Author: Bradley Bush

Maldigestion Creates an Environment Ripe for SIBO

Posted on by Bradley Bush

Maldigestion, the inadequate breakdown of food in the digestive system, is a significant contributor to Small Intestinal Bacterial Overgrowth (SIBO). In general, maldigestion alters the microbiome of the GI tract contributing to the overgrowth of bacteria. Therefore, it’s not surprising that maldigestion and SIBO share the same symptoms – belching, flatulence, bloating, abdominal pain, and constipation/diarrhea.

Hypochlorhydria- Less Acid, More Bacteria

One of the primary maldigestion factors is hypochlorhydria, or low stomach acid. Stomach acid plays a crucial role in the digestive process by breaking down food, especially proteins, and serving as a barrier to pathogens and bacteria entering the digestive tract. When stomach acid levels are low, as seen in conditions like hypochlorhydria, food isn’t properly broken down. Additionally, harmful bacteria that would normally be killed by the acidic environment survive to reach the small intestine. In short, low stomach acid creates a favorable environment for bacterial overgrowth, leading to SIBO.

Enzyme Deficiencies and SIBO

Another critical factor in maldigestion contributing to SIBO is enzyme production insufficiency. A lack in the enzyme that digest foods can create a more hospitable environment for overgrowth as well as feed the bacteria themselves.

Sugar Maldigestion– More Sugar. More Bacteria.

Deficiencies in enzymes required to break down sugars like lactose, sucrose, and fructose promote bacterial overgrowth. Enzymes, produced in the small intestine and pancreas, are essential for the proper digestion of sugars. When enzyme levels are insufficient, these sugars remain undigested and ferment in the small intestine, providing a rich source of nutrients for bacteria. This fermentation process produces gases and other byproducts, leading to symptoms associated with SIBO, such as bloating, gas, and diarrhea. Lactose intolerance, fructose malabsorption, and other related conditions are common examples where enzyme insufficiency can lead to SIBO.

Pancreatic Insufficiency–Environment for Overgrowth

Pancreatic insufficiency is another significant cause of maldigestion that can lead to SIBO. The pancreas produces essential digestive enzymes, including amylase, protease, and lipase, which are crucial for breaking down carbohydrates, proteins, and fats, respectively. When the pancreas is unable to produce enough of these enzymes, as seen in conditions like chronic pancreatitis or cystic fibrosis, the undigested food remains in the small intestine. This undigested food provides a fertile environment for bacteria to proliferate, leading to bacterial overgrowth. Additionally, pancreatic insufficiency can result in fat malabsorption, which further exacerbates digestive issues and contributes to SIBO.

Less Bile Production–Less Antimicrobial Effect

Reduced bile production or the absence of a gallbladder can also contribute to SIBO by affecting the digestion and absorption of fats. Bile, produced by the liver and stored in the gallbladder, is essential for emulsifying fats and aiding their digestion. Bile also has antimicrobial properties, helping to control bacterial populations in the small intestine. When bile production is reduced, or the gallbladder is removed, the body’s ability to digest fats is compromised, leading to fat malabsorption. The presence of undigested fats in the small intestine can alter the gut environment, making it more conducive to bacterial overgrowth, and the reduced antimicrobial effect of bile can allow harmful bacteria to proliferate, leading to SIBO.

Summary

In conclusion, maldigestion is a significant contributor to the development of SIBO, with various underlying causes such as hypochlorhydria, enzyme insufficiencies, pancreatic insufficiency, and reduced bile production. Each of these factors disrupts the normal digestive processes, creating an environment in the small intestine that favors bacterial overgrowth. Consequently, treatment strategies often involve addressing these specific issues, such as supplementing digestive enzymes, supporting stomach acid production, or improving bile flow. Understanding these underlying causes is crucial for effectively preventing and managing SIBO.

Our SIBO experts offer one-on-one, complimentary consults to healthcare providers performing Neurovanna sugar malabsorption and SIBO breath tests.

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SIBO as a Driver of NAFLD: Mechanisms, Evidence, and Treatment Approaches

Posted on by Bradley Bush

Small Intestinal Bacterial Overgrowth (SIBO) can contribute to the development of fatty liver disease, specifically nonalcoholic fatty liver disease (NAFLD), through several mechanisms related to inflammation, gut barrier function, and metabolism.

Mechanisms Linking SIBO to Fatty Liver Disease

1. Chronic Inflammation

  • Endotoxemia: SIBO can lead to the overgrowth of Gram-negative bacteria, which release lipopolysaccharides (LPS) into the gut. LPS, a component of the bacterial cell wall, can enter the bloodstream due to increased intestinal permeability (leaky gut). This triggers systemic inflammation, which contributes to liver inflammation and fat accumulation.
  • Cytokine Release: The chronic inflammation associated with SIBO leads to the release of pro-inflammatory cytokines, like TNF-alpha and IL-6, which can promote insulin resistance and hepatic fat accumulation.

2. Intestinal Permeability (Leaky Gut)

  • Increased Permeability: SIBO can damage the intestinal lining, increasing its permeability. This allows bacteria and their toxins to enter the bloodstream more easily, reaching the liver and causing inflammation and metabolic disturbances.
  • Liver Inflammation: The liver acts as a filter for these toxins, and chronic exposure can lead to hepatic inflammation, fibrosis, and ultimately fatty liver disease.

3. Metabolic Changes

  • Insulin Resistance: Chronic inflammation and endotoxemia can lead to insulin resistance, a key factor in the development of NAFLD. Insulin resistance promotes the storage of fat in the liver.
  • Altered Lipid Metabolism: SIBO can affect the metabolism of lipids, leading to increased fat deposition in the liver.

Use of Rifaximin in Treating SIBO and Nonalcoholic Fatty Liver Disease

Rifaximin is a broad-spectrum antibiotic that is minimally absorbed in the gut, making it effective for treating gastrointestinal conditions like SIBO. Not only is Rifaximin the preferred antibiotic to treat SIBO, but it has been proven to help reduce NAFLD.

