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SIBO: Internal Contribution to Dysfunction

Updated: Aug 21, 2019

Small Intestinal Bacterial Overgrowth (SIBO) is commonly defined as an increased number of bacteria and/or abnormal type of bacteria in the small intestine (Kwiatkowski, et al., 2017).  SIBO plays a role in malabsorption and nutritional deficiencies, altering the body’s homeostatic state (Zeigler & Cole, 2007).

The build-up of displaced bacteria can cause an increase in intestinal permeability leading to general malabsorption and alterations of certain water-soluble B vitamins including biotin, folate and B12 (Bures et. al., 2010). Overconsumption of vitamin B12 by the dysbiotic anaerobic flora, can cause deficiency and lead to conditions such as megaloblastic anemia or polyneuropathy (Sachdev & Pimentel, 2013).  Bacterial overgrowth leads to deconjugation of bile salts which appears to irritate the mucosal lining of the intestine and cause malabsorption of fatty acids (Wanitschke & Ammon, 1978).

Metabolic absorption of nutrients by dependent organs and bodily systems may be affected, due to altered health of the small intestine.  A recent study found that Non-alcoholic fatty liver disease, which affects 16-30% of the general population, was significantly higher in patients with SIBO compared to patients without SIBO (Fialho et al., 2016).  Dysbiosis of the gut bacteria has also been linked to other autoimmune diseases such as rheumatoid arthritis, type 1 diabetes and asthma (Tremlett et al., 2016).

The symptoms of SIBO can have a significant impact on quality of life. The condition can be economically burdensome as patients are likely to spend substantial sums of money on physician visits and medications seeking relief from their symptoms (Yakoob et al., 2011).  Socially, patients may suffer from gastrointestinal (GI)-specific anxiety (GSA) characterized by being fearful of GI symptoms, such as abdominal pain or discomfort, gas, and altered bowel habits. The unpredictability of their condition can lead to self-seclusion and avoidance of public and social gatherings (Lackner et al., 2014).

As evidenced by the research presented above, SIBO affects the gastrointestinal and supporting systems in a variety of ways, placing a heavy burden on individuals affected. 


Curious about the contribution of STRESS to SIBO (and other digestive dysfunctions)? Check out this article by Chris Kresser. 


Visceral Manipulation is a therapeutic approach to managing gut symptoms from SIBO. If you are in Denver, consider an appointment with Physical Therapist, Dr. Missy Albrecht who specializes in this bodywork. See more from Dr. Missy @stay_invincible



Bures J, Cyrany J, Kopacova M, et al. Small intestinal bacterial overgrowth syndrome. World Journal Of Gastroenterology[serial online]. June 28, 2010;16(24):2978-2990. Retrieved from

Fialho, A., Fialho, A., Thota, P., McCullough, A. J., & Shen, B. (2016). Small intestinal bacterial overgrowth is associated with non-alcoholic fatty liver disease. Journal of Gastrointestinal and Liver Diseases: JGLD, 25(2), 159-165. 10.15403/jgld.2014.1121.252.iwg Retrieved from

Kwiatkowski, Laura, Rice, Elizabeth, Landland, Jeffrey (2017). Integrative Treatment of Chronic Abdominal Bloating and Pain Associated with Overgrowth of Small Intestinal Bacteria: A Case Report. Alternative Therapies, 109(4), 56-61. Retrieved April 26, 2018, from

Lackner, J. M., Gudleski, G. D., Ma, C., Dewanwala, A., & Naliboff, B. (2014). Fear of GI symptoms has an important impact on quality of life in patients with moderate-to-severe IBS. The American Journal Of Gastroenterology109(11), 1815-1823. doi:10.1038/ajg.2014.241.Retrieved from

Sachdev, A. H., & Pimentel, M. (2013). Gastrointestinal bacterial overgrowth: Pathogenesis and clinical significance. Therapeutic Advances in Chronic Disease, 4(5), 223-231. 10.1177/2040622313496126 Retrieved from

Tremlett, H., Fadrosh, D. W., Faruqi, A. A., Hart, J., Roalstad, S., Graves, J., . . . Waubant, E. (2016). Associations between the gut microbiota and host immune markers in pediatric multiple sclerosis and controls. BMC Neurology, 16(1), 182. Retrieved from

Wanitschke, R., & Ammon, H. V. (1978). Effects of dihydroxy bile acids and hydroxy fatty acids on the absorption of oleic acid in the human jejunum. The Journal of Clinical Investigation, 61(1), 178-186. 10.1172/JCI108916 Retrieved from

Yakoob, J., Abbas, Z., Khan, R., Hamid, S., Awan, S., & Jafri, W. (2011). Small intestinal bacterial overgrowth and lactose intolerance contribute to irritable bowel syndrome symptomatology in Pakistan. Saudi Journal Of Gastroenterology: Official Journal Of The Saudi Gastroenterology Association17(6), 371-375. doi:10.4103/1319-3767.87176. Retrieved from

Ziegler, T. R., & Cole, C. R. (2007). Small bowel bacterial overgrowth in adults: A potential contributor to intestinal failure. Current Gastroenterology Reports, 9(6), 463-467. Retrieved from


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