SIBO

3 Causes of SIBO That Have You Suffering

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Irritable bowel syndrome has been a diagnoses of exclusion for many years. If the symptoms are severe enough you are referred for a colonoscopy or an endoscopy, and if tests are clear you are given the diagnosis. If the symptoms are mild enough, no testing is done and the diagnoses is given. This is an umbrella term however. In my practice I see varying causes of IBS since we are looking at the root cause. SIBO, or small intestinal bacterial overgrowth, is one very common cause of IBS. MDs do not have access to other GI tests like a SIBO breath test, or lack knowledge that SIBO is something that can be treated. I see many people with irritable bowel syndrome that show typical signs of SIBO. We test for it and treat accordingly. But WHY do they have it is the big question? 

Symptoms of SIBO

Common symptoms of SIBO are bloating, either with no known trigger food or very predictable trigger foods such as garlic, onion, greens, apples etc, abdominal pain, heartburn, either chronic constipation or diarrhea. Other associated conditions are rosacea, cystic acne, chronic pain, IBD, and even hypothyroidism! The list goes on. This is why I ALWAYS ask you about your gut! 

What Causes SIBO

There are many causes of SIBO that have been shown but I want to point out the most researched and most common causes. One of these may relate to you. 

  • Food poisoning - aka bacterial gastroenteritis. This is actually the #1 cause of SIBO. When you get food poisoning your body produces certain antibodies that decrease the motility of your gut. The wave of motility is called your migrating motility complex (MMC) and it is a very important housekeeping function of your gut to clean everything out in the directly of your bowels. When the MMC is disrupted certain “bad” bacteria in your large intestines can ascend upwards into your small intestines and start fermenting foods they aren’t supposed to (aka SIBO). Note - if you’ve had food poisoning once you are more likely to get it again due to the production of these antibodies so please be careful. 

  • Stress - This is the most common cause I see in practice. When we have chronic stress our bodies are in fight or flight mode and not rest and digest mode. This leads to a decrease in stomach acid, digestive enzymes and bile production. Stomach acid and enzymes suppress the growth of bacteria and they are also helpful in stimulating the MMC. Stress also affects the enteric nervous system (that gut-brain connection) which stimulates the MMC.

  • Abdominal strictures or adhesions - Scar tissue can occur from abdominal surgery, Crohns or Colitis or even endometriosis. The scar tissue then interrupts the proper flow of the gut, aka the MMC. 

As you can see all those causes have an affect on the MMC in our gut. The list does go on unfortunately including issues such as hypothyroidism, opiate use and even traumatic brain injury. 

If you suffer from the above symptoms, have been diagnosed with irritable bowel syndrome but given no treatment, or have digestive issues and have dealt with any of the issue above do not hesitate to get in touch. Let’s get to the root cause of your digestive concerns and help you feel better for good!

In health & happiness, 

Dr. Karen  

Indigestion - To Test or Not To Test

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I often see new patients with undiagnosed digestive issues, that they have been struggling with for months, sometimes years. They have seen their GP and given either no solutions, a medication they have to stay on to feel better, or referred to a GI specialist and are waiting for many more months to then be told their scope was clear and you just have IBS! I know this can very frustrating! 

This is where Naturopathic Medicine can come in and be very helpful. We have been trained in the ins and outs of the digestive tract and possible conditions and have had many hours of nutrition training to cater a food plan specific for you. I love treating digestive concerns for a few reasons:

  • Time to explain how the digestive tract works 

  • Access to GI lab tests that are specific to the patient

  • Tools such as nutrition, herbs, and neutraceuticals that can be specific for the patient 

  • Most conditions I have found stem from gut health so I can treat skin issues, hormone issues etc by addressing the gut! 

Testing can be an invaluable tool at times and can speed up the treatment process.  I go through the 4Rs in gut health (see post here) with all my patients and usually start with the basics in gut health and/or work with where they are at or how severe their digestive symptoms are, but testing can be very helpful. For example, a recent patient of mine opted to do both the SIBO breath test and the IgG food sensitivity panel during his initial visit so we could gather all necessary information as soon as possible then treat accordingly. On his second visit, we could jump right into the test results, in this case positive for hydrogen SIBO and a sensitivity to a few specific foods, and start antimicrobial herbs specific for his SIBO results. He then saw quick results! I believe we would still have gotten moderate results without testing but with it results happened much sooner and were much better. 

