SIBO is a Common Medical Problem
One of the most common digestive challenges I see in my offices is small intestinal bowel overgrowth, commonly referred to as SIBO. SIBO is a complicated medical challenge that may be the root cause of many of the cases of irritable bowel syndrome (IBS) currently being diagnosed in the United States.
So What Exactly is SIBO?
SIBO is a condition whereby an abnormal over-growth of bacteria accumulates in the small intestine. In a normal digestive tract, there are few bacteria in the upper digestive tract; as the upper digestive tract is where most nutritional absorption takes place. Consequently, if there are too many bacteria in the upper digestive tract, they can inhibit our body’s ability to absorb nutrition from our food.
In contrast, to the small intestine, the lower large intestine is rich in bacteria. Bacteria in the large intestine and colon help maintain healthy gut flora, break down cellulose and produce important nutrients, like vitamin K. Bacteria in the large intestine and colon are also an important part of our digestive tracts complex immune system.
Why We Get SIBO?
In a healthy digestive tract, food is consumed and passed from the stomach to the small intestine where it further digested and absorbed. The small intestine is divided into two areas, the duodenum, and the jejunum. One food has been chewed and mixed with saliva, it is churned by the stomach. The parietal cells and chief cells of the stomach then release hydrochloric acid and pepsinogen which further breaks down food particles. From there, food is passed onto the duodenum, where it is mixed with bile and additional pancreatic enzymes, and absorption of nutrition begins to take place. However, in the case of SIBO, an over-growth of bacteria disrupts nutritional absorption in the small intestine, and leads to a host of other health challenges.What are Some of the Health Challenges Associated with SIBO?
In addition to having trouble digesting your food, SIBO can also lead to gas and bloating, upset stomach accompanied by a distended stomach, maldigestion and malabsorption of nutrients. A person may also notice that they have an excessive amount of gas an bloating within an hour or so of consuming their meal. SIBO can also effect peristalsis, the natural wave-like motion of the digestive tract that allows food to move down the digestive tract as nutrients are absorbed and waste is eliminated. This may lead a person with SIBO to complain that they feel that things are “getting stuck” in the digestive tract.
What are the Signs and Symptoms of SIBO?
In addition to gas and bloating, symptoms may include upset stomach, cramping; especially in the lower right side of your abdomen—in an area known as the ileocecal valve. The ileocecal valve separates the small (or upper digestive tract) from the large intestine. In patients with SIBO, this valve may be damaged or inflamed; allowing bacteria to move up the digestive tract into the upper digestive tract, (the small intestine) leading to SIBO. Additional symptoms include, acne, migraine heaadaches, chronic joint pain and inflammation, as well as constipation that may be worse with fiber. People who suffer from SIBO may complain of a feeling that food is “stuck” in the digestive tract; as motility declines—especially after eating foods high in fiber.
What Can Cause SIBO?
There are a number of reasons why a person may suffer from SIBO. Simply growing older may be a risk factor. This is because as we age, our organs begin to age as well, like the pancreas, an organ that produces the enzymes that help us digest our food. When our food is not properly digested, it moves to the small intestine where it becomes food for bacteria. Once the bacteria begin to accumulate in the small intestine, they can inhibit nutritional absorption of food, leading to maldigestion and malnutrition. This, accompanied by poor pancreatic function, is one of the main reasons we see wasting diseases in senior citizens. SIBO may also inhibit normal peristalsis, the natural wave like movements our intestines make that allow our food to move through the digestive tract. Consequently, many people with SIBO complain of constipation, that is not relieved by fiber. Rather, fiber may make things worse. This is because SIBO will often feed on fiber supplements, leading to more pain, gas, bloating and more SIBO. Other risk factors for SIBO include, poor dental care, eating too quickly, chronic stress and worry, and prior appendectomy surgery that damages the iliocecal valve.
Testing for SIBO
Currently, the gold standard for testing for SIBO is the lactulose breath test. And involves consuming a small amount of the sugar lactulose and then breathing into a tube that collects the gasses produced by bacteria. The lactulose breath test allows us to see both the amount of bacteria in the small intestine, as well as the type of bacterial infection a person might have. Results can take about a week to be analyzed and the test itself can be done in the convenience of your own home.What Kinds of Bacteria Does the SIBO Test Detect?
There are two types of bacteria that the lactulose breath test can identify, hydrogen and methane. In my experience, in less severe cases of SIBO, a patient may begin with a hydrogen positive test result. However, in more severe cases of SIBO a patient will test positive for both hydrogen and methane producing bacteria. Methane producing bacteriaTreating SIBO with “the 4 Rs.”
When it comes to treating SIBO, like most naturopathic doctors, I start by treating the cause. I want to find out why the patient has developed the disease in the first place. Usually, I begin with a protocol known as “the 4 R’s”, Remove, Replace, Reinoculate and Repair.
First Remove the Cause
First things first, we want to remove the things that may be causing the health challenge in the first place, this may include such common pain relievers as non steroidal anti inflammatories (NSAID’s), proton-pump inhibitors (PPI’s), or key foods that a person is may be sensitive too, like processed foods, gluten, eggs, soybeans, coffee and alcohol.
Foods high in complex carbohydrates (especially what are known as FOD/MAPs) may also need to be removed; as they can aggravate SIBO. I also want to prescribe natural supplements that can be helpful in reducing SIBO.
I usually suggest taking antimicrobials before bed, when the stomach is empty, to better facilitate the health benefits of antimicrobials. My favorite go to products to reduce SIBO are Broad Spectrum Complex by Pharmax, Berberine by Thorne Research and Oregano oil with 80% carvacrol by natural Factors. I typically have my patients abstain from eating 3 to 4 hours before bed, and give antimocrobials at night, in order for them to be effective.
Because more pancreatic function is common in SIBO, especially in people over 40, I often discuss taking a good digestive enzyme. I like Digest Spectrum by Enzymatica; because it is especially formulated for people who suffer from food sensitivities. For people with low stomach acid, I recommend Biogest by Thorne Research; because it contains digestive enzymes along with hydrochloric acid and is a great product.Reinoculate
I have looked at several great probiotics on the market. And usually when I am ready to begin prescribing probiotics to patients, I choose HLC HIgh Potency Probiotics from Pharmax. This company is quite good, and their products have been independently tested for viability.
When it comes to repairing gut health, I like medical foods like Medi-Clear Plus by Thorne Research and Glutagenics by Metagenics. Both of these products are especially formulated to heal leaky gut, a common side-effect from SIBO. I advice people use these medical foods in the morning; to help rebuild the gut lining and strengthen gut health.
For most of my patients, I advice a commitment of about 3 months in order to heal the gut. In older patients, it may be advisable to remain on probiotics and digestive enzymes indefinitely; as both are quite helpful in the digestive health of older individuals.
Dr. Whimsy Anderson, ND