What Is Sibo: Causes, Symptoms, Prevention, and Ayurvedic Treatment

What Is Small Intestinal Bacterial Overgrowth (Sibo)?

Small intestinal bacterial overgrowth (SIBO) is a medical condition wherein there is a sudden increase in the bacterial population (exogenous bacteria) of the gut. This occurs following incidents like gastric surgery or bacterial disease or due to structural problems. This leads to the manifestation of several symptoms. This condition is also known as blind loop syndrome.

Understanding the Causative Factors of Small Intestinal Bacterial Overgrowth

We know that our gut is home to many microbiomes, which are essential for the body and metabolism. But in some cases, it becomes a temporary abode for a few unwanted bacteria. 

The small intestine accommodates a relatively smaller bacterial population than the large intestine due to the presence of highly alkaline bile (digestive fluid produced by the liver). The flow of food through the gastrointestinal tract is called peristalsis. But sometimes, the peristaltic movement of food is hindered. The food stagnates at some particular portion of the small intestine due to a false surgery or structural or anatomical abnormality in the small intestine, like scar tissue (intestinal adhesions), intestinal diverticulosis or any motility disorder. This stagnation leads to bacterial overgrowth.

How Do I Identify the Premonitory Symptoms of Sibo?

The common premonitory symptoms of SIBO are

• Abdominal pain
• Bloating
• Loss of appetite
• The feeling of heaviness, even after a light meal
• Diarrhoea has been persistent for a week or more
• Rapid weight loss leading to malnutrition
• Steatorrhea or oily/frothy stool

Laboratory Tests for Easy Diagnosis

• Hydrogen breath testing is a simple, noninvasive technique to diagnose bacterial overgrowth. The patient is asked to drink a sugar-containing solution. Then, I was instructed to exhale after a specific time period. Breath samples are analysed for hydrogen levels. This allows sugar to be properly digested.
• Get the vitamin levels checked to find out if vitamins A, D, E, and K are deficient and if folate is in excess. Vitamin B12 and iron should also be checked if they are deficient.
• Check serum proteins such as albumin levels and pre-albumin (PAB) to determine the person’s nutritional status.

Any healthcare expert will look into these investigation reports to reach a diagnosis and understand the gravity of the disease.

If you have the above symptoms, seek immediate medical care.

What Happens if You Ignore the Above Symptoms?

If symptoms are ignored or left untreated, it escalates the condition, leading to improper absorption of fats, carbohydrates, and proteins. 

Improper absorption of these essential substances from food can lead to a condition called ‘Hypovitaminosis’. Hypovitaminosis is due to prolonged deficiency of basic nutrients like fat-soluble vitamins A, D, E, and K and poor calcium absorption, leading to osteoporosis and kidney stones. Osteoporosis and kidney stones are two different manifestations of one chronic condition called poor and incomplete calcium absorption.

Natural Treatment to Prevent Small Intestinal Bacterial Overgrowth

Are there strategies to prevent bacterial overgrowth? This may be the primary thought coming into your mind right now. Yes, there are numerous strategies to keep this condition at bay.

There is no better science than Ayurveda to prevent and completely cure gastric conditions and improve gut health and metabolism. 

• The Ayurvedic approach aligns with its basic principles, i.e., to prevent disease conditions. As it is a gut-related disorder, detoxification and correction of the metabolism play a key role in treatment.
• Metabolism should be corrected by polyherbal remedies or single herbs that ignite a digestive fire. The doctor’s team at Nirva Health can give you suggestions about suitable remedies and herbs. 

Home Remedies to Prevent SIBO

• Symptoms like loss of appetite and malabsorption can be corrected by herbs and formulations that stimulate digestion and absorption. Digestion and metabolism can be corrected by ginger, fennel, cumin, etc. 
• Diarrhoea can be arrested by appropriate formulations after correcting the metabolism.
• Poor absorption of fats, carbohydrates, proteins, calcium, and vitamins leads to a deficiency of essential nutrients and vitamins. A deficiency of vitamins can be corrected by taking vitamin supplements. 
• Malnourishment can be corrected by consuming nourishing supplements. The inclusion of probiotic and prebiotic nutritional supplements also helps to re-establish your gut microbiome (good bacteria in the small and large intestines) by replacing the unwanted bacterial population.
• Inflammation can be reduced by including turmeric in your recipes. Turmeric latte (golden milk) can also be consumed ritually to add an adequate amount of turmeric into your everyday diet. 
• Ulcer, a complication of small intestinal bacterial overgrowth, can be effectively treated by herbs like liquorice, coriander, aloe vera, etc. 
• Intake of coconut water soothes the inflamed mucosal lining and hastens the repair of the mucosal lining.
• Neem and turmeric, due to their antibacterial properties, actively help heal and achieve faster recovery.

Treatment alone cannot bring back the normalcy of the gut. A conducive diet modification and lifestyle correction are essential for faster and easier recovery and to prevent a recurrence.

