Salt Therapy

Many people are affected by some form of irritable bowel, inflammatory bowel disease or other digestive complaints such as nausea, bloating and diarrhoea. Many of these disorders often have no obvious reason for their manifestation, however one possible causative factor could be a condition know as small Intestinal bacterial overgrowth. 

What is SIBO?

Small intestinal bacterial overgrowth (SIBO), is a condition in which abnormally large numbers of bacteria inhabit the small intestine. These types of bacteria closely resemble those that are usually found in the colon. This causes problems as the small intestine should contain relatively small amounts of bacteria in comparison to the colon.

The small intestine, otherwise known as the small bowel, is a part of the digestive system that connects the stomach with the colon. The main purpose of the small intestine is to digest foods that we eat and absorb the nutrients from it into the body. The small intestine comprises of three parts: the duodenum, the jejunum and the ileum which empties undigested food into the colon.

What causes SIBO?

Bacteria are usually moved from the small intestine to the colon by wave-like muscular contractions referred to as peristalsis. The ileocecal valve prevents movement of bacteria from the colon back into the small intestine. However disruptions in both protective mechanisms can occur which leads to the accumulation of bacteria in the small intestine.

This can lead to bacteria overgrowth in the small intestine and symptoms of bloating, flatulence, discomfort and nausea. Bacteria can break down bile acids needed for the absorption of fats and the fat-soluble vitamins A, D, E and K, resulting in excess fat excreted through faeces (steatorrhea), chronic diarrhoea and nutrient deficiencies. In severe cases, the bacteria can damage the lining of the intestines, impairing the absorption of carbohydrates and proteins from food and resulting in malnutrition.

Symptoms of SIBO?

• Nausea, vomiting or/and chronic diarrhoea
• Bloating and cramps
• Flatulence 
• Fatigue
• Weight loss
• Malabsorption which can lead to malnutrition or anaemia and nutritional deficiencies – including B12, f fat soluble vitamins

An Australian study detected SIBO in 13% of healthy participants using a lactulose breath test. SIBO is also higher in people with IBS. A study in 111 patients with IBS, found 20% had abnormal test results indicative of SIBO.

Celiac disease is associated with a significant increase in the prevalence of SIBO. 

According to a study published in the American Journal of Gastroenterology, 66% of patients with celiac disease who maintained a strict gluten-free diet tested positive for SIBO.  Although data is limited, SIBO in young and middle-aged adults appears to be low at about 6%, whereas prevalence rates appear to be consistently higher in people over the age of 61 (15%).

Rosacea, a skin condition that causes skin rashes and inflammation on the face is also associated with higher rates of SIBO.

SIBO is also related to other conditions including chronic fatigue syndrome, asthma, eczema and joint pain.

Risk factors factors for SIBO

There are many health conditions which may be associated with SIBO. These include:

• Chronic pancreatitis
• Diabetes mellitus
• Diverticulitis
• Scleroderma
• Structural defects, obstruction and scarring in the small intestine
• Fistula
• Celiac disease
• Certain medications: immunosuppressant’s and proton-pump inhibitors
• Low stomach acid
• Neurological conditions

SIBO is often treated with antibiotics, however may also lead to the destruction of the bacteria that is needed for healthy digestive function. Antibiotic therapy also increases the risk of SIBO reoccurring with worsened gastrointestinal symptoms. 

Help through Natural Therapies

Support the Digestive Process

Support digestion with a healthy diet and supplement such probiotics, Milk thistle, green tea, dandelion root and spirulina. Stimulate digestive function with supportive agents such as ginger, gentian, glutamine and digestive enzymes. Psyllium husks, slippery elm, chia seeds and linseeds are useful fibres which can be added to the diet. 

Reduce Inflammation

Herbs and nutrients that help to promote healing and repair  include licorice (Glycyrrhiza glabra), aloe vera, slippery elm, marshmallow (Althaea officinalis), vitamins A and D, and Zinc.

Eradicate and Remove Bacteria over-growth

Herbal medicine which can help reduce the load of pathogenic bacteria include Philodendron (Phellodendron amurense), garlic (Allium sativum) and oregano (Origanum Vulgare).

SIBO diet

Different diets may be used, depending on the individual and their symptoms. For people with IBS symptoms, following a FODMAP diet may help. FODMAPS’ are foods that ferment in the digestive tract, feeding the bacteria living in your small intestine. Foods to avoid include foods high in fructose, lactose in dairy, fructans (wheat, garlic, onion, broccoli, cabbage), galactans (legumes, soy, brussels sprouts) and polyols (sorbitol, malitol, xylitol). For more information refer to the article on FODMAPS diet.

Other diets suggestions include a wholefoods diet, gluten and dairy free diet, or an elimination diet with rechallenges to determine if there are any specific foods contributing to the problem.

• Reduce foods high in sugar which helps to reduce bacteria in the small intestine
• Avoid processed foods, alcohol, soft drinks 
• Increase water intake

The information contained in this article should purely be used as a guide only. If you have any of the symptoms of SIBO or would like to undergo treatment to resolve the condition it is best to seek help from your Naturopath or GP.

References

1. http://www.webmd.boots.com/digestive-disorders/small-intestinal-bacteria-sibo
2. Dukowicz AC, et al. Small Intestinal Bacterial Overgrowth. A comprehensive review. Gastroenterol Hepatol (N Y). 2007 Feb;3(2):112-122 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/
3. Tursi A, et al. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol. 2003 Apr;98(4):839-43 https://www.ncbi.nlm.nih.gov/pubmed/12738465
4. Egeberg A, et al. Rosacea and gastrointestinal disorders: a population-based cohort study. Br J Dermatol. 2017 Jan;176(1):100-106 https://www.ncbi.nlm.nih.gov/pubmed/27501017
5. Chedid V, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014 May;3(3):16-24 https://www.ncbi.nlm.nih.gov/pubmed/24891990
6. http://Leyva-López N, Gutiérrez-Grijalva EP, Vazquez-Olivo G, Heredia JB. Essential Oils of Oregano: Biological Activity beyond Their Antimicrobial Properties. Molecules. 2017 Jun 14;22(6):989. doi: 10.3390/molecules22060989. PMID: 28613267; PMCID: PMC6152729.
7. http://Ross ZM, O'Gara EA, Hill DJ, Sleightholme HV, Maslin DJ. Antimicrobial properties of garlic oil against human enteric bacteria: evaluation of methodologies and comparisons with garlic oil sulfides and garlic powder. Appl Environ Microbiol. 2001 Jan;67(1):475-80. doi: 10.1128/AEM.67.1.475-480.2001. PMID: 11133485; PMCID: PMC92605.