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SIBO – Some of you may have heard of this but most may not and it has become important in identifying one of the underlying causes of irritable bowel syndrome (IBS). In recent years SIBO has also been linked with fibromyalgia, acne rosacea and other health problems which is why it is a fascinating condition to diagnose and treat. Before you rush out to your GP, getting tested is not simple and it is not widely available on the NHS. SIBO is currently mostly diagnosed privately, some GP’s have never heard of the condition and some consultants are dubious as to it’s relevance in relation to IBS and other related health issues. In essence it is still quite controversial but if you would like to find out more, please read on as it may be one of the answers to your unanswered health problems.
What is SIBO?
Small Intestinal Bacterial Overgrowth is a chronic bacterial infection of the small intestine. The infection is due to bacteria that normally live in the gastrointestinal tract but have abnormally overgrown in a location not meant for so many bacteria. The bacteria can interfere with our normal digestion and absorption of food. It can also lead to deficiencies in iron and vitamin B12, causing certain anaemias.
After eating food, the bacteria produce gas within the small intestine which in turn can cause abdominal bloating, abdominal pain, constipation, diarrhea or both. This can get confusing because of course these are the symptoms of irritable bowel syndrome (IBS). SIBO has been shown to exist in up to 84% of IBS patients. However for my part, I have not seen this higher percentage and I find about 30% of IBS patients have a positive SIBO test. Apart from IBS, SIBO has been linked controversially to a whole host of other conditions. These include:
Heartburn (Reflux or GERD)
Skin symptoms (such as eczema or rashes)
Respiratory symptoms (such as asthma)
Mood symptoms (such as depression)
Steatorrhea (fatty stools)
Anaemia (Iron or B12)
How do I get SIBO?
The gastrointestinal tract is a continuous muscular tube which digesting food travels along on its way to the colon. Normally, the coordinated action of the muscles of the stomach and small intestine propels the food from the stomach, through the small intestine and into the colon. This muscular action also sweeps bacteria out of the small intestine and limits the numbers of bacteria in the small intestine. However when a condition interferes with the normal activity in the small intestine this can result in SIBO. By allowing bacteria to stay longer and multiply in the small intestine the lack of normal muscular activity also may allow bacteria to spread backwards from the colon into the small intestine. Possible causes are:
Long term use of PPI’s (proton pump inhibitors eg omeprazole)
Blind loop syndrome (after stomach surgery)
Scarring from previous surgery and crohns disease.
Diverticuli (small pouches) of the small intestine that allow bacteria to multiply inside diverticuli.
Disorders of the immune system can cause bacterial overgrowth
“It is mandatory to consider SIBO in all cases of complex non-specific dyspeptic complaints (bloating, abdominal discomfort, diarrhea, abdominal pain), in motility disorders, anatomical abnormalities of the small bowel and in all malassimilation syndromes (malabsorption, maldigestion).”J.Bures et al 2010.
Getting Tested for SIBO
SIBO is measured by a breath test. This measures the hydrogen and methane gas produced by bacteria in the small intestine that has diffused into the blood, then lungs, for expiration. The gas is graphed over a transit time of 2 or 3 hours and compared to a baseline. Patients drink a sugar solution of lactulose after a 1 or 2 day preparatory diet. The diet removes much of the food that would feed the bacteria, allowing for a clear reaction to the sugar drink. The test is performed either at home with a take home kit or a breath testing machine in hospital, doctors office, or lab. It takes 1-3 hours in the morning after a 12 hour fast the night before and a special diet needs to be adhered to the day before the test.
Who should get tested?
If you have IBS symptoms that have not got better despite seeing your GP and are also suffering from a range of unexplained symptoms, acne rosacea, fibromyalgia etc it may certainly be worth ruling SIBO out as a cause for your symptoms.
Breath tests are available- these are priced £150. – Please call me on 01323 737814 for more information.
What happens if the test is positive?
If the SIBO test is positive the best approach is antibiotic therapy taken over 7-10 days. The antibiotics will vary but this is usually enough to stop the problem and will mean you will be able to eat a normal diet again, if you have been eliminating suspect foods. Antibiotics used can include: tetracycline, amoxicillin, metronizadole, neomycin, cephalexin, and trimethoprim-sulfamethoxazole.
