Is your bloating caused by SIBO?

Small intestine. Image courtesy S Bhimji MD

You have probably heard that we are what we eat. I believe we are more accurately “what we absorb.” Much of our health and wellbeing hinges on a well-functioning gastrointestinal tract to absorb the nutrients that support the rest of the body. Pesky symptoms like constipation, diarrhea or frequent bloating and gas suggest that the GI tract may be compromised. These symptoms can be associated with small intestinal bowel overgrowth.

What is Small Intestinal Bowel Overgrowth (SIBO)?

Before we look at how the bowels can become overgrown with organisms, it is important to understand how the digestive system works. The intestines are comprised of the esophagus, stomach, small intestine and large intestines (also called the colon). Gastric acid produced in the stomach initiates the digestive process but also acts to suppresses the growth of ingested bacteria and control bacterial counts in the upper small intestines. The small intestines are where the majority of food is digested, and nutrients absorbed. The small intestines have an impressive length of approximately 10-15’ and are home to a large network of immune cells that help fight infection and regulate our immune system. The small intestines have a normal muscular activity which creates waves that move the intestinal contents, like food, through the gut. Our entire digestive tract is populated with trillions of organisms that make up our microbiome. The bulk of these bacteria live in our large intestines. The small intestines have relatively few bacteria in comparison to the large intestine. The normal (beneficial) bacteria are an essential part of the healthy small bowel. They help protect against bad (i.e. pathogenic) bacteria and yeast that are ingested. They also help the body absorb nutrients, and produce several vitamins like folate and vitamin K. Any disruption in the quantity of organisms, or balance of species, in the microbiome can be diagnosed as SIBO.   

What causes SIBO?

An overgrowth of organisms in the microbiome can occur when the stomach has inadequate gastric acid or the motility of the small intestines is slow. Food that nourishes us also feeds the microbiome and is subject to fermentation in the small intestines, especially if it spends prolonged time in the small intestines. This fermentation can produce gas (hydrogen or methane) that can be felt as bloating, belching, flatulence, reflux or the gas can trigger symptoms such as diarrhea or constipation. 

The conditions below are risk factors for SIBO and slow motility:

• Anatomic changes due to surgeries, scaring or small intestine diverticula

• Slow motility due to gastroparesis, celiac disease, scleroderma or pseudo-obstruction

• Metabolic changes such as those associated with diabetes or low gastric acid

• Advanced age

• Organ dysfunction like kidney failure, pancreatitis or liver failure

• Frequent medications use with antibiotics or gastric acid suppressers

How do you test for SIBO?

SIBO is most often diagnosed with a breath test. The test measures how much hydrogen or methane gas are in your breath. Both gasses are a byproducts of bacteria breaking down sugar in your gut. There are no blood or stool tests for SIBO. However, anemia, low B12 levels and markers of malabsorption may be seen on blood testing. 

How do you treat SIBO?

SIBO treatment includes 4 goals:

1. Correct the cause: SIBO is notoriously challenging to treat with a high recurrence rate. If possible, identifying and resolving the condition that initially predisposed one to the overgrowth increases the success rate of treatment. 

2. Provide nutritional support: Adopting a nutrient dense diet, supporting digestion/absorption and occasionally using targeted supplements can support gut healing. There are multiple dietary approaches for SIBO that also help relieve symptoms.

3. Treat the overgrowth: Although some antibiotics can predispose users to SIBO, there are other specific antibiotics and anti-microbial herbs that are useful in treating the overgrowth.

4. Prevent relapse: Sometimes it is difficult to completely resolve the predisposing risk(s) for SIBO. Using targeted pro-kinetics supplements of medications to promote small bowel motility can help prevent SIBO recurrence. 

Need help treating bloating, gas or abnormal stool patterns? Relish Health is here to help. 

Learn more about optimizing your gut health:

7 Steps to Fight Reflux and Bloating

Natural Foods for Gut Health

Promote Digestion and Gain Nutrients with Delicious Bitter Greens

Advice for Staying Regular When You Travel

Is a Low FODMAP diet right for you?

References:

• Collins JT, Nguyen A, Badireddy M. Anatomy, Abdomen and Pelvis, Small Intestine. [Updated 2020 Apr 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459366/

• Dukowicz AC, Lacy, BE and Levine, GM.  Small Intestinal Bacterial Overgrowth: A Comprehensive Review Gastroenterology & Hepatology Volume 3, Issue 2 February 2007 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/pdf/GH-03-112.pdf

• Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978‐2990. doi:10.3748/wjg.v16.i24.2978

7 Steps to Fight Reflux and Bloating

Reflux and bloating are common complaints that I hear frequently in the office. If you struggle with these symptoms as well, know you are not alone. It is estimated that 44% of Americans have heartburn once a month and as many as 10 million people have daily symptoms. 

Food is medicine and can be part of the trigger or the healing of these common complaints. Food plays many roles in our lives. It is delicious, comforting and linked to our identity and social connectedness, but is also the fuel and building blocks for health. It is information for your cells and gene expression. You eat approximately one ton of food each year and can change your body chemistry every time you eat.

Listed below are seven steps that may help you identify and address potential triggers for reflux and bloating. At a recent workshop event, we discussed these in more detail and sampled foods that can aid digestion. Look for future sessions like this on the Event page. 

1: Eat mindfully at the table (and your desk and steering wheel are not tables). Mindfulness can promote the parasympathetic nervous system responsible for the “rest and digest” function of the body. Eating slowly and paying attention to your food and how your body is responding can improve your overall digestion.

2: Get your digestive juices going. Bitter flavors can promote digestive juices. Consider adding bitter greens (eg. arugula, endive, radicchio, mustard greens, chard, parsley, cilantro, broccoli rabe or vinegars, etc.) to your plate.

3: Tend your inner garden. Our gut is home to a host of bacteria. Add fermented foods or probiotics to your diet to encouraged friendly flora. Make sauerkraut, kimchi, sour pickles and/or kefir regular condiments on your plate. Consume adequate fiber to keep the good bacteria happy and thriving and avoid processed, refined foods. 

4: Some foods can actually aid digestion. Consider adding ginger, fennel seeds and bitter flavors to your diet. Be aware of foods that may trigger reflux symptoms. They may include: fried and fatty foods, spicy foods, citrus, tomato-based foods, processed foods, alcohol, caffeine and tobacco. 

5: Consider eliminating and re-introducing foods that commonly trigger sensitivities. Start with eliminating gluten and dairy for 2-4 weeks then reintroducing and monitoring for symptoms. If bloating is still an issue, there are other diets to consider that are known to improve symptoms, including the FODMAP diet. 

6: Stay active and get your beauty rest. Movement promotes gastrointestinal motility and helps maintain ideal weight while sleep is important for overall health. Avoid going to bed with a full stomach by eating at least 2-3 hours prior to going to bed. Elevate the head of the bed to minimized night time reflux.

7: Seek help. While these interventions are generally safe for everyone, frequent or daily gastroentestinal symptoms, weight loss, blood in your stool, black tarry stools or a family history of gastrointestinal problems may siginfy more significant problems and need to be further evaluated. If you need more help identifying your particular triggers, come see me at Relish Health and we'll work on an individual treatment program designed for you.