Is Small Intestinal Bacterial Overgrowth (SIBO) Connected To Hair Loss?
Not long ago, I wrote an article about the connection between acne and hair loss (androgenic alopecia), and highlighted research suggesting that a primary driver of acne (specifically, acne rosacea) may be a condition known as small intestinal bacterial overgrowth (SIBO).
This got a lot of readers asking: is SIBO also related to hair loss? And if so — how do I test for small intestinal bacterial overgrowth… and how do I resolve it?
The answers aren’t straightforward. For one, I haven’t found a single paper demonstrating a clear connection between hair loss and SIBO. However, several papers suggest a connection between SIBO and intestinal inflammation, nutrient malabsorption, and the over-colonization of gram-negative bacteria… all of which are involved in the pathology of fibrosis (ie: scar tissue development) and certain fibrotic disease states (ie: cystic fibrosis). And as we know, fibrosis is directly implicated in the pathology of pattern hair thinning.
But we’re stretching the evidence here. We can’t conclude that just because SIBO is linked to cystic fibrosis — then it must also be linked to all forms of fibrosis — like the kind implicated in pattern hair loss (perifollicular fibrosis)…
But anecdotally, the SIBO-hair loss connection gets more interesting.
Of the female hair loss sufferers with whom I’ve worked — nearly every woman who tested for SIBO, tested positive. And of the women who sought SIBO treatment and later retested as SIBO-negative, those women reported a reduction in hair shedding, and that their hair (which in some cases, had stopped growing) started to lengthen again.
Those are huge wins — especially for any female hair loss sufferer who feels she’s exhausted her hair loss treatment routes and doesn’t know where to turn next. And while SIBO doesn’t seem as prevalent in male hair loss sufferers — at least the ones with whom I’ve worked — the reality is this: anything that contributes to chronic inflammation in the small intestine (ie: SIBO) has the potential to hurt our hair.
Why? Because the small intestine is roughly 20 feet long. And of the foods we eat, it’s responsible for nearly all nutrient absorption. That includes iron, vitamin B-12, and vitamin D — of which many female hair loss sufferers are deficient. Dozens of studies show that prolonged protein malabsorption and nutrient deficiencies can lead to diffuse hair thinning, excessive hair shedding (telogen effluvium), and even autoimmune-related hair loss like alopecia areata.
And encouragingly, studies also show that resolving these deficiencies — either with better nutrition, or fixing the underlying causes of malabsorption (like SIBO) — might sometimes lead to hair recovery (see these articles on vitamin D and zinc).
So… If I Have SIBO And Treat It, Will I Regrow My Hair?
Now, this doesn’t suggest that for the majority of those with hair loss — treating SIBO will regrow hair. But it does suggest — for men and women who fit the bill of SIBO symptoms — that resolving SIBO might also help resolve some of the underlying factors associated with their hair loss… and in doing so, maybe slow or stop hair loss (or encourage healthier hair growth).
So how do we test for small intestinal bacterial overgrowth? And if we test positive, how do we resolve it?
SIBO Treatment Recommendations Vary Wildly
There are many kinds of SIBO, and each kind requires a different treatment. Depending on the doctor — everyone seems to have differing opinions on how to best treat each SIBO type.
Resolving SIBO is also complicated, and it’s something of which I lack first-hand experience (I tested SIBO-negative in a breath test two months ago). Moreover, there’s limited research on SIBO pathology and treatment efficacy. As a result, SIBO sufferers often must rely on the experience and advice of medical professionals who work with SIBO patients regularly.
The bottom line: I’m a hair loss researcher, not an SIBO expert. And that means you shouldn’t read about SIBO treatments from me; you should read about them from someone more qualified. So I decided to forgo writing the rest of this article — and instead reach out to an authority in digestive health.
I’d like to introduce John Brisson — an author, researcher, educator, and expert in digestive disorders, hormone dysregulation, autoimmunity, and most importantly: small intestinal bacterial overgrowth.
John is the cofounder of fixyourgut.com. His deep-dive into health research began from a personal tragedy. His experience working with SIBO and digestive disorder sufferers spans years and thousands of hours. And today, he’s even referred to as a contributor and expert in published medical literature.
Note: I am not financially affiliated with John Brisson or his website. But I’ve spoken with him over Skype, and I value his work. There are few others qualified to write the same SIBO treatment guidelines, and my hope is that this content will help anyone who might be experiencing SIBO, hair loss, or both.
So let’s get started. John’s content covers what is SIBO, why SIBO negatively impacts our health, how to test for SIBO (and minimize false results), and most importantly: how to treat SIBO based on its type (methane-dominant, hydrogen-dominant, or both).
