How Bacteria Overgrowth is Damaging Your Health? What is SIBO and How to Treat it?

July 10, 2017

Small Intestine Bacterial Overgrowth (or SIBO) is a form of dysbiosis of the intestines. Dysbiosis, also called dysbacteriosis, is a unhealthy condition of imbalance of bacteria on or within the body. It is mostly common in the digestive tract, but can also occur in other mucous membranes, such as the skin, ears, nails, eyes, or vagina.

 

Dysbiosis, caused by changes in the composition of the gut bacteria is called SIBO. In contrary to what it seems, SIBO does not usually cause infection-like symptoms of diarrhea, fever, or stomachache. Study found that SIBO is responsible for many health conditions, such as autoimmune diseases, allergy, and even cancer.  The accumulation of harmful bacteria can lead to chronic irritation of your immune system and lead to constant inflammation. [1]

 

So what is SIBO? It is the overgrowth of harmful bacteria and the decline in the number of healthy bacteria. In some cases, we may also loss certain healthy bacterial species that are beneficial to us and protect us from the damaging bacteria. In other words, you now have more of the ‘bad’ guys than the ‘good’ guys in your gut.

 

What are the Symptoms of SIBO?

 

SIBO causes constant irritation to the immune system in the intestines, which leads to microscopic mucosal inflammation and destruction of the villi (the intestine cells that are supposed to absorb food). The excess of harmful bacteria, the damage caused to the intestine cells, together with the inflammation leads to the following symptoms: [2]

  • Abdominal pain/discomfort

  • Bloating

  • Abdominal distension

  • Diarrhea

  • Flatulence

  • Weakness

  • Fatigue

  • Disruption in the absorption of vitamins and minerals:

    • Fat-soluble vitamins (A, D, E, K) deficiency. Bacteria breakdown of bile salts from the gallbladder which are needed for the absorption of fatty vitamins and food. Thus leading to malabsorption of fatty vitamins

    • Vitamin B12 deficiency (bacteria consume the vitamin before we can)

    • Iron deficiency 

    • Excess Folate

Health conditions that are associated with SIBO

 

SiBO was found in patients with several diseases and is therefore suspected as a contributing factor for the following conditions:

  • Irritable bowel syndrome and celiac. [2]

  • Rheumatoid arthritis [3]

  • Fibromyalgia [4]

  • Neuro-degenerative diseases: Parkinson’s disease [5]

  • Overweight or inability to lose weight [6]

 

According to Dr. Gerard Mullin, MD, the author of the Gut Balance Revolution, healthy gut microbiome is essential for the development of our brain and hormonal function. Without  healthy microbiome, you might experience high stress response, impaired cardiac function, changes in your brain neurotransmitters and hormones, and have increased appetite. According to Dr. Mullin, a state of imbalance in your gut bacteria can also lead to mood disorders, such as depression and anxiety.

 

Which test NOT to do for SIBO?

 

Currently, the mainstream test for SIBO is Lactulose Breath Test, which measures the amount of exhaled hydrogen (and methane) after you ingest lactulose (a type of sugar). Unfortunately, studies show that this test is not very accurate. A study published in Digestive and Liver Disease Supplements, found this test to have poor specificity, sensitivity and low diagnostic accuracy. [7] Another study published in 2014 found that 41% of patients with irritable bowel syndrome without SIBO tested positive using the lactulose hydrogen test. The researches concluded diagnostic performances of this test is very poor. [8]

 

Which tests were found to be the most accurate?

Our recommendation is the Glucose breath test (GBT), which was found to have 100% accurate for detection of SIBO. It is a simple test to perform and is done in a lab. After you ingest glucose, you breath into a tube with a measurement device. However, it is important to mention the two disadvantages of this test. First, it only detect bacteria in the duodenum and proximal jejunum (first parts of the small intestine). Second, it is not sensitive to detect which type of bacteria are in the intestine. [8]

 

Another test, that is often considered the golden standard for detection of SIBO, is the Jenjunal Aspirate and Culture. [9] The test is performed in a medical clinic or hospital and called esophagogastroduodenoscopy (EGD). The procedure includes an insertion of a endoscope and collection of a sample of fluid from the small intestine. The fluid is placed in a special dish in the laboratory, where biologists can identify the bacteria or other organisms that are growing. 

 

Which SIBO treatments are not effective (and even harmful)?

 

While mainstream medicine is constantly treating bacterial overgrowth or infection with antibiotics, studies show that antibiotic was not very effective in the treatment of this condition and symptoms returned 22 days after antibiotics were finished. [10] It is important to remember that with the consumption of antibiotic, the gut flora is destroyed. A study publish in Microbiology magazine in 2010 reported that it may take the gut flora over 2 years to return to normal function after a single course of antibiotics. Furthermore, the consumption of antibiotics leads to the emerging of antibiotic-resistant bacteria. [11]

 

How to treat SIBO?

