SIBO, short for small intestinal bacterial overgrowth, affects thousands of Americans every year. Much like the name suggests, it’s a disorder caused by the presence of otherwise normal colonic flora growing in the wrong location - your small intestines. Issues arise when the gasses produced by this flora impact the small intestine’s enteric nervous system, resulting in changes in movement and increased sensitivity to pain, among other concerns like gas and bloating.
SIBO is a non-threatening but annoying condition that often causes long-standing issues if left without treatment. Learning you have SIBO can often be both a worry and a relief, as it provides some direction as to the underlying cause of your otherwise ‘IBS’ labelled symptoms. But what happens when you present with all the symptoms of SIBO, but your breath test results come back negative? Is that the end of the road for the microbiome's role in your gut issues?
What Is SIBO?
Your colon is currently hosting bacteria in large quantities to help break down food and absorb nutrients, even as you read this article. SIBO refers to these same organisms crowding in your small intestines, leading to irregular stools like diarrhea or constipation, gas, bloating abdominal pain and sometimes even belching and acid reflux.
SIBO is generally categorized into either a hydrogen dominant or methane dominant overgrowth, however, today’s doctors have learnt there may be a third source of SIBO symptoms:
HS2 SIBO, methane dominant SIBO, and hydrogen dominant SIBO have correlational symptoms, but the most common symptoms include:
Testing for Hydrogen Sulfide SIBO
Your physician will rule out other infectious and gastrointestinal disorders before diagnosing you with a SIBO. A lactulose breath test is used to do this - involving ingesting a non-digestible sugar solution that produces methane and hydrogen sulfide gas as gut bacteria ferments it. If these gasses spike quickly into testing, it's a telltale indicator of a SIBO diagnosis. However, when a SIBO breath test shows negative results, it doesn't confirm that a hydrogen sulfide overgrowth has been ruled out, as breath testing (to date) is not readily available for this type of gas. The Trio-Smart test, which has been developed in collaboration with SIBO researcher Dr. Mark Pimental, does have the potential for H2S diagnosis, but has yet to be adopted as a gold standard diagnostic technique and is not yet available in Ontario at the time of this article. While not as reliable as breath, stool testing is sometimes necessary to detect the presence of hydrogen sulfide flora.
According to clinical data, people with IBS and poor gut health are twice as likely to test positive for SIBO than the average person. Related health conditions associated with SIBO also include rosacea, fibromyalgia, ulcerative colitis, hypothyroidism, metabolic disorders, and arthritis - however, there is still a lack of data to confirm if the treatment of SIBO can resolve these conditions.
Hydrogen Sulfide SIBO Treatment
While H2S SIBO is often treated similarly to SIBO with antimicrobials, the therapies chosen are often different, as bacterial resistance occurs with many of the traditional first-line SIBO interventions and can often be why patients experience partial or minimal recovery from SIBO treatment. Important adjunctive therapies to integrate for success still include biofilm management and strain-specific probiotics alongside antimicrobial treatments.
Furthermore, while many SIBO treatments no longer recommended restrictive diets, hydrogen sulfide overgrowths will see more significant symptomatic improvements from a low sulfur diet and will be driven by the intake of certain fructooligosaccharides and sugar alcohols.
Lastly, if you suspect that you have SIBO, get a proper diagnosis before proceeding with a treatment program. Accuracy of therapies, as well as a proper diagnosis, can save time and headaches, as well as your good microbiota, down the road.
To learn more about SIBO, proper diagnostic assessments, and accurate treatment options, please contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today.
Can Pre- and Probiotics supplements actually improve gut health?
