SIBO Flashcards
SIBO
SIBO = an overgrowth of non-pathogenic bacteria in the small intestine. It is the most common cause of IBS (60‒70%)
SIBO: Symptoms
- Hallmark symptoms: Bloating, abdominal pain or discomfort, constipation and / or diarrhoea and flatulence
- Others symptoms include: nausea, GORD, excessive burping, prolonged feeling of fullness, malabsorption (e.g., anaemia symptoms), insomnia and brain fog.
- Hydrogen dominant gas production tends to cause diarrhoea; methane dominant gas production can cause severe constipation.
Key clinical indicators of SIBO
- Worsening of GI symptoms from probiotics.
- Fibre worsens GI symptoms.
- Chronic GI symptoms following long-term broad-spectrum antibiotics / PPIs / opiates.
- Chronic low ferritin / iron with no other cause.
- Developing IBS following GI infection (post-infectious IBS (PI-IBS).
- When a coeliac patient reports insufficient improvement from strict gluten-free diet.
SIBO aetiology
- Hypochlorhydria (e.g., due to chronic PPI use, stress, improper chewing etc.) and bile insufficiency — HCl + bile are anti-microbial.
- Low SIgA (see earlier).
- Prolonged stress (shuts off the MMC, lowers SIgA and HCl etc.).
- Scar tissue / adhesions from surgery (e.g., C-sections).
- Hypothyroidism (slows motility).
- Poor oral health (bacteria comes from the oral cavity).
- Ileocaecal valve dysfunction (related to a structural dysfunction, poor MMC functioning, etc.)
- Opioid pain medications (slows motility) and antibiotics
A common trigger of SIBO is acute gastroenteritis. * Pathogenic bacteria (e.g., salmonella) release a toxin called cytolethal distending toxin (CDT).
- A portion of CDT resembles nerve cells in the small intestine called interstitial cells of Cahal (ICC).
- The ICC are responsible for the MMC — a peristaltic movement that sweep bacteria into the colon.
- Through the autoimmune process of molecular mimicry, in response to CDT-B, the ICC can incur SIBO enough damage to negatively affect the MMC, resulting in SIBO
SIBO and food sensitivities
SIBO can damage the villi of the small intestine, reducing enzymes like lactase and diamine oxidase (DAO) that are produced in these finger-like projections.
- A loss of lactase = possible lactose intolerance.
- A loss of DAO = possible histamine intolerance.
This is because DAO metabolises histamine in the GIT. Therefore, less DAO can result in higher circulating histamine and reactions to high histamine foods (e.g., hives, migraines etc.).
- Therefore, a client presenting with multiple intolerances, including to histamine, should be automatically screened for SIBO.
Dietary approach to SIBO
The aim is to reduce food sources for the bacteria (feed the person, starve the bacteria).
- Restricting carbohydrates reduces fermentable sugars and fibres. Common dietary SIBO interventions include:
- Low FODMAP — generally advisable to follow this for up to 6 weeks before gradually reintroducing FODMAPs.
- Specific carbohydrate diet (SCD) — may be preferable to low FODMAPs, especially if there is intestinal inflammation.
- Sometimes symptoms will be more persistent / severe. It may be appropriate in some cases to combine dietary models (e.g., SCD and low FODMAP, or SCD and low histamine).
Anti-microbials and SIBO
In the initial phase of your SIBO plan, include anti-microbials to address the bacterial overgrowth. * Use 1‒3 of the following anti-microbials (or a specialised formulated herbal formula) for 4‒8 weeks depending on the case.
‒ Berberine (or barberry bark and goldenseal, e.g., as a tincture) — inhibits protein synthesis of bacteria; blocks TLR4 pathway.
‒ Oregano oil (affects bacterial cell membrane permeability).
‒ Allicin (extract of garlic) — mostly just for methane-producing bacteria.
‒ Neem.
‒ Also, uva ursi and cinnamon.
Other therapeutics for SIBO
- Digestive support:
– Digestive bitters at the start of meals (e.g., greens such as dandelion, rocket, watercress; herbs such as gentian, fennel, barberry bark).
– Betaine HCl, digestive enzymes, ACV.
- MMC support:
‒ 12-hour overnight fast (minimum) / intermittent fasting. Meal spacing (at least 4 hours) with no snacks.
‒ Pro-kinetic agents before bed, e.g., ginger root, artichoke. ‒ Practise mindful eating; diaphragmatic breathing exercises
- Repopulate the microflora (prebiotics and probiotics) and repair (see the 5R protocol).
- Visceral manipulation for the ileo-caecal valve.
- Lion’s mane — promotes regeneration of neurons if suspected autoimmune (also promotes regeneration of GI mucosa)
Biofilms
A biofilm is an extracellular matrix that can protect bacteria and fungus from our immune system. If antimicrobial protocols / dietary changes are not working, consider biofilm production. Natural approach: Coconut oil, ACV, garlic, curcumin.
Biofilm disruptors, e.g., NAC, nano silver, serrapeptase
