SIBO is defined as the following:
SIBO can be most inclusively defined as a clinical syndrome of GI symptoms caused by the presence of excessive numbers of bacteria within the small intestine (potential thresholds are discussed below). This definition implies that there must be a measurable and excessive bacterial burden within the small bowel, and that this microbial overgrowth has resulted in specific GI signs and/or symptoms. For example, the pathologic fermentation of nutrients that would ordinarily be completely absorbed in the small intestine could lead to the production of excess gas and bloating.
(Pimental et al, 2020)
SIBO symptoms include the following according to nearly all reviews of the condition:
- Bloating (most common)
- Flatulence
- Diarrhoea
- Abdominal pain
- Abdominal distention
- Weight loss
This is the belief we need to dismantle as per above paper:
The signs and/or symptoms of SIBO can arise from the malabsorption of nutrients, alteration in intestinal permeability, inflammation, and/or immune activation that arises from the pathologic bacterial fermentation within the small bowel.
Pathologic they say? How do they know it is pathological? They do not. It is based on the premise that there is a shift from the normal number of bacteria and that these bacteria are pathogenic.
The bacteria in question, mainly Escherichia coli, Aeromonas, and Klebsiella species, allegedly cause damage to the intestinal epithelium via lipopolysaccharides (endotoxin) and this is what causes the changes in motility (in part) and as they accumulate they then produce hydrogen gas that is perceived as bloating and can be painful.