Small Intestinal Bacterial Overgrowth

Overview

Small intestinal bacterial overgrowth (SIBO) is a chronic condition caused by bacterial overgrowth in the small bowel. The bacteria thrive on carbohydrates and produces large amount of gases, including hydrogen and methane. SIBO is often associated with the diagnosis of irritable bowel syndrome.

In many cases, SIBO is preceded by an episode of food poisoning. Toxins from food poisoning dampen or eliminate the “clearing” wave within the small bowel that normally propels food forward. Stagnant food in the small bowel facilitates the overgrowth of bacteria. The loss of the clearing wave is thought to be due to a toxin in the various organisms that cause food poisoning. This toxin is called cytolethal-distending toxin, and is thought to be the root cause of I.B.S.

Patients with chronic fatigue syndrome and fibromyalgia typically have low stomach acid and are more susceptible to SIBO. They may also suffer from decreased thyroid function and low levels of endorphins and serotonin, which stimulate intestinal movements.

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Symptoms

Because the liver has a hard time detoxifying methane and hydrogen, the following symptoms can occur:

  • Fatigue
  • Sleep disturbances
  • Headaches
  • Joint and muscle pain
  • Brain fog
  • Food allergies and sensitivities, especially to sugars and carbohydrates

Other symptoms include bowel sounds after and in-between meals, along with cramping and bloating. Rectal spasms are another fairly common symptom.

Large amounts of hydrogen gas can cause diarrhea, while methane gas can cause cramping and constipation. Bacterial overgrowth can also damage to the small intestinal lining, which in turn can cause leaky gut syndrome.

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Management

SIBO is diagnosed with a breath test to test for peaks of hydrogen or methane after a meal. Hydrogen sulfide accumulation may also be occur with SIBO, but there is no test at present to measure this, although certain laboratories are close to finding a reliable method.

At Houston Wellness Clinic, we follow a protocol for managing SIBO that begins with the use of designated antibiotics, which are absorbed through the gastrointestinal tract and remain largely within the small bowl. After 12 to 14 days, a breath test is repeated. As an alternative to antibiotics, herbal treatments may be utilized, including berberine, barberry, goldenseal, gold thread, Oregon grape, the ayurvedic herb leaf neem and the high-potency garlic extract Allimed, which releases allicin into the body.

Dietary changes can help manage SIBO. Vivonex Plus is a formula easily digested and allows for the elimination of high fiber foods, including beans, peas, whole grains, nuts and soy. Sugar and lactose are reduced and eliminated. Patients are also given prokinetic agents for at least three months to stimulate bacteria cleansing. Naltrexone and erythromycin are both effective in low doses. If naltrexone causes sleep disturbances, a good alternative prokinetic is Resolor, which is the brand name for prucalopride.

Vinculin is an antibody to cytolethal-distending toxin, and can simulate the clearing wave needed to move food out of the small bowel.

Diets that have proved successful in the management of SIBO include:

  • Specific Carbohydrate Diet (SCD)
  • The Gut and Psychology Syndrome Diet (GAPS)
  • Fermentable Oligo-Di-Monosaccharides and Polyols Diet (FODMAPS)

Individuals with SIBO may experience cardiovascular and breathing dysfunction, which can be managed with oral systemic balance (OSB), vitamin A and, in women, by balancing the sex hormones, especially estrogen.

The pain of fibromyalgia can be managed by detoxification, especially of the liver, by taking malic acid, apple cider vinegar and magnesium.

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Learn more about how the Houston Wellness Clinic manages Small Intestinal Bacterial Overgrowth.

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