Research and my clinic experience say yes. Probiotics have been proven to be helpful in several conditions, such as irritable bowel, yeast infections, weaken immune function, and even weight loss. There is no ‘one-size-fits-all', so choosing the right probiotic can be a tricky task. You have to first ask yourself ‘what are you looking to achieve?’. If you’re looking to improve digestive health, such as gas, bloating and irregular stools, look for a probiotic that's rich in bifidobacteria, such as b. animalis and b. infantis. For repeat yeast infections and urogenital health, you’re better off with lactobacillus species, such as l. acidophilus, l. rhamnosus and l. reuteri. Furthermore, some probiotic strains are not seen in the human microbiome but have been shown to prevent traveller's diarrhea or antibiotic-associated diarrhea, such as s. boulardii.
According to a new study presented by Dr. El-Salhy at the United European Gastroenterology week in Spain, fecal microbial transplants (FMT) may significantly improve the pain and distress caused by irritable bowel syndrome, if transplants come from what has been termed a 'super-donor'.
The double-blind, randomized control trial study found that 75-89% of recruits aged 18-75 receiving 30-60 g of endoscope administered feces into the duodenum donated same day from a human 'super donor' reported significant benefits in their overall IBS symptoms after 3 months, with no long term adverse effects (1). Slightly greater benefits were observed in the patients receiving higher dose transplants and/or repeat transplants (2). Furthermore, Dr. El-Salhy suggested that preliminary results show 90-95% of the patient who responded are still well 1 year later, and 50% are 'cured' (3).
One of the core principles of functional medicine is to nourish the body and ensure it is getting the appropriate balance of nutrients to stay healthy. Traditionally, this was achieved in a hunter-gather diet by eating colourful whole foods and by practicing “nose-to-tail” eating of meat, which included the consumption of skin, cartilage, marrow, tendons/ligaments, and other parts of the animal that are now typically discarded. Unfortunately, much of this practice has been lost as a result of prepared meats, microwaves, and canned soups over homemade stocks. As a result, our diets have become deprived of an important protein, known as collagen.
There is a lot of noise in the health industry lately about collagen supplementation. The concept of supplementing collagen attempts to regain what we’ve lost from our primitive diet, but the question becomes if supplementation has any benefit.
Benefits of Collagen
I’ll admit that when I first heard about the trend of supplementing collagen, I wasn't on board. It made no sense to me. Collagen is a tissue found in our bodies made from amino acids, vitamin C, etc. So how could supplementingthe end product collagen benefit us? But as it turns out, research in mice shows that hydrolyzed collagen peptides (from gelatin) have a 95% absorption rate at 12 hours after intake, and it distributes in the body similar to that of raw amino acids, with the exception of cartilage (1). Collagen was seen to concentrate more than twice as high in cartilaginous tissue that raw amino acids (1), giving collagen some unique benefits. So, I jumped on the bandwagon.
If you suffer from chronic GI or nasal/respiratory problems, but have been unable to get a proper diagnosis; or if you have tried antibiotics and antimicrobials to treat your irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), other chronic gut/respiratory problems with little success, it may be helpful to know what a biofilm is and why it may be at the root of your problems.
Its estimated that a staggering 23000 people die from antibiotic resistance infections every year, and the number is increasing. If your previous attempts at getting diagnosed or treating an existing GI condition haven’t been effective, it may be time to consider alternative treatment options to disrupt the biofilms living within you.
The most common time to take a probiotic is during + following antibiotic use. Antibiotics degrade the population of our good flora, and therefore they require replacement. Some antibiotics, such as amoxicillin, ciprofloxacin, etc, have also been shown to allow for opportunistic infections from candida, or yeast. The primary concern for antibiotic use is ultimately the results of dysbiosis, which is a severe imbalance in desirable vs undesirable bacteria in our gut.
Some of the other benefits of a probiotic use can include:
• Boosting your immune system
• Improving immune dysfunction, such as in seasonal allergies, eczema, asthma, etc.
• Improved digestive function
• Increased absorption of nutrients, and elimination of waste
• Fighting pathogens
There are many readily-available sources of probiotics, from supplements to food. Supplements usually only contain single strains of bacteria, sometimes in isolation, or other times multi-strain.
Unfortunately, some evidence suggests capsulated probiotics don't populate our gut long term.
