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SIBO; AN OVERGROWTH OF BACTERIA CAUSING GI PROBLEMS

SIBO; an overgrowth of bacteria causing GI problems


If you or your known have been experiencing symptoms like bloating, gas, abdominal pain then you should know about Small Intestinal Bacterial Overgrowth ( SIBO )

We all have bacteria in the gut (majorly large intestine) and they play a major role in digestion. If the “good” bacteria that help you digest food can’t keep up with the harmful bacteria, the “bad” germs can multiply too fast, leading to an imbalance.Hence when too many bacteria, or the wrong kind, populate the small intestine, it can lead to uncomfortable symptoms such as gas and diarrhea. It can also inhibit your ability to digest and absorb nutrients from food. This is SIBO (small intestinal bacterial overgrowth) 

As a result, the small intestine is not able to handle a large number of bacteria growing inside it. When a person eats, these bacteria begin to ferment the food. Hence to put it in simple words SIBO is a common digestive imbalance often found in patients that experience bloating, flatulence and burping, and a change in their bowel habits, becoming either more constipated or tending towards diarrhea.


Types of SIBO :

There are three different types of SIBO, differentiated by the main types of gas produced by the bacterial overgrowth in the small intestine.


1. Hydrogen Dominant (SIBO-D):

D-Stands for Diarrhea i.e. when there is an overgrowth of bacteria in the small intestine that product hydrogen then the patient is suffering from SIBO-D 

As a normal process bacteria produce hydrogen gas as a by-product of carbohydrate fermentation in the digestive system & hydrogen does exist in our large intestine as a by-product of this fermentation. But when large amounts of hydrogen gas is produced then the problem starts. This causes fast transit time and/or loose stools.


2. Methane Dominant (SIBO-C):

C-Stands for constipation. Now along with bacteria, our intestinal flora also consists of organisms known as Archaea which are a bit different than bacteria as they are single-celled organisms that don’t have a nucleus. They feed off of hydrogen that bacteria produce during the fermentation of carbohydrates (fiber specifically) and then produce methane as a byproduct of their digestion.

Due to Lactose malabsorption and decreased motility of the digestive tract, there is an overgrowth of archaea in the gut leading to more methane production which leads to constipation and excessive bloating.


3. Hydrogen Sulfide Dominant:

Our body uses sulfur for our cells and microbiome. It then detoxes and excretes most of the by-products of sulfur metabolism.

In a healthy person, a small amount of sulfur is converted into hydrogen sulfide. But if too much hydrogen sulfide is produced by our microbiome then the natural way to detoxify it in the gut is overwhelmed & it can cause many health issues, including SIBO.


What causes SIBO:

When Bacteria grow and stick around too long and the food is not moving in the right way then SIBO usually starts

Things that can cause SIBO or make it more likely are :

Low production of acid due to factors like H.Pylori infection, prolonged use of medicine like antacid & proton pump inhibitors or gastric bypass surgery or in old age 
Too long retention of waster in the small intestine before emptying into large intestine allowing small intestine bacteria to continue to multiply while large intestine bacteria make way         nto the small intestine in conditions like gastroparesis
Due to anatomical change in small intestine inhibiting motility and regular clearing of residual bacteria 
Due to medical conditions like diabetes, Irritable Bowel Syndrome or weak immune system affecting intestinal immunity to certain bacteria
Medications like  antibiotics that affect the bacteria in the intestine or narcotics


What are the symptoms of SIBO?
SIBO symptoms often mimic other disease states, the most common symptoms are :
Abdominal pain
Abdominal distension
Nausea
Bloating
Indigestion
Gas
Diarrhea
Constipation
Unintentional weight loss
Fatigue


What happens if SIBO is left untreated?
SIBO can cause more serious complications with long-term consequences. 

  • Excess bacteria in the small intestine
  • Breaks down bile salts which have a role in fat digestion hence resulting in diarrhea
  • Also, the incomplete absorption of fats result in poor absorption of Vitamin A, D, E, K causing a vitamin deficiency
  • It also reduces the absorption of proteins and carbohydrates
  • Malabsorption of fats, proteins and carbohydrates can lead to malnutrition and vitamin deficiencies

Bacteria in the small intestine synthesize as well as use vitamin B-12 which is essential for the normal functioning of the nervous system and the
production of blood cells and DNA. This deficiency of B-12 results in weakness, fatigue, tingling, and numbness in hands and feet and, in advanced cases, to mental confusion. Damage to the central nervous system resulting from B-12 deficiency may be irreversible.
With time this abnormal bacterial growth causes poor calcium absorption and may lead to bone diseases, such as osteoporosis and kidney stones.


Role of Lactobacilli in SIBO:
Lactobacilli are known as the Probiotics or the good bacteria and have a great ability to colonize the GI tract and restore microbiota-host symbiosis, an important element in treating gastrointestinal pathologies such as SIBO. A study conducted in 2019 showed evidence that a preparation containing L. acidophilus and Lactobacillus Plantarum along with boulardii showed a significant reduction in both SIBO prevalence and symptoms. Lactobacilli may work due to its amazing capability to produce an antimicrobial compound that is incredibly effective against E. coli, Klebsiella, and other bugs commonly found in SIBO. In other words, it effectively does the stomach acid’s job of killing off unwanted critters entering the body in the absence of it. Also, it may increase motility could provide an essential action for those who tend towards constipation.

Conclusion : 
Assuming that you experience the ill effects of gastrointestinal manifestations — bloating, gas, cramping and acid reflux — it could be SIBO. Since the underlying cause are similar to many other problems so in place of hoping for the symptoms to die down with time it is a better option to consult your doctor. You may also enquire about the advantage of lactobacilli or probiotics to help in the treatment 



Reference : 
https://www.medicalnewstoday.com/articles/324475
https://www.mayoclinic.org/diseases-conditions/small-intestinal-bacterial-overgrowth/symptoms-causes/syc-20370168
https://www.webmd.com/digestive-disorders/sibo-overview-what-is-it
https://andytherd.com/2021/08/24/the-best-probiotics-for-sibo-treatment/#:~:text=Multiple%20strains%20of%20lactobacillus%20display,who%20also%20suffer%20from%20IBS
https://my.clevelandclinic.org/health/diseases/21820-small-intestinal-bacterial-overgrowth-sibo


Disclaimer : 
All images, visuals are used for representation purposes. We do not claim any copyright over these images. 


Content Credit: Rajneesh Negi