SIBO: what is it and what are the symptoms

    SIBO: what is it and what are the symptoms

Have You Ever heard of SIBO ? It is, in medical terms, what is called bacterial overgrowth in the small intestine . A syndrome that, as stated by Amaia Martioda Lizarralde, D-nutritionist at EPICFIT, affects at least 35% of the population.

From the EPICFIT nutrition, health and sports center they tell us everything about SIBO. Do not lose detail!

SIBO ( Smal Intestine Bacterial Overgrowth), that is, bacterial overgrowth in the small intestine, is a syndrome that affects at least 35% of the population and can have a greater impact on people who also suffer from irritable bowel syndrome, constipation , chronic fatigue syndrome, celiac disease....

And although the intestinal microbiota is an essential organ for maintaining health, regulating the immune system, digestion, metabolism and is also related to the endocrine system, its alteration in diversity or population number of the microorganism can initiate this pathological process.

The Intestinal microbiota is the set of bacteria that live mainly in the large colon and in healthy conditions should not colonize the small intestine.

These bacteria mainly act in the digestion and absorption of food. But once they have been able to migrate to the small intestine, they will cause digestive discomfort, bloating, bloating, abdominal pain, bloating, belching, heartburn , constipation...

Types of SIBOs

To date we know of 3 types of SIBO and they are the following:

• Hydrogen SI BO , is generated by very large colonies of bacteria.
• SI BO of methane , generated by methanogenic archaea-like bacteria.
• Sulfate SI BO still under investigation.

Alteration of this microbiota produces proinflammatory cytokines that will simultaneously damage the intestinal mucosa. What will produce an intestinal inflammation and malabsorption of nutrients?

So it is common to find deficiencies in vitamin B12, fat-soluble vitamins A, D and E and iron. However, we could find high levels of folate and Vitamin K due to the ability of bacteria to synthesize them.

It is also common to see altered enzymatic activity of the following nutrients (fructose, histamine, sorbitol, lactose, gluten...), since both enzymes and transporters can be affected by intestinal inflammation.

Nutrient malabsorption and digestive discomfort can also lead to weight loss, fatigue, asthenia , lack of appetite, eating phobia, and even the risk of other opportunistic infections such as Candida or other yeasts.

With prolonging this condition, the risk of suffering intestinal permeability (leaky or leaky intestine) is generated. The final phase is where the immune system begins to act, generating systemic inflammation and increasing the risk of suffering from other inflammatory digestive diseases such as Crohn's, ulcerative colitis, allergies or other autoimmune diseases. But why does it appear or what causes generate it?

Causes of SI BO

anatomical

When the valve that separates the colon and the small intestine "ileocecal valve" remains open or even the "blind loop syndrome" can be an ideal place for the proliferation of bacteria (diverticulosis, fistulas, intestinal adhesions, intestinal surgeries... ).

Deficit in hydrochloric acid, bile or digestive enzymes

When there is low activity of these secretions and enzymes, the risk of more batteries reaching the stomach and then the small intestine increases (hypochlorhydria, consumption of proton pump inhibitor drugs, antacids, gastritis ...).

Lack of intestinal motility

Constipation, low-fiber diet, lack of physical activity, or diseases such as obesity, hypothyroidism, short bowel syndrome, or even autoimmune pathologies ( diabetes, celiac disease, Hashimoto's hypothyroidism, arthritis...)

If you suspect you have Sibo, the first thing you should do is go to a digestive doctor so that he can collect your complete medical history and recommend the most appropriate diagnostic tests for your case, and then proceed to a correct diagnosis. .

How can I tell if I have SIBO?

The glucose or lactulose breath test is the one that is usually requested for the diagnosis of SIBO. It is a non-invasive breath test and consists of blowing through a mouthpiece after taking glucose or lactulose syrup.

The results of this test are represented in a curve where the concentration of the gases (hydrogen and methane) will be represented during the horizontal axis, elapsed time.

Although the interpretation of the results must be done by a qualified professional for a correct diagnosis, we must emphasize that the test may have considerable limitations, since there is a risk of FALSE negatives in people with rapid intestinal transit or in cases of SIBO due to hydrogen sulfide. . In addition, it is important in the case of wanting to do this test, that the previous indications are respected.

How is SIBO treated?

Once SIBO is diagnosed, it is important to continue with the treatment indicated for it. In addition to being pharmacological (broad-spectrum antibiotics for 7-14 days), treatment can be accompanied by herbal treatment.

Pharmacological and herbal treatment should be considered in any case by a digestive doctor. But the therapeutic approach must consider not only correcting the overgrowth alteration but also restructuring the microbiota and addressing the cause of SIBO to avoid a second alteration, since relapses are quite common. About 50% of cases suffer second and third relapses and resistance to drug treatment.

As adjuvant treatment we can offer;

• PROKINETICS to improve intestinal motility.
• DIGESTIVE ENZYMES to prevent dyspepsia.
• PROBIOTICS to restore the microbiota once the antibiotic has finished.
• MULTIVITAMIN SUPPLEMENTATION should be assessed if there is a micronutrient deficit.

In addition to pharmacological and herbal treatment, we recommend adapting the diet to favor the person's symptoms. For this, it is convenient for a professional D-nutritionist to assess the case and consider the best feeding pattern so as not to generate complications. But the strategy that can best help these cases, always adapting it to the person and for a limited time, is the low FODMAPs diet. This strategy limits all fermentable carbohydrates and reduces the symptoms of SIBO , but does not eradicate it.

So it can be a useful tool as long as it is not kept for more than 4 weeks and is done under professional supervision.

Last but not least, we must mention the importance of stress management , since chronic stress has a direct implication in the proliferation of bacteria, it decreases the secretion of hydrochloric acid (achlorhydria), the rhythm intestinal increasing the risk of bacterial translocation and increases the risk of inflammatory bowel and autoimmune diseases.

Therefore, we must also consider the importance of night rest, synchronize circadian rhythms (the biological clock) and manage stress situations that may be affecting you in the day-to-day. Psychological therapy is an essential part of many people who suffer from this type of alteration in order to prevent possible future relapses.

AMAIA MARTIODA LIZARRALDE
D- EPICFIT nutritionist Collegiate