Shivan Sarna

SIBO: Small Intestinal Bowel Overgrowth

DATE AIRED: August 24, 2018

Episode Description

SIBO is a common GI problem throughout the world. Many of us have it but don’t know they have it. Symptoms can include bloating, diarrhea, constipation pain, burping, flatulance, fatigue, food sensitivities, depression, anxiety, and it can result in a leaky gut. SIBO is caused by bacteria that are normally in the large intestine to be dislocated in the small intestine. There are many causes including protein pump inhibitors (antacids ). Fifty percent of PPI users have SIBO after one year) Risk factors that increase the chances of getting SIBO to include drugs, stress, genetics and surgeries. The program will discuss how to diagnose SIBO, how to live with SIBO, how to repair the damage and recommended diets.

She had intestinal problems since age five.  Difficulties in not going to the bathroom

Diagnosed with a breath test to measure the bacteria in the Small Intestine.  Involves drinking lactose and measuring gas.  The results were negative.  This was a false negative

Food goes into the stomach and then into the small intestine with is thin.  Food then goes into the large intestine (where most of the gut’s bacteria (microbiome) is).  Food then moves to the rectum.

SIBO. Small Intestinal Bacterial Overgrowth

  • Is not a new condition
  • Is prevalent: many people do not know they have SIBO
  • It is important to know the cause of SIBO so the symptoms can be addressed
  • Is the number one leading cause of IBS (irritable bowel disease) which is a leading GI disease
    • 60 % IBS is caused by SIBO
    • Symptoms include constipation, diarrhea, or alternating diarrhea with diarrhea, anxiety, bloating
    • Diarrhea, constipation are serious disorders as constipation holds toxins in the body
    • IBS is a diagnosis of exclusion
  • Overgrowth of bacteria that is normally in the large intestine which is further down from the small intestine
    • Can be due to a mechanical mislocation to small intestine
    • A normal flow through the small intestine does not make it all the way out of the small intestine due to abnormal peristalsis (migrating motor complex)
      • Structural problems:
        • From a twist in the small intestines
        • Surgery
        • Adhesions
      • From opioid use
        • Slows the migrating motor complex
      • Alcohol Abuse
      • History of Food Poisoning
    • Immune system: scleroderma,
  • This affects the cells and nerves in the small intestines and creates disarray
  • Symptoms include
    • Bloating,
    • malnutrition,
    • nutrient malabsorption
    • pain
    • affects ferritin and iron levels
    • brain fog
    • diarrhea, constipation
    • anxiety and depression
    • burping, flatulence
    • fatigue
    • food sensitivities
    • GERD (esophageal reflux) from food staying in the stomach for too long
  • If one takes an antacid medication, bacteria overloads in the stomach and this overloads the bacteria in the small intestine.
    • Also, antacid medications can decrease digestive enzymes so food is not completely digested leading to leaky gut.
    • One study stated that 50 % of people taking proton pump inhibitor end up with SIBO within a year
    • Don’t stop antacids suddenly, due to acid rebound. Consult with physician
  • Other conditions look like SIBO, so it can be misdiagnosed.
  • It is important to test for the diagnosis of SIBO as SIBO has different causes than other causes of leaky gut. Also, people who self-diagnose might miss other causes of their discomfort such as cancer.

Risk Factors for SIBO

  • Low blood ferritin levels
  • Malnutrition
  • Micronutrient malabsorption
  • Fatigue
  • Fibromyalgia

SIBO vs Leaky Gut

  • SIBO can damage the tight junctions of the lining of small intestine which will cause the gut to be leaky. Curing a leaky gut can helps SIBO.
  • A leaky gut can allow undigested proteins into the blood creating an autoimmune response. Through molecular mimicry, the antibodies the body produces against the undigested protein can attack various organs in the body.
    • For example, gluten is similar genetically to the Purkinje (balance) cells, thyroid cells and the islet cells of the pancreas thus contributing to “gluten ataxia” thyroid autoimmune disease or diabetes.
  • Leaky gut leads to inflammation, oxidative stress leading to chronic disease

Tests for SIBO

  • Lactulose breath test
    • A preferred test
    • Lactulose is undigested sugar
    • After twelve hours of a special diet and then 12 hours fasting, Do a pretest of blowing into a plastic bag to look at baseline hydrogen, methane and gases exhaled
    • Drink a solution containing lactulose, an undigested sugar
    • Measure gas exhaled every 20 minutes. This will show if a person has SIBO
  • Simple at home observation
    • Check to see if stomach flat in the morning.
    • Check to see if stomach gets bloated as eat food throughout out the day
      • If bloating is a sign that gas is emitting methane
    • Anemia and low ferritin blood levels (cell iron reserves) is a sign that SIBO should be considered if there are other symptoms of SIBO
      • There are theories that the SIBO bacteria might consume the iron
      • Other causes of low iron
        • Low stomach acid
        • H-pylori
        • Celiac disease
        • Arterial-Venous malformation
        • Reflux esophagitis
        • Colon problems
        • Donating blood loss
        • Menstruation, pregnancy

Differential Diagnosis (Conditions with similar symptoms.

