Episode 131: Is Small Intestinal Bacterial Overgrowth (aka SIBO) the Cause of Your IBS?
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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:
- Abdominal pain/cramps
- Constipation, diarrhea or alternating
- Food sensitivities
- 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:
- 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
- see more info about leaky gut on Episode 8
- Motility support – prescription or nutritional eg. prucalopride, ginger, 5-HTP, acetyl L-carnitine, Iberogast, spacing at least 3+ hours between eating
- See more info about constipation on Episode 63
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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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.