SIBO (Small Intestine Bacterial Overgrowth) is known as a set of digestive symptoms that occur when there is an abnormal increase in the bacterial population in the small intestine. Despite the fact that lately it is known by its acronym in English, the truth is that this alteration has always existed and is commonly called bacterial overgrowth. In recent times, there is more talk than ever of a pathology that can lead to "chronic digestive problems, ranging from bloating, heaviness, nausea or changes in bowel habits, among others," explains Diego Sánchez Muñoz. , specialist in the Digestive System and medical director of the Digestive Institute of Seville (IDI).
The doctor corroborates that, indeed, "there is a certain fashion for making a diagnostic option that has actually always existed and that can occur at different moments in life, such as after certain infections, at specific moments of stress or in any circumstance in which that a bacterial overgrowth occurs and, to put it simply and graphically, the bad bacteria in the intestine occupy a place that would correspond to the good ones”, explains the doctor.
For her part, the microbiota expert and author of the book A happy intestine, Dr. María Dolores de la Puerta, agrees with Sánchez that this bacterial overgrowth can occur throughout life at specific moments and that we do not have to worry , since in many cases the body is capable of restoring balance on its own, without the need to resort to specific treatments. “There is a concept known as the Microbiota Resilience Index, which is the ability of the microbiota to recover when something attacks it, be it a toxin, a period of stress or gastroenteritis, for example”, explains the doctor. "The problem - he assures - comes when the organism is not capable of recovering from the damage, since it is cumulative, and what we know as dysbiosis or SIBO is consolidated, which does require specific interventions, depending on each case, in order to recover that ecosystem".
The doctor, who has spent more than twenty years studying the intestinal microbiota and treating cases of SIBO, points out that one of the reasons why diagnoses have increased is that "many people have suffered chronic digestive disorders for years, coming to normalize them, not knowing that it is something that can be diagnosed through a simple breath test and treated either through antibiotics, diet and lifestyle changes and other types of solutions. Among the typical symptoms of SIBO, De la Puerta highlights digestive disorders, gas, bloating, heavy digestion, diarrhea or constipation and other symptoms "that can be completed with the appearance of eczema, dryness, itching, migraines, headaches, tiredness, sleep problems and even severe mood disorders.”
Not surprisingly, in his book, De la Puerta insists on the importance of what is known as the gut-brain axis, which is conveyed through the enteric nervous system. “It is a network of nerve cells found in the intestine and that works in a similar way to neurons in the brain: there is a direct connection between them and they are responsible for the production of dopamine, serotonin, oxytocin and cortisol, which have a direct link with mood.
A good way to prevent bacterial imbalance in the small intestine, and to put it simply, give the beneficial bacteria the food they need, is to implement some dietary changes that may be beneficial. “We must bear in mind that these bacteria eat the same as we do, so diet is essential when it comes to preventing and treating SIBO cases. What they like best is high-quality fiber, present in whole grains, root vegetables (especially if they are cooked and allowed to cool), very high-quality carbohydrates and fermented foods such as yogurt, curd, kefir or cheeses fresh, as well as others such as sauerkraut, kombucha, tempeh or miso”, explains De la Puerta.
The expert also recommends consuming foods rich in polyphenols, such as pomegranate, coffee, chocolate, olive oil or turmeric, among others. As for probiotics, very fashionable to treat imbalances in the microbiota, the doctor explains that "they can be studied in specific cases."
Dr. Sánchez Muñoz agrees with her, who points out that although certain types of probiotics such as lactobacillus or saccharomyces can be of great help when it comes to complementing antibiotic treatment for SIBO "we are abusing the term so much that many people believe that probiotics are valid for everything, at all times, doses and situations, and that is not true. It must always be a professional who chooses the strains, doses and duration according to each specific case”. In addition, the supply of probiotics must coexist with drastic changes in the diet: "It is not only about introducing foods that help the intestinal flora, but also eliminating all those that can cause alterations, such as inflammatory foods, starting with carbohydrates. complex carbon.
Sánchez Muñoz points out that in order to diagnose a bacterial overgrowth it is important to "rule out other etiologies" and recalls that "one should not run the risk of overdiagnosing situations that at a given moment may be common and daily, typical of the Western lifestyle, since they do not it is convenient to supply antibiotics left and right when perhaps the situation does not require it”. De la Puerta agrees: “The classic protocols determine the treatment of SIBO with antibiotics, which are responsible for killing the bad bacteria that have overgrowth. In reality it is bread for today and hunger for tomorrow, because it is reducing the burden, but not addressing the cause of this growth”. Therefore, the best thing to do is "to carry out a cross-sectional diagnosis, which on many occasions makes it possible to address SIBO without antibiotics."
SIBO detection consists of a simple breath test. “Different determinations are made throughout the morning after a series of blows in a machine. With this simple test, you can find out how the flora reacts on the fly and determine what type of bacterial overgrowth you are suffering from,” says Sánchez Muñoz. Despite the reluctance that may exist in taking antibiotics, the doctor insists that in cases of severe SIBO “they are the only ones that have proven to be selective when it comes to killing everything that is not part of the intestinal flora. From here, treatments can be personalized or other ingredients can be added if there is any other associated infection." Despite the fact that, according to the doctor, some laboratories market simple tests to detect SIBO, "it is best not to use them, because they have not yet been scientifically validated and can lead to errors."
The fact that SIBO can be treated with antibiotics does not mean in any case "that there cannot be a relapse, although another thing is that it occurs with the same virulence", explains Sánchez Muñoz. In fact, “we shouldn't be surprised if it happens again at a given moment, since there are multiple situations in life that unfortunately we cannot control. It should not be worrisome if it is not sustained over time”. In addition to all the advice related to eating and sleeping and exercise habits, to maintain a good intestinal microbiota, the doctor recommends "trying to avoid as much as possible, from when we are little, the overuse of antibiotics for any reason, since that in the long run can cause adult disorders.”
Finally, Dr. De la Puerta recalls that antibiotics are not the only medicines whose consumption can cause imbalances. "Contraceptives, proton pump inhibitors such as omeprazole, some non-steroidal anti-inflammatory drugs and other drugs can damage the microbiota, although that does not mean that they should not be taken, just that it should not be done for free," she concludes.
