The causes of SIBO are complex and multifactorial. Changes or abnormalities in gastric motility, anatomy, immune function, hypochlorhydria, and metabolic and systemic disorders can lead to SIBO. Changes in host defense mechanisms such as decreased hydrochloric acid production (HCL is secreted in the stomach, which can happen to individuals taking proton pump inhibitors (PPIs ) long term), decrease in bile acid secretion (due to gallstones, or removal of the gallbladder) or decreases in proteolytic enzymes (associated with acute or chronic pancreatitis) all compromise the gastrointestinal system and increase the risk of SIBO.
An impaired ileocecal valve can lead to colon bacteria migrating into the small intestine’s ileum, increasing the risk of SIBO. Abnormalities of the GI tract that delay the emptying of the bowels, such as small intestinal diverticulosis, bowel strictures, post-operative adhesions, gastric bypasses with blind intestinal loops, and ileocecal resection, can also lead to the development of SIBO.
Compromise in secretory immunoglobulin IgA, which helps to maintain the integrity of the digestive tract and prevents pathogens and toxins from invading the systemic circulation, can increase the risk of SIBO.
SIBO can cause deficiencies in macro and micronutrients. The inability to absorb fats can lead to weight loss, diarrhea, and deficiencies of vitamins A and D. Abdominal distension (from methane, hydrogen, and carbon dioxide gas), excess flatus, and acid stool can be due to carbohydrates’ malabsorption. Decreased mucosal uptake can lead to protein malabsorption. Deficiencies in B vitamins such as B12, (thiamine) B1, and (nicotinamide) B3 are also often noted. Increases in vitamin K and folate can be seen.
Diets that are high in processed carbohydrates, alcohol, and sugar increase the risk of developing SIBO.
It is difficult to determine how many people are affected by SIBO because it is similar to other gastrointestinal ailments such as celiac disease, lactose or sucrose intolerance, fructose malabsorption, irritable bowel syndrome (IBS), or inflammatory bowel disease. SIBO is more prevalent in women and older adults.
There is a high correlation between IBS and SIBO; some believe that over 50 – 80% of IBS cases can be attributed to SIBO. IBS is a chronic bowel disorder associated with recurrent abdominal pain for at least one day during the week within the past three months. IBS is associated with two or more of the following: changes in stool form or frequency. IBS is another disease of exclusion, so it can take six months or longer for patients to be diagnosed. Bloating, constipation, diarrhea, and incontinence are common symptoms experienced by patients who are diagnosed with IBS. In addition, stress and anxiety are often associated with IBS. Women and people younger than the age of 40 are more likely to be diagnosed with IBS. Unfortunately, there are no diagnostic tests available to prove you have IBS.
Although IBS is diagnosed based on clinical symptoms, SIBO is diagnosed by a breath test or by obtaining an aspirate of fluid from the small intestine. The small intestinal aspirate is the gold standard. Still, it is invasive, expensive, requires a skilled gastroenterologist, and sampling errors can occur. A breath test can detect microbial overgrowth in the small intestines. Hydrogen and methane are produced by bacteria in the small intestines and exhaled on the breath. Excessive levels of Hydrogen, Methane, or hydrogen sulfide gas can be measured with a breath test. Compassion Primary Care has partnered with All Clear, a CLIA-certified lab company that supplies at-home breath kits to diagnose SIBO. Home testing provides an easier way for patients to be diagnosed and start treatment for SIBO.
Antibiotics such as Rifaximin may or may not be combined with neomycin and metronidazole for at least two weeks to treat SIBO. However, integrative or functional medicine approaches to SIBO include a low carbohydrate diet (low FODMAP—fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) or the elemental diet and different herbal antimicrobials such as oregano, berberine, allicin, or neem.
A diagnosis of SIBO is often delayed and, if not treated appropriately, can have a high rate of recurrence. As discussed here today, many people are suffering from undiagnosed SIBO. Several health conditions are associated with SIBO, including diabetes, autoimmune arthritis, rosacea, interstitial cystitis, restless leg syndrome, hypothyroidism, and more. Medications, including PPIs, narcotics, and antibiotics, can increase the possibility of developing SIBO. Left untreated, SIBO can lead to severe health conditions such as osteoporosis, anemia, and kidney stones. Why continue to suffer? If you have been dealing with symptoms related to SIBO, call Compassion Primary Care to set up an appointment and complete an affordable in-home test. Today can be the beginning of your recovery. Call or text us at 813-669-3084.
