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SIBO: When good bugs are bad

SIBO: When good bugs are bad

Ever since the Louis Pasteur showed evidence for the germ theory of disease, the simplified thought has been, “disease bad, germs bad.” More recently of course, since the discovery of the microbiome, the thought has been, “germs are bad, except when they are good, like in the intestinal tract (the gut).” With the discovery of Small Intestinal Bacterial Overgrowth (SIBO) , however, the thinking has taken another turn.  The large intestine is supposed to have many bacteria, the small intestine, a lot less. When good bacteria overgrow that is called SIBO and it is known to cause gas, bloating, abdominal pain, diarrhea, or constipation.

SIBO in fact, is greatly associated and thought to be one of the causative factors in Irritable Bowel Syndrome (IBS). It’s been estimated that it is involved in over half of the cases of IBS (1) and one breath testing study found it to be associated with up to 84% (2).  The overabundance of bacteria in the small intestine in part creates IBS, but making too much hydrogen or methane gas, which leads to bloating and distension (3).  People whose bacteria make too much hydrogen gas tend to have diarrhea and those that make too much methane tend to have constipation. People with IBS often have over sensitive intestines and all this GI chaos can easily cause abdominal pain as well as malnutrition in some cases.

Regretfully, amongst those that don’t have it, IBS often does not garner the respect it deserves, and similarly neither does SIBO.  But, a careful look at the medical literature shows, that SIBO is, in fact, associated with a lot of other conditions as reported by SIBO experts, Siebecker and Sandberg-Lewis  (4), including  hypothyroidism (5), systemic sclerosis i.e. scleroderma (6), celiac disease (7), diabetes with autonomic neuropathy (8), hepatic encephalopathy, nonalcoholic (9) fatty liver (10), interstitial cystitis (11), restless leg syndrome (12) ,acne rosacea (13) , and many more.

Now just because an association is true, we can’t say, “SIBO caused this disease” or “that condition caused SIBO.”   For each one, we would need to look at the evidence to make a causation hypothesis.  Scleroderma for example, likely causes constrictions, slowing down intestinal movement contributing to SIBO. Similarly, diabetes hurts the intestinal nerves everywhere, which can slow down intestinal movement contributing to SIBO.  SIBO might cause restless leg syndrome because one of the nutrients most susceptible to the general nutrient malabsorption is iron and low iron levels may cause restless leg syndrome.

One particular causative analysis along these lines involves the number one killer in all industrialized countries

Heart disease.

One of the greatest boons to detecting coronary heart disease early is the coronary calcium scan, which can detect the accumulation of calcium in the coronary arteries.  It turns out that we have a particular protein called matrix Gla-protein (MGP) that counteracts this calcification  (14, 15).  But it has to have undergone a chemical reaction called carboxylation and Vitamin K2 is what makes that happen (16).  The thing is though that we don’t get much Vitamin K2 from our diet. We make most of what we need in our gut from our gut bacteria.  Therefore, you’d think that if you had MORE gut bacteria you’d make more vitamin K2 and prevent atherosclerosis.    Surprisingly, though, SIBO is associated with impaired vitamin K metabolism in humans (17, 18).  Therefore, you can’t make the K2, then you can’t carboxylate the Gla-protein and you can’t as well prevent calcium from building up in your coronary arteries (19).

So yes, SIBO can be a cause of heart disease.   Seems more important now, doesn’t it?

While gastroenterologists do know about SIBO, it does seem that holistic, integrative doctors focus on it more and more often than not.  They are the ones to order the breath tests, which can detect it.

If you feel you would like to be checked for that, we can see you at Health and Wellness of Carmel.  And we can treat it!

-Dr. Bruce Thomas

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2. Lin HC et al. Small intestinal bacterial overgrowth: a framework for understanding irritable bowel syndrome. JAMA. 2004 Aug 18;292(7):852–858.

3. Youn YH, Park JS, Jahng JH, et al. Relationships among the lactulose breath test, intestinal gas volume, and gastrointestinal symptoms in patients with irritable bowel syndrome. Dig Dis Sci. 2011 Jul;56(7):2059–2066. Epub 2011 Jan 15.

4. Allison Siebecker, ND, MSOM, LAc, and Steven Sandberg-Lewis, ND, DHANP
Small Intestine Bacterial Overgrowth:
Often-Ignored Cause of Irritable Bowel Syndrome Townsend letter March/April 2013 https://www.townsendletter.com/FebMarch2013/FebMarch2013.html

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