Editor’s note: Wellness Word is an informational column which is not meant to replace a health care professional’s diagnosis, treatment or medication.
By Dr. Tom Messinger, ND, RN
SIBO stands for small intestinal bacterial overgrowth. As you may have heard, in our large intestine we have 10 times more bacteria than we do cells in our entire body. Those bacteria play a major role in helping to maintain health and proper immune function. However, those bacteria can sometimes migrate into the small intestine and start to overgrow which causes us problems. It’s a case of being in the wrong place.
What symptoms would one have if they had SIBO? The main symptoms are gastro-intestinal symptoms such as bloating, belching, gas, tendency towards constipation or diarrhea, reflux or GERD, nausea, abdominal pain. Some people only have 1-2 of these symptoms, some have more. The #1 symptom that seems to be present for patients who have a positive test is post-prandial bloating (bloating after eating). It can also cause systemic symptoms such as skin rashes, joint pain, fatigue, and mood symptoms.
SIBO has been associated as either a causative agent or an aftereffect of certain diseases including Fibromylagia, Irritable Bowel syndrome, Celiac Disease, Liver diseases, Restless Leg Syndrome, Rosacea, Hypothyroidism, Interstitial Cystitis, Renal Failure, Parkinson’s Disease, Crohn’s Disease, Ulcerative Colitis, Lactose Intolerance, Chronic Prostatitis, and Iron Deficiency (1).
Dr. Mark Pimentel, MD, Gastroenterologist, and recognized as the world’s leading researcher on SIBO, has found that it is the cause of Irritable Bowel Syndrome (IBS) in over 80% of cases (2). IBS is a disorder characterized by abdominal pain, change in bowel function, and bloating. The conventional treatment for IBS has been fiber and anti-depressants. Eradication of SIBO reduces symptoms of IBS (3).
How does someone get SIBO? There are various mechanisms that are known to contribute to the development. These include a single episode of gastroenteritis (intestinal flu or food poisoning); low stomach acid; low pancreatic enzyme production; gastro-intestinal surgery, any disease that alters motility such as hypothyroidism, diabetes, Lupus, scleroderma; and ingestion or intravenous infusion of any type of opiate such as Morphine, Percocet, Vicoden, etc.
Gastroenteritis is known as the “heralding event” where 50% of the cases will turn into IBS/SIBO. I see this commonly in my practice. When a patient comes in with longstanding digestive complaints that started near the incidence of a stomach flu, traveler’s diarrhea, or food poisoning, this is a scenario strongly suggesting the presence of SIBO. You also may have noticed I listed low stomach acid as a cause. Many people think that this is not a risk factor for them since they are on medicine to lower stomach acid (HCL) production because they have “too much stomach acid”. HCL has a protective effect as the acidity travels down the small intestine and helps to control bacterial population. People taking medicine to lower stomach acid have eliminated the protective effect of HCL, thus often leading to SIBO. In addition, one of the symptoms it causes is GERD, thus they may be taking medicine to suppress a symptom caused by SIBO and inadvertently they are making it worse.
SIBO is diagnosed via a Lactulose Breath Test. Lactulose is a sugar molecule that humans can’t digest, but bacteria can. When bacteria break it down, it produces hydrogen and methane gas. The patient drinks the lactulose. We know it takes 120 minutes for the lactulose to traverse the small intestine and reach the large intestine. During the first 120 minutes, since there should not be overgrowth of bacteria in our small intestine, there should be no gas elevations that are measured. If there is overgrowth, the lactulose is broken down and this byproduct is captured on the breath collection as elevated gases.
If one has a positive Lactulose Breath Test, then there are 2 phases of treatment. First phase is to eradicate the overgrowth with either prescription antibiotics or an herbal antibiotic protocol. The phase 1 treatment protocol and duration is determined by the types of gases and the degree of elevation. Phase 2 is prevention and gut healing. The prevention phase is important since SIBO can reoccur. So this phase involves a specific diet, adding a pro-kinetic, and healing the gut.
Since many patients have digestive symptoms and some of the systemic symptoms associated with SIBO, evaluation and treatment is an integral part of my practice. I have observed that when people have SIBO and get treated, they feel tremendously better even when symptoms have been plaguing them for many years. Some patients have shed tears of gratitude in my office as they feel they have gotten their life back after eradicating the disorder.
(1)- Weinstock. Dig Dis Sci 2010; 55:1667-73. Weinstock. Inflam Bowel Dis 2010; 16:275-9. Pimmentel. N Engl J Med 2011; 364:22-32. Parodi. Clin Gastroenetol Hepatol 2008; 6:759-764.
(2) Pimmentel. 1st International SIBO symposium. 1/18/14. Portland, OR
(3) Pimmentel. AM J Gastorenerol 2000 Dec:95(12): 3503-6
Dr. Tom Messinger, N.D., R.N. has a family practice. www.portlandnaturalmedicine.org