IBS, Celiac Disease, or SIBO?

Gut and digestion problems are my favorite topic. Due to my love for all things poop and healthy flora,  I have have a pretty constant stream of questions come to me in regard to gut dysfunction and questions about food. Since I spend a grand amount of time researching the gut, I wrote a post outlining some of the hot gut topics with hope to provide some insight.

Not only are “food intolerances”, and diagnoses of IBS surfacing left and right, but the obsession with probiotics, fermented foods, elimination diets and the self proclaimed diagnoses of candida are everywhere.  Between my crazy GI history the past couple years combined with my interest in the micro-biome and integrative medicine mixed with some conventional and herbals, I have quite a bit of knowledge on all things digestion and poop, so here is my attempt to shed some light and explain many common misconceptions and maybe even answer some questions about gut problems along the way.

In order to keep myself organized for my short and sweet intro to this (because quite literally I could write a full book), I want to list the topics I plan on addressing.

– Ignoring the signs
– IBS
– SIBO
– Probiotics
Signs and Symptoms– First and foremost, problems with digestion are on the rise. The number of allergy and food intolerances are increasing in the Untied States every year, and while there are tons of hypotheses on why that could be such as processed foods, or eliminating foods unnecessarily, it absolutely needs to be addressed and recognized in conventional medicine. So many people struggle with digestion issues or self proclaimed “intolerances” to certain foods, and deem it as normal. It almost seems as though the dysbiosis of the gut has become so prevalent, that it becomes common discussion and everyone and their mother is taking a probiotic or fermented products to keep their micorbiome at bay.   Excessive gas, bloating, alternating diarrhea and constipation, cramping, extreme fullness, sugar cravings, discomfort and even symptoms such as brain fog, acne and migraines can all be very much linked to the gut. I will hands down be the first person to say these things while common, are not normal, and should never be ignored because they are embarrassing, dismissed by a conventional medicine physician, or difficult to talk about.  On the other hand, self treating by cutting out whole food groups or taking a probiotic is simply not going to fix.  Go back to the basics and break it down. Look at the facts and what is going on in the gut. Was it predisposed by a virus, antibiotic use, travel, surgery? Without totally going into a tailspin about conventional medicine and diagnostics in this post, I just want to be clear that having these symptoms are common but not normal and to be addressed and worked on. Discussing with an integrative medicine practitioner or come pick my brain ( I am a nurse, not a dietician, but my plan is to become an FNP to work with clients and these problems in the near future).  to help determine what needs to be addressed in the gut, and what to change or try not only feel better in the gut, but improve your immune system as well as mental health as those three things go hand in hand.

IBS– This is the most common fishnet diagnosis given by conventional medicine doctors when they can’t find anything structurally wrong. You go in, explain your stool cycles, bloating, even the brain fog or fatigue and they run labs, schedule a colonoscopy or endoscopy, maybe even a CT. You go, and they rule out celiac disease, ulcers, IBD such as crohns or ulcerative colitis, and diverticulosis and leave you with a shrug and a diagnosis of “IBS”. Maybe you get told to take an osmotic laxative (amitiza or linzess), told to increase fiber or take an over the counter probiotic and they tell you to follow up in two months.  Though IBS is a very real diagnosis, I would argue from my research that often times is misdiagnosed, or the root problem is actually ignored. There are a few causes of IBS but the most common is  usually due to one of two things.

1. A dysbiosis of gut bacteria either in the large bowel or small bowel. This is basically another word for imbalance of the “good” and “bad” bacterias that are in your intestines.  In other words, when bacteria that are typically found in the gut such as candida or E coli wreak havoc and overgrow in the gut or are found in the wrong place.

2. Small intestinal bacterial overgrowth  (SIBO).  Now jumping into SIBO (this my favorite topic, seriously could write a small book on it).  It has been found that up to 78% of people who have been diagnosed with IBS actually have SIBO. This is becoming increasingly more accepted in the conventional medicine world, and I am so excited about it! SIBO used to be thought of as solely a diagnosis of motility dysfunction (1 point for myself there) but that is only one of many reasons someone can develop SIBO. Overuse of antibiotics, low stomach acid (due to under eating or eating disorders), longstanding undiagnosed celiac disease altering motility, contracting a parasite while traveling, or even a virus such as EBV or food poisoning are all reasons for why SIBO can develop.

 The basic facts (with short answers)

What exactly is SIBO? when the bacteria in your small intestine exceeds 10,000 organisms/mL. Any healthy person also has thousands of bacteria/mL in the small bowel, BUT with SIBO, its an overgrowth of this bacteria that causes the problem.

Why does bacteria overgrow:  The bacteria that should be in the large bowel are not getting pushed down with the migrating motor complex every 90-120 minutes,  which may be due to chronic motility problems, or  a temporary decrease in motility due to a travel bug, or temporary virus.  The other reason the bacteria may overgrow is due to antibiotics, which is especially seen with several rounds of it, wiping out all the “good” bacteria as well as the bad, predisposing the bacteria to overgrow.

