Small Intestinal Bacterial Overgrowth (SIBO)
It is slightly on the wordy side and so I will just use the acronym SIBO instead, to save my little typing hands.
SIBO is what its name suggests- an overgrowth of bacteria residing in the small intestines. We all have colonies of gut flora within our digestive system (also known as our microbiome) and these species all have their place where they should be and also be at certain levels to maintain our mood, immune and digestive system to function properly. But when there is an imbalance or certain gut flora are living somewhere in our gut that they shouldn’t be (in this case its the small intestine) then we get SIBO!
What are the symptoms of SIBO?
- Bloating after meals
- Burping after meals
- Constipation AND diarrhoea
- Stomach pain
- Skin rashes- acne rosacea
- Joint pain
- Restless Leg Syndrome
- Associate conditions- fibromyalgia, hypothyroidism, diabetes, celiac disease, obesity
You do not have to have all of these symptoms to have SIBO and it can be so common to other ailments related to digestion- especially Irritable Bowel Syndrome (IBS). I will discuss SIBO vs. IBS a little later.
What are the causes of SIBO?
- Very typical to have been caused by an infection (food poisoning etc.)
- Stress- the motility of your digestive system slows down and digestive enzymes are lowered (mostly HCL) and will cause inflammation in the gut.
- Abdominal surgery-endometriosis, appendicitis, caesarean
- Excess consumption of carbohydrates
- Blind loops (gastric bypass)
- Initial colonisation of microbiome
- Medications- proton pump inhibitors, narcotics
- Celiac disease
Pathophysiology of SIBO-
Generally, inflammation is the main cause of SIBO and if you look at any of the causes above they will all produce inflammation at some stage. Along our small intestine we have these projectile fingers all the way along that are called microvilli. The microvilli have brush boarder enzymes that help you digest and breakdown your food, so it can be absorbed into the blood stream and used for energy or where ever the body needs it.
When there is inflammation of the microvilli, damage is caused and will create tiny gaps. This can create huge problems such as leaky gut, food allergies (due to food not being broken down and the digestive system attacking it), nutritional deficiencies and you guessed it….SIBO.
This then can cause another cycle of events because the small intestine tries to flush out the excess of bacteria and opens up it’s little tight junctions and creates more gaps for food etc. to enter. The damaged microvilli then are not able to do their job properly because they are damaged, so food (mostly carbohydrates) can often ferment and cause gas- belching, reflux and flatulence .
There is a natural wave found in the small intestine called the migrating motor complex (MMC). This wave occurs every 90 minutes and has a sweeping motion that pushes your solid matter down towards your colon. In SIBO the MMC is impaired and will also create gas production due to fermentation. The bacterial imbalance will also ‘feed’ off the carbohydrates and this is another cause of gas production.
Testing for SIBO-
The testing for SIBO is non-invasive and is performed by a simple breath test done at home. It is called the Hydrogen Breath test, which test the levels of hydrogen and methane after drinking a lactulose solution. 10 breath test are performed every 20 minutes and the rise of either (or both) of these elements will determine if you have SIBO or not. A 2 day prep diet is required, where little carbohydrates are consumed to starve the bacteria. Following the 2 day prep diet is crucial, as a false negative may occur.
The benefits of doing the test is that you know which bacteria to treat and this can alter your treatment protocol. You will also see what levels your bacteria is sitting at. For instance, I was high in both hydrogen AND methane and my levels raised to an amount that I needed to take the anti-microbial for 12 weeks instead of 6 weeks.
Treatment for SIBO-
The treatment for SIBO is based on diet changes, anti-microbial/anti-bacterial supplements, improving the MMC and breaking down the biofilm. Biofilm is a protective mucosal layer that covers your gut bacteria. The good and bad bacteria do it, so its not an unusual thing to occur. But, some bacteria are very stubborn and lie very deep within your mucosal layer. Some bacteria (candida albicans) also have a hook at one end and they hook them selves into your gut wall for extra adhesion. Once the treatment has finished, you can start pumping yourself up again with probiotics.
I believe the most integrative aspect of treating SIBO is obviously eliminating the excess bacteria, but focusing on healing your gut wall. This is where pharmaceutical treatment fails unfortunately. The administration of antibiotics does kill the bacteria, but the gut wall hasn’t healed, so you will find that SIBO symptoms return very quickly because the gaps between the junctions are still there.
The way to heal your gut wall is by avoiding inflammatory triggers to begin with and foods that feed the bacteria. There is usually much discussion on whether to starve or feed the bacteria. But, I have found that by starving the bacteria, not only increases the death rate, but it will also improve candida symptoms.
Meat/fish stock is the best way to heal your gut lining. The gelatine that is extracted from the joints/tendons make a nutritious and healing stock that is full of natural collagen. Unfortunately, there has not been enough emphasis on this and is really the key to long term success.
There have also been a few dates linked to treating SIBO. all of them are low in carbohydrates, as it is the disaccharides that are difficult to digest and cause the most symptoms in SIBO. Most people will try all of the diets to see which one gives the best results before taking action and doing the breath test. There is FODMAPS, Specific Carbohydrate Diet (SCD) and Gut and Psychology Syndrome (GAPS) diet. But, you will receive a recommended food list to treat SIBO specifically if you decide to take the Hydrogen Breath Test.
You can order a test kit from SIBOTEST.com, but you will need a qualified practitioner to interpret the results for you and to gain access to the supplements required.
What is the link with IBS and SIBO?
You can see from the list of symptoms that SIBO and IBS are very similar. There is a link, and it is mostly that if you have IBS there 60-80% chance that you have SIBO as well. This could be due to the fact that you can develop IBS the same way as you can develop SIBO and that is by post infectious gastroenteritis. The four main organisms that cause gastroenteritis are:
- Campylobacter jejuni
These organisms release a toxin called Cytolethial distending toxin B (CdtB). This toxin is very similar to a protein vinculin. Vinculin helps protect the interstitial cells along your gut wall to keep it nice and healthy and tight. But unfortunately, when high levels of the similar looking toxin CdtB is released the body starts to attack vinculin and develops anti bodies. This leads to an auto immune response. Don’t worry too much- this doesn’t happen to everyone!
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