SIBO and How the Interaction of Gut Flora and Lifestyle Affects Our Health
When it comes to gut health, SIBO (Small Intestinal Bacterial Overgrowth) has gained increasing attention. It’s not just a digestive issue, but a complex interplay between our gut microbiome and lifestyle factors. By better understanding this relationship, we can take control of our digestive health and overall well-being. In this blog post, we look at the causes, treatment options, and lifestyle choices we can make to prevent SIBO. By Sofia Vieira.
What is SIBO?
According to the American Journal of Gastroenterology, small intestinal bacterial overgrowth (SIBO) is “the presence of excess colonic bacteria in the small intestine. These excess organisms lead to a variety of intestinal symptoms such as abdominal pain, bloating, diarrhea, and, rarely, malabsorption.”
Recently, Dr. Marc Pimentel described it as an overabundance of a specific type of bacteria—E. coli and K. pneumoniae.
What causes SIBO?
There are several factors that can lead to SIBO. The possible causes or risk factors are:
- Food poisoning: This seems to be one of the most common causes. Food poisoning can damage the MMC (migratory motility complex), allowing bacteria to migrate to the small intestine and multiply.
- Low stomach acid (hypochlorhydria): Reduces the body’s ability to limit bacterial growth.
- Impaired motility: Impaired small intestinal motility, often caused by conditions such as irritable bowel syndrome (IBS) or scarring, can slow the passage of food and create a favorable environment for bacterial overgrowth.
- Anatomical abnormalities: Structural abnormalities such as small bowel diverticula and obstructions can disrupt the normal flow of digestive contents and facilitate bacterial invasion.
- Immunologic: Human immunodeficiency virus, combined variable immunodeficiency, IgA deficiency.
- Medication: Excessive use of certain medications such as antibiotics, narcotics, opioids, and antacids.
- Diet: Dietary factors, such as high intake of carbohydrates or sugar, can provide a rich food source for bacteria and promote their overgrowth.
- Certain gastrointestinal conditions such as Diabetes, lupus, celiac disease, inflammatory bowel disease, irritable bowel syndrome, pancreatitis, colon cancer, scleroderma and many more.
Symptoms and manifestations
SIBO may manifest itself in a variety of symptoms and can easily be confused with other health problems. Some of the most common symptoms include:
- Abdominal pain or discomfort
- Bloating
- Diarrhea
- Fatigue or weakness
- Uneasy feeling of fullness after eating
- Vitamin deficiencies
- Weight loss
- Steatorrhea
- Signs of hypoalbuminemia
DiagnosIS
Diagnosing SIBO can be difficult due to the non-specific nature of the symptoms. However, there are several diagnostic tests that can help identify the condition:
- Hydrogen Breath Test: This non-invasive test measures the levels of hydrogen and methane gases in the breath after ingesting a special sugar solution. Elevated levels of the gases may indicate bacterial overgrowth.
- Small intestine aspirate: In more severe cases, a specialist may perform an endoscopy to take a sample of fluid from the small intestine and directly culture and identify the bacteria present.
- Blood tests: Blood tests can help identify nutritional deficiencies associated with SIBO, such as low levels of vitamin B12 or iron.
Types of SIBO
Today, we can distinguish between three types of SIBO based on gas production:
- Some bacteria consume carbohydrates and produce hydrogen gas. The most common symptom of hydrogen-dominant SIBO is diarrhea.
- Other bacteria, called sulfate-reducing bacteria, consume carbohydrates and produce hydrogen sulfide gas. Hydrogen sulfide-dominant SIBO is primarily associated with diarrhea, but also with constipation and mixed stools.
- Finally, a third type of bacteria – more specifically, another type of microorganism called archaea – consumes carbohydrates and produces methane gas. Methane gas has been linked to constipation.
It is possible to have 1, 2 or 3 species at the same time.
TREATMENT OF SIBO
Treatment of SIBO is a long process and may recur even after successful treatment, so it is very important that it is done under professional guidance.
Treatment of SIBO usually involves addressing the underlying causes, providing nutritional support, and managing the overgrowth of bacteria. Here are some common approaches:
- Antibiotics: Doctors often prescribe antibiotics to reduce the excessive bacterial load in the small intestine. Rifaximin is a common choice due to its minimal absorption and localized effect in the gut.
- Probiotics: Certain probiotic strains may help restore a healthy balance of gut bacteria. However, their effectiveness in treating SIBO is still being studied, and their use should be guided by a healthcare professional.
- Diet: A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet or other dietary changes may relieve symptoms by reducing the availability of fermentable substrates for bacteria. Lactose-free diet and supplements of vitamin B-12, calcium, and iron.
- Herbal therapy: A combination of oregano oil, garlic, and thyme has been shown to reduce the number of harmful bacteria in the small intestine.
Lifestyle and prevention
Prevention is key, and making healthy lifestyle choices can have a big impact on our lives. It is important to reduce the risk of SIBO:
- A diet rich in fiber, fruits, vegetables, and fermented foods to maintain a balanced microbiome, while avoiding processed foods, sugar, alcohol, and refined carbohydrates.
- It’s not just what we eat, but how often and when. It is advisable not to eat at least 3 hours before bedtime and to wait 3 to 5 hours between meals.
- Stress management: Chronic stress can disrupt the gut-brain connection, leading to changes in gut motility and secretions. These changes can create an environment that is conducive to the development of SIBO.
- Avoid sleep deprivation, which can lead to gut inflammation and gastrointestinal disorders.
- Be physically active: Sitting reduces blood flow to the digestive tract, which slows down bowel motility. Regular physical activity is associated with a healthier gut microbiome. It can help improve intestinal motility and promote a diverse microbial community, which reduces susceptibility to SIBO.
Conclusion
Small intestinal bacterial overgrowth (SIBO) is a complex gastrointestinal condition that is often misdiagnosed and can have a significant impact on quality of life.
Understanding the causes, symptoms and treatment options is critical for early diagnosis and effective treatment. This process must be done under the guidance of a healthcare professional.
It is not only in the medical field that we can find answers! A healthy lifestyle can help prevent the risk of SIBO.
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SOURCES
- https://elpais.com/salud-y-bienestar/2023-07-21/los-males-del-sibo-el-exceso-de-bacterias-en-el-intestino-delgado-que-causa-diarrea-e-hinchazon.html
- https://journals.lww.com/ajg/Fulltext/2020/02000/ACG_Clinical_Guideline__Small_Intestinal_Bacterial.9.aspx
- https://www.mayoclinic.org/diseases-conditions/small-intestinal-bacterial-overgrowth/diagnosis-treatment/drc-20370172
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386065/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/
- https://www.sciencedirect.com/science/article/pii/S1542356523004524
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