Benefits of Rifaximin

1. Reduction of Bacterial Overgrowth

  • Targeted Antibiotic Therapy: Rifaximin helps reduce the bacterial overgrowth in the small intestine, thereby decreasing the production of harmful bacterial metabolites and endotoxins.

2. Improvement in Gut Barrier Function

  • Reduced Intestinal Permeability: By decreasing the bacterial load, rifaximin can help restore normal gut flora and reduce inflammation, leading to improved gut barrier function and decreased endotoxin translocation to the liver.
  • Restoration of Tight Junctions: Rifaximin helps in the maintenance and restoration of tight junction proteins in the intestinal lining, which are crucial for a healthy gut barrier.

3. Reduction of Bile Acid Dysregulation

  • Bile Acid Modulation: Rifaximin can influence bile acid metabolism, which plays a role in lipid digestion and absorption. Proper bile acid regulation helps maintain metabolic balance and reduces liver fat deposition.

4. Decrease in Systemic Inflammation

  • Lower Cytokine Levels: By treating SIBO and reducing bacterial overgrowth, rifaximin helps lower the levels of systemic inflammatory cytokines that contribute to liver inflammation and insulin resistance.

5. Metabolic Benefits

  • Improved Insulin Sensitivity: Treating SIBO with rifaximin can help improve insulin sensitivity, reducing one of the key metabolic drivers of NAFLD.
  • Lipid Metabolism: Rifaximin can help normalize lipid metabolism by reducing inflammation and improving gut health.

Clinical Evidence

Studies on Rifaximin and NAFLD: Clinical studies have shown that rifaximin treatment can improve liver enzymes and reduce markers of liver inflammation in patients with NAFLD. The reduction in systemic inflammation and endotoxemia from treating SIBO is believed to contribute to these improvements.

Why Not Herbal Antimicrobials for SIBO and Nonalcoholic Fatty Liver Disease

There is emerging research suggesting herbal treatments for SIBO may also have beneficial effects on NAFLD. While the body of research specifically linking herbal treatments for SIBO to reductions in NAFLD is still growing, some studies provide supportive evidence for the beneficial effects of certain herbal compounds on both SIBO and liver health.

Key SIBO Herbal Treatments and Their Benefits for NAFLD

1. Berberine

  • Antimicrobial Properties: Berberine has been shown to have broad-spectrum antimicrobial activity, which can help reduce bacterial overgrowth in SIBO.
  • Liver Health: Research indicates that berberine can improve liver function, reduce liver fat accumulation, and enhance insulin sensitivity, making it beneficial for NAFLD. A study found that berberine significantly decreased liver fat content and improved markers of liver function in patients with NAFLD.

2. Oregano Oil

  • Antimicrobial Effects: Oregano oil contains carvacrol and thymol, compounds with potent antimicrobial properties that can help manage SIBO.
  • Anti-inflammatory Properties: The anti-inflammatory effects of oregano oil can contribute to reducing systemic inflammation, which is beneficial for both SIBO and NAFLD. Though direct evidence linking oregano oil to NAFLD reduction is limited, its role in reducing inflammation is well-documented.

3. Garlic (Allicin)

  • Antimicrobial Effects: Allicin, a compound found in garlic, has strong antimicrobial properties that can help control bacterial overgrowth in the gut.
  • Liver Health: Some studies suggest that garlic supplementation can improve liver enzyme levels and reduce liver fat in NAFLD patients. A study demonstrated that garlic powder supplementation reduced liver fat and improved lipid profiles in individuals with NAFLD.

4. Ginger

  • Digestive Health: Ginger has been traditionally used to improve digestion and has antimicrobial and prokinetic properties that may help in managing SIBO.
  • Liver Health: Ginger has been shown to have hepatoprotective effects, reducing liver inflammation and oxidative stress. A study indicated that ginger supplementation reduced liver enzymes and improved inflammatory markers in patients with NAFLD.

5. Milk Thistle (Silymarin)

  • Liver Protection: Silymarin, the active compound in milk thistle, is well-known for its liver-protective effects. Although it is not a SIBO antimicrobial, it is worth discussing because It can help reduce liver inflammation and fibrosis, making it beneficial for NAFLD.
  • Gut Health: While milk thistle is primarily known for its liver benefits, its antioxidant and anti-inflammatory properties can contribute to overall gut health, reduce side effects of SIBO activity and aid in the management of SIBO and NAFLD.

Research Evidence

  • Combined Herbal Treatments: A study published in the journal, Global Advances in Health and Medicine, evaluated the effects of herbal therapy on SIBO and noted improvements in both gut symptoms and overall health markers, including liver enzymes. This suggests potential benefits for NAFLD, though more targeted research is needed.
  • Systemic Benefits: Several studies have demonstrated that herbal treatments with antimicrobial, anti-inflammatory, and antioxidant properties can reduce systemic inflammation and improve metabolic health, which are critical factors in the management of NAFLD.

Summary

SIBO can contribute to the development and progression of fatty liver disease through mechanisms involving chronic inflammation, increased intestinal permeability, and metabolic disturbances. Rifaximin, by effectively treating SIBO, can reduce bacterial overgrowth, improve gut barrier function, decrease systemic inflammation, and improve metabolic parameters, thus providing therapeutic benefits for patients with NAFLD. It is also then likely that non-prescriptive treatments for SIBO, including herbal antimicrobials and the Elemental Diet, can also treat NAFLD.

Find out if SIBO is exacerbating NAFLD with non-invasive lactulose or glucose breath tests from Neurovanna. Healthcare providers sign up for an account. If you are a patient interested in SIBO testing, contact us for help in finding a provider near you.

References

  • Yin, J., Xing, H., & Ye, J. (2008). Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism, 57(5), 712-717.
  • Kasahara, A., & Matsumoto, T. (2008). Study on the effects of garlic powder intake on non-alcoholic fatty liver disease. Journal of Nutritional Science and Vitaminology, 54(6), 423-430. Kani, A. H., Alavian, S. M., Esmaillzadeh, A., Adibi, P., Azadbakht, L., & Safarian, M. (2017). Effects of ginger on serum lipids and liver enzymes in patients with NAFLD: A randomized controlled trial. Phytotherapy Research, 31(11), 2645-2650.
  • Mullin, G. E., Shepherd, S. J., Chander Roland, B., Ireton-Jones, C. S., Matarese, L. E., & Marinos Elia, M. (2010). Nutritional management of small intestinal bacterial overgrowth in clinical practice. Global Advances in Health and Medicine, 1(2), 31-37.

