Understanding SIBO (Small Intestine Bacteria Overgrowth) and the Dietary Management of it (May 2013)
How many of you are familiar with the term SIBO? I know clients bring this term up to me once they are diagnosed with it. SIBO which is also known as Small Intestine Bacteria Overgrowth affects can be responsible for up to the 84% of the IBS cases (Irritable Bowel Syndrome). Did you know that the human got flora has 10 times more bacteria than the body has cells?
Having too much bacteria (which should be located in the colon) can be overgrowing in the small intestines can lead to various digestive symptoms and nutritional deficiencies. The symptoms for SIBO and IBS are similar: flatulence, cramping, constipation and diarrhea, all of which can be frustrating. These gastrointestinal symptoms result from both the high osmotic activity and fermentation possibility of incompletely digested and unabsorbed carbohydrates present in the small intestines.
Both the gas and the produced by the intestinal fermentation and the water drawn through osmosis can contribute to bloating in SIBO clients. The type of gas produced by the bacteria has an impact on the motility on the intestines. Hydrogen producing clients are more likely to experience diarrhea, while the methane producers are more inclined to experience constipation.
Two-thirds of Celiac Disease Patients unresponsive to a gluten free diet and at least one quarter of acute flares in Crohn’s disease patients can be explained by SIBO. This chronic bacteria overgrowth can also be affiliated with headaches, joint pain, depression, hypothyroidism, diverticulitis, fatigue and other chronic conditions, according to Mark Pimentel, MD Director of the GI Motility Program at CSMC and author of A New IBS Solution.
Clients have measured the breath hydrogen and methane levels after giving patients a predetermined amount of Lactulose or glucose to diagnose SIBO. It is also important to know that positive breath tests for lactose, fructose and sorbitol can also indicate SIBO. Once the client is diagnosed antibiotics are given for treatment: (Neomycin & Rifaximin is the antibiotic of choice because 99.6% of it stays in the gut without being absorbed into the bloodstream), therefore reducing side effects and enhancing its efficacy within the gastrointestinal tract.
It is also important to note that clients may experience various nutritional deficiencies. These include having malabsorption induced by rapid intestinal transit time can lead to the loss of macro and micro nutrients. These include: omega-3 fatty acids, and fat soluble vitamins such as Vitamins D, A, K and E. Lastly it is important to point out that having excess bacteria in the small intestines can deconjugate bile acids and interfere with the absorption with the nutrients as well as Coenzyme Q-10 and Beta-Carotene. SIBO can reduce Vitamin B-12 levels and Iron levels which will increase the risk of anemia.
To make dietary changes is important. It is important to be mindful of foods that contain FODMAPs (fermentable olio-,di-,mono-saccharides and polyols) also can ferment in the small intestines and therefore may want to be limited if they induce symptoms in SIBO clients. To limit dairy, sugars, high residue starches and sugar is important. The client will notice an improvement in the bloating and normalization in bowel movements. The brush border will be in the process of being adequately healed to produce digestive enzymes again. It is important to meet with a registered dietitian who can customize meals options based on the necessary dietary changes that must be made.
It is important to spread meals out to eat every three to five hours. This will allow the cleaning process to take place in the gut (MMC) migrating motor complex. It is important to not snack and minimize stress, as Dr. Pimentel mentions in his book, the MMC is reduced by 70% if stress is decreased and can stop SIBO from returning.
References:
1. Pimentel, M. A New IBS Solution. Sherman Oaks, California: Health Point Press; 2005.
2. Siebecker A. Small intestine bacterial overgrowth: clinical strategies (webinar). September 17, 2011. Accessed September 25, 2012.
