For years you have been struggling with gases, bloating, diarrhea or other similar stomach problems? Have you tried every diet and all medications for IBS (iritable bowel syndrome) with minimal or no success? Research now suggests that SIBO (also known as small intestinal bacterial overgrowth) may account for as much as 78% of IBS cases. [1] Because the symptoms vary from person to person, SIBO was once diagnosed in only a few. Now doctors and researchers are discovering that the disease is more widespread than they thought, although the exact numbers are unknown. This is because you can easily overlook SIBO. Read on to learn more about SIBO symptoms, what tests can be performed to detect its presence and what diet to use to minimize symptoms.
What is SIBO?
Bacterial hyperplasia of the small intestine, or SIBO, is exactly what the name suggests - there are too many bacteria in the small intestine [2]. The small intestine is a narrow, twisting tube connecting the stomach with the large intestine or colon. Food mixes with stomach acid in the stomach before going into the small intestine, where most of the process of digestion and absorption of food takes place. While bacteria are necessary for proper digestion, most of our intestinal bacteria are found in the colon. When bacteria migrate back to the small intestine or reproduce there for other reasons, it can lead to digestive stress, poor absorption of nutrients, and even to the leaky intestinal syndrome.
What leads to SIBO?
Having healthy intestines depends on many factors and that is why many aspects affect the intestinal ecosystem to remain in balance and in good condition. Two things that disrupt the balance of intestinal bacteria are an insufficient amount of stomach acid and intestinal dysbiosis - a condition in which something weakens intestinal muscles, so the intestinal contents do not move as they should. [3] [4]
Slow intestines and SIBO
In the normal small intestine, muscle contractions push food through the small intestine into the large intestine. When the muscles can not shrink properly, the reason for this is usually the failure of the muscle or nerve (the impulse controlling the movement of the muscles). If your intestines are moving some of the digested food too slowly, they can not effectively push the bacteria into the large intestine to eliminate them. So these bacteria are still living and multiply in the small intestine, acting to the detriment of our health and well-being.
Several factors can affect the delicate muscles and nerves of the digestive system and cause intestinal dysmotility. It is known that some nerve and muscle disorders are hereditary. In such cases, it often happens that family members suffer from other problems related to the functioning of the small intestine or the bladder muscles. [5] Sometimes they are also symptoms of other diseases.
The most common causes of bowel dysfunction include:
- Medicines. To name a few: antibiotics, birth control pills, proton pump inhibitors, antacids, and NSAIDs.
- Endocrine disorders such as thyroid disease
- Metabolic disorders, including diabetes
- Neurological disorders such as intestinal neuropathy and Parkinson's disease
Low stomach pH and SIBO
Another main cause of intestinal dysbiosis and SIBO is low stomach acid levels. Adequate levels of stomach acids ensure that you break down food before entering the intestines, which helps speed up digestion. If partially digested food and microorganisms will not have a chance to settle and stay too long, your intestines will not be such a friendly environment for bacterial growth.
The low level of gastric acid also contributes to the hypertrophy of Helicobacter pylori (H. pylori), [6] [7] which doctors associate with various types of digestive problems, including peptic ulcers, gastric cancer, and SIBO.
A low stomach acid level can be difficult to identify because it looks and feels - similar to overproduction of gastric acid. Some of the most common symptoms are:
- heartburn (often misinterpreted as too much stomach acid),
- bloating
- diarrhea,
- constipation
- food allergies
- mineral deficencies
- autoimmune diseases
- unwashed food in the stool
- hyperemia candida
- skin problems such as rashes, eczema, and urticaria
- parasites
Often, doctors diagnose gastric acid deficiency as too much stomach acid. If you tell your doctor that you have heartburn and some of the above symptoms, you'll probably get a prescription for proton pump inhibitors that reduce the acid levels in your stomach. PPI increases the risk of developing H. Pylori hypertrophy [8], which contributes to digestive problems and SIBO.
Perform the following tests to find out if you have a low stomach acid level. Then try simple, homemade methods to increase the amount of acid in the stomach. Warning: do not try them all at once, because you can end up with too much stomach acid.
Apple vinegar
Drinking apple vinegar before meals increase the acidity in the stomach. It also contains prebiotics that helps balance intestinal microbiota and keep H. pylori in check.
Capsules with hydrogen chloride (HCl)
Start with one HCL capsule (buy pepsin products so that you can digest both proteins and fats) at the beginning of each meal, drink plenty of water. If you do not feel a warm, irritated or generally unpleasant feeling in the abdomen or esophagus, increase the dose to two capsules before meals. Increase the dose of the capsule every few days until you find the amount that will give you a gentle feeling of warmth in the stomach, but without discomfort. Warning: some medications such as NSAIDs and corticosteroids should not be taken in the company of HCL. Before experimenting with HCl tablets, please consult your doctor or pharmacist.
Symptoms of SIBO
SIBO is one of those elusive diseases that doctors often pull up under a common diagnosis like irritable bowel syndrome or diagnose it as something completely different.
Your SIBO symptoms may be radically different from your friend's or mother's symptoms. It manifests itself in many different ways and there are a million different combinations of a long list of symptoms that may point to SIBO.
SIBO can look like any combination of symptoms such as:
- Indigestion,
- Bloating,
- Cramps and stomachaches,
- Diarrhea,
- Constipation,
- Allergies and food intolerance,
- Impaired absorption of nutrients,
- Mineral deficiencies, in particular, B12 vitamin deficencies,
- Autoimmune diseases,
- Unwashed food in the stool,
- Skin rashes, urticaria, eczema, rosacea,
- Diagnosis of Irritable Bowel Syndrome (IBS or IBD).
