Small Intestinal Bacterial Overgrowth (SIBO)

[bookly-cancellation-confirmation]Whenever I have mentioned to people that I have small intestinal bacterial overgrowth, their first reaction is- 'You have what'?...

It is slightly on the wordy side and so I will just use the acronym SIBO instead, to save my little typing hands.

SIBO is what its name suggests- an overgrowth of bacteria residing in the small intestines. We all have colonies of gut flora within our digestive system (also known as our microbiome) and these species all have their place where they should be and also be at certain levels to maintain our mood, immune and digestive system to function properly. But when there is an imbalance or certain gut flora are living somewhere in our gut that they shouldn't be (in this case its the small intestine) then we get SIBO!

What are the symptoms of SIBO?

• Bloating after meals
• Burping after meals
• Flatulence
• Constipation
• Diarrhoea
• Constipation AND diarrhoea
• Stomach pain
• Reflux
• Nausea
• Skin rashes- acne rosacea
• Joint pain
• Restless Leg Syndrome
• Associate conditions- fibromyalgia, hypothyroidism, diabetes, celiac disease, obesity

You do not have to have all of these symptoms to have SIBO and it can be so common to other ailments related to digestion- especially Irritable Bowel Syndrome (IBS). I will discuss SIBO vs. IBS a little later.

What are the causes of SIBO?

• Very typical to have been caused by an infection (food poisoning etc.)
• Stress- the motility of your digestive system slows down and digestive enzymes are lowered (mostly HCL) and will cause inflammation in the gut.
• Abdominal surgery-endometriosis, appendicitis, caesarean
• Excess consumption of carbohydrates
• Blind loops (gastric bypass)
• Initial colonisation of microbiome
• IBS
• Alcoholism
• Medications- proton pump inhibitors, narcotics
• Celiac disease

Pathophysiology of SIBO-

Generally, inflammation is the main cause of SIBO and if you look at any of the causes above they will all produce inflammation at some stage. Along our small intestine we have these projectile fingers all the way along that are called microvilli. The microvilli have brush boarder enzymes that help you digest and breakdown your food, so it can be absorbed into the blood stream and used for energy or where ever the body needs it.

When there is inflammation of the microvilli, damage is caused and will create tiny gaps. This can create huge problems such as leaky gut, food allergies (due to food not being broken down and the digestive system attacking it), nutritional deficiencies and you guessed it....SIBO.

This then can cause another cycle of events because the small intestine tries to flush out the excess of bacteria and opens up it's little tight junctions and creates more gaps for food etc. to enter. The damaged microvilli then are not able to do their job properly because they are damaged, so food (mostly carbohydrates) can often ferment and cause gas- belching, reflux and flatulence .

There is a natural wave found in the small intestine called the migrating motor complex (MMC). This wave occurs every 90 minutes and has a sweeping motion that pushes your solid matter down towards your colon. In SIBO the MMC is impaired and will also create gas production due to fermentation. The bacterial imbalance will also 'feed' off the carbohydrates and this is another cause of gas production.

Testing for SIBO-

The testing for SIBO is non-invasive and is performed by a simple breath test done at home. It is called the Hydrogen Breath test, which test the levels of hydrogen and methane after drinking a lactulose solution. 10 breath test are performed every 20 minutes and the rise of either (or both) of these elements will determine if you have SIBO or not. A 2 day prep diet is required, where little carbohydrates are consumed to starve the bacteria. Following the 2 day prep diet is crucial, as a false negative may occur.

The benefits of doing the test is that you know which bacteria to treat and this can alter your treatment protocol. You will also see what levels your bacteria is sitting at. For instance, I was high in both hydrogen AND methane and my levels raised to an amount that I needed to take the anti-microbial for 12 weeks instead of 6 weeks.

Treatment for SIBO-

The treatment for SIBO is based on diet changes, anti-microbial/anti-bacterial supplements, improving the MMC and breaking down the biofilm. Biofilm is a protective mucosal layer that covers your gut bacteria. The good and bad bacteria do it, so its not an unusual thing to occur. But, some bacteria are very stubborn and lie very deep within your mucosal layer. Some bacteria (candida albicans) also have a hook at one end and they hook them selves into your gut wall for extra adhesion. Once the treatment has finished, you can start pumping yourself up again with probiotics.

I believe the most integrative aspect of treating SIBO is obviously eliminating the excess bacteria, but focusing on healing your gut wall. This is where pharmaceutical treatment fails unfortunately. The administration of antibiotics does kill the bacteria, but the gut wall hasn't healed, so you will find that SIBO symptoms return very quickly because the gaps between the junctions are still there.

