Episode 131: Is Small Intestinal Bacterial Overgrowth (aka SIBO) the Cause of Your IBS?

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:

  • Bloating
  • Gas
  • Abdominal pain/cramps
  • Constipation, diarrhea or alternating
  • heartburn/reflux
  • Nausea
  • Food sensitivities
  • Fatigue
  • Headaches
  • Joint pain
  • Brain fog
  • 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:

  1. Liver and gallbladder support eg. NAC, dandelion, artichoke, beets, green tea
  2. Herbal or specific prescription antibiotic to lower bacteria levels eg. rifaximin, specific garlic, oregano extracts, berberine, myrrh, thyme, goldenseal, enteric coated peppermint oil
  3. 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
  1. Motility support – prescription or nutritional eg. prucalopride, ginger, 5-HTP, acetyl L-carnitine, Iberogast, spacing at least 3+ hours between eating

Mindful raisin-eating exercise 

Other treatment options: 

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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Stay safe and healthy everyone!

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.

Episode 63: Backed up? How to Deal with Constipation in Mamas and Kids

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
  • Certain medications 
    • Allergy medication
    • NSAIDs like ibuprofen and opioid pain killers like Tylenol 3
  • Nerve damage 
  • 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

Some medical tests to consider:

  • HCl challenge in adults
  • Thyroid blood test – see Episode 42 for more info
  • 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
  • Increase fibre:
    • 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
    • Ground flaxseed 
    • 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
  • Abdominal massage
    • Clockwise on belly
    • I Love You massage
    • Can use castor oil for extra relief from discomfort
  • Pelvic floor physiotherapy for kids with constipation

Dr. Aviva Romm’s fruit balls.

Dr. Toni’s breakfast bar recipe is on the show notes for Episode 32 on hot flashes.

This Week’s Mama Must Have: 

Dr. Lisa is a big fan of her son’s Lunii storyteller audiobook device for screen-free entertainment.

Dr. Toni loves to have a light, easy read before bed and just read her first Bridgerton book! She highly recommends The Girl with The Make Believe Husband by Julia Quinn.

Dr. Toni’s next HypnoBirthing info session for expecting parents looking for increased calm, confidence and comfort during labour and birth is March 29th. Join her at https://www.hypnobirthingcalgary.com/register

Dr. Lisa’s Wild Mama free virtual 30-minute info session is happening on March 17th – SIGN UP HERE. Program starts on March 24th!  

Email us or connect with us on  Facebook  and  Instagram. We’d love you to subscribe, leave us a review and a 5-star rating if you enjoyed this episode.

Please tell your perimenopausal mama friends about us, too!

Stay safe and healthy everyone!