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what is sibo?


“According to a recent report, PPIs provoke dysbiosis of the small intestinal bacterial flora, exacerbating nonsteroidal anti-inflammatory drug-induced [NSAID] small intestinal injury. Several meta-analyses and systematic reviews have reported that patients treated with PPIs, as well as post-gastrectomy patients, have a higher frequency of small intestinal bacterial overgrowth (SIBO) compared to patients who lack the aforementioned conditions.  At this time, PPI-induced dysbiosis is considered a type of SIBO.

It now seems likely that intestinal bacterial flora influence many diseases, such as inflammatory bowel disease, diabetes mellitus, obesity, non-alcoholic fatty liver disease, and autoimmune diseases. When attempting to control intestinal bacterial flora with probiotics, prebiotics, and fecal microbiota transplantation [FMT], etc., the influence of acid suppression therapy, especially PPIs, should not be overlooked.” From this June’s issue of World Journal of Gastroenterology (What Are the Effects of Proton Pump Inhibitors on the Small Intestine?)

For years I’ve been telling you about the numerous pitfalls associated with ANTIBIOTICS (as well as NON-ANTIBIOTICS) and Dysbiosis.  DYSBIOSIS simply means that some part of your body has an imbalance in its normal flora (the ratio of good bacteria to bad bacteria is out of whack), which, with what we currently know about GUT HEALTH, is a deal-breaker as far as good health is concerned.  A small example of this phenomenon that all women understand would be a YEAST INFECTION.  But what happens when Dysbiosis is not so ‘in-your-face’ obvious?  One of the many ways that Dysbiosis can destroy your life is via SIBO (Small Intestine Bacterial Overgrowth).

Most people are completely freaked out by the very thought of bacteria.  This is why Antibiotics are such an easy sell here in America, and why the wide array of commercially available antimicrobial products continues to be popular despite much evidence to the contrary (look at how many women now have the little bottle of hand sanitizer key-chained to their purses).  Once you begin to have an understanding of the HYGIENE HYPOTHESIS, you start to see why anything that kills your normal flora is destroying your own IMMUNE SYSTEM (although your large intestine should be loaded with bacteria, your small intestine should contain relatively fewer).

According to any number of sources, SIBO that does not have an anatomical basis (surgery, diverticulitis, blind loops, etc) is usually caused by poor diets and too many drugs.  Other than Antibiotics, the drugs most likely to cause SIBO are PROTON PUMP INHIBITORS (PPI’s) — not surprising once you understand the importance of STRONG STOMACH ACID’S ROLE as a destroyer of pathogenic bacteria. 

And like any number of other health issues (H. Pylori — see previous link, C. DIFF, EAR INFECTIONS, SINUS INFECTIONS, and a multitude of others), even though Antibiotics are the medical treatment-of-choice for SIBO (the specific drug is called Rifaximin), they actually turn around and cause the very problem they are trying to treat.  Again, not difficult to understand when you realize that bacteria make up the vast majority of your Immune System.  Some of the chief risk factors for SIBO include……… (some of these are not only risk factors, but potential symptoms of the problem as well)