If you go to the doctor with any of the above, it is worth to mention your concerns about SIBO.
Are there any tests confirming SIBO?
Diagnosing is difficult. Endoscopy only reaches the upper segment of the intestine, and the colonoscopy only reaches the lower segment. This leaves a large part of the small intestine that can not be accessed by the camera or for sampling.
Another problem lies in the available tests. No test indicates 100% for the presence or absence of SIBO and is not yet accepted standard. At the moment, the most helpful tests will be presented below.
Intestinal fluid suction
Intestinal fluid suction (duodenal aspiration, jejunal aspiration, etc.) It involves taking a sample of fluid from small intestine sections and analyzing its bacterial profile.
Because the test is expensive and involves sedation and endoscopy, this is not a popular way of studying, especially when the symptoms are mild.
SIBO breathing tests
Doctors more often choose respiratory tests to check our body for SIBO and H. Pylori. These bacteria feed on carbohydrates from food to form fermentation gases, in particular, methane and hydrogen. The SIBO breath test measures the level and presence of these gases.
The procedure for the implementation of the mentioned tests is as follows: Patients follow a strict diet for several days before its completion. On the day of the test, they give a breath sample for the baseline measurement and then drink a glucose or lactulose solution. The lab will then take additional breath samples within two or three hours and finally check how the results differ over time.
Test - Lactulose Breath (LBT)
When we consume lactulose in our food, we do not digest it properly. Bacteria have enzymes that break it down and then release gas. The breath test, examining this gas, indicates how much more or less the bacteria is hidden inside of us. The downside of LBT is that it is not as sensitive as the glucose breath test.
Test - Glucose Breath (GBT)
Unlike lactulose, people absorb and use glucose without major problems. People absorb glucose in the first few minutes of its adoption, and when we metabolize it, we use it as energy and do not produce any by-products of gas produced by bacteria. When bacteria ingest glucose in deeper intestinal layers, they secrete hydrogen and methane, and the "glucose breath" test detects this.
GBT accurately indicates bacterial overgrowth in the duodenum (first part of the small intestine), but not in the ileum (end).
Stools tests
The stool test shows the bacterial profile in the large intestine. A high percentage of all bacteria (friendly and unfriendly) in the large intestine may indicate SIBO.
Best SIBO treatment methods (and worst)
Be careful with antibiotics.
The standard SIBO treatment is to provide a series of antibiotics. While antibiotics will certainly eliminate H. Pylori in the intestines, they will also erase all friendly bacteria in the digestive tract. This will definitely disturb your intestinal balance and may lead to digestive, mental and physical problems. Your intestinal flora affects the functioning of your entire body.
While some extreme cases require antibiotics, talk to your doctor about whether you can change your diet and lifestyle to see if things get better. It is always better to first check the less invasive methods of treatment, and after the strong pharmaceuticals reach at the end.
Does the FODMAP diet treat SIBO?
Physicians often decide to recommend a slow-fermenting diet with oligosaccharides, disaccharides, monosaccharides, and polyols, ie the FODMAP diet. The idea behind the FODMAP diet is that if you avoid certain substances that break down with the help of bacteria that cause gases, bloating and other symptoms, you will not have that many IBS or SIBO symptoms. [9]
The problem is that bacteria consume not only what will be eliminated in dietary recommendations. So they can still work inside you, even if they do not generate all the byproducts that make you bloated and gassed. The FODMAP diet will reduce the symptoms [10], which is a good start, but it will not cure SIBO.
A better way: attack SIBO in three phases
First of all, you want to stop feeding harmful bacteria so that they stop working and multiply. To achieve this - follow the main dietary principles of SIBO:
- Limiting sugar, alcohol, low-nutrient carbohydrates and conventional dairy products will be very helpful. Concentrate on a low-sugar low-carbohydrate diet that contains vegetables, proteins, and omega fats
- Organize your diet. Start by eliminating gluten, grains, and mycotoxins.
- Avoid non-nutrients, such as phytic acid. Anti-nutrients deplete your mineral resources, and you want your system to have everything that is needed for proper operation and maintain control of the bacterial flora. Eliminating seeds is a good starting point.
- Good prebiotics. Prebiotics are bacteria-friendly foods. You can find good things in green vegetables, coffee, and chocolate. You can also experiment with prebiotic resistant starches, such as banana flour and raw potato starch. (Start slowly and gradually increase the dose.)
- Add collagen. Any microbiological imbalance can lead to intestinal leakage. The hydrolyzed collagen protein has exactly what the intestinal lining needs to heal and seal.
Remove harmful bacteria
Doctors prescribe antibiotics to remove bacteria associated with the development of SIBO. Studies show that herbal antimicrobials treat SIBO as well as rifaximin, the most common antibiotic administered during SIBO therapy. [11] Although natural herbal antimicrobials are much milder than prescription antibiotics, you still kill some of the good bacteria when fighting against these bad ones.
Rebuild your intestinal microbes
Every time you change your diet, lifestyle, or even sleep patterns, your microbes adapt to these changes. At this stage, the key is to encourage the bacteria to achieve a balance that will make you feel better and healthier. You should care for having enough "good" strains and keeping the "harmful" strains under control. You can do this with probiotics (in particular Lactobacillus, Bifidobacterium and S. Boulardii) prebiotics (resistant starch) and a diet rich in nutrients.
SIBO is one of those insidious diseases that often eludes doctors when diagnosing a patient's condition. Current diagnostic methods are not ideal and often require consultation with at least several specialists
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