SIBO

  I am not a doctor – so I can’t help you with any medical advises. For these you will need to consult your doctor. But you will find (on the bottom of each page) medical articles on which I based my information. My advise is that after you read the information I presented – to print the references and have a discussion with your doctor.

  While I can’t help you medically, I am a certified Life Coach and Professional Engineer (PEng). So I can counsel and encourage you in taking the best decisions in your personal life.

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  Please read also the Lectins, the Evil Protein. It will explain certain facts about why you have gut issues and weight gain.

  So, SIBO… What is this strange looking mix of letters!!!

  SIBO is the acronym for “small intestinal bacterial overgrowth.” According with Wikipedia:

Small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowths, or small bowel bacterial overgrowth syndrome (SBBOS), is a disorder of excessive bacterial growth in the small intestine. Unlike the colon (or large bowel), which is rich with bacteria, the small bowel usually has fewer than 10,000 organisms per milliliter.

  So, while bacterium naturally occurs throughout the digestive tract, in a healthy system, the small intestine has relatively low levels of bacteria; it’s supposed to be at highest concentrations in the colon. The small intestine is the longest section of the digestive tract. This is where the food intermingles with digestive juices, and the nutrients are absorbed into the bloodstream. When in proper balance, the bacterium in the colon helps digest foods and the body absorb essential nutrients. However, when bacteria invades and takes over the small intestine, it can lead to poor nutrient absorption, symptoms commonly associated with IBS, and may even lead to damage of the stomach lining. When you have SIBO, as food passes through the small intestine, the bacterial overgrowth interferes with the healthy digestive and absorption process. The bacterium associated with SIBO actually consumes some of the foods and nutrients, leading to unpleasant symptoms, including gas, bloating and pain. Even when treating small intestinal bacterial overgrowth with antibiotics, relapse rate is high. This is a chronic condition that can be cured, but it takes patience, perseverance and a change in diet. In fact, SIBO treatment include a healing diet, and some foods should be avoided until the gut flora is back in balance.

  What is even more troubling is that there seems to be a definite association between IBS and SIBO (reference 1).

  But what are some of the SIBO symptoms? They are common symptoms for SIBO and IBS:

  • Nausea
  • Bloating
  • Vomiting
  • Diarrhea
  • Malnutrition
  • Weight loss/gain
  • Joint pain
  • Fatigue
  • Rashes
  • Acne
  • Eczema
  • Asthma
  • Depression
  • Rosacea

  So how is all these happening?

  The bacteria interfere with our normal digestion and absorption of food:

  • They consume some of our food which over time leads to deficiencies in their favorite nutrients such as iron and B12, causing anemia.
  • They consume food unable to be absorbed due to SI lining damage, which creates more bacterial overgrowth (a vicious cycle).
  • After eating our food, they produce gas/ expel flatus, within our SI. The gas causes abdominal bloating, abdominal pain, constipation, diarrhea or both (the symptoms of IBS). Excess gas can also cause belching and flatulence.
  • They decrease proper fat absorption by deconjugating bile leading to deficiencies of vitamins A & D and fatty stools.
  • Through the damaged lining, larger food particles not able to be fully digested, enter into the body which the immune system reacts to. This causes food allergies/ sensitivities.
  • Bacteria themselves can also enter the body/bloodstream. Immune system reaction to bacteria and their cell walls (endotoxin) causes chronic fatigue and body pain and burdens the liver.
  • Finally, the bacteria excrete acids which in high amounts can cause neurological and cognitive symptoms.

  So you suspect that you may have SIBO. But you may ask yourself: how I know for sure and what I do after, how I treat it?

SIBO Testing

  Unfortunately there is no perfect test. The small intestine is a hard place to get to. If the doctor wants to see or sample the small intestine, endoscopy only reaches into the top portion, and colonoscopy only reaches into the end portion. The middle portion, which is substantial (about 17 feet) is not accessible, other than by surgery. And stool testing predominantly reflects the large intestine microbiota. Luckily, there is a non-invasive test which is commonly used in SIBO research; the Hydrogen Breath Test.

