As discussed in this issue, the bacteria in our gut are essential to our health. They perform important functions and even have a compelling impact on our mental health and general brain function. And they are normally present in our gut throughout the large and small intestine, but in very different amounts. The large intestine typically has at least 1 trillion bacteria per milliliter of fluid, whereas the small intestine has only 10 thousand bacteria per milliliter of fluid – significantly less by comparison. While it is vital to have a healthy microbiome in intestines, overgrowth, or even an imbalance of good versus bad bacteria in the small intestines can lead to leaky gut and a number of other symptoms. This imbalance, or overgrowth, has been termed SIBO, which stands for small intestinal bacterial overgrowth.

The small bowel, which connects the stomach to the large bowel, is approximately 20 feet long and plays an important role in digesting food and absorbing nutrients as well as maintaining normal muscular activity. The small intestine also has an impressive network of cells that help fight infections and regulate our immune system. In playing such an important role in digestion and our immune system as well as in simply moving food through our intestinal track, any dysfunction has the potential to lead to major consequences. SIBO has been shown to significantly interfere with the digestion of food, absorption of nutrients, and the structure of the small bowel. All of this can lead to allergic reactions to food, inflammation, and autoimmune disease.

It is believed that SIBO goes largely under-diagnosed in part because people don’t seek medical attention for their SIBO symptoms and because many doctors are unaware of how common SIBO is. Some studies suggest 6 to 15% of healthy, asymptomatic people have SIBO and up to 80% of people with irritable bowel syndrome (IBS) have SIBO.

The most common symptoms include:

Abdominal pain
Bloating and abdominal distension
Diarrhea
Constipation
Excessive gas and belching
Chronic illnesses including fibromyalgia, chronic fatigue syndrome, autoimmune diseases, inflammatory bowel disease
Vitamin and mineral deficiencies

The cause of SIBO is often multifactorial, but some of the contributing factors include moderate alcohol consumption; medications such as acid blockers, antibiotics, and steroids; a diet high in sugar or refined carbohydrates; oral contraceptive pills (OCPs), and diabetes. Unlike many other bacterial infections, SIBO is not contagious.

The standard treatment for SIBO is either an antibiotic or herbal antibiotic protocol. Unfortunately, the likelihood of recurrence has been shown to be high emphasizing the importance of making good nutritional choices afterward. One study demonstrated that patients with SIBO have significant delays in bowel transit time (the amount of time it takes for something to move through the small bowel). It’s possible that this contributes to the high rate of recurrence and that post-SIBO treatment should include an agent that helps with muscle contractures.

As research continues to shed light on this complex disease we will continue to learn how to maximize success by tailoring improved treatment and preventing recurrence.

Dr. Brian Myers is a naturopathic primary care doctor with a focus on pediatric and family medicine at Live Well Clinic in La Quinta. www.livewellclinic.org or call (760) 771.5970.

Sources: 1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890937/;
2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/;
3) http://www.ncbi.nlm.nih.gov/pubmed/22109896;
4) http://www.ncbi.nlm.nih.gov/pubmed/18684177;
5) http://www.ncbi.nlm.nih.gov/pubmed/18802998;
6) http://www.ncbi.nlm.nih.gov/pubmed/25319735;
7) http://www.ncbi.nlm.nih.gov/pubmed/22472730