If you are looking for ways to increase your probiotics consumption, it may be best to start with probiotic-rich foods like some of these:
• Yogurt (make sure to choose a yogurt with live or active cultures)
What to expect when you are taking probiotics?
Most people can tolerate probiotics fairly well; however, the most common side-effects are a temporary increase in gas and bloating, constipation, and thirst. The cause of these side-effects in some people is not entirely known, but they usually subside after a few weeks of continued use.
And while there may be several health benefits associated with taking probiotics, there are some people who should always seek advice before starting a probiotic. These people include individuals on immunosuppressive drugs, those with a compromised immune system, or a serious illness which predisposes them to more severe complications.
Can probiotics make you feel worse?
Our intestinal tract is a veritable colony of microorganisms. There are trillions of these little guys inhabiting our GI tracts and the exact combination and strains make for an incredibly complex interaction within us.
When we introduce different species into the mix, it can cause a temporary impact on our intestinal environment. The equilibrium that existed previously has been thrown off balance and needs to readjust. Once the new – and hopefully more beneficial – balance establishes itself, the symptoms should stop.
One primary instance where probiotic may persistently make symptoms worse is in cases of small intestinal bacterial overgrowth (SIBO). Since the root of this problem is already an overgrowth of bacteria in the wrong place (the small intestine), adding more bacteria to the mix can often aggravate symptoms. SIBO symptoms look a lot like IBS, which is why it is important to speak to your naturopath before starting a probiotic.
You should always introduce probiotics slowly – a process called “titrating” – and increase to a full dose gradually.
The Must-Knows when choosing a probiotic
#1: Not every probiotic is the same. L rhamnosus GG has been shown to decrease the incidence of asthma and allergies in children, L. acidophilus is helpful in preventing repeat yeast infections, and B. lactis has been shown in clinical trials to improve intestinal dysbiosis and IBS symptoms. Taking an over the counter probiotic is useless unless it contains the proper strains indicated for your concern. This is where you want to speak to your ND to choose a probiotic that's right for you.
#2: Most probiotics cannot survive at room temperature. Multiple consumer reports have confirmed that many probiotics taken off the shelf are no longer alive, and therefore relatively unhelpful. Many strains of probiotics must be kept at < 8 degrees C or they will degrade at roughly about 4% per day. Meanwhile, some strains of probiotics are completely safe at room temperature, such as S. boulardii, which makes it great for travel. Do your research before buying strains off the shelf, or stick to probiotics found in the refrigeration section of your health food store.
#3: Quantity matters. Some probiotics will claim to be over 50 billion bacteria per capsule, but in fact, contain less than 5 million colony forming units of the desired strains (this is very common with l. acidophilus). Many clinical trials show no benefit to probiotic strains until they reach a certain quantity of exposure. Always read the label, which breaks down the strains and counts of each colony.
#4: Watch for fillers and Prebiotics. For those searching for probiotics for gas, bloating, IBS, IBD, etc, if a probiotic makes you feel worse, it may not be the actual bacteria. Many capsulated probiotics contain prebiotics such as inulin, pectin, potato or tapioca starches, maltodextrin, and/or fructooligosarccharides (FOS), which in and of themselves can create gas and bloating. Many are also washed in dairy, which can be a problem for those sensitive to dairy products.
When is it time to call the doctor?
Once starting a probiotic, if you haven’t presented with an exacerbation of symptoms (suggesting potential overgrowth of bacteria in your gut), no infectious pathogens are present, and your symptoms are on the mild end of the spectrum, you can probably keep taking it. Eventually, your GI tract will settle back down to normal.
If you find that you cannot tolerate probiotics, it could be a sign of gut pathogens like parasites or bacterial infections, as well as potential overgrowths. Because each of these issues requires a different treatment approach, it is important to have functional GI testing done to work out exactly the root cause of the problem.
If you want further help, or wish to discuss ways to support optimal gut health, please feel free to contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today!