  Hydrogen Breath Test can be used to diagnose several conditions: H pylori infection, carbohydrate malabsorption (ex. lactose) and SIBO. Breath testing measures the hydrogen and methane gases produced by bacteria in the small intestine that has diffused into the blood, then lungs, for expiration. Hydrogen and methane are gases produced by bacteria, not by humans. The gas is graphed over the small intestine transit time of 2 or 3 hours and compared to baseline. You drink a sugar solution of glucose or lactulose after a 1 or 2 day preparatory diet. The diet removes much of the food that would feed the bacteria, allowing for a clear reaction to the sugar drink.

  Lactulose Breath Test (LBT) Humans can’t digest or absorb lactulose. Only bacteria have the proper enzymes to do this. After they consume lactulose, they make gas. If there is an overgrowth, this will be reflected in the levels of hydrogen and/or methane. The advantage to this test is that it can diagnose overgrowth toward the end of the small intestine, where is thought to be more common. The disadvantage is that it can’t diagnose bacterial overgrowth as well as the Glucose Breath Test (GBT).

  Glucose Breath Test (GBT) Both humans and bacteria absorb glucose. Glucose is absorbed within the first three feet of the small intestine, therefore if the bacterial gases of hydrogen and/or methane are produced during this test, it reflects an overgrowth in the upper end of the SI (within the first two feet). The advantage to this test is that it successfully and accurately diagnoses upper part of the small intestine overgrowth. The disadvantage is that it can’t diagnose lower small intestine overgrowth, occurring in the next 17 feet of the small intestine, which is thought to be more common.

  So, there is no real way to know 100% if you have or not SIBO. Invasive or non-invasive testing there is no way to reach most of the small intestine except if you may consider a surgery. But, honestly, I don’t think that any doctor will be willing to do such surgery only for diagnoses – even if you will be willing to go to such extreme measures.

  Then, you may think: if I suspected I have SIBO but I can’t prove it (at least enough for a doctor to believe it) what can I do? First, I will advise to still have a talk with your doctor and see if you can get a glucose test. But if that doesn’t work and you are still willing to do something to see if you can improve your health – may be you can try keeping a diet indicated for SIBO and use herbal remedies. There are amazing medical researches that show that herbal remedies are at least as effective as medication (reference 4). I listed only one, but a google search will reveal much more.

SIBO Treatment

  Small intestinal bacterial overgrowth is most often treated with antibiotics. This helps reduce the problem bacteria but also kills off the healthy bacteria necessary for proper digestive functioning. The primary antibiotics used are Rifaximin (Xifaxan) and Neomycin. They are almost completely non-absorbable which means they stay in the intestines, having a local action and don’t cause systemic side effects, such as urinary tract infections. They are chosen specifically for this property which allows them to act only where they are needed.

  • Rifaximin may be used for all cases of SIBO.
  • Neomycin is effective for constipation cases and is used in addition to Rifaximin. Metronidazole is an effective alternative to Neomycin
  • If alternating diarrhea is present with constipation, the use of Rifaximin alone has been suggested.

  Even with antibiotics, SIBO is difficult to treat. In fact, a study published in the American Journal of Gastroenterology (reference 5), researchers concluded SIBO patients treated with antibiotics have a high recurrence rate and that gastrointestinal symptoms increased during the recurrences.

  The good news is that researchers have found that herbal remedies are as effective as three courses of antibiotic therapy in patients who don’t respond well to rifaximin (reference 4). This study mentions a variety of herbal remedies but doesn’t include dosing or further details. Oregano oil, berberine extract, wormwood oil, lemon balm oil and Indian barberry root extract are all mentioned in the study. I found that very same combination in herbal remedies for treating candida overgrowth and/or parasites. As there doesn’t seem to be a recommended dosage for these herbs I went through cycling between the candida and parasites combination – and that made a big difference. While I didn’t do the breath test, on my search for trying to treat the IBS I bumped on this information and after reading about each of the herbs I found that can’t harm me but could help – and helped they did. But, warning I never had the courage to use oregano oil – that is the only one from the herbs that has question marks as it can be really dangerous if not used properly.