  • CONSTIPATION:  The slow passage of food through the digestive tract (CONSTIPATION) can make the small intestine stagnant.  In the same way that you won’t find moss growing on the CURRENT RIVER even though you’ll find it growing on a stagnant farm pond, so will you find bacterial overgrowth in a small intestine with diminished motility.  Scleroderma, FIBROMYALGIA, Pancreatitis, and CELIAC DISEASE, are all thought to cause diminished motility (there are others).  In fact, the villi (and microvilli) of the small intestine of an individual with SIBO will have an appearance similar to that of the large intestine of an individual with Celiac Disease.
  • DIARRHEA:  The August 2004 issue of the Journal of Gastroenterology and Hepatology (Small Bowel Bacterial Overgrowth is a Common Cause of Chronic Diarrhea) concluded that, “Small bowel bacterial overgrowth is a common (33-67%) cause of chronic diarrhea“.  Put bacteria where they should not be (the small intestine) and it causes massive amounts of INFLAMMATION, which in turn leads to diarrhea.  Poorly or incompletely digested particles of food then enter the colon (large intestine), which can be extremely bad news if you have a “Leaky Gut” — see the final bullet point.
  • IRRITABLE BOWEL SYNDROME:  When you combine the two previous bullet points together in tandem, you get IBS.  Some studies show that as many as 4 out of 5 IBS SUFFERERS have SIBO.  For instance, BioMed Central’s Gastroenterology journal published a study in 2010 (Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Are There Any Predictors?) that stated in their ‘discussion’ that, “SIBO was detected in up to 84% of patients who met Rome criteria for IBS“.  There are any number of similar studies.
  • TYPE II DIABETES / INSULIN RESISTANCE:   This, folks, is not rocket science.  Not only is there a ton of research on this topic (most of it seemingly concerning Type I or “Autoimmune” Diabetes) but we already know that SUGAR FEEDS INFECTION.  And what is Dysbiosis, but a nasty bacterial infection of the small intestine.  Living the HIGH CARB LIFESTYLE is another of the risk factors for developing all types of Dysbiosis, including SIBO.
  • IMMUNE SYSTEM DYSFUNCTION / SUPPRESSION:   Twenty seven years ago this month, the journal Surgery carried a study called Small-Bowel Bacterial Overgrowth and Systemic Immunosuppression.  I’m not going to delve into the specifics of this study, but suffice it to say that I have shown you how huge numbers of our nation’s drugs WORK VIA IMMUNO-SUPPRESSION.  This is probably why there are studies linking SIBO to problems as diverse as RESTLESS LEG SYNDROME (an Autoimmune form of NEUROPATHY).  A study published in the June 2011 issue of Sleep Medicine (Restless Legs Syndrome is Associated With Irritable Bowel Syndrome and Small Intestinal Bacterial Overgrowth) found that, “SIBO was diagnosed in 69% of RLS subjects compared to 28% of general population controls“.  The August 2012 issue of Sleep Medicine Reviews (Restless Legs Syndrome–Theoretical Roles of Inflammatory and Immune Mechanisms) goes in a similar direction by stating that, “Increased prevalence of small intestinal bacterial overgrowth (SIBO) in controlled studies in RLS and case reports of post-infectious RLS suggest potential roles for inflammation and immunological alterations.  Overall, 42 of the 47 RLS-associated conditions (89%) have also been associated with inflammatory and/or immune changes. In addition, 32% have been associated with SIBO.  The fact that 95% of the 38 highly-associated RLS conditions are also associated with inflammatory/immune changes suggests the possibility that RLS may be mediated or affected through these mechanisms.

Diagnosing SIBO can be done via a sample of material taken from the small intestine (invasive, expensive, and not necessarily as accurate as we have always been led to believe) or it can be done via any number of breath tests.  The breath tests usually look for metabolites of carbohydrate metabolism or methane gas.  That’s right; nasty gas and foul-smelling stools are a hallmark of SIBO as well as other forms of Dysbiosis.

The treatment of this problem is tricky for reasons explained earlier — Antibiotics — the medical treatment of choice for bacterial infections — tend to cause the very problem(s) they are used to treat.  The August 2008 issue of the American Journal of Gastroenterology (Small Intestinal Bacterial Overgrowth Recurrence after Antibiotic Therapy) concluded that half of everyone treated for this problem had relapsed within a year — which is itself a risk factor. 

GBT positivity recurrence rate was high after antibiotic treatment. Older age, history of appendectomy, and chronic use of PPIs were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.” 

GBT is the Glucose Breath Test — a test for SBIO.  I know, however, that the question everyone is asking is how can this problem be solved once it’s diagnosed?

Eight MD’s (mostly Gastroenterologists from Johns Hopkins University) and an RN published a study in last May’s issue of Global Advances in Health and Medicine (Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth) which, as the title might suggest, concluded that herbs work as well as drugs for this particular problem.

SIBO is widely prevalent in a tertiary referral gastroenterology practice.  Patients with small intestine bacterial overgrowth (SIBO) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success.   Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT.  Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responder.” 

In case this didn’t hit you like a wrecking ball, re-read it until the magnitude of this paragraph sinks in.

Beyond following some of the GENERAL RECOMMENDATIONS found in these posts, those who have SIBO are advised to feed their microbiome properly (HERE).  This will definitely involve following a LOW FODMAP DIET (or HERE).  It may also mean you need to increase the strength of your stomach acid (see earlier links).  This is also an area where medicine to increase small intestinal motility is needed.  However, before trying that, I would see if CHIROPRACTIC ADJUSTMENTS will accomplish the task.  

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Just remember that the information in this post and on my site is just that — information.  It is not meant to diagnose, treat, or manage any disease.  If you think you may have an actual disease make sure to see your doctor immediately if not sooner.


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