Probiotic Supplementation for Repopulating Good Bacteria

• Consume probiotic supplements, which help to increase good bacteria, which in turn replace the bad ones in the gut.
• Include fermented foods like Kimchi, Sauerkraut, and Kefir are known for their probiotic action as well as those which stimulate digestion and breakdown because of the presence of digestive enzymes.

Take Digestive Enzyme Supplements.

• Consume digestive enzyme supplements that improve digestion. The primary ingredients that most digestive enzymes contain are Amylase, Lipase, Protease and Lactase. They make digestion easier and faster. 
• Amylase, Lipase, protease, and Lactase stimulate carbohydrate, fat, protein and lactose (A sugar found in milk and other dairy products) digestion, respectively.

Fruits to Promote Digestive Enzyme Production.

• Papain and Bromelain, digestive enzymes in papaya and pineapple, respectively, help break down protein into amino acids.
• Mangoes contain a digestive enzyme called amylase, which aids in carbohydrate digestion.
• Bananas contain amylase and glucosidase, two enzymes that aid in digesting complex carbohydrates. In addition, bananas, a rich source of dietary fibre, prevent food stagnation in a particular portion of the gut by facilitating the motility of food inside the gut.
• Avocados are a rich source of lipase (the digestive enzyme which breaks down fat).
• Kiwi fruit and ginger contain actinidain and zingibain (a digestive enzyme that breaks down protein)
• Include all the fruits mentioned above to aid in easy digestion, by which SIBO can be prevented. 

In addition to the fruits, honey and ginger are rich sources of digestive enzymes.

• Honey contains digestive enzymes (diastase, amylase, invertase and protease). Diastase and maltase aid in starch digestion, invertase aids in the digestion of sugar, and protease aids in the digestion of proteins.
• The digestive stimulant action of ginger is well known through Ayurvedic scriptures. Ginger is the most common herb used in most Ayurvedic medicinal formulations to facilitate digestion.

Nutrient and Vitamin Supplementation

• People with SIBO are usually deficient in specific vitamins due to malabsorption of essential nutrients such as B12, magnesium, calcium, iron, zinc, copper, and vitamins A, D, E, and K.
• Figure out which one you are deficient in and consume supplements to compensate for that particular nutrient to correct the overgrowth of Intestinal bacteria.

Antimicrobial Herbs and Remedies

• Food poisoning or gastrointestinal effects impact the gut microbiome and lead to SIBO. The long-term effects of food poisoning can be corrected by an Ayurvedic remedy called Vilwadi gulika. But make sure you consume it only after medical supervision.

A few antimicrobial herbs and their active compounds inhibit bacterial growth in SIBO, which are mentioned below.

• Berberine, an antimicrobial compound in tree turmeric, Phellodendron and goldenseal, inhibits the small intestine’s pathogenic bacteria.
• Allicin, a prominent active compound in garlic, contributes to the broad-spectrum antimicrobial action. Consumption of garlic also keeps the pathogenic bacteria at bay.
• Curcumin, a potent anti-inflammatory and anti-oxidant compound in turmeric, keeps the intestine’s inner lining healthy and bacteria-free.
• Omega-3 fatty acids present in fish, nuts, plant oils, and fortified foods also reduce the inflammation of the intestine due to SIBO.

Diet and Lifestyle Correction

• Avoid consuming meat daily and for longer, as meat is more difficult to digest.
• Limit the sweet and starchy foods in your diet, as both are difficult to digest.
• Include slimy veggies like okra and aloe vera in your diet as they help repair the inner lining of your gut (mucosal layer).  
• Avoid beverages, scorching drinks, and caffeinated drinks in your diet. Drinks like coconut water and cool milk can soothe the inflamed gut lining.
• Reduce the quantity of spicy, salty, sour, and acidic foods.
• Consume every food warm and fresh.
• Consume food only when the previous meal is digested. Hunger is the sign of a good appetite and complete digestion, which opens the door to welcome another meal. Eat only when you are really hungry.
• Avoid complex carbohydrates, high-fat content, high sugar, and ultra-processed foods.
• Most importantly, avoid the food that you find difficult to digest. You are the one who will be able to figure out which food is hard for you to digest, as everyone’s gut is different. Replace those with foods that you find easier to digest.

If you do not know how to recognise your gut type, read about it in this blog - Understanding the 3 Gut Types and How They Impact Digestion.

• Include regular activities and exercises, yoga, etc., into your everyday regimen. It helps to increase the free flow of food through your gut by increasing the peristaltic movement.

By consuming light and healthy food, following the above-mentioned lifestyle corrections, and staying alert during every medical intervention, one can easily prevent small intestinal bacterial overgrowth.

Conclusion

Small intestinal bacterial overgrowth (SIBO) is a condition which can be managed very effectively if diagnosed and treated at the right time. Ayurveda contains a range of polyherbal formulations and single herbs for gastric conditions, including SIBO, which can be potential alternatives to antibiotics. It’s high time that the world should realise the importance of a natural and holistic cure for small intestinal bacterial overgrowth. By following a conducive diet and regimen, SIBO can be effectively managed. Certain dietary approaches, maintaining nutritious foods, and a hygienic lifestyle help in preventing SIBO.