SIBO – SMALL INTESTINE BACTERIAL OVERGROWTH
SIGNS YOU MAY HAVE SIBO:
Constipation or Diarrhea – either or both
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?
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.
- Some bacterial species tend to produce constipation while others tend to diarrhea.
- Some bacteria produce chemicals which have a profound impact on brain function, particularly on dopamine.
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.
STOMACH ACID MEDICATIONS: Over 50% of people who regularly take antacid medications (Pepsid, Prilosec, Nexium, Ptotonic, Prevacid, etc.) will develop SIBO.
FOOD SENSITIVITIES (allergies/intolerance): such as gluten, dairy and other food intolerance, which creates inflammation in the small intestine.
GUT INFECTIONS (overgrowth of the wrong kind of bacteria) 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.
POOR DIET: High sugar and simple carbohydrate diets tend to feed inflammatory gut bacteria and yeasts.
ABDOMINAL SURGERY or procedures which traumatize the intestines.
STRESS: THE VAGAL NERVE sends signals to stimulate the movement of food through the digestive tract and stimulate digestive juices. Stress shuts down vagal activity. Stress can be current time or old, often childhood, stress and trauma. This is a big topic but vagal activity can be directly stimulated through physical activities including electrical stimulation, yoga, acupuncture, etc. Internal stress can be helped by meditation, therapy and also by a number of herbs and nutraceuticals which help regulate the mid brain response to perceived stress.
DISCOVERING GUT MICROBIAL IMBALANCE: My first choice is using the Organic Acid Test which gives a good survey of gut microbial balance while also giving much useful information on many other aspects of your health.
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 BUT it is not a cure.
FIX STOMACH ACID – Too little stomach acid is actually more common than two little. Low stomach acid leads to undigested food and poor stomach emptying which can cause reflux and dumping of partially digested food into the small intestine where it can allow overgrowth of unfriendly bacterial species. It is important to investigate the cause: bacterial infection (H. Pylori or other), autoimmune attack on the stomach (often associated with gluten intolerance), stress (through it’s effect on the vagal nerve) or nutrient deficiency.
FIND AND AVOID FOOD INTOLERANCES – the LOW FODMAP diet can help here because it gets you off many potential allergens. In many cases this is temporary. There are excellent lab tests from Cyrex Labs to test for actual immune reactions to foods. Some intolerance, such as histamie intolerance, are not true immune reactions and can be addressed by working with biochemical pathways. Others are true autoimmune reactions.
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 because, if carefully chosen, they will not wipe out good bacteria.
PROBIOTICS MAY HELP BUT GET THE RIGHT KIND – Some specific probiotics can make SIBO worse. Many probiotics have been shown to have little or no real benefit. I use advanced spore based probiotics chosen to match individual needs. My first choice is Microbiome Labs. I have a personal connection with the principals and have seen real results with patients.
Location of the illeocecal valve
MECHANICAL STIMULATION OF THE ICV.- This is an old technique which can often help.
STIMULATION OF THE MYELINATED VAGAL NERVE. The vagus turns on digestion and assimilation. Any sense of threat – real of imagined – turns it off. There are many techniques of stimulating the vagus including physical or electrical stimulation using a TENS unit. Yoga, exercise, meditation, social interaction are all helpful. Many people carry old trauma which is a constant source of often subconscious stress. Techniques such as Emotional Freedom Technique and other therapies can help reduce these stressors.