Bacteria are found on every external surface of the body, including the entire gastrointestinal tract. You’re probably no stranger to probiotics and their endless health benefits, and you may even be purposefully increasing your intake of fermented foods as a result. But what if I was to tell you that probiotics might be making your digestion symptoms worse?
The diversity and quantity of bacteria in each part of the digestive system varies greatly. For instance, you can easily find over 1 billion bacteria per milliliter in the colon, and only 10,000 bacteria per milliliter in the small intestine. In addition, the bacteria in the small intestine function differently from those in the rest of the digestive tract.
In the small intestine, the bacteria are responsible for aiding in digestion and helping absorb vitamins, minerals, and nutrients in the foods we ate. These same bacteria also help support immune function. However, in many people experience IBS-like symptoms such as gas, bloating, constipation/diarrhea, and abdominal cramping, the number of bacteria in the small intestine increases significantly. The bacterial that typically colonize the digestive tract (most commonly the colon or large intestine1) overgrow in a location not intended for so much bacteria, and as a result, begin to produce symptoms. We call this condition Small Intestinal Bacterial Overgrowth or SIBO. And as you can imagine, adding more bacteria (like probiotics) to the mix may produce undesirable outcomes.
What Are Some Symptoms of SIBO?
When SIBO occurs, it interferes with normal digestive processes. The vitamin, minerals, and nutrients which are normally absorbed by the intestinal cells become diminished, while some strains of bacteria actually consume the nutrients for themselves, ultimately fueling their growth.
As a result, we often see nutrient deficiencies such as iron and b12 in this patient population. Gas becomes a byproduct of the fermentation of sugars and proteins, and bloating results. The most characteristic symptoms of SIBO patients include:
• Abdominal Discomfort, Cramping, and Pain
• Vitamin Deficiencies
• Unexpected Weight Loss
• Abdominal Distention/Bloating
Long-term concerns of untreated bacterial overgrowth include damage to the intestinal lining, resulting in increased intestinal permeability, often termed “leaky gut syndrome”. This condition predisposes a person to autoimmune diseases, allergic reactions to foods they previously were not allergic to, and overall inflammation2. Furthermore, bacterial endotoxins burden our liver and immune system, increasing incidences of chronic fatigue.
What Causes SIBO?
Any disease or illness that affects the body’s defenses put a person at risk for SIBO. The actual causes complex, but major of people with SIBO have developed an issue with the intestinal anatomy or musculature. Infectious gastroenteritis, bowel strictures or surgery, nerve damage, appendicitis, and birth control use are among some of the predisposing factors to SIBO development.
Various research studies have discovered that the following conditions may also increase the risks for SIBO:
• Crohn’s Disease
• Type I or Type II Diabetes
• Irritable Bowel Syndrome
• Previous Surgery of the Bowel/Intestines
• Celiac Disease
• Conditions of the Liver, Pancreas, and Others
• Low Stomach Acid
• Regular and Heavy Alcohol Consumption
Can SIBO be treated?
First and foremost, a diagnosis should be made using a 3 hr Lactulose Breath Test. Treating SIBO normally requires the use of specific antibiotics and/or antimicrobial therapy to erratic the overgrowth, along with identifying co-morbidities that may have caused its development in the first place. In cases where patients were treated, but their underlying condition was ignored, many experienced a reoccurrence of SIBO with a year or less3.
Since there can be a variety of underlying causes, it is essential to develop treatments which are tailored specifically for each individual.
Click Here to learn more about Dr. Courtney Holmberg ND’s approach to SIBO management. If you suspect you might have SIBO or have experienced any of the symptoms we discussed, contact Dr. Holmberg at 647-351-7282 to schedule a consultation today!
© 2018 Courtney Holmberg ND. All rights reserved. Dr. Courtney Holmberg, ND does not endorse or have professional affiliation with any discussed supplement or lab companies. All material provided is for general education and may not be construed as medical advice. The information is not intended to assist in diagnosing to treating a medical condition. Legal & Medical Disclaimer, sitemap