In this episode, Dr. Lisa and Dr. Toni are discussing a potential root cause for digestive symptoms like bloating and gas called Small Intestinal Bacterial Overgrowth, otherwise known as SIBO.
SIBO = Small Intestinal Bacterial Overgrowth
-abnormally large numbers of commensal bacteria are found in SI
-bacteria is fed by carbohydrates and produces excess amounts of gas – hydrogen, methane, hydrogen sulfide
-bacterial overgrowth interferes with proper digestion and absorption of nutrients
-gas interferes with proper bowel motility, resulting in constipation and/or diarrhea
Up to 84% of people with IBS also have SIBO, so it’s thought to be an underlying cause
Symptoms of SIBO can include:
Constipation, diarrhea or alternating
Malabsorption issues like anemia, chronic low ferritin (iron stores), fat soluble vitamin deficiency like vitamin D deficiency
Skin issues like eczema, rosacea
Inflammatory conditions like pancreatitis, interstitial cystitis, prostatitis
What causes SIBO?
Conditions affecting intestinal motility and damage to MMC (migrating motor complex), including thyroid issues, concussions, head injuries, chronic high blood sugar
Acute gastroenteritis from food poisoning or “stomach flu”
Use of proton pump inhibitors (PPI) acid inhibiting medications
Low stomach acid, pancreatic enzyme and bile secretion
Ileocecal valve dysfunction, resulting in reflux of colonic bacteria into small intestine
Complications of abdominal surgery, including gastric bypass for obesity and gastrectomy to treat peptic ulcers and stomach cancer, postoperative loop, stricture or fistula
How do you know if you have SIBO?
IBS symptoms get worse when you take a probiotic, especially with a prebiotic
IBS symptoms might get better after antibiotic treatment for another infection
Symptoms worse after eating more fibre – veggies like broccoli, fruit like apples
How can you test for SIBO?
Breath test = most common method of testing for SIBO
-fasting after fibre restricted eating day before
-provocation with lactulose non-absorbable sugar
-breath sample every 20 minutes over 3 hours, tested for levels of hydrogen, methane, hydrogen sulfide in the gas in the sample tube
Small intestinal aspirate culture = currently the gold standard test for bacterial overgrowth. To obtain the fluid sample, doctors pass a long, flexible tube (endoscope) down your throat and through your upper digestive tract to your small intestine. A sample of intestinal fluid is withdrawn and then tested in a laboratory for the growth of bacteria.
Possible alternative: a course of specific antibiotics to see if you’re successful in reducing your symptoms may also be a way to assess if you have SIBO
Comprehensive Approach to Addressing SIBO:
Liver and gallbladder support eg. NAC, dandelion, artichoke, beets, green tea
Herbal or specific prescription antibiotic to lower bacteria levels eg. rifaximin, specific garlic, oregano extracts, berberine, myrrh, thyme, goldenseal, enteric coated peppermint oil
Digestive support for stomach acid, pancreatic enzyme, and bile production, leaky gut eg. bitters like gentian, L-glutamine, NAG, lemon water or D-limonene, topical castor oil pack
Elemental diet – liquid diet for at least 2 weeks to starve and kill off bacteria
Biofilm disruptors like NAC, black cumin, ALA
Today’s Mama Must-Have:
Dr. Lisa loves using apple cider vinegar before meals, as well as adding lemon and lime zest to salads, coleslaw and in water to support her digestion.
Dr. Toni is a big fan of the wet sock treatment to support immune health, especially at the first sign of a cold.
Dr. Toni’s next HypnoBirthing session for expecting parents looking to decrease fear and anxiety to support their natural instincts around labour and birth is happening this summer. Join her at https://www.hypnobirthingcalgary.com/register
Join Dr. Lisa’s new Meetup group Wild Woman Adventures Toronto if you want to get out in nature, connect with other women and push yourself out of your comfort zone. Activities include: sunrise/sunset SUP, tree-top trekking, a new moon workshop and more!