The way to heal your gut wall is by avoiding inflammatory triggers to begin with and foods that feed the bacteria. There is usually much discussion on whether to starve or feed the bacteria. But, I have found that by starving the bacteria, not only increases the death rate, but it will also improve candida symptoms.

Meat/fish stock is the best way to heal your gut lining. The gelatine that is extracted from the joints/tendons make a nutritious and healing stock that is full of natural collagen. Unfortunately, there has not been enough emphasis on this and is really the key to long term success.

There have also been a few dates linked to treating SIBO. all of them are low in carbohydrates, as it is the disaccharides that are difficult to  digest and cause the most symptoms in SIBO. Most people will try all of the diets to see which one gives the best results before taking action and doing the breath test. There is FODMAPS, Specific Carbohydrate Diet (SCD) and Gut and Psychology Syndrome (GAPS) diet. But, you will receive a recommended food list to treat SIBO specifically if you decide to take the Hydrogen Breath Test.

You can order a test kit from SIBOTEST.com, but you will need a qualified practitioner to interpret the results for you and to gain access to the supplements required.

What is the link with IBS and SIBO?

You can see from the list of symptoms that SIBO and IBS are very similar. There is a link, and it is mostly that if you have IBS there 60-80% chance that you have SIBO as well. This could be due to the fact that you can develop IBS the same way as you can develop SIBO and that is by post infectious gastroenteritis. The four main organisms that cause gastroenteritis are:

1. Campylobacter jejuni
2. Salmonella
3. E.coli
4. Shigella

These organisms release a toxin called Cytolethial distending toxin B (CdtB). This toxin is very similar to a protein vinculin. Vinculin helps protect the interstitial cells along your gut wall to keep it nice and healthy and tight. But unfortunately, when high levels of the similar looking toxin CdtB is released the body starts to attack vinculin and develops anti bodies. This leads to an auto immune response. Don't worry too much- this doesn't happen to everyone!

If you would like to make an appointment with me regarding your digestive complaint, you can do so here:

Histamine Intolerance

1% of the world's population has histamine intolerance according to an article in The Journal of Allergy and Clinical Immunology, with 80% of them being middle aged. Personally I see many of my GAPS clients with a histamine intolerance with no restrictions on age.

You would be familiar with the term 'anti-histamines', which are typically used when someone suffers from hay fever, sinusitis or experience an acute skin reaction. Histamines are released from your mast cells due to an inflammatory response. Masts cells are part of your immune system and are regularly called upon to out the flames out of a fire that may be occurring in your body.

When histamine is released it dilates your capillaries, resulting in lowering blood pressure, it contracts smooth muscles (including your lungs), increases gastric secretions, raises heart rate and is a neurotransmitter in your brain (McAuliffe, G. 2015).

Typical symptoms of histamine intolerance:

• rhinitis
• sinusitis
• asthma
• headaches/migraines
• nausea
• flatulence
• abdominal cramps
• diarrhoea
• hives
• flushing
• insomnia
• arrhythmia
• stuttering
• nasal congestion
• sneezing
• abnormal menstrual cycle/dysmenorrhea
• mental disorders such as depression and schizophrenia

Histamine is also found in foods that we eat and fermented beverages (red wine and beer . So when someone has a histamine intolerance, they have an impaired ability to break histamine down in their digestive system and the histamine accumulates, and the person will experience symptoms similar to a hay fever sufferer. There are also foods that may not contain high histamine levels, but may influence a histamine RESPONSE. For a full list of high histamine containing foods and high histamine releasing foods click -histamine-food-list

Are you born histamine intolerant?

Yes and no. There are two enzymes that break down histamine in your digestive system. Diamine Oxidase (DAO) is the most common enzyme that people are insufficient of. To boost the productivity of this enzyme vitamin C and vitamin B6 are needed. The other enzyme that is needed to break down histamine is N-methyltransferase (HNMT). HNMT is needed mostly in the lungs to break down histamine (asthma link?), but is expressed in the kidneys and liver also. To increase HNMT activity the enzyme SAMe ( S- adenosyl-methyl-methionine) is required. You can lack either of these enzymes genetically or they can be blocked by various pharmaceutical drugs (or acquired from health ailments such as leaky gut, small intestinal bacterial overgrowth, candida overgrowth or Epstein Barr virus). Any one can experience symptoms of histamine intolerance, just by ingesting too many high histamine foods. This is referred to mostly as 'histamine excess'.

