What Is SIBO?
SIBO stands for Small Intestinal Bacterial Overgrowth, it is defined as an increase in the number of bacteria and/or changes in the type of bacteria present in the small intestine.
What is a Healthy Small Intestine?
Normally, bacteria are found in the trillions in the LARGE INTESTINE, where they perform various symbiotic functions for the human body. Specifically, these bacteria play an essential role in protecting against other pathogenic bacteria and yeast, absorbing vitamins and nutrients, and maintaining healthy gut motility. In the case of SIBO, the SMALL INTESTINE has become overgrown with bacteria and sometimes yeast, which can cause many issues with our health.
What are the symptoms of SIBO?
There are many and typically non-specific. They can be digestive in nature as well as systemic. You may also see things in a blood chemistry panel that show signs of SIBO: They include:
Bloating and abdominal distention
Gas and or belching
Constipation or Diarrhea (can be alternating or just one)
Skin Problems - eczema, acne, rosacea, psoriasis
Small intestine inflammation
Weight loss or sometimes gain
Increased cholesterol levels
Muscle ache/joint pain/weakness
B-12 deficiency or other vitamin and mineral deficiency
Low vitamin D
Mood Disorders such as anxiety, depression
What Causes SIBO?
There are several risk factors for the development of SIBO. Look these over and see if you have a predisposition to having SIBO, or getting SIBO.
Low stomach acid, also known as hypochlorhydria. This could be due to chronic stress, which changes the pH of the stomach. It could also be due to a diet high in processed foods or an infection like H. Pylori. Taking medications like proton pump inhibitors for an extended period of time, can also lead to low stomach acid. NSAID’s can also alter the pH of your stomach, as well as the gut lining.
Having a pre-existing medical condition like diabetes (type I and II), Crohn’s disease, celiac disease, or bowel surgery.
A diet that is high in carbohydrates, alcohol and refined sugars. All of these feed the “bad bacteria” which creates an environment for SIBO to manifest.
Small intestine motility disorders. This can be due to various reasons, but namely it due to a malfunction in the migrating motor complex. The migrating motor complex is a distinct pattern of electromechanical activity observed in gastrointestinal smooth muscle during the periods between meals. It is thought to serve a "housekeeping" role and sweep residual undigested material through the digestive tube. This can become impaired due to low stomach acid, stress, eating too often, low thyroid function, low adrenal function, constipation and infections. Having hypothyroidism can predispose one to getting SIBO, because hypothyroidism is associated with altered GI motility. SIBO is common in people who have thyroid issues.
Having a diagnosis of Irritable Bowel Syndrome, this can be a cause as well as an effect of SIBO.
Age can also be a risk factor in allowing SIBO to proliferate. As we age we produce less stomach acid.
Medications such as PPI’s, birth control pills, antidepressants, antibiotics can all deplete or affect the microbiome. A disrupted gut microbiome has been shown to cause dysfunction of the ileocecal valve, and we know that dysfunction of the ileocecal valve can lead to translocation of bacteria that should stay in the large intestine into the small intestine, just another way that SIBO can develop.
What are the Impacts of SIBO?
SIBO has been shown to negatively affect both the structure and function of the small intestine in a number of different ways. Complications of SIBO are listed here:
SIBO may significantly interfere with the digestion of food which will affect the absorption of nutrients. This primarily happens because the bacteria damage the lining of the small intestine (the mucosa), which is known as “leaky gut.” Leaky gut means that the intestinal barrier has become permeable and can allow large proteins to escape in the bloodstream. These large proteins then cause the immune system to upregulate, which puts a burden on the immune system.
If SIBO effects our absorption of nutrients, we will then have nutritional deficiencies. For example: if we are not digesting and absorbing our fats, this will lead to fat malabsorption. A decline in fat absorption can affect our bone health and lead to osteoporosis (low vitamin D and low vitamin K2). People may also have night blindness due to vitamin A deficiency and retinopathy, and prolonged clotting times due to vitamin K deficiency.
Many times people will end up with a B-12 deficiency. B-12 is absorbed in the terminal ileum, and this is where SIBO is most likely to develop, which can lead to neuropathy, cognitive decline and even dementia.
SIBO can also lead to blunted small intestinal villi which will affect the brush border. This can then lead to decreased activity of disaccharides, which are enzymes that are required to break down carbohydrate. In turn this can lead to carbohydrate malabsorption (think vitamin and mineral deficiencies), AND these undigested carbohydrates feed the bacteria, so they have a field day, which creates a vicious cycle.
If you are someone that has many of the risk factors listed above as well as many of the symptoms, please feel to reach out. Getting to the root cause will put you on the road to health.