  But what to do while this treatment is doing its work. Is anything you can do in the meanwhile to help and send SIBO in a permanent remission. Yes, there are few things. Consume smaller amounts of food during meals. Eating smaller meals allows you to digest foods more quickly which is crucial to overcoming SIBO. Overeating is one of the worst things for SIBO because it causes food to sit longer in the stomach and can also damage gastric juice production. Low stomach acid production is one of the main contributing factors of SIBO because stomach acid kills of bacteria in your upper small intestine regions. And, also, follow a SIBO diet:

SIBO Diet

  At least in the very start of getting rid of SIBO is advised to follow what is also called “FODMAP elimination diet”. FODMAPs stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are specific sugars found in food, such as fructose, lactose, fructans, galactans and polyols. Because they’re not absorbed completely by the human body, they’re easily fermented by gut bacteria and can cause significant gastrointestinal (GI) problems. The fermentation actually feeds the bacteria, making it more difficult to fight SIBO and SIBO symptoms. While I already mentioned them under “IBS” page – I will continue here with also listing the foods to avoid:

Foods to avoid

  • Fructose — some fruit and fruit juices, honey, processed cereals, baked goods, high-fructose corn syrup, maple syrup, processed sugars
  • Lactose — conventional dairy and processed products with dairy and added lactose
  • Fructans — wheat, garlic, onion, asparagus, leeks, artichokes, broccoli, cabbage
  • Galactans — legumes, cabbage, Brussels sprouts, soy
  • Polyols — sorbitol, isomalt, lactitol, maltitol, xylitol and erythritol, commonly found in sugar-free gum, mints and some medications

Foods to enjoy

  • Wild-caught tuna and salmon
  • Grass-fed beef and lamb
  • Free-range poultry and eggs
  • Raw hard cheeses
  • Almond or coconut milk
  • Leafy greens
  • Squash
  • Cucumbers
  • Bananas
  • Blueberries
  • Grapes
  • Cantaloupe and honeydew melons
  • Pineapple
  • Strawberries
  • Quinoa

  The goal of the SIBO diet is to repair the intestinal lining, ease inflammation, get rid of the bacterial overgrowth and eat a diet rich in the essential nutrients that your body hasn’t been absorbing. High-quality clean proteins, including wild-caught tuna and salmon, grass-fed beef and lamb, and free-rage poultry and eggs are easy to digest — and will give your body essential nutrients and energy. While somewhat limited during the FODMAPS elimination, you can still enjoy some fruits, including bananas, grapes, blueberries, strawberries, cantaloupe, honeydew melons and pineapple. As your body heals from SIBO, eating fresh pineapple, which is rich in bromelain, each day can help lower inflammation while helping digestion. Bromelain has unbelievable health benefits, particularly for those with digestive disorders, allergies, asthma and joint pain. In addition to pineapple, bananas help improve digestive health and boost energy levels. They’re a good source of both potassium and manganese, which the body needs while healing from SIBO.

  And if this diet looks very similar with the “Paleo” diet is because the “Paleo” also believes that we need to eat what our bodies are design to eat. That all our food is to be easily digestible by our gut. And that is why a lot of people that switched their lifestyle to a “paleo” diet lifestyle mostly forgot about their IBS and/or SIBO problems.

  Please continue reading the next page and I hope will help you understand one of the biggest reason where all these issues are actually starting. And hopefully a possible solution to help in the future.


References:
1. Uday C Ghoshal and Deepakshi Srivastava US National Library of Medicine 2014 Mar 14 Irritable bowel syndrome and small intestinal bacterial overgrowth: Meaningful association or unnecessary hype
2. Benjamin Wedro, MD, FACEP, FAAEM Medicine.net Small Intestinal Bacterial Overgrowth (SIBO)
3. Jan Bures, Jiri Cyrany, Darina Kohoutova, Miroslav Förstl, Stanislav Rejchrt, Jaroslav Kvetina, Viktor Vorisek, and Marcela Kopacova US National Library of Medicine 2010 Jun 28 Small intestinal bacterial overgrowth syndrome
4. Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, Justino E, Tomakin E, Mullin GE US National Library of Medicine 2014 May Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth.
5. Lauritano EC, Gabrielli M, Scarpellini E, Lupascu A, Novi M, Sottili S, Vitale G, Cesario V, Serricchio M, Cammarota G, Gasbarrini G, Gasbarrini A US National Library of Medicine 2008 Aug Small intestinal bacterial overgrowth recurrence after antibiotic therapy.