5 Mechanisms Linking SIBO to GERD and Sliding Hiatal Hernias

Posted on by Bradley Bush

Small Intestinal Bacterial Overgrowth (SIBO) can lead to or exacerbate Gastroesophageal Reflux Disease (GERD) and sliding hiatal hernias through several mechanisms.

1. Increased Intra-abdominal Pressure

  • Gas Production: The excessive bacterial fermentation in SIBO produces large amounts of gas, leading to bloating and increased intra-abdominal pressure. This pressure can push the stomach upwards, potentially causing or worsening a hiatal hernia.
  • Reflux Promotion: The increased pressure also promotes the back-flow of stomach contents into the esophagus, leading to GERD symptoms such as heartburn and acid regurgitation.

2. Motility Disorders

  • Impaired Gut Motility: SIBO is often associated with dysmotility, where the normal movement of the digestive tract is impaired. This can lead to delayed gastric emptying and increased likelihood of reflux as the stomach contents linger and create pressure.
  • Vagus Nerve Dysfunction: The vagus nerve, which controls gut motility, can be affected by chronic inflammation and gut dysfunction caused by SIBO, further contributing to GERD.

3. Diaphragm Dysfunction

  • Increased Abdominal Pressure on the Diaphragm: The bloating and distention from SIBO can affect the function of the diaphragm. If the diaphragm is pushed upwards, it can cause or exacerbate a sliding hiatal hernia, where part of the stomach slides through the diaphragm into the chest cavity.
  • Hiatal Hernia: A sliding hiatal hernia occurs when the junction of the esophagus and stomach (the gastroesophageal junction) and a portion of the stomach move above the diaphragm. This can weaken the lower esophageal sphincter, making it easier for stomach acid to reflux into the esophagus, thereby causing GERD.

4. Altered Gut Flora and Inflammation

  • Inflammation: SIBO leads to chronic inflammation in the small intestine, which can affect the entire gastrointestinal tract, including the esophagus. Inflammation can compromise the integrity of the lower esophageal sphincter, increasing the risk of acid reflux.
  • Gut-Brain Axis: The gut-brain axis, which involves communication between the gut and the central nervous system, can be disrupted in SIBO. This disruption can influence gut motility and function, contributing to both GERD and hiatal hernias.

5. Dysbiosis and Esophageal Sensitivity

  • Microbiome Imbalance: SIBO results in dysbiosis, an imbalance in gut bacteria, which can affect the upper gastrointestinal tract. Dysbiosis can lead to increased sensitivity of the esophageal lining, making it more susceptible to acid damage and contributing to GERD symptoms.

Summary

SIBO can contribute to GERD and sliding hiatal hernias through increased intra-abdominal pressure from gas production, impaired gut motility, diaphragm dysfunction, chronic inflammation, and altered gut flora. Managing SIBO through appropriate treatments, such as dietary changes, antibiotics, or herbal antimicrobials, can help reduce these pressures and mitigate the symptoms and risks associated with GERD and sliding hiatal hernias.

Even though SIBO can be a root cause for GERD and hiatal hernias, more severe cases often include additional causes that should be investigated including: musculoskeletal causes, food allergies/ sensitivities, and maldigestion.

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5 Ways to Support Immune and GI Health to Fend Off SIBO

Posted on by Bradley Bush

When the immune system is compromised or dysregulated, it can lead to Small Intestinal Bacterial Overgrowth (SIBO). Various natural supplements can help address the underlying issues that contribute to SIBO by improving gut motility, supporting immune function, repairing intestinal permeability, balancing microbiota, and reducing inflammation.

Diagram of the 5 ways to support immune system to fend off SIBO
5 Ways to Support Immune & GI to Fend Off SIBO

1. Support Gut Motility and Clearance

Migrating Motor Complex (MMC): The MMC is essential for clearing bacteria and food debris from the small intestine during fasting. Supplements that support gut motility can help restore MMC activity.

  • Ginger: Known for its prokinetic properties, ginger can enhance gastric motility and help stimulate the MMC. Studies have shown that ginger can speed up gastric emptying and improve gastrointestinal motility (Frontiers).

2. Increase Immunoglobulin Production

IgA Deficiency: Immunoglobulin A (IgA) is crucial for neutralizing pathogens in the gut. Supporting IgA production can help control bacterial populations and prevent SIBO.

  • Colostrum: Rich in immunoglobulins, colostrum can boost IgA levels and enhance immune function in the gut. It provides antibodies that help protect the gut lining from pathogens (Revista ACTA).
  • Probiotics: Certain probiotic strains, such as Lactobacillus rhamnosus GG, have been shown to increase IgA production and improve mucosal immunity, helping to maintain gut health (Revista ACTA).

3. Reduce Intestinal Permeability

Leaky Gut Syndrome: Chronic inflammation or immune dysfunction can increase intestinal permeability. Supplements that strengthen the gut barrier can help prevent bacterial translocation and systemic inflammation.

  • L-Glutamine: This amino acid is a key nutrient for intestinal cells and can help repair and maintain the gut lining. Studies have demonstrated its effectiveness in reducing intestinal permeability and supporting gut health (Revista ACTA).
  • Zinc Carnosine: This compound has been shown to protect the gut lining and promote healing of the intestinal mucosa, thereby reducing permeability (Revista ACTA).

4. Restore Microbiota Composition

Dysbiosis: An imbalance in the gut microbiota can favor the overgrowth of pathogenic bacteria. Probiotics and prebiotics can help restore a healthy balance of gut bacteria.

  • Probiotics: Strains like Bifidobacterium and Lactobacillus can help restore balance to the gut microbiota, inhibit pathogenic bacteria, and improve overall gut health (Revista ACTA).
  • Prebiotics: Compounds such as inulin and fructooligosaccharides (FOS) feed beneficial bacteria, promoting a healthy microbiota balance and supporting gut homeostasis (Revista ACTA).

