What is Irritable Bowel Syndrome?
Gastrointestinal complaints are some of the most common seen in primary care offices. In fact, up to 30% of all visits accounted for come from digestive complaints like distension and bloating, abdominal pain, constipation, and diarrhea (1). The umbrella diagnosis given to patients who present with these symptoms is irritable bowel syndrome, or IBS. IBS was once regarded by the medical community as being psychosomatic, however emerging research now proves otherwise. In fact, up to 78% of IBS patients have small intestinal bacterial overgrowth, or SIBO (1). It is now our understanding that IBS is largely misdiagnosed. Fortunately, the functional medicine model aims to understand the why behind the reason these symptoms are manifesting the way they are so, then we are able to target the source of the problem. In our experience at Hudson Wellness, most patients test positive for SIBO when they present with IBS symptoms.
Small Intestinal Bacterial Overgrowth – What is it?
Small intestinal bacterial overgrowth, or SIBO, is defined as methane and hydrogen producing bacteria that overpopulate the small intestine, causing digestive distress. In order to reach a SIBO diagnosis, one must have >100,000 colony forming units per mL of proximal jejunal fluid (cfu/mL)(2). The most common symptom we see in SIBO causes is extreme bloating, especially after meals. Other symptoms include constipation, diarrhea (and alternating between the two) reflux, gas, and abdominal pain. Since our GI tract is the interface for all nutrient absorption and assimilation, when we run ourroutine micronutrient test and the patient is also deficient in many nutrients, that’s almost always a telltale sign that the patient is suffering from malabsorption from SIBO.
Low stomach acid is one of the leading contributors to small intestinal bacterial overgrowth because it negatively impacts GI motility (3). Bacteria needs to be effectively swept from the proximal bowel into the colon and when gastric peristalsis happens, it can cause food and bacteria to move slowly through or even get stuck in the upper GI tract (3). In reality, anything that causes gastric peristalsis, such as stress, antibiotics, and a lowered immune system, can predispose you to SIBO.
Treating the Trigger of IBS
How do we test for an overgrowth of bacteria in the small intestines? The gold standard for diagnosing SIBO comes from investigating jejunal aspirates after an endoscopy. A hydrogen breath test is another, less invasive way to test for overgrowth of bacteria, and is usually the most common test used in our office for SIBO. With this, patients will be given a full test kit where they drink a glucose solution and blow into a straw with a breath collection tube at the end at four different times, so this can be tested for hydrogen and methane (typical byproducts of bacteria). There is no other source of hydrogen gas in humans other than from bacterial metabolism of carbohydrates – so if hydrogen is present in your breath than you likely have bacterial overgrowth. There are many factors associated with increased risk for developing SIBO and these include being a female, older age, proton pump inhibitor use, narcotic intake, low hemoglobin, diarrhea predominant IBS, and bloating with flatulence.
SIBO treatment is different for everybody depending on the severity but regardless, it’s usually a combination of both antibiotics and herbal antimicrobials. The goal is to kill off the bad bacteria and therefore decrease the amount of gas that is being produced. Depending on your breath test results, it may only be necessary for you to do an herbal antimicrobial treatment, which we do often at Hudson Wellness. We use a product called candibactin AR and BR which contains an essential oil blend of oregano, sage, thyme, and lemon balm – all great herbs for supporting the gastrointestinal tract and killing off unnecessary bacteria.
So what about diet and nutrition?
As we all know, diet plays a pivotal role in health. So it’s no surprise that diet can make or break the treatment of SIBO. If we’re continuously eating foods that are feeding the overgrowth of bacteria, chances are we’re not going to see it go away. At Hudson Wellness, we typically put people on a low FODMAP diet, which stands for fermentable oligo-, di-, monosaccharides and polyols. These compounds are distinguishable types of carbohydrates that are poorly absorbed and cause excessive gas accumulation, exacerbating the growth of bacteria and IBS symptoms.
Some of the best ways to treat SIBO and reduce your chances of getting it include lowering consumption of refined sugar and flour, limiting alcohol intake, and managing stress.At Hudson Welllness,our Functional Medicine Program is a personalized, patient-centered, science-based approach to healthcare for treating the individual, not just the disease. Patients go through a six-month program, addressing everything from stress to sleep management, we get down to the root cause of their health issues so they can live a healthier, happier life.
To learn more about our functional medicine program, call 646-783-0068
1. Ghoshal UC, Shukla R, Ghoshal U. Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut Liver. 2017;11(2):196–208. doi:10.5009/gnl16126
2. Diana L. Franco, Molly B. Disbrow, Allon Kahn, et al., “Duodenal Aspirates for Small Intestine Bacterial Overgrowth: Yield, PPIs, and Outcomes after Treatment at a Tertiary Academic Medical Center,” Gastroenterology Research and Practice, vol. 2015, Article ID 971582, 5 pages, 2015. https://doi.org/10.1155/2015/971582.
3. Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol (N Y). 2007;3(2):112–122.
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