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SIBO: What Is It?

If you're following the 4 R's to address your leaky gut but not experiencing significant improvement, you might be contending with SIBO, which stands for small intestinal bacterial overgrowth. SIBO, pronounced as SEE-bo, is one of the underlying causes of leaky gut, although their treatment approaches differ.

SIBO manifests with common symptoms such as abdominal pain or discomfort, bloating/distention, diarrhea and constipation, and excessive burping and flatulence. It tends to be under-diagnosed due to the overlap of these symptoms with various other gastrointestinal disorders.

Let's delve into some background information about SIBO:

The small intestine plays a crucial role in the digestive process. Stretching over 20 feet in length, it occupies a significant portion of the abdominal cavity. Directly above it, the stomach's primary function is to mix partially digested food with stomach acid, initiating the breakdown of food particles.

After thorough mixing in the stomach, this concoction moves into the small intestine, where it undergoes further digestion, and nutrients are absorbed into the bloodstream. Some nutrients are also synthesized here.

Ideally, the small intestine should have very few bacteria, and only specific types should be present. However, sometimes, this balance is disrupted. The main colonies of beneficial bacteria, essential for good health, primarily reside further down in the colon (large intestine).

A one-way valve, the ileocecal valve (ICV), is between the small and large intestines and is designed to maintain the flow of digested material forward. If the ICV is damaged or stuck, partially digested material can flow back into the small intestine. At this point, the normal bacteria from the colon, which are just trying to do their job to maintain our health, get introduced into the mix.

However, it's crucial to remember that bacteria, even the beneficial kind, should not be present in the small intestine. Their presence can trigger an inflammatory cascade with wide-ranging effects, which can lead to various digestive issues like GERD, leaky gut, and IBS and even affect hormone production, mood, and brain function.

Clearly, this is not a desirable situation.

Numerous factors can contribute to the development of SIBO, but the primary factor is a history of gastroenteritis, commonly known as stomach flu. And who hasn't experienced stomach flu at some point in their life?

The severity of physical damage caused by these infections can vary, so not every instance of stomach flu results in SIBO. However, if your gut is significantly damaged, it can impair intestinal function in several ways:

  1. The ICV could malfunction, causing a backup.
  2. The villi on the intestinal wall may become scarred, rendering them unable to absorb nutrients properly, leading to fermentation issues and affecting the ICV.
  3. The natural cleansing action that should occur between meals might cease (a housekeeping problem).

Regardless of the cause, normally beneficial bacteria relocate to an inappropriate location and transform from helpers into troublemakers.

If you suspect you have SIBO, the most common diagnostic test is a breath test that assesses incomplete digestion. Some practitioners are also starting to use a urine panel to check for organic acids.

Once diagnosed, various approaches are used to treat SIBO. Some doctors opt for low-level antibiotics, while others believe that antibiotic treatment offers only temporary relief, with SIBO often returning. The effectiveness of treatment can depend on a multitude of physical and emotional factors.

However, most practitioners concur that dietary changes are essential in managing SIBO. Dietary changes typically involve the removal of inflammatory foods, such as starches, sugar, alcohol, grains, probiotics, and prebiotics. Many dairy products and legumes are also restricted; sometimes, you may have to avoid certain fruits. Balancing nutritional intake while starving out the SIBO can be challenging and may require a delicate approach.


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