SIBO stands for “small intestinal bacterial overgrowth.” It’s normal and healthy to have bacteria living in small intestine, but too many can cause problems with our digestion. The wrong bacteria can overwhelm the beneficial bacteria that we need to be there, and they can upset our digestive system by feeding on products that aren’t meant for them.

Bacteria in our small intestine digest carbohydrates and convert them into gas and short-chain fatty acids. More bacteria can mean more gas and other byproducts. When more bacteria are present and feasting, we might notice we feel gassier than usual. The bacteria also consume proteins and vitamin B12 meant for our body, and bile salts that are supposed to be there to help us digest fats.

All of this leads to poor digestion of fats and poor absorption of nutrients, especially calcium and fat-soluble vitamins. The result is a variety of gastrointestinal symptoms in the short term, and malnutrition in the longer term. Over time, vitamin and mineral deficiencies can cause lasting damage to our bones and nervous system.

What causes small intestinal bacterial overgrowth?

Our body maintains the balance of flora in our gut through a complex network of chemical and mechanical functions. For small intestinal bacterial overgrowth to occur, one or more of these functions must not be working properly.

Small intestinal bacterial overgrowth has a variety of causes, these include chemical functions like low stomach acid and certain allopathic medications, and mechanical functions like small intestine dysmotility and structural problems in our small intestine.

Low stomach acid

Low stomach acid (hypochlorhydria) reduces our body’s ability to moderate bacterial growth. Factors that may reduce our stomach acid levels include:

• Helicobacter pylori infection.
• Prolonged use of medications (allopathic) like antacids and proton pump inhibitors (PPIs).
• Gastric bypass surgery.

Allopathic medications

Overuse of certain allopathic medications can upset the normal balance of flora. These include:

• Antibiotics,
• Narcotics,
• Painkillers,
• Gastric acid suppressants.

Small intestine dysmotility

Our small intestine normally has motility, or the ability to keep digestive contents moving. Small intestine dysmotility means that waste is retained for too long in our small intestine before emptying into our large intestine. This allows the small intestine bacteria to continue to multiply, while the large intestine bacteria may make their way into our small intestine. Some dysmotility disorders include:

• Gastroparesis.
• Intestinal pseudo-obstruction.
• Hypothyroidism.

Structural problems in our small intestine

Structural problems in our small intestine can inhibit motility and the regular clearing of residual bacteria and create extra nooks and crannies for bacteria to build up. Gastrointestinal diseases or complications of surgery can cause structural problems for example:

• Small bowel diverticulosis,
• Small bowel obstructions,
• Abdominal adhesions.

How do you know if you have Small intestinal bacterial overgrowth?

Small intestinal bacterial overgrowth symptoms can resemble a variety of other gastrointestinal conditions, and often another condition has contributed to small intestinal bacterial overgrowth. Patient may experience some or many of these, depending on the severity of his/her condition:

• Abdominal pain.
• Abdominal distension.
• Nausea.
• Bloating.
• Indigestion.
• Gas.
• Diarrhea.
• Constipation.
• Unintentional weight loss.
• Fatigue.

What does small intestinal bacterial overgrowth stool look like?

Small intestinal bacterial overgrowth may cause fat malabsorption and patients may notice changes like:

• Soft, loose and watery stool,
• Stool smells extraordinary,
• Fatty stool (floating in commode),
• Mucus in/on or with stool,
• Thin and pencil-like stool,
• Hard and lumpy stool.

What are the risk factors for small intestinal bacterial overgrowth?

As we get older, we gain more risk factors for small intestinal bacterial overgrowth for example, lower stomach acid and motility levels as well as higher levels of medications (allopathic only) that might encourage small intestinal bacterial overgrowth.

Medical interventions like abdominal surgery and radiation exposure can cause structural problems in our small intestine as well as damage our mucosal lining, which affects our immunity. Immunodeficiency disorders can affect our intestinal immunity to certain bacteria.

Certain gastrointestinal conditions can affect intestinal motility or create intestinal structural problems, for example:

• Diabetes.
• Lupus.
• Celiac disease.
• Inflammatory bowel diseases.
• Irritable bowel syndrome.
• Pancreatitis.
• Colon cancer.
• Scleroderma.
• Chronic renal failure.
• Cirrhosis of the liver.