 

Since administration of antibiotic medication does not provide a safe and healthy solution, we look into natural approach that will treat SIBO successfully.

 

Probiotics

Since bacteria constantly compete for nutritents and space, it was found to be beneficial to consume probiotics to reduce SIBO and assist with the healing of the barrier of the gut. While NOT all probiotics were effective for SIBO, the bacteria Lactobacillus rhamnosus GG and Lactobacillus plantarum were especially effective. [12]

 

Prebiotics

The prebiotic fiber can help nourish the probiotic in your gut. It is important to remember to start in low dosages (such as 1g daily) and increase to 5 grams daily to prevent an increase in abdominal symptoms. Among the fibers, Partially-hydrolysed Guar gum was found to be beneficial with improving the clearence of SIBO during 3 months treatment. [13] 

 

Diet

Check for nutritional deficiencies, such as iron, B12,  and serum 25-hydroxy vitamin D. It is recommended to eliminate foods containing lactose, corn syrup, maltose, maltitiol, mannitol, sucralose (splenda), and sorbitol. Also avoid sodas and fruit juices. Fresh fruits, whole grains, animal protein, and fats are allowed. 

 

Digestion Aid

We recommend to use digestion enzymes with every meal to assist you with breaking down the food. Also, if you do not have gastritis, heartburn, or peptic ulcers, we also recommend the use of Betaine HCL (digestion acid) to help the enzymes with digestion.

 

Bowel movement

Stimulating bowel movement is very important since that is how our body gets rid of the pathogenic (harmful) bacteria. Use fiber such as inulin and stay physically active to maintain a minimum of two bowel movements a day.

 

Gut Healing Agents

  • Saccharomyces cerevisiae var boulardii was found to be beneficial with reducing the inflammation in the gut and promote recovery. [14]

  • L-Glutamin is the main fuel source for enterocytes (intestine cells) and assist with maintaining mucosal integrity. [15]

 

References:

  1. Round JL, Mazmanian SK. The gut microbiota shapes intestinal immune responses during health and disease. Nature Reviews Immunology. 2009;9(5):313-323. doi:10.1038/nri2515.

  2. Dukowicz AC, Lacy BE, Levine GM. Small Intestinal Bacterial Overgrowth: A Comprehensive Review. Gastroenterology & Hepatology. 2007;3(2):112-122.

  3. Henriksson, A. E., L. Blomquist, et al. (1993). "Small intestinal bacterial overgrowth in patients with rheumatoid arthritis." Ann Rheum Dis 52(7): 503-510.

  4. Pimentel, M., D. Wallace, et al. (2004). "A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing." Annals of the Rheumatic Diseases 63(4): 450-452.

  5. Gabrielli, M., P. Bonazzi, et al. (2011). "Prevalence of small intestinal bacterial overgrowth in Parkinson's disease." Mov Disord 26(5): 889-892.

  6. Ley, R. E., P. J. Turnbaugh, et al. (2006). "Microbial ecology: Human gut microbes associated with obesity." Nature444(7122): 1022-1023.

  7. Parodi, A., E. C. Lauritano, et al. (2009). "Small intestinal bacterial overgrowth." Digestive and Liver Disease Supplements 3(2): 44-49.

  8. Ghoshal, U. C., D. Srivastava, U. Ghoshal and A. Misra (2014). "Breath tests in the diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome in comparison with quantitative upper gut aspirate culture." Eur J Gastroenterol Hepatol 26(7): 753-760.

  9. Gasbarrini, A., G. R. Corazza, et al. (2009). "Methodology and Indications of H2-Breath Testing in Gastrointestinal Diseases: the Rome Consensus Conference." Alimentary Pharmacology & Therapeutics 29: 1-49.

  10. Di Stefano, M., E. Miceli, et al. (2005). "Absorbable vs. non-absorbable antibiotics in the treatment of small intestine bacterial overgrowth in patients with blind-loop syndrome." Alimentary Pharmacology & Therapeutics 21(8): 985-992.

  11. Jernberg, C., S. Löfmark, et al. (2010). "Long-term impacts of antibiotic exposure on the human intestinal microbiota." Microbiology 156(11): 3216-3223.

  12. Vanderhoof, J. A., R. J. Young, et al. (1998). "Treatment strategies for small bowel bacterial overgrowth in short bowel syndrome." J Pediatr Gastroenterol Nutr 27(2): 155-160.

  13. Furnari, M., A. Parodi, et al. (2010). "Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth." Aliment Pharmacol Ther 32(8): 1000-1006.

  14. Pothoulakis, C. (2009). "Review article: anti-inflammatory mechanisms of action of Saccharomyces boulardii." Alimentary Pharmacology & Therapeutics 30(8): 826-833.

  15. Kuhn, K. S., M. Muscaritoli, et al. (2010). "Glutamine as indispensable nutrient in oncology: experimental and clinical evidence." Eur J Nutr 49(4): 197-210.

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