Normally, bacteria are found in the trillions in the LARGE INTESTINE, where they perform various symbiotic functions for the human body. SIBO is a condition where bacterial overgrowth occurs in the absorptive area of the body—the SMALL INTESTINE. Symptoms of SIBO can include:
Diarrhoea
Constipation
Alternating constipation and diarrhoea
Abdominal cramping
Bloating and/or wind
Burping and Acid reflux/GORD
Food sensitivities
Joint pain
Skin rashes
Iron and B12 deficiency
Respiratory symptoms such as asthma
SIBO can occur when
The ileocecal valve (which connects the large and the small intestine) is dysfunctional, allowing large intestinal bacteria to migrate upwards into the small intestine where they wreak havoc. The normal cleansing wave of the small intestine is disrupted or stopped – this cleansing wave is called the Migrating Motor Complex (MMS), and occurs approximately every 90 minutes, typically between meals. The function of the MMC is to wash out accumulated bacteria and propel them toward the colon. The MMC is not related to the peristaltic waves of the large intestines. The result is bacteria are allowed to grow and proliferate throughout the small intestine (a little over 6 meters in length). SIBO causes damage to the absorptive surface of the small intestine - the ability of the body to absorb nutrients from food. The absorptive surface of the small intestine is likened to a shaggy carpet, with finger-like protrusions called villi. The surface of the villi contain microvilli which act as the interface of absorption—microvilli secrete enzymes called “brush border enzymes” which break starches into single molecules, proteins into single amino acids so these can be absorbed. SIBO can result in
Malabsorption of monosaccharides and amino acids (carbohydrates and proteins)
Fermentation of disaccharides by bacteria causing hydrogen, methane and hydrogen sulphate gasses
These gasses themselves are damaging to the gut wall
Malabsorption of vitamins (especially B12 and Folic acid)
Malabsorption of minerals (especially, magnesium, iron, and calcium SIBO can cause leaky gut, with a damaged gut wall allowing larger particles to pass through, causing an immune response. Causes of SIBO
Post infectious: a case of gastroenteritis can often be the “heralding event” for the development of SIBO
Overconsumption of simple carbohydrates
Medications: proton pump inhibitors, morphine and other opiates, narcotics, possibly beta agonists and calcium channel blockers
Stress: chronic stress can decrease stomach acid output (hypochlorhydria). Stress also causes changes in the motility of the small intestines, causing a pooling and stagnation which allows for bacterial overgrowth
Altered anatomy: malformation of the ileocecal valve, surgical intervention causing scarring and adhesions altering the normal anatomy of the small intestines
Initial colonization of bad bacteria: caesarean birth, no breast feeding. Associated conditions
Fibromyalgia and Chronic Fatigue Syndrome – especially associated with diarrhoea dominant SIBO
Chronic constipation – associated with methane-dominant SIBO
Irritable bowel syndrome (IBS)
Inflammatory Bowel disease (Crohn’s disease and ulcerative colitis)
Acid reflux
Coeliac disease
Interstitial Cystitis
Restless leg syndrome
Acne
Rosacea
Diabetes
Hypothyroidism
Scleroderma
Chronic Prostatitis
Non alcoholic Steatohepatitis (NASH)
Liver cirrhosis
Diverticulitis