5. Reduce Chronic Inflammation

Inflammatory Bowel Diseases (IBD): Conditions like Crohn’s disease and ulcerative colitis involve chronic gut inflammation and immune dysregulation. Anti-inflammatory supplements can help reduce inflammation and support gut health.

  • Curcumin: The active compound in turmeric, known as curcumin, has potent anti-inflammatory properties. It can reduce gut inflammation and support overall digestive health (Revista ACTA).
  • Omega-3 Fatty Acids: Found in fish oil, omega-3s have anti-inflammatory effects and can help reduce chronic inflammation in the gut. They are beneficial for managing IBD and supporting gut health (Revista ACTA).

Conclusion

Immune and GI health play integral roles in preventing dysbiosis and the development of SIBO.  Maintaining gut homeostasis involves a multifaceted approach, especially when the immune system is compromised. Natural supplements like ginger, colostrum, L-glutamine, probiotics, and curcumin can address the root causes of SIBO by enhancing gut motility, supporting immune function, repairing the gut lining, balancing the microbiota, and reducing inflammation. Incorporating these supplements into a comprehensive treatment plan can help prevent and manage SIBO effectively.

 

Neurovanna practitioners receive complimentary one-on-one support from our SIBO experts who help manage SIBO risk everyday in their practice. Sign up to become a Neurovanna practitioner and learn from their experience.

 

Further Reading

  • Ghoshal, U. C., & Ghoshal, U. (2017). “Small Intestinal Bacterial Overgrowth and Other Intestinal Disorders.” Gastroenterology Clinics of North America.
  • Quigley, E. M. (2019). “The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO).” Current Gastroenterology Reports.
  • “Role of the Gut-Associated Lymphoid Tissue in Maintaining Intestinal Homeostasis.” Journal of Clinical Gastroenterology.

The Immune System’s Role in Maintaining Gut Homeostasis and Its Relation to SIBO

Posted on by Bradley Bush

The human gut is a complex ecosystem where the immune system plays a crucial role in maintaining balance, or homeostasis. This intricate relationship between the gut microbiota and the immune system is essential for overall health. Disruptions in this balance can lead to conditions such as Small Intestinal Bacterial Overgrowth (SIBO). Let’s explore how the immune system helps maintain gut homeostasis and its connection to SIBO.

The Immune System and Gut Homeostasis

Gut-Associated Lymphoid Tissue (GALT)

The gut contains the largest mass of lymphoid tissue in the body, known as Gut-Associated Lymphoid Tissue (GALT). GALT includes Peyer’s patches, lamina propria lymphocytes, and intraepithelial lymphocytes, which work together to monitor and respond to pathogens while tolerating beneficial microbes.

  • Peyer’s Patches: These are specialized areas in the small intestine where immune cells sample gut contents and generate appropriate immune responses.
  • Lamina Propria Lymphocytes: These cells produce immunoglobulins, particularly IgA, which neutralize pathogens and prevent them from invading the gut lining.

Mucosal Barrier

The gut mucosal barrier consists of a mucus layer, epithelial cells, and immune cells. This barrier functions as a physical and immunological shield, preventing harmful microbes from entering the bloodstream.

  • Mucus Layer: Produced by goblet cells, this layer traps microbes and contains antimicrobial peptides.
  • Epithelial Cells: These cells form tight junctions to prevent microbial translocation and produce antimicrobial peptides and cytokines to regulate immune responses.

Immune Surveillance and Regulation

  • Pattern Recognition Receptors (PRRs): These receptors, such as Toll-like receptors (TLRs), detect microbial components and initiate immune responses. TLRs recognize bacterial lipopolysaccharides (LPS), flagellin, and other microbial molecules, triggering inflammatory pathways to combat infections.
  • Regulatory T Cells (Tregs): Tregs help maintain immune tolerance to beneficial microbes and food antigens, preventing unnecessary inflammation.

5 Ways Immune System Dysregulation Contributes to SIBO

5 ways immune dysregulation and gut homeostasis contributes to sibo

When the immune system is compromised or dysregulated, it can lead to SIBO. Here’s how.

1. Impaired Motility and Clearance

Migrating Motor Complex (MMC): The MMC is a pattern of electromechanical activity that occurs in the gastrointestinal tract during fasting. It helps clear bacteria and food debris from the small intestine. Immune system dysfunction can impair MMC activity, leading to bacterial stasis, overgrowth, and eventually, SIBO.

2. Reduced Immunoglobulin Production

IgA Deficiency: Immunoglobulin A (IgA) is crucial for neutralizing pathogens in the gut. A deficiency in IgA production can lead to an inability to control bacterial populations, contributing to SIBO.

3. Increased Intestinal Permeability

Leaky Gut Syndrome: Chronic inflammation or immune dysfunction can increase intestinal permeability, allowing bacteria and toxins to enter the bloodstream. This can trigger systemic inflammation and contribute to conditions like SIBO.

4. Altered Microbiota Composition

Dysbiosis: An imbalance in the gut microbiota can occur due to immune system dysregulation. This dysbiosis can favor the overgrowth of pathogenic bacteria in the small intestine, leading to SIBO.

5. Chronic Inflammation

Inflammatory Bowel Diseases (IBD): Conditions like Crohn’s disease and ulcerative colitis involve chronic gut inflammation and immune dysregulation. These conditions can disrupt gut motility and barrier function, increasing the risk of SIBO.

Conclusion

The immune system plays a pivotal role in maintaining gut homeostasis by regulating microbial populations, ensuring gut barrier integrity, and modulating inflammatory responses. When this delicate balance is disrupted, it can lead to conditions like SIBO. Understanding the interplay between the immune system and gut health is crucial for preventing and managing SIBO and other related disorders.

Neurovanna offers customers complimentary one-on-one support from SIBO experts who have tested and treated thousands of patients. Get access to their expertise by creating an account. If you are patient, please contact us to help you find a Neurovanna practitioner near you.