What foods trigger small intestinal bacterial overgrowth?

While foods aren’t the original cause of small intestinal bacterial overgrowth, certain foods do encourage the overgrowth of the wrong bacteria in our small intestine. If we’re feeding them their favorite foods, they’re going to grow more, and that will trigger more of our small intestinal bacterial overgrowth symptoms.

By the same token, we can help reduce the overgrowth by starving the problematic bacteria of their favorite foods. This strategy has led to a number of proposed small intestinal bacterial overgrowth eating plans. The plans vary, and so do individual results. But in general, they tend to recommend limiting carbohydrates. These include:

• Sugars and sweeteners (except natural sweets – they are good for gut health),
• Processed/canned fruits, vegetables, dairy and meat etc,
• Processed cocking oils, margarine etc,
• Artificial dairy products (Cheez, creams, packed & dry milk),
• Carbonated drinks,
• Broiler chickens,
• Coffee,
• White flour.

Complications

What happens if small intestinal bacterial overgrowth is left untreated?

Common symptoms of Small intestinal bacterial overgrowth — including gas, bloating, abdominal pain and distension — are uncomfortable enough. But left unmanaged, small intestinal bacterial overgrowth can cause more serious complications with long-term consequences. Malabsorption of fats, proteins and carbohydrates can lead to malnutrition and vitamin deficiencies, Parkinson disease, delirium, strokes and paralysis, encephalitis, low hemoglobulin levels (in particular, vitamin B12 deficiency can cause nervous system problems and anemia), poor calcium absorption can lead to long-term osteoporosis and/or kidney stones.

How is Small intestinal bacterial overgrowth diagnosed?

The symptoms of small intestinal bacterial overgrowth overlap with many other gastrointestinal conditions, some of which patients may already have. So, when you seek a medical diagnosis, Small intestinal bacterial overgrowth might not be the first thing you suspects. But if patient’s symptoms and medical history suggest Small intestinal bacterial overgrowth, you may suggest a breath test to verify it. This simple, noninvasive Small intestinal bacterial overgrowth test measures hydrogen and/or methane levels in patient’s breath to determine the presence of gas-producing bacteria in his/her gut. If patient’s levels are above a certain number, it suggests an abundance of bacteria.

Suggest additional tests to look for signs of causes and complications of Small intestinal bacterial overgrowth, for example:

• Blood tests for vitamin deficiencies and blood protein deficiencies,
• A stool test for excess undigested fats or bile acids,
• Imaging tests to check for structural problems.

Treatment and Options

Small intestinal bacterial overgrowth is often a complication of another condition and often causes complications of its own. When treating small intestinal bacterial overgrowth, a good doctor needs to address:

• The overgrowth itself,
• The complications of Small intestinal bacterial overgrowth,
• The underlying cause(s).

Probiotic therapy results in bacterial overgrowth syndrome are very good and recommended for general clinic use. Yogurt /kefir is very beneficial for regrowth and maintain intestinal flora.

What is the fastest way to cure Small intestinal bacterial overgrowth?

A course of antibiotics is the standard allopathic treatment for bacterial overgrowth. Doctors will then seek to manage patient’s most acute complications. In the management of bacterial overgrowth syndrome (BOS), antibiotic treatment may be cyclic and adjusted based on culture and sensitivity results if symptoms recur, although changing antibiotics can be challenging due to the presence of multiple bacterial species. The exact length of therapy is not clearly defined; length of therapy should be tailored to symptom improvement. A single 7–10-day course of antibiotic may improve symptoms in 40-60% of patients with bacterial overgrowth syndrome.

Rifaximin (higher doses – 1200 or 1600 mg/d) is currently the mainstay of treatment. Tetracycline was the mainstay of therapy, but its use as a single agent has fallen out of favor in adult patients given community increases in bacterial resistance.

Bacterial sensitivities from duodenal intubations with non-idiopathic bacterial overgrowth syndrome support the use of amoxicillin-clavulanate. Amoxicillin-clavulanate appears to be 75% effective in patients with diabetes.

