VERIFIED CONTENTAuthor: Dominika Wilk
SIBO, or bacterial overgrowth in the small intestine, can be cured. However, if we do not find the root cause of this disease, despite the use of appropriate antibiotics and following a strict diet by a dietitian, it can quickly return. Find out what needs to be done to minimize the risk of recurrence of SIBO and what measures should be taken to make it a memory.
SIBOit is an overgrowth of bacteria in the small intestine. It is the leading cause of gas, abdominal pain, excess gas, diarrhea or constipation. In addition, the symptoms mentioned above may also be caused by SIFO - an excess of Candida fungi, or IMO - an overgrowth of methane-producing archaea. SIBO can be cured with the help of a special eubiotic - rifaximin. They can also be combated thanks to a well-planned herbal therapy ( although the treatment time is significantly extended then) and a special diet (mainly Low Fodmap), which is used just after the end of rifaximin treatment. Some people feel better after the first dose of eubiotic, and the diet is the dot on the "i" and the point at which treatment is completed. Usually, however, patients need several repeated treatments of antibiotic and diet to regulate their intestinal microbiota.
Why does SIBO convert?
A lot of people who enjoy the recovery moment quickly become depressed: SIBO relapses after a few months and is just as severe as before. The sense of treatment and adherence to a long-term diet is therefore questionable. For the SIBO physician, however, this process seems obvious.
SIBO is only the effect, not the cause of the problems. If we do not find the main SIBO substrate and do not eliminate it, the problem will reoccur.
The substrate of SIBO can be many diseases and disorders. These include, among others :
- autoimmune diseases, e.g. Hashimoto's disease,
- hypothyroidism,
- poorly working MMC complex, which is responsible for cleansing the intestines,
- anatomical defects,
- bad bile flow,
- poor production of hydrochloric acid in the stomach,
- problems at the level of the oral cavity,
- disturbance of circadian rhythm,
- too short breaks between consecutive meals,
- lack of food hygiene.
The causes of SIBO, which should be eliminated before treatment
Without the removal of the main SIBO substrate, we will not achieve good treatment results, and the bacterial overgrowth will continue to take its toll. Therefore, before starting treatment with rifaximin, with the help of a doctor, you should find the cause of the excessive multiplication of bacteria in the small intestine and try to eliminate it or, for example, in the case of autoimmune diseases, try to bring them into remission.
Problems at the level of the oral cavity
Intestinal dysbiosis is always a consequence of what happens in the higher parts of the digestive system. Therefore, problems at the oral cavity level can be a factor contributing to the formation of SIBO. It is enough for our mouth to develop bacteria that then pass through the acidic stomach to the intestines to cause dysbiosis.
In addition, insufficient production of saliva, such as in diabetes, connective tissue diseases, may cause carbohydrates to be insufficiently digested in the oral cavity.
Saliva contains an enzyme called amylase, which is used to digest carbohydrates. If there is little saliva, there is little amylase, so the intestines end up with a pool of carbohydrates that has not been pretreated.
These carbohydrates can ferment and cause gas. Improper food hygiene, too fast and inaccurate chewing of food can also cause intestinal discomfort.
Problems at stomach level
Hydrochloric acid in the stomach protects us from the penetration of bacteria together with food into the lower digestive system, which inactivates microorganisms. However, when stomach cells produce too little of it, pathogenic bacteria can enter the intestines and either settle there or cause damage.
In both cases, the microbiome is unbalanced and SIBO appears.
Who is particularly vulnerable to a reduction in the production of hydrochloric acid in the stomach?
People who use PPIs (proton pump inhibitors), which are popular for heartburn and stomach ailments for too long, and who have active Helicobacter Pyroli - a bacterium that destroys the walls of the stomach and damages its cells.
Also the elderly, who lose the ability to produce hydrochloric acid with age, and people who consume too much alcohol, may lead to stomach under-acidification resulting in SIBO.
