Small Intestine Bacterial Overgrowth

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Too much of a good thing?

Many of my patients report feeling bloated almost everyday - some of them are so used to it that they are surprised to hear that this feeling is not normal.  Chronic abdominal bloating is one of the key symptoms of a condition known as SIBO  (Small Intestine Bacterial Overgrowth).  It is a colonization of the small intestine by bacteria that are normally not present there. Bacteria are healthy inhabitants of our gut but our small intestine should host a relatively small amount of bacteria compared to that of the large intestine. When the wrong bacteria do take up residence in the small intestine or the normal inhabitants become too many, a host of uncomfortable symptoms can result including:

  • Abdominal bloating
  • Belching
  • Abdominal pain
  • Constipation
  • Diarrhea
  • Heartburn or GERD
  • Food sensitivities
  • Joint pain
  • Nausea
  • Headaches
  • Brain fog
  • B12 deficiency
  • Iron deficiency
  • Vit D deficiency

SIBO interferes with both the structure and the function of the small bowel: inhibiting nutrient absorption and digestion and leading to changes in the mucosal lining that can cause leaky gut (linked with immune imbalances, autoimmunity, food allergies and intolerances).

Causes of SIBO

The causes of SIBO usually involve disruption of one of the protective mechanisms in the small intestine including gastric acid production, the migrating motor complex (waves of muscular activity that help clean the small intestine), the immune system in the gut and some of the small structural components.

Risk factors that can lead to SIBO include:

  • Low stomach acid
  • Irritable bowel syndrome
  • Celiac disease (long-standing)
  • Crohn’s disease
  • Prior bowel surgery
  • Diabetes mellitus (type I and type II)
  • Multiple courses of antibiotics
  • Organ system dysfunction, such as liver cirrhosis, chronic pancreatitis, or renal failure
  • Moderate alcohol consumption
  • Oral contraceptive use
  • Diet high in refined and processed carbohydrates

Testing and Treatment

The standard way SIBO is diagnosed is with a breath test that involves drinking a sugar solution and then measuring the amount of hydrogen and methane produced in the breath (administered by a qualified health care practitioner).

The standard treatment involves using antimicrobial agents to eradicate the bacteria. This can be done with antibiotics or natural antimicrobial substances such as allicin, berberine, oil of oregano, neem and cinnamon.

Treatment and prevention of recurrence also involves the use of a prokinetic agent to help with motility, which can be in the form of a prescription drug, a natural substance like ginger, or an herbal preparation such as Iberogast.  Another important component is a low carbohydrate diet such as the FODMAP diet, SCD (Specific Carbohydrate Diet), GAPS diet, the Cedar Sinai Diet or a combination of these.

SIBO is not an easy condition to identify and treat, but it can be done! The best recommendation is to work with a qualified health care practitioner (an ND or an MD) to navigate through all of the testing, treatment and prevention methods. 

Resources:

http://www.siboinfo.com/

http://chriskresser.com/sibo-what-causes-it-and-why-its-so-hard-to-treat/

https://sibocenter.com/sibo-symposium/

http://www.cedars-sinai.edu/Research/Research-Labs/Pimentel-Lab/