Digestive Health-SIBO

There is less bacteria in small bowel (less than 10,000 bacteria per milliliter of fluid) compared to large bowel (at least 1,000,000,000 bacteria per milliliter of fluid).

Functions of these small bowel bacteria:

1. These beneficial microorganisms help protect against bad (i.e. pathogenic) bacteria and yeast that are ingested.
2. They help the body absorb nutrients, and also produce several nutrients (such as short chain fatty acids) and vitamins like folate and vitamin K.
3. These bacteria help maintain the normal muscular activity of the small bowel, which creates waves that move the intestinal contents, like food, through the gut.

 Accuracy, antibiotic and probiotic use prior to the test:

1. Test results can be negative despite having all the symptoms of SIBO. The gold standard for detecting SIBO is the lactulose (glucose) hydrogen breath test, which is cheap and easy to administer, it just requires that you drink a sugar solution and blow into a tube at regular intervals for two hours.
2. If a person has taken antibiotics prior the test, the test result can be negative.
3. If one has to take antibiotics then the test should be done a month later.
4. Probiotic should also be discontinued for a few days before being tested for SIBO.
5. Despite doing everything right and getting the best test possible, SIBO testing is still not 100% accurate.
6. Studies show that it is only around 65-70% accurate.
7. SIBO is largely under-diagnosed. This is because many people don’t seek medical care for their SIBO symptoms, and because many doctors aren’t aware of how common SIBO is.

 Side Effects of SIBO

1. In most patients, SIBO is not caused by a single type of bacteria, but is an overgrowth of the various types of bacteria that should normally be found in the colon.
2. Less commonly, SIBO results from an increase in the otherwise normal bacteria of the small bowel.
3. SIBO has been shown to negatively affect both the structure and function of the small bowel.
4. These pathogenic bacteria may significantly interfere with digestion of food and absorption of nutrients, primarily by damaging the cells lining the small bowel (the mucosa).
5. This damage to the small bowel mucosa can lead to leaky gut
6. Leaky gut can cause immune reactions that cause food allergies or sensitivities, generalized inflammation, and autoimmune diseases .
7. The bacteria will take up certain B vitamins, such as vitamin B12, before our own cells have a chance to absorb these important nutrients.
8. They may also consume some of the amino acids, or protein, that we’ve ingested, which can lead to both mild protein deficiency and an increase in ammonia production by certain bacteria.
9. Ammonia requires detoxification, so this may add to an already burdened detoxification system.
10. The bacteria may also decrease fat absorption through their effect on bile acids, leading to deficiencies in fat soluble vitamins like A and D.

Causes of  SIBO

1. Low stomach acid
2. Irritable bowel syndrome
3. Celiac disease (long-standing)
4. Crohn’s disease
5. Prior bowel surgery
6. Diabetes mellitus (type I and type II)
7. Multiple courses of antibiotics
8. Organ system dysfunction, such as liver cirrhosis, chronic pancreatitis, or renal failure
9. Moderate alcohol consumption and oral contraceptive pills

Symptoms of SIBO

1. Abdominal pain/discomfort
2. Bloating and abdominal distention
3. Diarrhea
4. Constipation
5. Gas and belching
6. In more severe cases, there may be weight loss and symptoms related to vitamin deficiencies
7. Digestive upset
8. Intolerance for sugars/desserts
9. Burping at very regular intervals about 15-45 minutes after a meal

Treatments of SIBO

1. First starve the bugs:
   1. Begin with The Specific Carbohydrate Diet. The diet includes grain free, sugar free, starch free and unprocessed foods.  All the complex sugars should be removed that can feed the bad bacteria. Natasha Campbell suggests to avoid multi-chain carbohydrates: disaccharides and polysaccharides.  Follow the Gaps diet on this web site or call my office for assistance.
   2. FODMAPs is an acronym coined by researchers based in Melbourne, Australia. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And P  In other words, FODMAPs represent a group of short-chain fermentable carbohydrates which have the property of being easily fermented by the bacteria in your gut, depending on your gut health and gut flora.

FODMAPs currently include fructose, lactose, fructans, galactans, sorbitol and mannitol.

Fructose malabsorption is the term used to refer to the inability to properly absorb fructose and is often associated with an intolerance to other FODMAPs too.

Even if you avoid food products sweetened with isomalt, xylitol, mannitol and sorbitol, some of these polyols are also naturally present in some food. For example, snow peas, apricots,   blackberries, cherries, nectarines, peaches, plums and other stone fruits as well as watermelon, persimmon and pears contain high amounts of polyols.

Moderate quantities of polyols are also present in avocado, cauliflower, celery, mushrooms, lychee, sweet potatoes and yams. Make sure you read the ingredient list of any supplements or  medications you take and beware of any ingredients ending in –ol.

Desiccated coconut, coconut flour and coconut butter could contribute to your IBS symptoms. Even coconut milk or coconut cream may contain some types of fermentable carbohydrates either naturally or from the added gums (read the ingredient list to choose a gum-free brand). The same goes for nuts and nut butters. The only nut with published FODMAP values so far is pistachios, which is apparently high in fructans.