Anyone with any of the common tell-tale signs of small intestinal bacterial overgrowth, SIBO, should definitely embark on an effort to reverse this situation. It may involve H2-breath testing, using the new Aire device (that I shall be discussing in future) to detect breath hydrogen, or empirically treating because of signs such as intolerance to prebiotic fibers.
But what if you have none of the tell-tale signs such as intolerance to prebiotics, fat droplets in the toilet, or irritable bowel syndrome-like symptoms? Should you still be suspicious that you might have SIBO?
I believe that you should. SIBO is so incredibly common with considerable potential for health complications down the road that it is worth looking for, then managing. Many studies have compared people with a disease such as diverticular disease vs. people without diverticular disease. Time and again, the presumed “normal healthy control” groups chosen for comparison also have high levels of positive testing for SIBO, as high as 40%. This and other signs therefore suggest that we are witnessing an epidemic of unprecedented proportions, some of it outwardly evident, some of it silent.
What are the long-term consequences of uncorrected SIBO? SIBO has been associated with:
- Diverticular disease
- Colon cancer
- Restless leg syndrome
- Type 1 diabetes, type 2 diabetes
- Autoimmune conditions such as Hashimoto’s thyroiditis
- Fatty liver
- Ulcerative colitis, Crohn’s
- Irritable bowel syndrome, IBS
- Increased visceral fat, obesity
- Coronary artery disease
It is not always clear if SIBO is a cause and when it is a consequence. But given the positive response of, say, fibromyalgia or IBS that can virtually disappear with management of SIBO, in most instances it is looking like SIBO is indeed a cause. SIBO can also complicate various conditions, worsening signs and symptoms. The list of such conditions is growing rapidly and includes dementia, cirrhosis and liver failure, Parkinson’s disease, scleroderma, multiple sclerosis, and celiac disease.
Sadly, because the science documenting SIBO has emerged mostly within the last few years, most physicians pooh-pooh questions about SIBO, denying that it is a real condition or telling you that you have nothing to worry about. Or worse, a primary care doctor refers you to a gastroenterologist who recommends upper endoscopy and colonoscopy (ka-ching!), who declares “Good news: You don’t have an ulcer nor colon cancer. Bye.” You ask “But what about my question about SIBO?” The answer 9 times out of 10: “Go back to your primary care doctor” or “You’re fine, don’t worry about it.” Occasionally, a better-informed gastroenterologist will write a prescription for rifaximin, the conventional antibiotic for SIBO, but make no mention of alternative treatments, how to prevent recurrences (which are the rule), fail to discuss the role of probiotics, fermented foods, or prebiotic fibers, or discuss any of the many other important issues surrounding SIBO.
Because of the widespread ignorance of doctors on SIBO, we’ve been having frequent discussions on self-managing SIBO in our Undoctored Inner Circle that starts with an Undoctored Protocol for SIBO, followed by two-way video discussions of all the finer points.