Learn how to support the immune system using natural products to resolve SIBO.

Further Reading

  • Ghoshal, U. C., & Ghoshal, U. (2017). “Small Intestinal Bacterial Overgrowth and Other Intestinal Disorders.” Gastroenterology Clinics of North America.
  • Quigley, E. M. (2019). “The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO).” Current Gastroenterology Reports.
  • “Role of the Gut-Associated Lymphoid Tissue in Maintaining Intestinal Homeostasis.” Journal of Clinical Gastroenterology.

Is SIBO Caused by Food Poisoning?

Posted on by Bradley Bush

Food poisoning can indeed lead to the development of Small Intestinal Bacterial Overgrowth (SIBO). This connection primarily revolves around the impact of food poisoning on the gut’s motility and the subsequent development of a condition known as post-infectious irritable bowel syndrome (PI-IBS), which is a common precursor to SIBO.

Mechanisms Linking Food Poisoning to SIBO

Gut Motility Disruption

Post-Infectious IBS: After an episode of food poisoning, some individuals develop PI-IBS, characterized by altered gut motility. The inflammation and damage caused by the infection can impair the migrating motor complex (MMC), which is essential for moving food and bacteria through the small intestine. When the MMC is disrupted, it can lead to the stagnation of contents in the small intestine, creating an environment conducive to bacterial overgrowth (Frontiers) (Revista ACTA).

Enteric Nervous System Damage: Food poisoning can damage the enteric nervous system, which regulates gut motility. This damage can result in delayed intestinal transit, further promoting bacterial overgrowth.

Inflammatory Response

Increased Permeability and Immune Activation: Food poisoning triggers a significant inflammatory response in the gut. This inflammation can increase intestinal permeability (leaky gut) and disturb the local immune response, both of which can contribute to an imbalance in gut bacteria and facilitate SIBO development (Frontiers) (Revista ACTA).

Changes in Gut Microbiota

Microbiome Imbalance: Food poisoning can lead to a temporary or permanent shift in the gut microbiota. The disruption in the balance of beneficial and harmful bacteria can create conditions favorable for bacterial overgrowth in the small intestine.

Evidence from Research

Study on Post-Infectious IBS and SIBO: Research indicates that individuals who develop PI-IBS following an episode of gastroenteritis (food poisoning) have a higher prevalence of SIBO. The altered motility and persistent inflammation seen in PI-IBS are significant risk factors for the development of SIBO (Ghoshal et al., 2017).

Role of the Migrating Motor Complex: Studies highlight that impaired MMC activity, often seen in PI-IBS patients, is a key factor in the development of SIBO. The MMC is crucial for clearing bacteria from the small intestine, and its dysfunction can lead to bacterial overgrowth (Pimentel et al., 2003).

Preventive and Management Strategies

Prokinetic Agents: To improve gut motility, especially in those with PI-IBS, prokinetic agents can be prescribed. These medications help restore normal MMC activity, reducing the risk of SIBO.

Dietary Adjustments: Diets low in fermentable carbohydrates (low FODMAP diet) can help manage symptoms and reduce the substrate available for bacterial fermentation.

Antibiotic and Herbal Treatments: For those diagnosed with SIBO, antibiotics like rifaximin or herbal antimicrobials can help reduce bacterial overgrowth.

Others: Activated charcoal or other binders when you get food poisoning to reduce its impact by absorbing intestinal toxins.

 

In conclusion, food poisoning can lead to the development of SIBO by disrupting gut motility, altering the gut microbiota, and inducing inflammation. Understanding this connection is vital for both prevention and treatment, particularly in managing the sequelae of food poisoning, such as post-infectious IBS, which predisposes individuals to SIBO.

If you have experienced symptoms of SIBO after food poisoning, contact us to find a provider near you. Healthcare providers, set up an account to offer SIBO testing to your patients.

Sources

Ghoshal, U. C., & Ghoshal, U. (2017). “Small Intestinal Bacterial Overgrowth and Other Intestinal Disorders.” Gastroenterology Clinics of North America.

Pimentel, M., et al. (2003). “Small Intestinal Bacterial Overgrowth: Associations With Irritable Bowel Syndrome and Gastrointestinal Motility Disorders.” Gastroenterology.

Toxic Byproducts: How SIBO Bacteria Disrupt Digestion Through Metabolic Waste

Posted on by Bradley Bush

Small Intestinal Bacterial Overgrowth (SIBO) leads to the production of various metabolic waste products by the overgrown bacteria. These waste products can cause a range of symptoms and side effects. The list below shares the main metabolic waste products produced by SIBO bacteria and the associated side effects.

1. Hydrogen Gas

Produced by fermentation of carbohydrates by anaerobic bacteria.

Side Effects

  • Bloating: Excess hydrogen gas causes abdominal distension and discomfort.
  • Diarrhea: Hydrogen gas can increase gut motility, leading to loose stools.

2. Methane Gas

Produced by: Archaea, particularly Methanobrevibacter smithii, which consumes hydrogen.

Side Effects:

  • Constipation: Methane gas slows intestinal transit time, leading to constipation.
  • Bloating and Discomfort: Methane gas can also cause abdominal bloating and pain.

3. Hydrogen Sulfide Gas

Produced by: Sulfate-reducing bacteria such as Desulfovibrio.

Side Effects:

  • Diarrhea: Hydrogen sulfide can irritate the gut lining, leading to diarrhea.
  • Rotten Egg Smell: The gas has a characteristic foul odor, leading to malodorous flatulence.

4. Lactic Acid

Produced by: Fermentation of carbohydrates by lactic acid bacteria such as Lactobacillus.

Side Effects:

  • Acidosis: Accumulation of lactic acid can contribute to an acidic environment in the gut, potentially causing pain and discomfort.
  • Bloating and Gas: Excess lactic acid can lead to increased gas production and bloating.

5. Ammonia

Produced by: Breakdown of proteins and amino acids by bacteria

Side Effects:

  • Neurotoxicity: High levels of ammonia can cross into the bloodstream and affect the brain, leading to symptoms like confusion and fatigue.
  • Gut Irritation: Ammonia can damage the gut lining, contributing to inflammation and discomfort.

