free.