Dr. Lisa’s Wild Collective in Fall 2022: get on the waitlist: wildcollectivetoronto.com
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Disclaimer:The information provided is not meant to replace treatment with a licensed health care practitioner. It is for informational purposes only. Consult with a Naturopathic Doctor or other licensed health care professional to determine which treatments are safe for you.
In this episode, Dr. Lisa and Dr. Toni talk about the causes and therapies for constipation in you and your kids. They discuss what is expected or ideal with respect to your bowel movements, the causes of constipation, and some tests and treatments to consider if you or your kids are experiencing constipation.
What is constipation?
Generally considered when you have less than 3 bowel movements a week, or discomfort, even you have a daily bowel movement.
As naturopathic doctors, we consider at least 1 bowel movement daily with a Type 4 rating on the Bristol stool chart to be ideal. You want your stool to sink without mucus, blood or undigested food (with the exception of corn).
What are some causes of constipation?
Not enough water
Not enough fibre from veggies and fruit
Lack of movement and proper circulation
Stress, especially in the case of irritable bowel syndrome (IBS)
Travel or another break in your routine
High intake of constipating foods: rice, toast, cooked carrots,unripe bananas
Hypothyroidism or sluggish thyroid function – see Episode 42 for more info
Reduced stomach acid, digestive enzyme and bile flow, often caused by stress and stimulation of sympathetic nervous system response
Gut bacterial imbalance
NSAIDs like ibuprofen and opioid pain killers like Tylenol 3
Hormone imbalance or PMS – constipation then possibly loose stools when your period comes is a common pattern in Traditional Chinese Medicine called Liver Overacting on Spleen
Harmful effects of constipation can include:
Discomfort, bloating, just feeling crappy
Reabsorbing toxins and hormones in your circulation
Megacolon or the abnormal dilation of the colon
Encopresis in kids, which is the uncontrollable leakage of stool
Stool testing through specialized labs, like Comprehensive Stool Analysis or GI-MAP
Small Intestinal Bowel Overgrowth (SIBO) breath test
Common treatments for constipation include:
Restoralax or Miralax, also known as Polyethylene Glycol (PEG) 3350
Adverse effects can include abdominal cramps, diarrhea, bloating, gas, nausea
Potential link to development of tremors, tics and obsessive compulsive behaviour
Contamination with small amounts of ethylene glycol and diethylene glycol
Not meant to be used daily and over the long term
The safety and efficacy of Restoralax for use in children under 18 years of age have not been established
Laxative herbs like senna
Side effects can include developing a dependence causing further constipation and other digestive disturbance, electrolyte imbalance, darkening of your intestinal tract called melanosis coli, finger clubbing, kidney inflammation
What else can you do about constipation?
You can try one or more of the following:
Increase fluid, especially pure water
8 oz (250ml) of water multiplied by age (number of years) up to 2 litres daily
Aim for 19g daily for kids 1-3 years, 25g daily for kids 4-6 years, at least 26 g and up to 31g daily for kids 9-13 years and up to 38g daily for kids over 14 years
Beans or legumes – ½ cup = 6 g fibre
Broccoli and other cooked veggies – ½ cup = 4 g fibre
Apples, pears, berries – ½ cup
Prunes or dates – see Episode 45 for more info on sugar balance
Chia seed pudding
Support stomach acid and digestive enzyme production
Bitter foods and herbs like arugula, dandelion root/greens, artichoke, gentian
Start your kids young with small amounts!
Support gut bacteria with fermented foods or probiotic supplement and prebiotic fibre
Magnesium citrate and vitamin C provides osmotic laxative effect
Start with small amount and use only to bowel tolerance
Support proper anatomical positioning with something like Squatty Potty
Slippery elm found in powder, capsules, lozenges and teas, taken away from medications and other supplements
Other herbs and homeopathy for relaxation
Clockwise on belly
I Love You massage
Can use castor oil for extra relief from discomfort
Pelvic floor physiotherapy for kids with constipation