Understanding gastrointestinal issues is in its infancy stage for BOTH medical doctors AND functional medicine. My gastroenterologist told me it may take another decade before her profession gets a grasp of it. And that includes bacterial overgrowth, specifically Small Intestinal Bacterial Overgrowth (SIBO). In this article, I will discuss what SIBO is, how and why it is formed, current methods used to treat it; and what we need to do to stunt it, forever!
How is Small Intestinal Bacterial Overgrowth formed?
The three macronutrients the human body needs to maintain structure and energy are: protein, carbohydrates and fats. Of these three, one stands out in terms of SIBO development. When the gastrointestinal system cannot break down this certain nutrient in the intestines — in simple terms — it rots! That nutrient is called: protein — specifically, animal protein, like beef, fish and eggs. If the small intestine cannot break down these proteins into smaller digestible molecules called amino acids, then these undigested proteins leave the small intestine, then pile up in the large intestine. The body cannot do anything with these undigested proteins and is forced to either expell them through feces or break them down into a more desirable component. That is where bacteria comes in to play. The more abundant the protein pile up, the more the bacteria needed. If these proteins become unmanageably large in accumulation, then bacteria in the large intestines will proliferate. If these proteins back up into the small intestine, from whence they came, then bacteria is forced to follow. This sequence of events is what has become known as: Small Intestinal Bacterial Overgrowth!
Why is Small Intestinal Bacterial Overgrowth Formed?
If there were no bacteria in the intestines, mankind would cease to exist. Intestinal bacteria has a strange way of keeping us alive. When the large intestine breaks down the protein we consume, nitrogen is released in the form of ammonia as a byproduct. It takes ammonia/nitrogen to build protein — and it takes the release of ammonia/nitrogen to free protein into its smaller amino acid component. This ammonia under ideal circumstances is then transported to the liver via the portal vein, to be processed.
The liver then uses a process called the urea cycle to convert ammonia into urea, which is then processed by the kidneys and excreted in urine.
However, this process does not always go as planned.
If the liver is damaged, it cannot effectively process and turn ammonia into urea, leading to a buildup of ammonia in the blood — a condition that can lead to severe ammonia accumulation, called hyperammonemia. A build up of this ammonia can actually lead to brain injury, and even death!
Now comes Intestinal Bacterial Overgrowth to the rescue! Bacterial Overgrowth is actually a defense mechanism the body uses to prevent injury or death from high ammonia! Instead of being called Bacterial Overgrowth, it may be more appropriately called Bacterial Necessity!
This then causes hydrogen and methane gases to raise in the small intestine and colon, to buffer excess ammonia. In fact, there are three common tests to check for SIBO:
Hydrogen dominant SIBO
Methane dominant SIBO (n.k.a. Intestinal Methanogen Overgrowth [IMO])
Hydrogen sulfide SIBO
As these names imply, hydrogen, methane and sulfide gases are produced and increased in the intestines due to bacterial, methanogen and even fungal activity. In fact, there is even Small Intestinal and Large Intestinal Fungal Overgrowth (SIFO/LIFO).
There is always a balance between bacterial and fungal ratio in the intestines just as there is in our soil.
So hydrogen is produced in the colon, but instead of being recycled back into the rest of the body as an antioxidant — which is what it should be doing — much of it is being used to fuel hydrogen dominant bacteria. Sulphate-reducing bacteria ((SRB) will use bile from the gallbladder and sulfur from our diet to produce hydrogen sulfide. Methanogens (anaerobic archaea, not bacteria) both in the small intestine and colon — often associated with bloating and constipation — turn existing carbon dioxide into methane. All of these gases are interchangeable!
Then doctors identify these excess hydrogen and methane production in the intestines to diagnose SIBO. It is called the hydrogen breath test — such as the trio-smart breath test — which introduces glucose or lactulose into the gut to stir up and determine if the levels of these gases rise unusually high.
How do doctors and functional medicine treat SIBO?
If you are diagnosed with SIBO, doctors will quickly try to treat the symptom rather than the cause. A combination of antibiotics is introduced — the most popular being Rifaximin and Neomycin. They may also prescribe Metronidazole, which systematically affects the microbiome not only of the gastrointestinal tract, but of the entire body. They may also prescribe medication such as Fluconazole to treat fungal overgrowth — a medication known for causing liver damage.
Functional medicine is not much different — they use a combination of natural antibiotics to treat the symptom rather than the cause. These include: allicin, oil of oregano, caprylic acid, monolaurin, grapefruit seed extract, pomegranate husk and a product called Atrantil, specifically designed for methane dominant SIBO.
How to stunt Small Intestinal Bacterial Overgrowth forever?
Before even thinking about restoring microbiome, we must first make sure the back door is opened! That back door has a simple name — it is called, the anus.
If you are chronically constipated, stunting SIBO would be next to impossible. This is where peristalsis, the migrating motor complex (MMC) that pushes food from the small intestine to the large some every 90 minutes during fasting, and fiber, come in to play.
If your liver is damaged, stunting SIBO will also remain next to impossible, since a proper functioning liver is needed to turn ammonia into urea, for excretion by the kidneys and bladder.
If there is any congestion or chronic inflammation of the intestine, colon, urinary tract system or reproductive system (such as endometriosis), stunting SIBO permanently will also be next to impossible.
If you have chronic constipation, see: Healing Chronic Constipation and Irritable Bowel Syndrome May Be Both a Chemical and Mechanical Issue.
If there is liver damage (just assume there is!), see: Deflate Fatty Liver disease.
If there is inflammation and/or congestion, see: Out Ulcerative Colitis Fire Forever, Histamine Intolerance Defused and, other topics soon-to-be announced.