Problems at the pancreatic level
Lack of sufficient digestive enzyme production is another cause of SIBO. One of the more important glands producing both the enzymes necessary for the digestion of proteins, fats andcarbohydrate is the pancreas. When unwell, food cannot be properly prepared to be absorbed in the gut.
The digestive process is disturbed and food "deteriorates" in the intestines by fermenting excessively. Therefore, with chronic pancreatitis, there is often a bacterial overgrowth in the small intestine.
Problems at the intestinal level - MMC disorders
The Wandering Myoelectric Complex (MMC) is simply a "bowel brush" that removes food particles between meals. If the functioning of the MMC fails, the intestines cannot be cleaned of debris, and this causes fermentation and at the same time serves as a breeding ground for the bacteria. Often the cause of a disturbed MMC is damage to the Cajal cells in the gut, on which the MMC depends.
This damage occurs most often as a result of a viral or bacterial infection, when the body produces antibodies against bacteria such as:
- Salmonella,
- Campylobacter,
- Clostridium,
also begins to produce immunoglobulins directed against vinulin - a protein that is part of Cajal cells.
For this reason, the development of SIBO and a number of unpleasant symptoms from the digestive system often begin after the so-called "intestines".
The worse functioning of MMC is also influenced by various diseases, e.g. hypothyroidism, diabetes, neurodegenerative diseases.
Also, too frequent snacking between meals disturbs the activities of the migrating myoelectric complex.
Problems at the intestinal level - anatomical defects
If a patient has anatomical defects in the intestine, such as adhesions, strictures, or diverticula in the small intestine, he will be at a higher risk of bacterial overgrowth. People who have undergone surgery in the small and large intestine or women suffering from endometriosis are most exposed to SIBO. Also, a malfunctioning ileocecal valve that will cause bacteria to move from the large intestine to the small intestine will create problems.
These microorganisms produce gases: hydrogen, methane and hydrogen sulphide and it is not felt if the whole process takes place in the large intestine.
However, when it happens in the small intestine, it causes a lot of discomfort and causes bloating. That is why so many people with SIBO struggle with abdominal pain, stinging, and a feeling of pushing in the stomach.
A poorly functioning ileocecal valve is also associated with problems such as keeping the intestinal contents in the small intestine for too long, which results in excessive fermentation of food debris in the place notintended and internal poisoning of the body with toxins (and this in turn, if it happens chronically, may be one of the factors activating autoimmune diseases).
How to eliminate SIBO relapses?
Remove SIBO source
First of all, we remove the source of intestinal dysbiosis. In the case of problems with the liver and bile flow, we use drugs or choleretic herbs and support the functioning of the liver with supplements, e.g. milk thistle, silymarin, choline, curcumin, artichoke, dandelion.
In the case of problems with the oral cavity, we remain under the care of a dentist and treat, for example, xerostomia or periodontitis. If the problem is the low amount of hydrochloric acid in the stomach, after gastroscopy and other tests, under the supervision of a gastrologist, we eliminate H. Pyroli with antibiotics or, for example, we use betaine to acidify the stomach or we make other medical recommendations.
When having problems with the pancreas, we take appropriate enzymes to aid digestion, and we also monitor the pancreas for ultrasound and the level of elastase.
If we have diagnosed anatomical defects, we should visit an osteopath regularly, who will help us properly "arrange" the organs, prevent them from pressing against each other or be more relaxed, which will facilitate the flow of nutritional content through the digestive system.
Of course, after some operations, e.g. resection of a piece of the intestine, it is not always possible to restore the proper functioning of the intestines and you should take into account that after these procedures you will always be prone to dysbiosis.
Improvement of motor functions is achieved through sufficiently long intervals between consumed meals (so that the MMC complex has a chance to activate and clean up food debris from our intestines) and 12-hour fasting at night, taking prokinetics, as well as by taking care of activity physical, preferably yoga, pilates.
