The SIBO Curse

Have you ever known anyone who no matter what they eat they blow up like a balloon and suffer painful and uncomfortable gas and bloating?  Perhaps you even experience this yourself?  You may have been to every doctor in town and tried every probiotic with no avail.  A lot of your friends, who pay attention to natural medicine, all feel that you most definitely have the dreaded candida (yeast) curse!  I end up hearing so much about candida from my patients that it is surprising really.  So you go on a radical diet, take probiotics and a bunch of anti-candida herbs.  Nothing works.  And in fact you think that it even might have made you worse!  Okay, what already?  What could be causing so much discomfort?

Perhaps it is SIBO…  Small Intestinal Bacterial Overgrowth.  But what in the world does that mean?  Simply put the small intestine should contain virtually little to no bacteria.  The primary location for bacteria along the digestive tract (respectfully speaking… bacteria is of course just about everywhere) is in the large intestine/colon.  When these bacteria in the small intestine overgrow they end up breaking down carbohydrates and fibers too early in the process and produce gas in the wrong compartment!  When this happens in the large intestine the gas can pass rather easily, though not always conveniently of course.  Like on a plane, or in class, or on a first date…  But I digress.  J  But if this takes place in the small intestine that gas will get trapped and build up causing bloating and pain in a lot of cases.  The most common symptom associated with SIBO is frequent bloating after meals.  And this bloating can often be described as looking something like pregnancy!  The tummy can quite literally be round and firm.  There can also be either constipation or diarrhea which may differ from person to person.  In fact the typical “Irritable Bowel Syndrome” (IBS) condition may actually be due to SIBO!  I have heard all too often where a patient was diagnosed by their medical doctor with IBS and given acid reducing medications, case closed.  Did this therapy in fact help?  No!  That is why they found my office after all.  In fact I would argue that the therapy actually made them worse.  I will go into some of the factors leading to SIBO below so that you can better understand how and why each case could be different.

One of the most common reasons for SIBO to develop is low stomach acid.  This is more common than you know.  And this is something that can easily be induced with both prescription and over the counter medications.  Know anyone who parks themselves next to an economy sized bottle of anti-acid tablets?  I do.  These people are neutralizing their stomach acid.  Aside from digesting the food, stomach acid is also responsible for sterilizing the first section of the small intestine.  If this does not occur bacteria can grow there and lead to SIBO!  So I urge you to think twice when someone tells you to cover up your digestive symptoms with acid reducing medications.  I recently went to see a gastroenterologist for something that I was experiencing and wanted a medical opinion about.  They found that it was a mild hiatal hernia and he then prescribed acid reducing medications.  I told him I might try a short trial, but that I didn’t like the idea. (I decided not to.)   I was surprised to hear his reply, “Yeah, they aren’t very good for you.”  It is kind of like any woman with hormone concerns who always gets put on birth control pills.  Most everyone with any digestive concerns almost always get put on acid reducers!  But they may just be leading to larger problems in the end.  If you choose to go this route, please do your research and proceed with caution! 

Another very common situation that can lead to SIBO is poor neurological function.  The gut, like everything else, is stimulated directly by the brain via the Vagus nerve.  If there is damage to this nerve, or even if there is a decline of overall brain function the stimulation to the gut will be hindered.  (Poor brain function will lead to poor Vagus nerve activity and therefore poor gut stimulation.)  This impacts blood flow to the area and certainly the functioning of the various valves sealing off the different compartments of the intestinal tract which can all lead to bacterial overgrowth.  This is something that you see a lot in the elderly who often times suffer from advancing neurological decline.  But rarely does anyone ever make the link between their bloating after meals and their neurological status.  But pay attention.  The next time you talk to someone of advanced age with neurological decline see if you can find out if they are digesting their food well. Most are constipated and bloated.   In these cases simply “fixing the gut” will not get very far.  Brain support is critical for them and in some cases all we can do is stop the progression.  If enough nerve damage has occurred that may just be how it will be going forward.  We can however support the condition to reduce discomfort and make eating a bit more enjoyable while not being so scary.

Lastly I wanted to talk briefly about “IBS” while I am at it because it is a very commonly thrown around diagnosis.  I personally take offense to a diagnosis like this because it is nothing more than a description of a set of symptoms.  There is nothing in that “diagnosis” that tells us anything about the root condition!  An irritable bowel can be from a lot of different things.  But regardless this condition often involves constipation and/or diarrhea.  Interestingly in the SIBO spectrum of disorders depending upon the type of bacteria that is overgrown in the small intestine there can either be Methane gas or Hydrogen gas produced by the bacteria present.  Methane tends to decrease intestinal motility leading to constipation and Hydrogen tends to increase motility leading to diarrhea.  So is the proper therapy for these conditions acid reducing medications (which can lead to bacterial overgrowth), smooth muscle relaxants (which can lead to poor valve control in the digestive tract leading to translocation of bacteria from large to small intestine), or something like laxatives/Imodium to quell the symptoms?  Well perhaps that is the way you prefer to go.  But perhaps steps could be taken to address the specific underlying mechanism at play.  Is it low stomach acid?  And if so why?  Is the Thyroid working properly?  Are there medications involved that are working to lower the acid production?  Are there infections in the gut which may be impacting acid production? Or is there perhaps a neurological condition leading to these symptoms?  Was there head trauma? Or is there any developmental disability?  There might even be physical reasons like an abdominal injury or surgery.  Each case is a little different. 

So what can be done?  First like I described above it is important to understand the specific mechanism involved in each case.  That means it is important to find a practitioner who is knowledgeable about the differences and how to pick up on the subtle signs and symptoms of each.  Second you must work to nutritionally support the small intestine itself by providing compounds needed by the intestinal cells to thrive.  Digestive enzyme support is also essential to help the body break down the food more efficiently before the bacteria can get ahead of things.  It is essential to provide good probiotic support to promote optimal bacteria distribution in the gut but make sure that they do not contain any prebiotics (bacteria food).  Most probiotics contain prebiotics which are generally great but not with SIBO!   And lastly in some cases a person may need to work on the neurological function associated with the gut.  There are some tricks for stimulating the Vagus nerve and I am happy to share them with you in person sometime. 

In closing I want to share just a few statistics from a couple of well-respected medical journals.  (Journal of Clinical Gastroenterol & Gastroenterology Hepatology).  The following list are percentages of certain groups of people who show positive for SIBO:
  • ·         66% of patients with Celiac Disease
  • ·         53% of patients who use antacid medications
  • ·         78% of patients who have been diagnosed with Irritable Bowel Syndrome (IBS)
  • ·         33% of patients with chronic diarrhea
  • ·         90% of alcoholics

The consequences of long term SIBO are many.  Over time this can lead to permanent nerve damage to the digestive tract.  Food sensitivities become more and more common. It can be argued that all chronic disease can arise from chronic inflammation in the gut.  SIBO is one way to foster such inflammation.  It has been with us for a while but with the widespread use of antacid medications, poor diets, and poor physical health in general the condition is only getting worse.  I urge you to take your symptoms of gas and bloating seriously.  It isn’t just uncomfortable.  Your body is working hard to try and tell you something is not right.  I am happy to schedule a consultation to go over some of your concerns.  I am here for you.  Call on me anytime!