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Reasons for Reoccurring SIBO

Let’s talk SIBO

If you are suffering from digestive discomfort you have likely heard of Small Intestine Bacterial Overgrowth (SIBO). Maybe you were tested and treated for SIBO and were feeling great, that is until the symptoms started to creep back in. The treatment of SIBO is not as simple as prescribing a change in diet or an antibiotic, whereas it takes an integrative approach that addresses the root cause of SIBO and not just its symptoms. In this post, we are discussing the most common causes of recurring SIBO we see in our clients and our approach to treating SIBO. 

Reasons for recurring SIBO

Before we jump into some reasons why SIBO may come back after treatment, you may want to take a look at our other blog post on SIBO which addresses its signs and symptoms, causes, diet, and more!

If you read that post, you may come to realize that many of the underlying factors that contribute to the development of SIBO are the same as the factors that may cause SIBO to reoccur. The reality is that more times than not SIBO is not properly treated the first time where treatment is focusing on resolving the symptoms but fails to address the root cause. In this scenario, symptoms resolve temporarily, however, they slowly return as the root cause behind the symptoms persists. 

Reasons why we see SIBO recurrence

  • Constipation/Slow Motility – If you have slow motility (aka constipation) and are not going to the bathroom regularly (think: at least once a day)  then you are prone to an overgrowth of bacteria because you are not eliminating food, waste, and bacteria causing it to build up. Additionally, these food particles may begin to ferment enabling bacteria to thrive and feed off these particles. There are MANY reasons for constipation/slow motility ranging from diet to what we talk about below. 
  • Low Stomach Acid –  Having adequate acid in the stomach is essential for the breakdown and digestion of food. When stomach acid is low, food breakdown is impaired resulting in larger food particles entering the small intestine. Bacteria are able to thrive off of these food particles. Additionally, stomach acid helps keep a sterile environment and kills off bacteria/parasites before they can enter the small intestine. If stomach acid is low,  bacteria and pathogens can pass through to the Small Intestine resulting in overgrowth. Note that low stomach acid can cause heartburn which is why oftentimes going on an acid-suppressing drug is ineffective in the long-term and makes digestive issues worse. 
  • StressBelieve it or not, chronic stress can actually reduce stomach acid, and reduce bile secretion and enzyme secretion. These factors are key players in the breakdown and emulsification of food. Bacteria thrive off these undigested food particles. Furthermore, chronic stress weakens the immune system making it more prone to infection and susceptible to pathogenic bacteria and parasites. Lastly, stress manifests differently in everyone, but sometimes may slow motility. 
  • Migrating Motor Complex (MMC) Dysfunction – The MMC is a less talked about, but super important, mechanism. Putting it simply, its role is to signal your small intestine to contract, alternatively moving food through your GI tract so it can be absorbed and eliminated. The MMC is stimulated around every 90 minutes when the stomach is empty. So if you are snacking often or drinking your calories then this process is not occurring resulting in slowed motility. Our recommendation is to wait 3-4 hours between meals and snacks. Other reasons for MMS dysfunction may include hypothyroidism, IBD, bacterial infection, gastroenteritis, lymes disease, diabetes, and proton pump inhibitors (PPIs). 
  • Parasites or food poisoning  – Food poisoning due to certain pathogenic bacteria can impair motility. One way that this may occur is that this pathogenic bacteria releases a toxin impairing the MMC leading to bacterial overgrowth. 
  • Lack of digestive enzymes and/or impaired bile secretionBile is secreted by the liver and stored in the gallbladder. Its primary function is to help break down fats. When there is a lack of  digestive enzymes or bile,  food particles are not able to be fully broken down enabling bacteria to feed off of these food molecules. Often resulting in digestive distress like bloating, the feeling of food sitting,  and undigested food particles in stool. Additionally, bile acids have antibacterial effects heping protect against bacterial overgrowth. 
  • Antibiotic Usage – While we recognize antibiotics have a time and a place, they can wreak havoc on gut health. The reason being that antibiotics are not selective in that they kill off both helpful and harmful bacteria. This may lead to gut dysbiosis (imbalance of “good” and “bad” bacteria), providing “bad” bacteria with the perfect opportunity to thrive. If you have to take antibiotics, make sure to take a good probiotic, and if you are on antibiotics long-term have a conversation with your doctor. 
  • HypothyroidismA sluggish thyroid may also result in sluggish motility. Be sure to work with an integrative health professional here to address the thyroid and motility. 

In reading the above, you may have noticed a common thread. In many cases it comes down to motility! Many of the above conditions/factors alter motility resulting in slowed intestinal motility and delayed bowel functions creating the perfect environment for bacteria to thrive. 

Our approach to treating SIBO 

If you are suffering from SIBO it is imperative to ask why this bacterial overgrowth is happening. Oftentimes, practitioners jump into treating the symptoms without really thinking where it came from. 

At Isabel Smith Nutrition (ISN), we have worked with countless clients who came to us seeking help for their SIBO treatment after multiple rounds of treatment (antibiotics, herbals, etc.). Nine out of ten times, it was because the root cause was never addressed. Therefore, we take a comprehensive approach taking a deep dive into one’s diet, lifestyle, medical history – you name it, we factor it in! This way, we can get a look at the whole picture and pinpoint the underlying cause of why this overgrowth is happening. 

Given each case of SIBO is unique, (DYK there are actually different types of SIBO?) we take a customized approach for every client. However, we often utilize a handful of therapies to effectively treat SIBO. This may look like a combination of stress-management techniques, gut-healing nutrients, antimicrobials, diet modifications, and when the time is right layering back in nutrients to nourish the good gut bacteria. 

The Bottom Line

SIBO is complex with different types of SIBO, and varying underlying causes. Each case of SIBO needs an individualized approach that is comprehensive and addresses the root cause. The recurrence of SIBO can be incredibly frustrating, we recognize this at ISN which is why we work with clients to effectively treat SIBO once and for all. 

Suffering from SIBO? Click here to work with us! 

Written by Alison Richman MS, RDN