Clindamycin and metronidazole are useful in elderly patients with idiopathic bacterial overgrowth syndrome.

Cholestyramine reduces diarrhea in infants and neonates with intractable diarrhea.

Ciprofloxacin and metronidazole result in normalization of hydrogen breath tests in most patients with Crohn disease.

Norfloxacin, cephalexin, trimethoprim-sulfamethoxazole, and levofloxacin have been recommended for the treatment of bacterial overgrowth syndrome.

This might mean nutritional support and supplementation for vitamin and mineral deficiencies. It might mean a strict short-term dieting plan to manage symptoms and then a modified longer-term eating plan to replenish patient’s nutrition and keep bacterial overgrowth in check.

Newer research of allopathic doctors

Ultimately, allopathic doctors will try and want to locate and treat the underlying cause of patient’s SIBO. This may require additional testing. If you (a doctor) suspect patient have a motility disorder, you might prescribe motility agents to help stimulate the process and keep things moving. If you identify a structural problem, you might recommend surgery to correct it.

Recurrence rates

Recurrence following allopathic therapy, is not uncommon and is more likely in elder patients, especially those with history of appendectomy and chronic proton pump inhibitor use. Patients with recurrent symptoms may need repeated (eg, the first 5-10 d of every month) or continuous (lifetime) use of cyclical antibiotic therapy.

Homeopathic treatment for 

Homeopathy is the fastest way to cure Small intestinal bacterial overgrowth

Ultimately, Homeopathic doctors will try and want to locate and treat the underlying cause of patients with small intestinal bacterial overgrowth. All Homeopathic medicines are broad-spectrum and treats the diseases and cause(s) at the same time (motility, structural problem, bacterial flora, infections etc).

The analysis found that Homeopathic medicines were significantly more effective in improving symptoms in patients with SIBO compared to those who received allopathic medicines including antibiotics.

Additionally, Irritable Bowel Syndrome patients with small intestinal bacterial overgrowth showed higher response rates to Homeopathic medicines than allopathic. These results suggest a potential benefit of Homeopathy in treating small intestinal bacterial overgrowth and highlight the importance of considering precision medicine approaches in IBS treatment.

The exact length of Homeopathic therapy is less than 60 days (including old/chronic cases); Homeopathic therapy tailored to treat and cure the disease and its root cause(s), not only to improve the symptom. A single 10-20-day course of Homeopathic compound (combination of) will definitely improve symptoms in 80-100% of patients with bacterial overgrowth syndrome.

Recurrence following Homeopathic therapy is almost zero (0) in all cases. Here some well proven medicines for SIBO:

Nux Vomica

In my (Dr. Qaisar Ahmed) opinion Nux Vomica is the top medicine for SIBO and IBS. The prominent symptom is frequently/urging constantly passage of a small quantity of stool with colic like abdominal pain. The abdominal pain relieved after each stool for a time. This is most of the times accompanied by a distended abdomen after eating. Sour taste, and nausea in the morning, after eating.

Bilious attacks, Biliousness, Carriage/sea/motion-sickness, catarrh, clavus, spasmodic colic, Constipation, Convulsions, Cramp, Delirium, Diarrhea after a debauch; worse, morning. Frequent small evacuations. Scanty stool, with much urging. Dysentery, Dyspepsia, Emissions, Erotomania, Gallstones. Gastritis, Liver disorders, Locomotor ataxia, Constipation, with frequent ineffectual urging.

Food that worsens the condition is spicy food, coffee, and alcoholic drinks. The worsening of condition after anger spells is also an important marker for natural Homeopathic remedy Nux Vomica.

 Aloe Socotrina

Aloe Socotrina is the best choice when the urge to pass stool is soon after eating or drinking something. Irregular intestinal movements, Severe gastritis, mucus may be along with stool, pain in the abdomen (colic) before and during stool which vanishes after passing stool, Tenesmus, Colin Tuberculosis. Colic before and during stool. Burning, copious flatus. Pain around navel, fullness in region of liver, pain under right rib, abdomen feels full, heavy, hot, bloated.