Some GI tests have been criticized in the news as of late but considering the results I see when these tests are included in our clinical diagnoses and ultimately the treatment, I have to disagree with some of their conclusions. A few of the digestive system tests I use are:

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  • IgG food sensitivity - This is a comprehensive test including 160 foods that you could have an IgG sensitivity to. I always make sure patients are aware that if several foods come back as a sensitivity then we are dealing with a “leaky gut” generally and eliminating the bigger culprits is important as well as a lot of gut healing support. 

  • SIBO Breath Test - Many cases of “IBS” are associated with an imbalance in bacteria that cause bloating, gas or bowel movement issues. In the case of SIBO it is an imbalance in the upper GI bacteria and the digestive wave is not functioning correctly. Testing reveals if this is the case, how severe the imbalance is and what type of dysbiotic bacteria is highest. We can then treat more effectively. 

  • GI Mapping or Stool Analysis - In more complex cases or if there is a history of parasites and negative scopes, stool analysis is valuable. Among other things his reveals what bacteria, parasite or virus is running rampant in the gut as well as how much inflammation is present. This test is very comprehensive and informative, but it is also more expensive. 

If you have been dealing with digestive issues for awhile with no diagnosis or direction, testing may be of benefit to you. There are many Naturopathic approaches to healing the digestive system and it is one area I love treating. Come visit me! 

In heath & happiness,

Dr. Karen

(Photo credits: 1 - https://www.everydayhealth.com/digestive-health-pictures/lets-hope-its-just-gas.aspx; 3 - www.sibodoctors.com)

IBS Diet - Why A lowFODMAP Diet Is Not Advised Long-Term

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More and more digestive patients of mine tell me that it has been suggested they go on a low-FODMAP diet (easily fermentable foods) to help/cure their IBS symptoms. Sometimes they are even told to stay on it longterm despite not seeing a big benefit. Unfortunately this is not the best suggestion and can actually cause some long-term side effects leading to worse digestive issues. The only digestive condition that warrants a low-FODMAP diet is something called SIBO, small intestinal bacterial overgrowth, and only for a short amount of time. To simplify, SIBO basically means that bacteria have ascending up from the large intestine into the small intestine where they are not suppose to be and cause symptoms such as bloating, gas, and pain. Yes, many patients with IBS do have SIBO, however it is important to accurately test and properly treat, instead of staying on a restricted diet long-term. 

A low-FODMAP diet keeps symptoms of SIBO under control simply by starving the bacteria in your small intestines. When they don’t have food, they aren’t able to ferment that food and produce unwanted gas. It doesn’t actually get rid of them. Longterm, this can starve the bacteria in your large intestines that have a beneficial role in our gut and overall health as well as potentially set patients up for reoccurrence of SIBO. Studies have shown that a long-term low-FODMAP diet can reduce the diversity and quality of beneficial bacteria in the large intestine.  

Yes this diet can reduce symptoms IF you have SIBO however dietary changes alone are often not enough to treat. We want to actually kill the bacteria vs starve them into a dormant state. A low FODMAP diet (or similar low carbohydrate diet) is only one portion of my SIBO protocol and should only be used for about 6-8 weeks in the final phase. As mentioned, my main goal is to kill the unwanted microbes with antimicrobials, while actually feeding them with FODMAP foods to make sure they are active and easier to kill. This phase does not happen for long as well, only about 6 weeks. 

In the long term, we want to eat FODMAP foods to feed the beneficial bacteria in the large intestines. We also want to keep our diet as diverse as possible to allow greater nutrient density and get a wider variety of nutrients. 

My last point is that SIBO is often a symptom of a deeper digestive problem therefore, after properly treating this condition we then address the root cause, which could be low stomach acid, gallbladder issues, intestinal motility issues, stress and so on. 

Therefore if you have been advised to start a low FODMAP diet, or have been on it for even a few months already, please consider seeing a Naturopathic Doctor like myself to consult on whether this is the right treatment path for you, to get tested for SIBO or to help get to the root cause of your digestive concerns. 

Any questions? I'm happy to help!

In health & happiness,

Dr. Karen

 

 

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In health & happiness,

Dr. Karen