Note: the following is written by John Brisson of fixyourgut.com
SIBO, Gut Health, And Bacterial Overgrowths
Bacterial dysbiosis (a microbial imbalance of bacteria inside the body) can wreak havoc on many different aspects of our overall health. I have coached many people with SIBO, and I have seen those with the condition struggle trying to manage their illness and the stress of modern life. Imagine reacting negatively to almost everything you consume, causing severe abdominal distension to the point where you look like you are pregnant, for weeks and months at a time.
SIBO (small intestinal bacterial overgrowth) is a medical condition where many people have an opportunistic bacterial infection in the small intestine. And unfortunately, SIBO can take a serious toll on one’s physical, social, spiritual, and mental health because it directly compromises the functionality of the small intestine.
Why Is The Small Intestine So Important?
The small intestine helps to break down proteins, lipids, and simple carbohydrates and is very important for the assimilation of nutrients. The MMC (migrating motor complex) maintains peristalsis in the small intestine and helps move our food along for proper digestion.
With a bacterial overgrowth in the small intestine, our ability to process and absorb nutrients is significantly impaired, and will remain so until the condition is addressed.
What Causes SIBO?
The development of SIBO is usually caused by the poor standard American diet, food poisoning, viral gastroenteritis, antibiotic overuse, motility issues (mainly chronic constipation), or long-term use of stomach acid reducing medications (proton pump inhibitors or antacids).
The long-term use of acid-reducing medications causes opportunistic bacteria that would typically be eliminated by stomach acid, to survive and flourish in the small intestine. A lack of stomach acid causes food proteins to become partially undigested. Allergies develop from the undigested proteins.
Undigested proteins also cause excessive flatulence and increase inflammation. The standard American diet of FODMAP carbohydrates allows opportunistic bacteria to thrive, strongly colonize the small intestine, and produce excess gas.
How Does SIBO Develop?
These contributing factors create a window of opportunity for microorganisms to enter and colonize the small intestine, an organ with relatively fewer microorganisms than the rest of our intestinal tract. This leads to something known as opportunistic dysbiosis (a microbial imbalance), which depending on the severity, begins to inhibit the small intestine’s ability to perform its tasks.
The more opportunistic bacteria in our small gut, the more food that bacteria ferments, and the more gas byproducts and toxins they produce.
The opportunistic microorganisms (and their toxic byproducts) then begin to decrease fat absorption in the intestines. This leads to stool problems with color/fat content. And unfortunately, the cycle reinforces itself. Increased fermentation in the small intestine also increases the chances of further small intestinal dysbiosis, and as a result, the intestinal lining further degrades and eventually cannot digest larger nutrients correctly.
These improperly digested start to cause food allergies and sensitivities.
The opportunistic microorganisms produce toxins that then enter the bloodstream from the loss of integrity in the intestinal wall. Excessive toxins in the bloodstream lead to an immune overreaction that causes fatigue, systemic joint pain, and elevated liver enzymes.
Finally, these byproducts or toxins that cause neurological and cognitive problems including cognitive impairment and forgetfulness. The vicious cycle continues as the body’s immune system tries to eliminate the opportunistic microorganisms, which react to the body’s defenses by releasing more acids, toxins, and creating more opportunities for these inflammatory microorganisms to continue to flourish. The cycle then repeats itself, and the end result is chronic illness.
What Are The Symptoms Of SIBO?
The main symptoms of a SIBO infection are indigestion, an increase in flatulence, and horrible-smelling deification, burps, and flatulence. Other symptoms of SIBO include abdominal pain, severe bloating, abdominal distention, chronic constipation, acid reflux (GERD), fatigue, headaches, chronic diarrhea, fat malabsorption, food allergies, and occasional low-grade fever. There is also a strong correlation between rosacea and SIBO.
In my coaching experience. I’ve found that most people with IBS (irritable bowel syndrome) are actually suffering from SIBO, and that SIBO is their main cause of their digestive problems.
Diagnosing SIBO: The Hydrogen/Methane Breath Tests
A hydrogen/methane breath test is often the standard used to diagnose SIBO.
The hydrogen/methane breath test is a non-invasive fasting test in which your doctor has you breathe into a machine that monitors excess hydrogen or methane that is released by the opportunistic bacteria in your small intestine.
You are given glucose, dextrose, or lactulose, during the test to consume, and the test input is collected at twenty-minute intervals for at least three-five hours.
If you produce at least twenty ppm of hydrogen or three ppm of methane during the test, you test positive for an active SIBO infection (but even a result of twelve ppm hydrogen should be treated at the very minimum).
If your hydrogen and methane are flat-lined or do not rise during the test, you may have the third type of SIBO: hydrogen sulfide producing bacterial overgrowth.