6. Short-Chain Fatty Acids (SCFAs)

Produced by: Fermentation of dietary fibers by gut bacteria.

Side Effects:

  • Bloating and Gas: Excess SCFAs can lead to gas production, causing bloating and discomfort.
  • Diarrhea: Some SCFAs can increase intestinal motility, leading to diarrhea.

7. Ethanol

Produced by: Fermentation of sugars by yeasts and some bacteria.

Side Effects:

  • Intoxication: In severe cases, excess ethanol production can lead to symptoms similar to alcohol intoxication.
  • Liver Stress: Chronic production of ethanol can stress the liver, potentially exacerbating liver-related conditions.

8. Succinate

Produced by: Fermentation processes of certain bacteria.

Side Effects:

  • Metabolic Acidosis: Excess succinate can contribute to metabolic acidosis, leading to systemic symptoms like fatigue and muscle weakness.

9. Lipopolysaccharides (LPS)

LPS are large molecules found in the outer membrane of Gram-negative bacteria. They are released when these bacteria die and their cell walls break down. LPS are potent endotoxins and can trigger significant immune responses in the human body

Managing the Impacts of SIBO

In addition to the effects of metabolic waste, SIBO bacteria have clinical impacts beyond gas and bloating. They can exacerbate or even cause some autoimmune and inflammatory conditions.

Managing SIBO typically involves dietary modifications, probiotics, and in some cases, antibiotics or herbal antimicrobials to reduce bacterial overgrowth and alleviate these symptoms.

If you are a patient looking for a Neurovanna provider, contact us. Healthcare providers set up a Neurovanna account for access to gold-standard Quintron breath testing and SIBO experts.

 

References:

– Pimentel, M., et al. (2003). “Small Intestinal Bacterial Overgrowth: Associations With Irritable Bowel Syndrome and Gastrointestinal Motility Disorders.” Gastroenterology.

– Rezaie, A., et al. (2017). “Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus.” The American Journal of Gastroenterology. https://pmc.ncbi.nlm.nih.gov/articles/PMC5418558/

– Lauritano, E. C., et al. (2008). “Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome.” Gut.

– Tana, C., et al. (2010). “Altered Profiles of Intestinal Microbiota and Organic Acids May Be the Origin of Symptoms in Irritable Bowel Syndrome.” Neurogastroenterology & Motility. https://pubmed.ncbi.nlm.nih.gov/19903265/

The Top 10 SIBO Bacteria and How They Impact Your Health

Posted on by Bradley Bush

Small Intestinal Bacterial Overgrowth (SIBO) occurs when bacteria from the large intestine colonize the small intestine. The top 10 bacteria commonly associated with SIBO are responsible for many of the clinical side effects of SIBO. The list below shares the most common side effects for each of those 10 SIBO bacteria when overgrown, along with additional clinically relevant details regarding histamine production, autoimmune associations, and other health impacts:

Escherichia coli (E. coli)

  • Side Effects: Bloating, abdominal pain, diarrhea, and gas. E. coli overgrowth can also increase the risk of leaky gut syndrome by causing inflammation in the gut lining, leading to a compromised intestinal barrier.
  • Clinical Relevance: E. coli is known to release lipopolysaccharides (LPS), which can trigger systemic inflammation. LPS can contribute to autoimmune reactions and has been linked to conditions such as autoimmune thyroiditis (Hashimoto’s disease).

Streptococcus

  • Side Effects: Diarrhea, gas, bloating, and abdominal discomfort. Streptococcus can lead to significant inflammation due to the release of bacterial toxins, contributing to digestive disturbances.
  • Clinical Relevance: Streptococcus species have been implicated in promoting histamine production, which can exacerbate symptoms of histamine intolerance. Excessive histamine may worsen symptoms in people with Mast Cell Activation Syndrome (MCAS) and food sensitivities.

Lactobacillus

  • Side Effects: Gas, bloating, diarrhea, and abdominal discomfort. While typically beneficial in the large intestine, Lactobacillus overgrowth in the small intestine can lead to excessive fermentation.
  • Clinical Relevance: Certain strains of Lactobacillus can also produce D-lactate, which can lead to lactic acidosis and neurological symptoms, such as confusion and fatigue. This overgrowth may also contribute to histamine production in some cases, aggravating conditions like MCAS.

Bacteroides

  • Side Effects: Abdominal pain, bloating, and diarrhea. Overgrowth of Bacteroides can disrupt the balance of the gut microbiota and contribute to chronic inflammation.
  • Clinical Relevance: Bacteroides species are associated with increased production of thyroid antibodies, which can exacerbate autoimmune conditions like Hashimoto’s thyroiditis. They can also influence systemic inflammation and are linked to the development of non-alcoholic fatty liver disease (NAFLD).

Enterococcus

  • Side Effects: Bloating, gas, diarrhea, and abdominal pain. Enterococcus overgrowth is associated with chronic gut inflammation and may interfere with normal gut motility.
  • Clinical Relevance: Enterococcus is linked to the production of biofilms, which can protect bacterial colonies from both the immune system and antibiotics, making infections harder to treat. It has also been associated with urinary tract infections and is increasingly found to be resistant to antibiotics, including vancomycin-resistant Enterococcus (VRE).

Klebsiella

  • Side Effects: Severe bloating, gas, and abdominal pain. Klebsiella species can produce significant amounts of gas and promote inflammation in the gut.
  • Clinical Relevance: Klebsiella is strongly associated with autoimmune conditions, particularly ankylosing spondylitis and other spondyloarthropathies. It can trigger molecular mimicry, where the immune system attacks the body’s tissues, mistaking them for bacterial invaders.

Clostridium

  • Side Effects: Diarrhea, abdominal cramping, and bloating. Certain species, such as Clostridium difficile, can cause severe inflammation in the gut and colitis.
  • Clinical Relevance: Clostridium species, particularly C. difficile, can produce harmful toxins that lead to colitis and severe gut inflammation. Overgrowth of this bacteria is often linked to antibiotic use and can be difficult to treat. Some Clostridium species are associated with increased histamine production, exacerbating symptoms in histamine-sensitive individuals.