Alumina

If small intestinal bacterial overgrowth is with constipation (intestinal dryness), Alumina is the medicine of my choice, obstinate constipation, knotty stools, slow intestinal pace, the stool remains in the rectum for many days without any urge to pass stool. that’s why the stool expelled with much strain. Dryness of mucous membranes and skin, weak peristaltic movements and tendency to paretic muscular states. Sometimes the stool is soft but hard to expel (low intestinal pace, weak intestine). Old people, with lack of immunity, or prematurely old, with debility.

Carbo Vegetables

IBS with bloated abdomen, heavy and tense abdomen soon after eating, even the simplest and softest kind of food seems to worsen the condition. The passage of gas or belching provides slight relief. Acidity accompanied by frequent loose stool of offensive odor. Cramping pain in the abdomen may also be present.

Catarrh, Chilblains, Cholera, Constipation, Debility, Diarrhea, Distension, Dysentery, Dyspepsia, Emphysema, Eructation, Flatulence, bad or low blood circulation in some part of intestine, Gangrene. Hemorrhages, Hemorrhoids, Tympanites, Typhus, Ulcers, Yellow fever.

Lycopodium

Lycopodium is the medicine of choice when IBS and small intestinal bacterial overgrowth is with heaviness in the abdomen even after eating of a small quantity food, The abdomen feels full and distended, Gas fills the abdomen, gurgling. Alteration between diarrhea and constipation.

Constipation. Intestinal Consumption. Intestinal polypus, Cramps. Cystitis. Debility or intestinal/rectal weakness. Diphtheria. Distension. Dropsies. Dysentery, polypus of canthus. Fibroma. Flatulence. Gall-stone colic. Glands, swelling, Liver malfunctioning, liver-spots. Locomotor ataxia (intestinal/rectal), Paralysis. Paralysis agitans, Typhoid fever. Varicose that is disturbed intestinal blood circulation, CA intestine.

Croton Tiglium

In irritable bowel syndrome cases Croton Tiglium and podophyllum has same symptoms that is diarrhea with gushing stool, urging for stool soon after eating or drinking; watery stool, copious stool, weakness after passing stool, profuse and highly putrid/offensive stool, fetid flatus, diarrhea that worsens after eating fruits.

Podophyllum

Grinding the teeth at night; intense desire to press the gums together. Tongue broad, large, moist. Foul, putrid taste. Burning sensation of tongue. Hot, sour belching; nausea and vomiting. Thirst for large quantities of cold water. Vomiting of hot, frothy mucus. Heartburn; gagging or empty retching. Vomiting of milk.

Abdomen distended, heat and emptiness. Sensation of weakness or sinking. Can lie comfortably only on stomach. Liver region painful, better rubbing part. Rumbling and shifting of flatus in ascending colon. Cholera infantum and morbus. Diarrhea of long standing; early in morning; during teething, with hot, glowing cheeks while being bathed or washed; in hot weather after citrus. Morning, painless diarrhea when not due to venous stasis or intestinal ulceration. Green, watery, fetid, profuse, gushing. Prolapse of rectum before or with stool. Constipation; clay-colored, hard, dry, difficult. Constipation alternating with diarrhoea (Ant crud). Internal and external piles.

Bryonia Alba

IBS with constipation and dry, large, hard stool. The stool is excessively dry as if burnt. Rectal and anal burning on passing stool. Headache along with constipation.  Intermittent fevers. Jaundice.  Liver disorders/malfunctioning. Constipation; stools hard, dry, as if burnt; seem too large. Stools brown, thick, bloody; worse in morning, from moving, in hot weather, after being heated, from cold drinks, every spell of hot weather.

Bryonia is one of the polychrest medicines. Dryness of mouth, tongue, and throat, with excessive thirst. Tongue coated yellowish, dark brown, heavily white in gastric derangement. Bitter taste.

Colocynthis

Irritable bowel syndrome with loose stools attended with abdominal cramps. Eating or drinking in the smallest quantity leads to cramping. Bending double or pressure over abdomen may provide relief. Stools are watery, yellow and frothy and attended with the passage of flatulence.