Testing for histamine intolerance

• Histamine blood serum
• Genetic testing (DNA)
• Methylation profile
• Food allergy test

Management of histamine intolerance

• Keep a food diary for any reactions to histamine foods
• Check if on any medication that could block histamine enzymes or are pro-histamine releasing
• Do you have any symptoms of histamine intolerance?
• Eliminate histamine foods from diet, heal your gut and reintroduce slowly

If you feel that you may have a histamine intolerance, book an appointment to discuss your needs today![bookly-form]

REFERENCES

Maintz, Laura and Novak, Natalija. 'Histamine and histamine intolerance', American Journal of Clinical Nutrition, 2007, 85:1185-96McAuliffe, George. "Histamine', Journal of the Council on Nutrition of the American Chiropractic Association, 2015, Vol.38, No.3 30-33Smolinska, S. Jutel, M. Crameri, R. O'Mahony, L. 'Histamine and gut mucosal immune regulation', 2014, 69:273-281Vickerstaff-Joneja, Janice. & Carmona-Silva, Cabrini. 'Outcome of a histamine restricted diet based on chart audit', Journal of Nutritional & Environmental Medicine, 2001: 11, 249-262

The difference between food allergies & food intolerances

Can you remember when you went to school as a kid?

We could take anything to eat to school. These days nuts are banned, sometimes seeds (sesame seeds), eggs and even kiwi fruit!

The banning of these foods is because they cause an allergic reaction which is IgE mediated. This is when your body has an immediate response to a food antigen that can cause breathing difficulties (anaphylaxis), hives, rhinitis, atopic dermatitis and often a predisposition to asthma. The most common food allergens are tree nuts, peanuts, cow's milk protein, wheat, soy protein, eggs, shellfish and fish.

Whereas celiac disease is considered non-IgE mediated response because it involves other components of the immune system. Gluten is found in rye, barley and wheat and the diagnosis can be made on by taking the history of the patient, blood test (looking for gluten antibodies) or biopsy.

So what's happening?! Why in the last 20 years has everything gone pear shaped?

One of the theories is the 'Hygiene Hypothesis' and that means that we have become so 'clean' in the last 30-50 years that we are not allowing ourselves to become exposed to bacteria and germs the way we used to. We are constantly using cleaning agents to clean our hands, houses, cars and environment that we are living in a hospital environment. Out door play is also becoming less frequent and we are spending more time in doors in our lovely sanitised capsule. I remember fondly as a child making mud cakes for my dolls and not bathing everyday!

My personal belief is that our overall gut health has deteriorated over the last 50 years due to the exposure of environmental toxins, processed foods, antibiotics and genetics. Our gut flora gets out of balance and is unable to cope with all of the external load we keep giving it and therefore creates an inflammatory response to it, which can often turn chronic if not rectified. This can create a 'leaky gut' or symptoms can arise from an episode of gastroenteritis (post infection IBS).  You will also find that our gut health can be inherited from our parents. Are there any autoimmune disorders in your family? Has any of your family passed away from bowel cancer etc.?

Another term that you may often hear to these days is 'food intolerances/sensitives'. This is when you may get a reaction from a certain food, but it can be up to 48 hours later. Such reactions may include headaches, bloating, stomach pain, flatulence, diarrhoea, hyperactivity. These reactions are also not detected on a typical skin prick test that is used to test IgE reactions and can often be difficult to detect because the reaction is so delayed the food source can be hard to pin point.

Generally the elimination process begins with avoidance of the suspected food, along with a food diary to note any symptoms when the food has been re-introduced. This can be a long and tiring process. The awkward part of food intolerances is that every one has an individual threshold, and it can take time (and a lot of sore tummies or rushing off to the toilet) to find what works for you.

The most common non-immune response can be from cow's milk, gluten, soy and chemical compounds such as glutamates, salicylates and histamines. In the last 5 years or so there are more tests available to identify food intolerances by testing your IgG levels to certain foods. The ALCAT test has been used in a few studies with positive results in identifying food triggers. The test uses blood serum for lab findings. Unfortunately, this method can be invasive for most children. The ALCAT test also can test chemical sensitivities and herbs and spices (the more you test for, the more expensive it is).

There is also now available Gluten Sensitivity Panels for those that have not fallen in the celiac bracket. This test can be done easily via a finger prick for a blood spot sample. Or if testing is a little out of your reach now, try removing the suspected food for 2-3 weeks and slowly introduce it and notice take note of any reaction. You can also check if any symptoms have cleared up while the food has been removed this way too.

If food intolerances are a problem for you, press the button below to contact me today!

References

Boettcher, Erica (MD) and Crowe, Sheila, E. (MD), 'Dietary Proteins and Functional Gastrointestinal Disorders', The American Journal of Gastroenterology 2013; 108: 728-736

Gibson, Peter, R. 'Food Intolerance in Functional Bowel Disorders', Journal of Gastroenterology and Hepatology 26 (2011) Suppl. 3; 128-131

Pietschmann, Nicole (PhD), ' Food Intolerances: Immune Activation Through Diet- Associated Stimuli in Chronic Disease', Alternative Therspies, July/August 2015 Vol. 21,4