SIBO – SMALL INTESTINE BACTERIAL OVERGROWTH

 

DO YOU HAVE SIBO?

  • Bloating

  • Nausea

  • Constipation or Diarrhea – either or both

  • Joint Pain

  • Fatigue

  • Depression

  • Malabsorption

  • Malnutrition

  • Asthma

Bloating every time you eat any carbohydrates is the hallmark of SIBO.

While the “Gold Standard” for diagnosis involves invasive testing, the clinical diagnosis seems to be just as accurate.  Improvement with the FODMAP diet cliniches the diagnosis.

THE BIG ISSUES ARE:

  • WHAT CAUSED IT?

  • WHAT WILL CURE IT?

EVERYONE IS DIFFERENT BUT THERE ARE SOME COMMON ISSUES.

A LITTLE ANATOMY

You eat food. It goes into the stomach which empties into the small intestine where the nutrients are absorbed. At the end of the small intestine is a valve called the ileo-cecal valve or ICV. Normally there are very few bacteria in the small intestine but the large intestine is normally full of bacteria. The job of the ICV is to keep it that way.  If the ileo-cecal valve is not working properly, large numbers of bacteria can enter the small intestine from the large intestine causing small intestine bacterial overgrowth. Normally the digesting food is moved through the small intestine by a wave of muscular contraction. This whole process is called intestinal motility.  People with SIBO tend to have low intestinal motility which means that the bacteria that do get into the small intestine aren’t moved along well and tend to stick around.

Some people with SIBO have very different kinds of bacteria growing in the small intestine and some just have too many of the normal bacteria usually found in the large intestine.

  • If you produce a lot of gas you probably have bacteria that produce hydrogen or methane gas..
  • If the gas is very smelly, like rotten eggs, you probably have bacteria that produce sulfur gas.

WHY DOES THIS HAPPEN?

  • ANTIBIOTICS and other drugs can kill off healthy bacteria. What is left can cause local irritation and inflammation causing the leocecal valve to be stuck open.  Over 50% of people who regularly take antacid medications (Pepsid, Prilosec, Nexium, Ptotonic, Prevacid, etc.) will develop SIBO. 
  • Food sensitivies such as gluten intolerance and celiac disease.
  • Gut infections – some cases of SIBO start with a GI infection such as “food poisoning” which seems to set off a chain reaction resulting in long term dysfunction.
  • Abdominal surgery or procedures which traumatize the intestines.
  • STRESS and lack of neurotransmitters. Gut motility and ICV tone are under the control of the vagal nerve.  The alarm state shuts down this function and can result in SIBO particularly if it is chronic

SOLUTIONS

  • FODMAP DIET (link) – This diet,  works by reducing the kinds of starches that feed SIBO bacteria. If you feel better on the FODMAP diet that is a sure indication you do have SIBO.

  • SPECIAL DIGESTIVE ENZYMES – To digest starches before they reach the lower small intestine.  These can dramatically reduce gas and bloating.

  • CORRECT LOW STOMACH ACID – if this is an issue as it commonly is.

  • FIND AND AVOID FOOD INTOLERANCES – the LOW FODMAP diet can help here because it gets you off many potential allergens.

  • ANTIMICROBIALS –  Antibiotics are often used but have not been shown to be effective in the long run because they have been shown to be the cause of SIBO.  Herbal antimicrobials can be very helpful.

  • PROBIOTICS MAY HELP BUT GET THE RIGHT KIND – Some specific probiotics can make SIBO worse.

  • MECHANICAL STIMULATION OF THE ICV.- this is an old technique which can often g

    ive relief.

    Location of the illeocecal valve

  • STIMULATION OF THE MYELINATED VAGAL NERVE – Electrical stimulation is easy and cheap.

Some people can recover fairly quickly and get off most or a

ll of these treatments including the Low FODMAP diet. Others may need to maintain some level of ongoing treatment of keep symptoms under control.

WHY IS THIS SO IMPORTANT

SIBO can really interfere with your life. But beyond that it can cause serious inflammation that can affect your whole digestion, immune system, blood sugar balance, and many other body systems. SIBO can cause serious nutritional deficiencies due to poor absorption. Altered bacteria in the gut can have a direct effect on the production of neurotransmitters. SIBO can cause a B12 deficiency due to both a lack of good microbes and poor absorption.  SIBO is one of those conditions that if untreated can lead to a host of more serious disease conditions. Early intervention is important.