SIBO Tests Aren’t Perfect! Sugars & False Results
It’s debatable which sugar is best to ingest for diagnosing SIBO (lactulose or glucose). For instance, bacteria have to ferment lactulose in the intestines for it to be absorbed by the body. Glucose is easily broken down by the microbiome or directly absorbed by the gastrointestinal system.
Moreover, the use of glucose as a test marker may give a false negative reading because at least seventeen feet of the small intestine may not be tested. And in people with irritable bowel syndrome with diarrhea (IBS-D), the glucose might reach the cecum and begin fermentation sooner, creating a false positive SIBO result in people with strictly colonic overgrowth.
There are also issues with the use of lactulose that might produce false negatives. Not all organisms that cause an overgrowth ferment lactulose, and if you have an overgrowth of bacteria that doesn’t ferment lactulose, you might receive a false negative test result. In addition, lactulose increases bowel transit time, which can further skew test results. So if you’re going to test for SIBO, you need to be aware of these issues so that you can maximize your chances for an accurate diagnosis.
Want To Get Tested For SIBO?
I recommend using these guidelines of hydrogen/methane breath interpretation by the leading SIBO expert, Dr. Allison Siebecker. I also recommend getting a GI Effects performed by Genova Diagnostics through your gastroenterologist.
You can find out how to order the SIBO tests (based on your location) right here.
It might be best to get both tests done (glucose and lactulose) to determine bacterial overgrowth, alongside that bowel transit test as well, to determine one’s motility and how long it would take the test substances to reach the colon. That way, you’ll have a better idea of what’s going on (and help minimize your chances of an incorrect diagnosis).
And remember, some people can have SIBO symptoms and still receive a negative diagnosis. This is because not every overgrowth of bacteria in the gut will contain bacteria that produce hydrogen.
There is also no unified medical interpretation of SIBO breath tests. Therefore, a doctor might perceive your results to be normal, and they aren’t. If your values do not rise during the test, you may have hydrogen sulfide producing bacterial overgrowth in the small intestine.
How Do You Treat SIBO? It All Depends…
So, what do you do if you have SIBO? In general, it’s better try an SIBO treatment if you have many of its symptoms, instead of relying on an unpredictable diagnosis from breath testing.
Depending on the type of SIBO you have, some doctors might prescribe antibiotics including Xifixan, Cipro, Flagyl, or Neomycin. Some more integrative doctors may prescribe more natural approaches like Allison Seibacker’s natural protocol for tackling SIBO.
Many people follow a low FODMAP diet to try to reduce overgrowth and control symptoms with moderate success (if you’re interested, here are specific guidelines).
If you are not any better within a month of following a low FODMAP diet or doing any SIBO protocols, then SIBO was either not your problem in the first place (it could be small intestinal yeast overgrowth (SIYO)), or the protocol was not strong enough to eliminate some of the hardier bacteria like MAP (Mycobacterium avium paratuberculosis, a cause of Ulcerative Colitis and Crohn’s disease) or Klebsiella (a cause of Rheumatoid Arthritis and Ankylosing Spondylitis).
If you find yourself in the latter position, you should know there’s currently no public test for MAP (outside of specific testing at a university or hospital pathology laboratory), but Klebsiella can be tested for by using Genova’s GI Effects Stool Profile test (you’ll need a gastroenterologist to order the test, though some functional medicine practitioners can order these too).
SIBO Treatment Guidelines
Treating Hydrogen-Producing SIBO
If you are suffering from hydrogen producing SIBO, taking the antibiotic Xifixan for ten to fourteen days, or following my hydrogen SIBO protocol for two to four weeks, may help reduce your overgrowth and improve your digestion.
In addition, many of my clients with dominant hydrogen overgrowth have seen success with using berberine and oil of oregano as antimicrobial agents, and activated charcoal to help with loose stools. Moreover, following a low FODMAP diet for a few weeks may help reduce bloating.
Treating Methane-Producing SIBO
If you are suffering from methane-producing SIBO, following my methane dominant SIBO protocol for two to four weeks may help reduce your overgrowth and improve your digestion.
Many of my clients with dominant methane overgrowth have seen success with using allicin, neem, or Atrantil as antimicrobial agents and magnesium and 5-HTP to help increase motility. Multiple protocols and rotation of herbs may be needed for proper recovery, as most your gut issues didn’t start overnight, and it might take some time for your digestion to improve.
Above all, don’t become discouraged. Most people improve their quality of life or conquer their SIBO in time.
Note: the above segment is written by John Brisson of fixyourgut.com
Rob English is a researcher, medical editor, and the founder of perfecthairhealth.com. He acts as a peer reviewer for scholarly journals and has published four peer-reviewed papers on androgenic alopecia. He writes regularly about the science behind hair loss (and hair growth). Feel free to browse his long-form articles and publications throughout this site.