Is your digestion anything less than a smooth sailing system? Food accepted kindly by your body with appreciation, and waste removed comfortably and predictably like a well oiled machine?
Effortless digestion is a reality for many people and is a worthy goal. Unfortunately, uncomfortable or downright painful digestion is the norm for too many people, and since most people eat 1-7 times each day that makes me sad. Digestive complaints have become the cornerstone of my practice over the years.
For those of you who dread eating and have been diagnosed with IBS (Irritable Bowel Syndrome) fear not! I see your IBS as totally treatable. It might be SIBO, or it might not be. Read on to see if SIBO resonates with you…
What is SIBO?
Small Intestine Bacterial Overgrowth (SIBO) is a chronic overgrowth of bacteria in the wrong part of the digestive tract. The large intestine is where our resident bacteria and yeast thrive and support the health of the body, but when those microbes take over stretches of the small intestine they can interfere with normal digestive processes such as nutrient absorption, and trigger reactions outside of the digestive system including the skin, joints, and brain.
Symptoms may be mild or severe depending on the degree of overgrowth, the make up of the bacterial populations involved, and the potential damage done to the lining of the small intestine.
SIBO is considered to be a significant cause of IBS which is characterized by abdominal pain or discomfort and variable stools (1). IBS may express as diarrhea, constipation, or a mixed type in which diarrhea and constipation alternate.
What causes SIBO?
A number of factors can lead to the overgrowth of bacteria in the small intestine (SI). A well functioning small intestine *should* have low levels of bacteria. When there is a significant lull between meals the brain helps to shift the small intestine into self-cleansing mode. Muscular contractions start at the top of the small intestine moving remnants from the last meal down towards the large intestine. These increase in intensity over time and help to sweep the SI clean. This is called the MMC or Migrating Motility Complex.
Some cases of food poisoning or traveller’s diarrhea are caused by viruses and bacteria that don’t just ruin a few days of your life by keeping you locked in a bathroom feeling awful. They can have a longer impact on digestion by releasing compounds that damage the nerves along your small intestine. Weak nerves leads to weak muscles which in turn leads to a slower and less effective conveyor belt between the stomach and the large intestine. Fibres and other food debris can then accumulate in the small intestine and create a smorgasbord for bacteria!
A concussion can similarly affect the nerve health of the intestines via the vagus nerve.
Hypothyroidism
Symptoms of SIBO
- Abdominal discomfort or pain
- Anemia that is non-responsive to iron supplementation
- Autoimmune conditions
- Belching and burping (often chronic)
- Bloating
- Brain symptoms (including autism)
- Constipation
- Diarrhea
- Fatigue
- Flatulence
- Food allergies or sensitivities
- Headaches
- Heartburn
- Joint pain
- Mood changes (namely depression)
- Nausea
- Respiratory symptoms (including asthma)
- Skin reactions from eczema to rashes
- Steatorrhea (fatty stool)
- Vitamin B12 deficiency
Testing
SIBO is tested through a simple, non-invasive breath test. After 1-2 days of starving the bacteria through a modified diet a breath sample is taken upon rising in the morning to set a baseline. After drinking a solution of lactulose, a sugar that is non-digestible by humans but a birthday party for bacteria, breath samples are taken every 20 minutes for 3 hours (I know…it’s your whole morning but well worth it!). The fermentation of the lactulose by bacteria creates gases that enter the blood stream and are released through the breath. By tracking the release of gases a map of bacterial growth along the small and large intestines is created.
Treatment
There are a few stages to the treatment of SIBO and restoring the small intestine to health.
I do play with the order of the stages depending on the patient in front of me, but here’s a general guideline of what to expect when you work with me to treat SIBO.
- Elimination of the overgrowth
- Retrain the small intestine to work more effectively
- Address the underlying factors that led to SIBO (if possible)
- Restore a healthy microbiome in the large intestine
- Move on with happy digestion and a greater awareness of food triggers and lifestyle factors that could lead to relapse
SIBO treatment can be straight-forward and direct. But often the process of removing the overgrowth and restoring a calmly functional digestive tract is a period of education for the patient in which they learn their triggers and how to avoid them for ongoing success and digestive happiness.
References
- Ghoshal UC, Shukla R, Ghoshal U. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut Liver. 2017;11(2):196-208. doi:10.5009/gnl16126
