A healthy intestinal microbiome is essential for optimal immune function and wellness. However, the overgrowth of pathogenic microbes in the small intestine is linked to several health problems. Overgrowth may occur due to several factors. Small intestinal bacterial overgrowth (SIBO), specifically, is a condition that presents with a range of detrimental gastrointestinal (GI) and non-GI-related symptoms and is linked to several comorbid conditions. But you can restore the healthy balance to your gut flora with appropriate interventions that address lifestyle factors and nutritional needs that may dramatically improve health.
SIBO and Co-Occurring Health Problems
Research suggests that there are clear links between SIBO and diseases such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), motility disorders, chronic pancreatitis, cirrhosis, and various immunodeficiency syndromes. A 2020 systematic review and meta-analysis about SIBO examined 25 case-controlled studies with a total of 3,192 IBS patients and 3,320 controls and found that SIBO prevalence in patients with IBS was significantly increased.
Smaller studies have shown that SIBO occurs more frequently in people with active H. pylori infection and spinal cord injury with deep vein thrombosis. SIBO is also associated with pediatric obesity, papulopustular rosacea, and nonalcoholic fatty liver disease (NAFLD) at a higher rate than controls.
One study of children with obesity and SIBO found an increased risk for developing NAFLD. The study concluded that the relationship between intestinal dysbiosis and diet can influence the gut-liver axis. Another interesting conclusion was drawn that showed a lower prevalence of SIBO in patients with type 1 diabetes. The researchers suggested this may be due to the nutritional aspects of diabetes management.
SIFO and fungus
Within a healthy GI tract, bacterial and fungal organisms most heavily colonize the colon and less in the small intestine. Small intestinal fungal overgrowth (SIFO) may lead to various systemic symptoms such as migraines, fatigue, depression, bloating, and more. Intestinal dysmotility and reduced amounts of stomach acid resulting from PPI use are potential risk factors specifically for SIFO.
Although treatment for SIBO may include probiotics and antibiotics, SIFO typically requires antifungal therapy to improve symptoms of SIFO. Dietary modifications may also be beneficial for both conditions. A pilot study evaluated the effectiveness of dietary intervention in combination with antifungals for patients with a chronic form of intestinal Candida overgrowth. Ten days after the diet and control groups received an antifungal treatment, both showed satisfactory antifungal and symptomatic effects with no statistically significant difference; However, at the second examination three months later, the diet intervention group showed a significantly higher percentage of patients without symptoms (85%) compared to the control group (42.5%).
Clinical diagnosis and root cause of SIBO and SIFO
SIBO can be difficult to diagnose, and it can have many overlapping symptoms with SIFO. Both may contribute to a GI imbalance. It is important to pinpoint the root cause for the most effective treatment. Some tests may help diagnose SIBO such as the breath test used for patients with IBS. However, your doctor will most likely make regular assessments once a SIBO diagnosis is made.
For potential SIBO and SIFO diagnoses, the identification and treatment of the underlying conditions causing microbial imbalances in the small intestine is important, and the restoration of gut flora may dramatically improve health and ameliorate a range of symptoms. You may need several approaches to address GI health issues, including SIBO and SIFO, and use specific steps—remove, replace, re-inoculate, repair, and rebalance—to help restore a natural balance to the GI system. Functional medicine approaches to improve gut health may involve changes in nutrition that lower the fermentation of carbohydrates in the gut to help address bacterial and fungal overgrowth. Or, you may find that an elimination diet will remove trigger foods to potentially reduce inflammation and improve symptoms.