Ciliary neuralgia. Colic. Coxalgia. Diabetes. Diarrhea. Dysentery. Colic. Neuralgia.  Paraphimosis. Peritonitis. Tumors.

China Officinalis

China Officinalis is the most recommended medicine for IBS with weakness and weight loss from chronic diarrhea. The diarrhea is painless. Persons in need of China Officinalis have a chronically loose stool, marked flatus and bloated abdomen. Abdominal colic from flatus in abdomen is also present.

Bilious attack. Catarrhal affections. Constipation. Debility. Delirium. Diarrhea. Dropsy. Dyspepsia. Emissions. Hemorrhoids. Headache. Hectic fever. Ichthyosis. Intermittent fever. Jaundice. Lientery. Liver diseases, Liver cirrhosis, Spleen affections. Taste disorder. Tea and coffee effects. Thirst. Tobacco habit. Traumatic fever. Tympanites. Varicose veins, Blocked or bad blood circulation to intestines.

Pulsatilla Nigricans

Pulsatilla Nigricans is one of the top-grade medicines for irritable bowel syndrome where taking milk or milk products worsens the complaint. Symptoms include rumbling in abdomen, flatulence, bitter mouth taste, belching that tastes like ingesta and changeable stool. These symptoms worsen upon consuming milk.

In my (Dr. Qaisar Ahmed MD, DHMS, Isl. Jurisprudence) experience deficiency of some types of minerals makes changes in cylindrical shaped organs especially intestines, that’s why I tried following elements on my patients during last fifteen years and I found great results. Patients with chronic IBS (even older then 2-7 years), were treated in 20-60 days successfully. They are the following:

Argentum Nitricum

Acidity. Addison’s disease. Anemia. Chancre. Dyspepsia. Epilepsy. Eructation. Flatulence. Gastric ulcer. Gonorrhea. Impetigo. Locomotor ataxia. Neuralgia. Paralysis. Prostate, Scarlatina. Smallpox. Spinal irritation. Syphilis. Taste, altered. Throat, affections of. Tongue ulcerated. Warts. Zona.

Merc Solubulis

Appendicitis, Diarrhea, Dysentery, Dyspepsia, GIT inflammations, Fainting, Fevers, Fissures, jaundice, Liver affections, Peritonitis. 

Phosphorus

Irritates, inflames and degenerates of mucous membranes. Tongue dry, smooth, red or white, not thickly coated. Burning in esophagus. Dryness in pharynx and fauces. Hunger soon after eating. Sour taste and sour eructation after every meal. Belching large quantities of wind, after eating. Gastro esophageal reflux (GERD). Vomiting: water is thrown up as soon as it gets warm in the stomach. Post-operative vomiting. Pain in stomach; relieved by cold food, ices. Region of stomach painful to touch, or on walking. Inflammation of stomach, with burning extending to throat and bowels. Bad effects of allopathic drugs, of eating too much salt.

Abdomen feels cold. Sharp, cutting pains. A very weak, empty, gone sensation felt in whole abdominal cavity. Liver congested. Acute hepatitis. Fatty degeneration. Jaundice. Pancreatic disease. Large, yellow spots on abdomen.

Stool very fetid stools and flatus. Long, narrow, hard, like a dog. Difficult to expel. Desire for stool on lying on, left side. Painless, copious debilitating diarrhea. Green mucus with grains like sago. Involuntary; seems as if anus remained open. Great weakness after stool. Discharge of blood from rectum, during stool. White, hard stools. Bleeding hemorrhoids.

Magnesia Carbonica

Constipation. Diarrheas, Dyspepsia. war zone remedy, Fears, Green diarrhea and the green part floats upon the watery portion of the stool, the stool is often lumpy, and liquid, the lumps lie in the bottom of the vessel, but floating upon the liquid portion of the stool is the green like the scum of the frog pond (one of the most striking features), bloody, mucous.

Diet

Probiotics for Crohn’s Disease

Supplements

P. S: This article is only for doctors and students having good knowledge about Homeopathy and allopathy.

For proper consultation and treatment, please visit our clinic.

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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