Understanding Small Intestinal Bacterial Overgrowth (SIBO) - Part 2

In my last article I explained that so many of the IBS or digestive symptoms that are ‘unknown’ in cause may be linked to something called Small Intestinal Bacterial Overgrowth.  I also described the science behind the ‘why’ and highlighted cases where SIBO might form part of the clinical picture.But today I wanted to put out a mini-blog to explain something that I am starting to see more frequently in my clinic and which may be one of the reasons why I think many people suffering with SIBO are going undiagnosed.

Gravitating to Paleo or Low-Carb Diets

I know countless people who have gravitated towards a low-ish carbohydrate, dairy and gluten free diet because of the groundswell of information promoting such a lifestyle.  From Taubes to Ludwig, sugar has been branded the enemy - and carbohydrates have tended to be lumped into that category of 'insulinogenic', 'weight-promoting' foods.This is NOT a post about the scientific validity of the low-carb claims...

However, it is definitely common for anyone attempting to lose weight to trial themselves on such a macronutrient template.

Additionally, much of the popular Paleo or Ancestral Health movement is founded on the principles of a so-called ‘anti-inflammatory’ diet.  For this reason, it is a very attractive first step for anybody experiencing symptoms of any kind and who is trying to improve their health.

A Paleo/Ancestral approach, however, not only removes inflammatory foods from the diet, it also tends to make people who try it remove a lot of fermentable carbohydrates from their diet.

This is not actually a promoted feature of the Paleo diet - the true approach is macronutrient agnostic, and in fact a moderate carbohydrate intake from whole food sources is more classically 'ancestral'.  However transitioning from grain-heavy, gluten-heavy, sugar-heavy Standard American Diets onto a Paleo template tends to herald a drop in carbohydrate calories as fats and proteins are increased.

In my clinic these days I am dealing with much more complex health conditions, and frequently clients are consulting me long after dropping gluten and dairy from their diets and ‘going Paleo’.  In these patients, when discussing the symptom improvement they benefited from when changing their diet, so much seems to have improved when they ditched sugar, grains, dairy, soy etc. all in one go that it is difficult to isolate what nutrient was causing any impact.

Now, this is not true for everyone by any means, but there is a subset of people who not only move to a Paleo approach but also continue to cut their carbohydrates significantly.  What began as an almost natural cessation of eating legumes and beans, grains and fruits has turned into a mandatory need to keep them out of their diet because they feel so much better.It is in these patients where I am starting to suspect that this gravitation towards such a low carb lifestyle is actually a natural attempt to self-manage an undiagnosed condition: SIBO.

Is Life Better Low Carb?

I myself am someone who did this.  If you read my last post you will know my intimate familiarity with the vagaries of SIBO diagnoses!  For me, naturally migrating to a low carbohydrate diet, I instantly did not like the way my body felt when I tried to add back whole food carbohydrate sources such as rice or, in particular, the "Paleo-friendly" sweet potato.  Staying away from starchy vegetables seemed to be the only way to stay symptom-free.

As a result, I (and the same is true for many of my clients) ended up building a diet that was precariously balanced on the edge of feeling OK - wherein I was constantly, subtly symptomatic but coping.  The 'coping', however, was founded on a diet of restriction.  Always a little more bloated and uncomfortable than you feel you ‘should’ be, knowing that just eating a potato will likely cause you to blow up like a balloon.

Carbohydrates and SIBO

Carbohydrates (including sugars, but more often grains, dairy, fruits, legumes and FODMAP vegetables) prove a huge problem for patients suffering from SIBO.  The reason behind this is fermentation.  Those bacteria in the small intestine will take advantage of the any fermentable substrates placed inside the digestive tract, which means carbohydrates.  If you’re the kind of person who has naturally graduated to this sort of diet, and who experiences huge symptomatic increase when you veer back towards the carbohydrates, then it could be that you’re symptomatically managing your issues through being restrictive with your diet.

Additionally, due to the tendency towards constipation, if you are finding yourself managing your bowel movements using magnesium supplementation or natural laxatives then you may also be hiding your symptoms by self-medicating when actually your bowels should function smoothly on their own.If distention, bloating and burping or flatulence are part of your everyday life experience then SIBO might be something you need to consider.  But if they’re NOT part of your everyday life because you’ve found a way to live without carbohydrates which cause them, it could still be that SIBO is something you need to look into.

So, if you have other symptoms which seem to map to your carbohydrate intake - anything from fatigue and brain fog to acne rosacea, joint pain, and seemingly erratic and multiple food sensitivities - SIBO might be part of your clinical picture and is definitely worth investigating.

Demeanour and SIBO

For an even more subtle indication of whether SIBO might be an issue for you, I always ask my clients how they’re feeling about changing their diet.  Though confusion and fear of food comes from many places, I have witnessed (in myself and others) that excessive nervousness, particularly around food and/or digestion, treatments and dietary changes are a common feature of someone who has balanced their life around avoiding the symptoms of SIBO.

So if you experience - or explicitly avoid experiencing - symptoms on a daily basis that you just can’t seem to rationalise, then SIBO might also be part of what is happening for you, because worryingly, over 60 diseases have been scientifically linked to SIBO.

If any of this sounds familiar, please do get in touch.  As I mentioned in my last post on this, SIBO can be finicky to treat and really does require the help of someone qualified to interpret all of the variables and construct the right plan for you.  I love helping people with SIBO because it can be seriously life changing (and I should know).  And don’t forget to sign up (Top Right of this page) so you’ll receive updates from me straight to your inbox on all the latest developments in research on SIBO and other health conditions.  And if you’re wondering about whether working with a Functional Medicine Coach is the right move for you - my Completely Free PDF might help you make up your mind!