Proteus

  • Side Effects: Bloating, gas, and diarrhea. Proteus overgrowth contributes to significant digestive disturbances and systemic toxin production.
  • Clinical Relevance: Proteus is another biofilm-producing bacteria that can evade immune system attacks. It has been linked to urinary tract infections and can also contribute to kidney stones due to its ability to produce urease, which breaks down urea into ammonia, increasing alkalinity in the urine.

Methanobrevibacter smithii

  • Side Effects: Constipation and bloating. This archaea produces methane, which slows intestinal transit time and contributes to constipation.
  • Clinical Relevance: Methane production by Methanobrevibacter smithii is linked to constipation-predominant IBS (IBS-C). High methane levels can also correlate with slower motility, leading to a higher risk of SIBO recurrence. Some studies suggest it may also affect thyroid function by slowing gut motility and altering hormone metabolism.

Prevotella

  • Side Effects: Bloating, diarrhea, and gas. Overgrowth of Prevotella can disrupt gut balance, leading to inflammation and digestive symptoms.
  • Clinical Relevance: Prevotella is commonly linked to chronic inflammatory conditions such as rheumatoid arthritis and periodontitis. It may exacerbate autoimmune responses by triggering systemic inflammation. Prevotella overgrowth has also been observed in individuals with dysbiosis associated with Western diets high in refined carbohydrates.

 

Summary of Common Side Effects and Clinical Relevance:

  • Bloating: Most of these bacteria produce excessive gas through fermentation, leading to bloating and abdominal discomfort.
  • Diarrhea: Disruption of digestion can cause frequent, loose stools, often seen with bacteria like E. coli, Streptococcus, and Bacteroides.
  • Constipation: Methanobrevibacter smithii is linked to methane production, which slows motility, causing constipation.
  • Histamine Production: Bacteria like Streptococcus, Lactobacillus, and Clostridium can contribute to elevated histamine levels, which aggravate conditions like MCAS.
  • Autoimmune Associations: Bacteria such as Klebsiella, Bacteroides, and Proteus have strong links to autoimmune conditions, including ankylosing spondylitis, Hashimoto’s thyroiditis, and rheumatoid arthritis.
  • Systemic Inflammation: The overgrowth of these bacteria, through mechanisms like LPS release (E. coli) and biofilm production (Enterococcus), can trigger systemic inflammation, leading to conditions such as leaky gut, autoimmune flare-ups, and metabolic disorders.
Chart of 10 SIBO Bacteria and what their bloating contributes to.
Chart of SIBO Bacteria

Managing SIBO with Clinical Insight

Effectively managing SIBO requires not only addressing bacterial overgrowth but also understanding the broader clinical implications each bacterial strain has on the body. Whether through histamine management, addressing autoimmune triggers, or treating systemic inflammation, treating SIBO patients in a holistic manner requires an appreciation and understanding of bacteria’s impact on health.

Our SIBO experts are available to assist Neurovanna healthcare providers with understanding SIBO. Complete our new account form to become a Neurovanna healthcare provider. If you are a patient seeking SIBO care, contact us to find a Neurovanna practitioner near you.

Why is SIBO Trending?

Posted on by Bradley Bush

The long and short of it? Small Intestinal Bacterial Overgrowth (SIBO) is trending because gut health has been trending. Over the past decade, people have learned that changing their diets improves their overall health. However, restrictive diets are difficult to maintain. Now, patients, who know they can feel better on a restrictive diet but want to enjoy more of the foods they love are seeking to uncover the root of the problem– which is often SIBO.

Gut-Friendly Foods, Beverages and Diets Went Mainstream

The rising focus on gut health in general has played a key role in SIBO’s growing popularity. With an increased awareness of how digestive health impacts overall well-being, the mainstream culture has embraced fermentable foods like yogurt, kefir, kimchi, and kombucha, as well as probiotics and gut-friendly diets. Popular diets like Paleo, Whole30, GAPS, Specific Carbohydrate Diet, and Atkins have created a patient-driven movement toward focusing more on diet and gastrointestinal health, and less on medications.

5 reasons SIBO is more well known
Reasons SIBO is Better Known

Trendy Restrictive Diets Kill SIBO Bacteria

One major reason SIBO is gaining attention is people are starting to notice new food aversions or significant improvement in their symptoms after adopting highly restrictive diets. Many individuals who experience weight loss on diets like Paleo or Whole30 do so because they are effectively “starving” the bad bacteria in their small intestines—specifically SIBO bacteria. Gluten and dairy-free diets, often considered trendy fads, are actually helping many people feel better because they eliminate key foods that “feed” the bacteria associated with SIBO. Interestingly, this perceived improvement in health might not be due to an actual gluten or dairy allergy, but rather the avoidance of foods that fuel the overgrowth of bacteria in the small intestine.

The Common-Sense Interpretation 

If you find avoiding gluten and dairy improves your digestion, you might be dealing with SIBO. Or, if you experienced rapid weight loss during a low-carbohydrate or restrictive diet (like Paleo or Whole30), SIBO may be an issue for you. While these diets help reduce symptoms by depriving the bacteria of their food source, it’s a sign that bacterial overgrowth may be playing a role in your digestive issues.

Confirming SIBO

SIBO has been recognized in gastroenterology for many years, but recently, the condition has become more “mainstream” due to advancements in gut health understanding and lab testing. In the past, intestinal aspiration and culture were considered the most accurate way to diagnose SIBO. However, this invasive method is not cost-effective or convenient. It also carries some health risks. As a result, non-invasive tests have been developed, with breath testing now widely recognized as the standard.

As gut health continues to take center stage in health discussions, SIBO and breath testing will likely remain a focal point for those seeking to understand and improve their digestive health. If you think SIBO may be at the root of your health issues, we can help. Download the referral form to give your doctor or contact us to find a Neurovanna provider in your area.

