How Functional Medicine Can Address SIBO

Beating the Bloat

Do you feel bloated some of the time, or even worse, all of the time? If you have a ‘food baby’ after your meals, then you want to read this. One of the more common reasons why a person bloats after eating is due to an issue called SIBO. SIBO stands for ‘small intestine bacterial overgrowth’. For the most part, the bacteria aren’t usually pathogenic – just too many in the wrong place. Once they get where they shouldn’t then we start to have symptoms. Unfortunately, a person is usually wrongfully diagnosed with IBS, and with about 15% of Americans complaining of IBS, that is a lot of people that are not getting relief. Beano, Miralax, and Immodium AD will never address bacterial levels, or what allowed SIBO to happen in the first place.

Symptoms of SIBO

As you have probably guessed, one of the most common complaints is bloating, and it is usually after eating carbohydrates or a high fiber meal. The reason this happens is bacteria metabolize the carbs and fiber and produce two types of gas. The first type of gas is called methane. This is actually a defense mechanism of the bacteria to also decrease bowel motility, leading to bloated and constipation. This happens because the methane gas shuts off the synthesis of a chemical called serotonin. Contrary to popular belief, the vast majority of serotonin is made and used in the gut. However, with an inflammatory condition like SIBO, the body doesn’t produce serotonin, instead, it makes other chemicals called kynurenic and quinolinic acid. When this starts to happen, now a person is bloated, constipated, depressed with brain fog, and might even have trouble sleeping.

The other type of gas is hydrogen gas. These are sometimes made by a type of bacteria called sulfur-reducing bacteria (these patients pass gas that has an eggy odor to them, also their skin changes color when exposed to cheap jewelry). When the bacteria make hydrogen, there is also typically a lot of toxins made as well, called lipopolysaccharides (LPS). From the point of view of your body, it is easier to eliminate a toxin than to absorb it and then have to deal with it. For this reason, the LPS is combated by histamine made in the bowel lumen. This increases bowel motility and causes diarrhea. This is very good for the body, believe it or not, as LPS is a substance that promotes a leaky gut, autoimmunity, and brain degeneration (think Alzheimer’s). This person will complain of bloating, diarrhea, weight loss, and malnutrition – even if they are supplementing.

Fatigue is present with a lot of the people that also have the above complaints. Regardless of constipation or diarrhea, there is typically malabsorption present. With some, the stomach doesn’t get acidic enough, and the bacteria compete for the protein and amino acids. Multiple processes in the body require these amino acids, but some very important processes are making neurotransmitters, building cell walls, and liver detoxification. Also, the ability to make glutathione (the bodies major antioxidant) requires adequate amino acids, vitamins, and minerals. When the stomach gets acidic enough, then the food is properly digested, the food is sterilized, and signals are sent to the brain to tell the other digestive organs to start doing their job because the food is coming.

Another mechanism of malabsorption is that bile secreted by the gallbladder is made into a substance called lithocholic acid. This causes oxidative stress (rust) to the GI cells, immune cells, and the nerves in the gut called the enteric nervous system (ENS). As this bile is degraded, this leads to poor fat digestion and absorption. Proper fat absorption is necessary for sex hormone production, cell walls, and especially neurons. Also, the fat-soluble vitamins don’t get absorbed as well.

Poor absorption can also stem from damage to the actual GI cells. The GI tract is like a shag carpet rolled in on itself. The shags have a name called villi. These villi account for the vast surface area of the intestines, as well as absorption. When these get damaged, a person can have problems absorbing iron, B12, amino acids, and minerals. These villi also produce enzymes called ‘brush-border enzymes’ that break down sugars such as lactose, maltose, and sucrose (this leads to symptoms when a person consumes dairy or fruit). All the brush-border enzymes are important, but there is also one called diamine oxidase (DAO). This DAO is supposed to break down histamine in food, as well as histamine released by the body to combat the LPS. If this histamine doesn’t get broken down, then this leads to a bigger inflammatory response resulting in even worse absorption.

The fatigue can also come from anemia, either iron or B12 type anemia. A person can even be low in these if they are taking a supplement due to poor absorption.

Mechanisms and SIBO

Although several people can have the same symptom, it can be caused by a different problem. A common cause of SIBO is a reduction in stomach acid. There can be several reasons the stomach isn’t making any, and they can include:

  • Proton pump inhibitors
  • Chelation therapy
  • H. pylori
  • Autoimmunity
  • Pernicious Anemia
  • Cancer
  • Alcohol intake
  • Eating too fast
  • Eating under stress
  • Drinking too much fluid with meals
  • Nutrient depletion
  • Dehydration

The primary focus should be on why the stomach doesn’t work. The reason the stomach must get acidic is so signals can be sent to the brain to help regulate hunger, satiety, and metabolism. Typically a person is diagnosed with GERD and given a medication that actually worsens the problem. Usually, a person will complain of bad breath, acid reflux, distaste for meat, belching, and a ‘heavy’ feeling in their stomach.

Another issue that can lead to bloating and a SIBO is poor motility and valve control. This is termed the brain-gut axis. In a nutshell, signals from the ENS relay info to the brain, and the brain responds accordingly. This two-way street is always in motion. Speaking of motion, the brain uses a nerve called the vagal nerve to stimulate bowel motility through something called the motor migratory complex (MMC). Inflammation in the GI tract can degrade the ENS, which causes poor communication. There are triggers such as strokes, MS, or TBI that can degrade this system relatively quickly, but the most common cause of poor motility is an overactive stress response.


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Treatment for SIBO

The current treatment for a SIBO is an antibiotic called Rifaximin. Some other antibiotics used are metronidazole and neomycin. People usually have to go on