Why is this a problem: The large majority of nutrient absorption occurs in the small bowel, so when someone is affected by SIBO, the bacteria are fed before your body gets the chance to absorb those nutrients, leading to malabsorption problems and leaky gut.  Leaky gut can even lead to food sensitivities long term, making the problem even more complex.

symptoms: severe bloating, discomfort gas, diarrhea, constipation and weight gain
The bacteria eat your food and then produce one of two gasses:
1.  A byproduct of fermentation of carbohydrate consumption, hydrogen gasses are produced leading to symptoms of diarrhea and belching.

2.The archaea bacteria feed off of hydrogen gas to  release methane gasses lead to symptoms of constipation, weight gain, and severe bloating. This is more commonly seen with gastroparesis, altering migrating motor complexes, and is much harder to treat with antimicrobials due to the thick biofilms that occur as a result.

How to diagnose  SIBO:

The most common way to test for SIBO is through lactulose and hydrogen breath tests. These are cheap simple tests done in 3-5 hours to determine the amount of bacteria present after drinking a sugar solution. The concentration of bacteria present in your breath help determine whether your SIBO is hydrogen or methane dominant, and therefore can give a better indication on how to treat it.

Treatments: 

Meds: Treatment can be tricky, and is totally dependent on whether the SIBO is hydrogen or methane dominant.

The conventional medicine route is actually through use of an antibiotic, but rather than broad spectrum, it targets the GI tract. the antibiotic xifaxan is the drug of choice but there has also been some success seen with neomycin. The problem with conventional antibiotics is that if you have recurrent SIBO, this is not a long term solution, and many insurance companies wont cover it.

In alternative and integrative medicine, antimicrobials work wonders.  A few of my personal favorites are Berberine, Allicin and Biocidin. Biocidin helps break up that biofilm as seen with methane based SIBO whereas Berberine and Allicin work as antimicrobials.

Diet: Aside from herbals or antibiotics, diet plays an important role. Jumping to an elimination diet or anything extreme can be detrimental to nutrient absorption, but decreasing carbohydrates and sugars are a good place to start. The carbohydrates and sugar act as fuel for the bacteria to feed off of. Packaged foods and extra carbohydrates provide little to no nutrients, and are a good place to start. If you are active however, carbohydrates and bread are a necessity, so it can be difficult to find that balance. The Specific carbohydrate diet and Low FODMAP diet are also good options if just watching sugars and carbs is not enough and symptoms are unbearable.  Just keep in mind that these diets are to be used for 2-6 weeks maximum to help treat the SIBO, and are not a permanent solution as they will lead to nutritional deficiencies and imbalances if used long term.

Ultimately, SIBO should be treatable, and FODMAPS and other fermentable foods can be reintroduced in the diet (more about those below), but with those who suffer from motility disorders, SIBO is often a recurring issue that needs to be managed in a cyclical pattern. Finding the right combination of antimicrobials, diet and stress management is key to alleviating the SIBO symptoms. Stimulating the vagus nerve through gargling, yoga, belly breathing, singing and “om-ing” can also help keep that migrating motor complex at work.

Probiotics: I have so much to say in regard to probiotics, but I will save the majority of it for later post.  I am going to hit a few key points. For starters, probiotics are absolutely not for everyone. There is actually not a whole lot of hard science backing up probiotics. They can actually exacerbate symptoms in someone with IBS or SIBO. If fermentable foods like pickled veggies, onion, or kombucha are making the bloating and gas worse, that is an indicator to me that SIBO is absolutely a possibility, and avoiding pre and probiotics is a must. Same goes for carbonated beverages, beer etc.

On the other hand, probiotics can be wonderful for someone who is undergoing a round of antibiotics, and can prevent stomach upset or a vaginal yeast infection. In crohn’s or autoimmune disease, super high concentrations of probiotics have been found necessary and helpful. Some of the high end recommended probiotics are VSL #3, prescript assist, and probio 225 if you find that they do help you and if you are in need of some high quality probiotics. I have also heard contradictory advice from physicians and practitioners with regard to IBS and SIBO and probiotics, which even further shows how little evidence based rooted the research is. My advise is, be weary. Don’t just hop on the probiotic train because everyone else is doing it, but instead try first to get the healthy bacteria in normal amounts through yogurt (greek is better for more protein!). and trying them won’t hurt. Go for an over the counter brand first such as florastor and give it 3-4 weeks. See how you feel. If there’s an improvement, keep taking them or switch to a heavier probiotic. On the contrary, an increase in GI upset, bloating or gas could be an indicator of SIBO and hopping off the probiotic train is probably the best move.  I promise, more on the pre and probiotics to come!

Hopefully this was a helpful intro into the gut, IBS, SIBO and some of the more common functional GI disorders. I have linked a few articles that thoroughly explain SIBO below if you’re interested in learning more in depth.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347643/

https://www.sciencedirect.com/science/article/pii/S0889855316300838

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/

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