Prokinetics - a key point in SIBO recurrence inhibition
The treatment and diet alone are not enough to say goodbye to SIBO. It is equally important to include prokinetics after them, which will improve the migrating myoelectric complex (MMC) and prevent the retention of food content in the intestines. Prokinetics should not be confused with laxatives.
They are not intended to accelerate defecation, but to stimulate perist altic movements (they affect Cajal cells) so that the removal of food debris, parasites or pathogenic bacteria takes place quickly and prevents fermentation or settlement of pathogens.
Natural prokinetics include :
- ginger extract,
- Triphala,
- Motil Pro
- or Iberogast.
In turn, prescription prokinetics are usually:
- Itopryd,
- Cisapride,
- Metoclopramide,
- Trimebutin.
They are most often taken between meals, although the most important thing is to take them before going to bed, 3-4 hours after eating dinner.
Probiotics - one of the options for balancing the gut microbiome
The issue of using probiotics with SIBO is sometimes controversial because they can exacerbate ailments. If the doctor selects a probiotic, it is usually a product containing one strain of bacteria, usually of the Bifidobacteria species.
Probiotics are used singly, turning them on slowly and observing the body's reactions. If the symptoms worsen, then the selected probiotic is replaced with another or the probiotic therapy is abandoned at all.
Despite everything, a doctor or nutritionist always tries to use a beneficial strain, because introducing it inhibits pathogenic bacteria and helps to neutralize harmful compounds that are formed in the intestines. If the patient tolerates the probiotic well, it will always benefit his gut microbiota.
Stress Relief
Chronic stress has disastrous effects on the body and it has a real justification in the case of intestinal dysbiosis. Stress causes intestinal leakage, which leads to the penetration of endotoxins and antigens into the bloodstream.
The irritated immune system devotes its resources to fighting toxins and antigens, which means there is no more time and resources to fight pathogenic bacteria in the gut.
For this reason, it is very important in SIBO not so much to limit stressful situations (which we often have no influence on), but to learn to deal with them constructively and without harm to the psyche.
Many people with SIBO experience significant improvement after switching to psychotherapy and see the real impact of calming their thoughts on the better functioning of their body.
Normalizing the circadian rhythm
Despite the progress of civilization, we humans still function according to the principles of nature. And this makes us live according to a constant circadian rhythm and violating it often brings dire consequences in our body. According to what mother nature has planned for us, we should not overeat at night, because then it is time for the intestines to rest, and the liver and gall bladder prepare for cleansing (this takes place between 1 and 3 am).
In addition, there is natural insulin resistance at night, caused, among others, by by melatonin, which makes the economy worsesugar, and we are exposed not only to increasing the amount of adipose tissue, but also to glycemic disorders in our body.
Eating at night also disrupts the functioning of the MMC complex ("intestinal brush"), which cannot clean the intestines of food residues and pathogens, because, as already mentioned, it is included in the period between meals and during the night fast.
If we don't go to bed before midnight, we disrupt the production of melatonin, which is one of the strongest antioxidants that supports the regeneration of the intestines and the reconstruction of its mucosa. In addition, it has a positive effect on the functioning of the wandering myoelectric complex, i.e. it supports the cleansing of the intestines.
By not allowing ourselves to sleep at night, we also strongly disturb the functioning of the thyroid gland, and this is also very much related to the proper functioning of intestinal motility.
To restore the proper circadian rhythm, we should go to bed around 10 p.m. and then eat a light supper 2-3 hours earlier , consisting of good-quality carbohydrates, with addition of fat and protein containing tryptophan, which will facilitate our sleep and the production of melatonin.
Before going to bed, we should not use blue light from, for example, mobile phones, or watch news or movies that throw us off balance (it is about ensuring good quality sleep).
In order to activate our hormones in the morning, we should go outside right after getting up, so that sunlight can signal our cells that the day is about to begin and the entire machinery of hormone production, enzymes, etc. can be activated .
Meal times are also important, as are eating the most meaty meals during the day, not just before going to bed (because it disrupts digestive functions).
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