Don’t Take Heartburn or IBS Lightly.
As if you could take either one lightly. They invade your life and make you miserable. I wasn’t sure if I was going to cover this next topic until I read more about it and realized I needed to get this information out to you. This week’s article is about something you may have never heard of: SIBO, or small intestinal bacterial overgrowth. It’s another gastrointestinal condition with familiar symptoms like gas, bloating, nausea, vomiting and cramping.
What is SIBO?
SIBO is an overgrowth of bacteria in a place it should not be – the small intestine. The large intestine is the proper home for our friendly bacteria. When they get stuck in or migrate to the small intestine, where they don’t belong, they wreak havoc. The small intestine is where most of our nutrient absorption occurs. The large intestine is where bacteria feed on the leftovers. When bacteria live in the small intestine they can interfere with our absorption of nutrients by stealing them away. If there is a predominance of bacteria in the small intestine that metabolize bile salts, it could lead to fat malabsorption as well as malabsorption of fat-soluble nutrients like vitamins A, D, E, K, B12 and iron.
Vitamins A and E are important antioxidants we need to support the immune system. Vitamin K is essential for bone and heart health, as well as proper blood clotting. Vitamin D deficiency (actually a hormone) has been linked to a whole host of chronic health conditions like cancer, diabetes and cardiovascular disease (our biggest killers). If the overgrowth is of carbohydrate metabolizing bacteria, it could lead to bloating and carbohydrate malabsorption. Vitamin B12 is an essential nutrient our bodies cannot make on their own. We need to obtain B12 from our diets. There are many things that can interfere with the absorption of B12, and SIBO is just one.
Iron is critical to the production of new red blood cells. Our red blood cells carry oxygen throughout our body. However, they only live for about 120 days and then they die. So we need to support the production of new red blood cells. Anemia is a condition where the red blood cell count is too low, meaning the body is not producing enough red blood cells to replace them as they die. Dietary related anemia is often tied to iron intake.
What we need to keep in mind is that bacteria should not be taking up permanent residence in the small intestine. The two most common issues that predispose an individual to SIBO are underproduction of gastric acid (common to heartburn) and intestinal motility disorders. We’re going to talk about why these two conditions are so critical to keeping bacteria in their place.
SIBO and IBS
I mentioned in the IBS article that SIBO could be a root cause of IBS. However, the relationship between IBS and SIBO are like the chicken and the egg enigma. We’re not really sure which came first. It’s sounding more and more like IBS predisposes to SIBO, but it’s still not clear. If you suffer from IBS, you may want to get tested for SIBO.
SIBO and Heartburn
You are likely familiar with heartburn. You were introduced to the necessity of stomach acid several weeks ago when we covered the stages of the digestive system. Adequate production of stomach acid is necessary to kill off unwanted bacteria and break down the food we eat. Inadequate levels of stomach acid allow bacteria to pass on to the small intestine and flourish. If you have taken drugs that reduce stomach acid, especially proton pump inhibitors (PPIs) or H2RAs, you have an increased risk of SIBO. The majority of non-structural heartburn cases actually involve low stomach acid production, not excessive acid production.
Addressing the stomach acid issue where heartburn is concerned can be difficult depending on what’s causing heartburn. If it’s structural, in that the esophageal sphincter to the stomach is not closing properly; you can’t just increase stomach acid to address SIBO. If you do, it will increase the amount of stomach acid flowing back up into the esophagus. If it’s not structural, you can be tested for stomach acid production and go from there. There are many steps you can take to increase stomach acid production. Slowing down the digestive process to give your system a chance to respond to the cues and the food is just a start. Drinking fewer liquids with meals will reduce the dilution of stomach acid. Your doctor may also suggest supplements for hydrochloric acid production if he or she determines this is right for you.
Regardless, start with testing. I am a huge proponent of getting to the root cause of the problem before drafting an action plan. It saves time, effort and is a much safer course of action.
SIBO and Motility Disorders
This is the other big risk factor for SIBO. The migrating motor complex (MMC) is the cleaning system for the gastrointestinal tract. There are two functions of the intestines: digest and rest. The MMC is part of the rest phase. When we are not actively digesting food, the MMC kicks in and starts cleaning up. These fasting periods prompt the MMC to do a sweep of the intestinal tract every 90 to 120 minutes. The key here is that we have fasting periods for the MMC to do its work. One of the reasons the MMC may be deficient during the day is due to snacking; or as I like to call it – grazing. I can call it that because I used to be a grazer. I ate my three meals a day and 2 -3 snacks each day. It wasn’t until I eliminated snacks that I saw huge improvements in my gut health.
Spacing meals out by 4-6 hours with no snacks in between gives your gastrointestinal tract the time to see everything through from digestion to cleaning up. One of these maintenance tasks is clearing extra food particles and bacteria out of the small intestine and into the large intestine where it can receive a final processing and removal. Balancing your meals to include the proper amounts of fat, protein and carbohydrates will provide adequate nutrition and reduce the need for snacks. That being said, if you are suffering from a condition related to glucose or insulin regulation, you will want to talk with your doctor before making drastic changes to your dietary schedule.
So Now What?
If you think you may have bacterial overgrowth in you small intestine, do not attempt to treat it on your own. You definitely want to get tested. Why? Because addressing SIBO is a multi-step process and you want to approach it in a way that will address the bacteria as well as determine what is causing it in the first place. How SIBO is treated is determined by what is causing the overgrowth. The most common means of testing is non-invasive breath testing.
Here is a list of risk factors for SIBO:
- Structural abnormalities like diverticulitis, Crohn’s, gastric resection or surgeries, fistulas and resection of the ileocecal valve.
- Motility disorders like celiac disease or any impairment of the MMC.
- Metabolic disorders like diabetes and hypochlorhydria (low stomach acid).
- Age – elderly individuals are at a higher risk.
- Organ system dysfunctions like cirrhosis, renal failure, and pancreatitis.
- Medications like gastric acid suppressors and antibiotics.
- Weak immune system.
- Insufficient digestive enzymes.
Too many individuals have gone decades without any substantial relief for their gastrointestinal issues. I know I did. Test after test always coming back negative but the issues remained. It drags you down because you know what you are feeling, yet you are being told there is nothing wrong. As you have seen over the last few months, these issues are real. Many of them can be addressed through diet and lifestyle changes, so that’s great news.
If you have been diagnosed with a lifestyle illness and need assistance implementing a program to address your illness, consider health coaching. Health coaches fill the gap between what you’ve been told to do, figuring out how to do it, and actually doing it. Read more about my health coaching programs and my approach to health coaching.
Yours in Wellness,
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