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Studies show that small intestinal bacterial overgrowth (SIBO) occurs in 90 to 100 percent of fibromyalgia patients. Dr. Alex Vasquez, author of Fibromyalgia In A Nutshell, says that fibromyalgia is the result of SIBO and that treating bacterial overgrowth results in significant alleviation of FM symptoms. This prompted me to write this post about small intestinal bacterial overgrowth…what SIBO is, the symptoms and how to treat it.
Our intestines consist of two major subdivisions: the small intestine and the large intestine. The small intestine is much smaller in diameter but is much longer and more massive than the large intestine. The intestines are an important part of the immune system, especially the small intestine.
Normal bacteria that are part of the small intestine help protect against bad bacteria and yeast that are ingested. They help the body absorb nutrients, and also produce several nutrients and vitamins.
Research has revealed that gut bacteria perform a host of useful functions. These include interacting with the immune system, producing vitamins such as vitamin K, stimulating the release of hormones involved in the storage of fats and influencing mood and our feeling of well-being.
What Is Small Intestinal Bacterial Overgrowth?
Small Intestine Bacterial Overgrowth is a chronic overgrowth of bacteria in the small intestine. SIBO is not caused by a single type of bacteria. It is an overgrowth of various types of bacteria that should normally be found in the colon (large intestine).
Bacteria overgrowth interferes with normal digestion, the absorption of food and leads to damage of the lining of the intestine. Eventually, the bacteria enters the bloodstream and cause problems with the immune system. The immune system’s reaction to the bacteria causes fatigue, body pain and burdens the liver.
Finally, the bacteria excrete acid, which in high amounts causes neurological and cognitive symptoms.
Symptoms Of SIBO
The main symptoms of SIBO are those of Irritable Bowel Syndrome (IBS):
- Abdominal gas and bloating
- Abdominal pain and cramps
- Constipation, diarrhea or both
- Mucus in the stool
Other symptoms may include:
- Heartburn, acid reflux
- Nausea, vomiting
- Vitamin and mineral deficiencies
- Food sensitivities
- Joint pain
- Brain fog
- Skin rashes or eczema
- Respiratory symptoms such as asthma
- Depression and/or anxiety
SIBO may be an underlying cause or a major factor in all of the following diseases: acne rosacea, anemia, autism, celiac disease, cystic fibrosis, chronic fatigue syndrome, diabetes, diverticulitis, fibromyalgia, GERD (gastroesophageal reflux disease), hypothyroidism/Hashimoto’s thyroiditis, IBD (inflammatory bowel disease) such as Crohn’s and ulcerative colitis, IBS (irritable bowel syndrome), muscular dystrophy, rheumatoid arthritis and many others. You can see a full list of associated diseases at SIBO Info.
The most common way to diagnose SIBO is with a breath test. The breath test involves drinking a prepared glucose or lactose solution, then measuring the presence of methane and hydrogen gasses. There is a 24-hour preparation period before taking the test. The first 12 hours require a specific diet and the last 12 hours require a fasting period. After drinking the solution, the patient produces breath samples every 20 minutes over a 3-hour period. The test is performed in a doctor’s office, hospital, clinic or with an at-home test kit.
Treatment involves reducing the bacteria, healing the intestinal lining and preventing relapse.
- Antibiotics – The most common prescribed antibiotic used to kill SIBO is Rifraximin. However, using antibiotics can also have a negative impact on the good bacteria in the gut. With that in mind, many people choose to try an herbal antibiotic such as enteric coated peppermint, garlic, oregano and golden seal.
- Diet – Bacteria primarily feed off of sugars and starches in the diet (both refined sugars and natural sugars). So it is essential to eliminate all refined sugars from the diet and most starchy foods. Keeping your diet low in carbohydrates will starve the bacteria. Established SIBO diets are:
- Specific Carbohydrate Diet (SCD) – The Specific Carbohydrate Diet is a group of foods which are grain-free, sugar-free, starch-free, and unprocessed. The diet is an all natural way to break this cycle of bacteria and yeast overgrowth by eliminating the food sources they feed on. This book, Breaking the Vicious Cycle by Elaine Gottschall can help you understand the diet.
- Gut and Psychology Syndrome Diet (GAPS) – The GAPS diet is based on the Specific Carbohydrate Diet. 85% of everything you eat daily should be made out of meats, fish, eggs, fermented dairy, and vegetables. Baking and fruit should be kept out of the diet for a few weeks, and then be limited to snacks. Homemade meat stock, soups, stews and natural fats are the main staples of this diet. Gut and Psychology Syndrome by Dr. Natasha Campbell-McBride can help fully understand the GAPS Diet before you start. Starting the diet incorrectly may lead to unnecessary diarrhea or constipation.
- Low FODMAP Diet – FODMAPs is an acronym referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are the names for a collection of molecules found in food, that can be poorly absorbed by some people. The Low FODMAP diet has two phases. The first phase restricts all high FODMAP foods for 6 to 8 weeks. The second phase is where the type and amount of FODMAPs are identified so that the longer term diet can be established. Dr. Sue Shepherd developed the low FODMAP diet in 1999. This book, The Complete Low-FODMAP Diet by Dr. Shepherd and Dr. Peter Gibson is a complete reference guide about the low-FODMAP diet.
You can follow one or a combination of these diets.
Several studies have connected fibromyalgia with the gut, emphasizing a strong relationship between fibromyalgia and bacterial overgrowth in the small intestine. Researchers discovered that the degree of bacterial overgrowth detected in the small intestine has a direct relationship with the severity of fibromyalgia. Some even suggest, small intestinal bacterial overgrowth may lead to fibromyalgia.
Since small intestinal bacterial overgrowth can contribute to pain, your diet can help alleviate FM symptoms and protect your gastrointestinal tract and nervous system.