SIBO Symptoms or Food Sensitivities? How to Identify the Real Cause of Your Digestive Issues

Posted on by Bradley Bush

Having a bad reaction to food can be a confusing and frustrating experience. You may feel fine one moment and then suddenly suffer from bloating, cramps, or even more severe symptoms the next, derailing all your plans. This leads many to avoid certain foods, often gluten and dairy which have been named as culprits for decades. When people feel better avoiding trigger foods, it reinforces the notion that they have either food sensitivities or allergies to those foods. Now this may be true for some people, but as immunologists and allergists correctly point out, the numbers do not add up.

According to a study published in JAMA Network Open, around 20% of Americans self-report having food sensitivities. This statistic includes individuals who might not have a clinically diagnosed condition but experience symptoms like bloating, inflammation, or fatigue after eating certain foods. Many of these individuals follow specific diets, such as gluten-free, based on their self-diagnosed sensitivities.

However, only about 6% of, or 19.2 million, Americans have a food allergy according to a Centers for Disease Control (CDC) 2023 National Center for Health Statistics review of two studies. The prevalence is slightly higher among black, non-Hispanic individuals, with 8.5% of adults and 7.6% of children reporting food allergies. Comparatively, white, non-Hispanic adults and children have food allergy rates of 6.2% and 5.3%, respectively. Hispanic populations have the lowest levels reporting food allergy rates of 4.4% for adults and 5% for children.

Chart showing food allergies in adults and children in black, white, and hispanic races.
Percentage of adults and children with food allergies in Black, White, and Hispanic races.

With 6% of the population suffering from food allergies, the remaining 14-20% of self-reported sufferers from undiagnosed digestive issues may or may not be suffering from food sensitivities. It turns out that small intestinal bacterial overgrowth (SIBO) causes similar GI distress symptoms. Understanding the differences can help get to the root cause of GI distress. With proper treatment, you can enjoy your meals again.

Understanding Food Sensitivities and Allergies

Food sensitivities and allergies are immune system responses to certain foods. They can range from mild to severe, with symptoms varying widely among individuals.

  • Food Allergies involve an immediate reaction by the immune system and are typically IgE-mediated. Common symptoms include hives, swelling, difficulty breathing, and anaphylaxis in severe cases. These reactions are quick and often occur within minutes to hours after consuming the offending food.
  • Food Sensitivities are generally less immediate and severe but can still significantly impact quality of life. They may involve IgG, IgG4 and complement 3 factors. Symptoms can include digestive issues like bloating, diarrhea, and constipation, as well as headaches, fatigue, and joint pain. Unlike allergies, sensitivities can take hours to days to manifest.

Testing for Food Sensitivities and Allergies

Diagnosing food sensitivities and allergies often involves various blood tests.

  • IgE Testing is used to diagnose food allergies. High levels of IgE antibodies specific to certain foods indicate an allergic reaction.
  • IgG4 Testing measures the presence of IgG4 antibodies against specific foods, helping to identify food sensitivities and IgE allergy tolerances.
  • IgG Testing measures the presence of IgG antibodies against specific foods, helping to identify food sensitivities. IgG is made for both good and bad reasons. Therefore, it isn’t diagnostic on its own but can be used along with other testing or used to create a guided elimination diet.
  • Complement 3 Factor Testing can be used in conjunction with IgG4 to provide a more comprehensive picture of food sensitivities. Complement 3 factor increases adverse reactions of IgG sensitivities.

These tests can provide valuable insights but should be interpreted by a healthcare professional to create a tailored treatment plan.

What is SIBO?

SIBO occurs when there is an abnormal increase in the number of bacteria in the small intestine. These bacteria can disrupt normal digestion and absorption, leading to a variety of symptoms, including:

  • Bloating
  • Gas
  • Abdominal pain
  • Diarrhea or constipation
  • Malabsorption of nutrients

Testing for SIBO

SIBO is typically diagnosed through breath testing.

  • Lactulose Breath Test involves ingesting a sugar solution and measuring hydrogen and methane levels in the breath over a few hours. Elevated levels indicate bacterial fermentation in the small intestine. Lactulose is not absorbed by humans, but they are an easy sugar for bacteria to consume. Lactulose breath testing assesses gas activity of both the small and large intestines.
  • Glucose Breath Test works similarly, using glucose instead of lactulose. It’s another way to detect bacterial overgrowth based on the gases produced during digestion. Glucose absorbs quickly in the small intestines, with very little reaching the large intestines.

Differentiating Between Food Sensitivity and SIBO

While both food sensitivities and SIBO can cause digestive distress, there are key differences.

  • Symptom Onset: Food sensitivity symptoms can take hours to days to appear while food allergies typically occur immediately or within minutes of consumption. SIBO symptoms often occur shortly after or within 2-3 hours of eating and can linger.
  • Symptom Types: Food sensitivities can cause a wide range of symptoms including systemic issues like headaches and fatigue. SIBO primarily causes digestive symptoms although they too can contribute to systemic issues (headaches, rashes, etc.) which confuses clinic diagnosis.
  • Diagnostic Tests: Blood tests can identify food sensitivities and allergies, whereas breath tests are used to diagnose SIBO. As a side-note: Finger-prick food sensitivity testing should be avoided due to reduced specificity and more false positives and negatives versus a more reliable blood draw test.
Chart showing differences in food sensitivities and SIBO.
Chart of Food Sensitivities V. SIBO

Managing Food Reactions

  • Food Sensitivities: Avoiding trigger foods, working with a dietitian and healthcare provider, as well as using elimination diets can help manage symptoms. In some cases, supplements like digestive enzymes or probiotics may be beneficial.
  • SIBO: Treatment typically involves antibiotics or herbal antimicrobials to reduce bacterial overgrowth, followed by dietary changes and probiotics to restore a healthy gut microbiome.

Understanding the root cause of your food reactions is the first step toward effective management and relief. Whether it’s a food sensitivity or an imbalance in your gut microbiome, proper diagnosis and treatment can help you reclaim your health and enjoy your meals without discomfort.

If you are a patient interested in testing with Neurovanna, ask your doctor to complete this referral form or contact us to find a doctor near you. If you are a healthcare provider interested in using breath testing to assess SIBO, set up a Neurovanna account.