  • Not clear if these cause SIBO
  • Ahlos Danlos (poor collagen with possibly loose intestines
  • Mast Cell Activation Syndrome (MACS)
    • Leonard Weinstock – mentioned that with mast cell activation, the lining of the gut
    • Has to do with histamineà pain, brain fog, fatigue, fibromyalgia like symtoms
  • Round up Exposure
  • Mold exposure
  • Lyme
  • Epstein Barr Virus (EBV) exposure
    • Causes inflammation leading to a leaky gut.
    • People who get EBV when older run into more problems
  • Acne Rosacea
  • Restless Leg Syndrome (could be related to anemia)
  • Fibromyalgia
  • Chronic prostatitis (connection unknown)

Treatments for SIBO

  • A study of 2000 patients with SIBO, 1/3 resolved quickly; 2/3 had a chronic condition
  • Herbal Treatments:
    • more effective than antibiotic (Jerry Mullin study)
    • Takes longer than antibiotics: four weeks vs. two weeks
    • Neem Plus Ayush Herbs
    • Allemed-Allicin (garlic)
      • Garlic can make symptoms flare
    • Do herb treatments separate from antibiotic treatment
  • Antibiotic treatment: rifaximin
    • Is effective in hydrogen dominant SIBO
    • For methane dominant SIBO
      • Associated with constipation
      • Use metronidazole (flagyl) in addition to rifaximin
    • Mark Timmons, MD found that rifaximin reduces bacteria load in small intestine
    • Each dose drops amount of hydrogen/ methane in breath test by 20 points
    • Rifaximin does not get out of small intestine
    • Given as prevention for traveler’s diarrhea
    • Helps with inflammation
    • Helps liver function
  • Diets
    • Elemental Liquid Diet eradicates bugs
      • Done two weeks at a time
      • Has good rate of removing all the bacteria from small intestines by starving bacteria
      • Has amino acids
      • Is recipe that would be put into a feeding tube.
      • Taste bad
      • Can make it or buy it premade
        • (Nestles)
        • Integrated Therapeutics tastes like a milkshake
      • Can cause a spike in candida overgrowth
        • So some people doing an anti-fungal medication at the same time
      • More info at SIBOinfo.com
    • For managing symptoms
      • Fast Track diet
        • Low fermentable diet
        • Some believe it can eradicate SIBO. Most feel this diet only manages symptoms
      • Specific carbohydrate Diet
        • Great for leaky gut
      • SIBO specific food guide
      • Combination of low fermentable diets
      • LOW FODMAP Diet
        • Not for long period of time because it can reduce the biodiversity in the microbiome
      • Want a diet with low fermentation because these ferment in small intestine producing a gas causing bloating
  • Monash University AP
    • They rate food as to how fermentable it is and how many FODMAPs are in it
  • Generally avoid
    • carbs which turn to gas, milk, ice cream (heavy cream is OK), sugars (except honey and stevia), artificial sweeteners, bread, pasta, white potatoes,
    • cashews can lead to symptoms
    • apples, onions, garlic can cause flares (high in FODMAPs
  • OK to eat
    • oily fish, salmon, sardines, mackerel, grass fed beef, organic poultry, nuts seeds, pumpkin seed, sunflower seeds, extra virgin olive oil, coconut oil
    • avocado no more than a quarter or half
  • White Rice is OK because it is absorbed in a higher place
  • Clover Honey is OK because it is too dense for bacteria to grow
    • Is absorbed high up
    • Has a proper ratio of sucrose and glucose
  • Managing with diet is very important

Fatty Stools

  • More associated with other organs

Gas

  • Fiber is indigestible but addressed in large intestines
  • Hydrogen Dominant
    • Diarrhea
    • rifaximin
  • Methane dominant
    • Leads to constipation, nausea,
    • GERD
      • Due to back pressure
    • Tend to burp and pass gas
      • Burping and gas help get gas out
    • Herbs generally effective
    • Possibly statins effective
  • Hydrogen sulfide
    • Test not yet released
    • Some use a flat line from previous test to indicate hydrogen sulfide
    • Has a different treatment emulsified oregano
    • Can go to blood and CSF (cerebral spinal fluid) leading to anxiety, brain fog, concentration problems, panic attacks, making heart rate go slower

Post Infectious IBS

  • Food poisoning, gastritis, stomach flu can damage nerves in the small intestines which can later lead to food poisoning
  • People who have had food poisoning are more susceptible to future episodes of food poisoning.
  • These people have a more serious condition that is harder to treat and does not resolve quickly with herbs or antibiotics
  • These people tend to become histamine intolerant and food intolerance
  • Food intolerances are difficult to deal with because the SIBO diet includes low fermentable foods which limits food choices.