There is only one study using herbal “antibiotics” for the treatment of SIBO, which used enteric coated peppermint oil (ECPO). Besides this, herbal antibiotcs have not been studied for the reduction of SIBO. The question is whether they will target the bacteria that is overgrown. However, it has been suggested that some herbal antimicrobials do not kill our beneficial bacteria, certainly a unique and desirable quality. Herbal antibiotic formulas abound in the supplement industry. These include: Garlic, Cinnamon, Oregano, Goldenseal, and Barberry.
What about special diets?
Patients who come to me with suspected SIBO issues are already on severely restricted diets – avoiding wheat, gluten, dairy, lactose, large amounts of carbohydrate and all manner of different variations of elimination diets. It is advisable to eradicate SIBO quickly and get back to eating as normally as possible rather than staying on restricted diets long term which may lead to different health issues. It is commonplace for patients to think they have multiple food intolerances and lists of foods they cannot eat when in fact it may be only a few foods and the problem they are suffering from is SIBO not from the food itself. Often people with SIBO tell me it does not matter what they eat – even a glass of water can make them feel bloated. This should ring alarm bells, if it’s not the food there is something going on in the gut. Time to get tested. There are a few diets that can help symptoms of SIBO and IBS as well. These include the Specific Carbohydrate Diet and Low FODmap diet which I will be discussing in the next issue as well as the GAPS diet which has found huge popularity recently.
Headaches? Tired All the Time? IBS? Fuzzy thinking? Aches and Pains? Not feeling your best? I am offering my two hour 1-1 MOT service (normal price £165) for £120 from 1st January to 31st January. Start the new year the healthiest you have been! Call me for more details on 01323 737814.
Welcome to my December newsletter. Here we are again, and I cannot believe I find myself at the end of another year. I have had the busiest year to date here at Kate Arnold Nutrition. From gout to fibromyalgia, PMS to IBS, from the easy to the highly complex, you have sought out nutrition as a way forward for your health. A big thank you as always to everyone for your positive response – it’s been a joy to work with you all. 2014 for me sees the start of some exciting new projects, working within schools and the local community. I will keep you posted as to what is happening!
More and more of you are aware of how you are spending your money and what corporations you are willing to give your hard earned cash. Despite still being on the back end of a recession most people I’ve seen are still choosing to eat as well as they can which is fantastic news. I’m off for a well earned rest for a week over Christmas but will be back on January 3rd. I can’t wait to see what the New Year brings forth. Wishing you all a very healthy and happy Christmas and New Year.
Kate’s 12 Festive Food Tips
It’s very usual for the average person to gain 4-6/lbs over Christmas and I know those of you following my weight loss programmes are beginning to panic even more than usual. As much as Christmas seems to be about excess fundamentally it is about having a break from work and being with family more than how much ginger wine and chocolate brazils you can consume! Here are a few easy tips to follow that will help prevent weight gain:
1. Christmas Day is long – or it seems to go on forever, perhaps it’s because I remember my mother getting up at 5am to prepare the lunch! So first things first. Start the day with a good breakfast. Scrambled eggs with smoked salmon and a glass of champagne is fine – honestly! Or what about grilled kippers (probably only for those that have their kitchen well ventilated). Porridge may be a slow release carbohydrate but its still carbohydrate, so protein is the key here.
2. Continuing with the protein theme. Try and make Christmas savoury rather than sweet, and higher in protein – this will help fill you up and you hopefully won’t want to graze so much on the things that you are trying hard to avoid ie The Quality Street tin.
3. Most people will eat what they buy and what’s in the cupboard, so try not to buy cakes and biscuits and tins of chocolates. Homemade is far better if you have the time as you have control over the ingredients and amount of sugar added. Bowls of popping corn are a good idea or why not try dipping nuts ie pecans, brazils and walnuts into dark chocolate. Wholewheat crackers with a little cheese and chutney will fill you up more than cake and mince pies!
4. Don’t forget to drink water and if that’s too boring try a cordial instead: here are some healthy alternatives to alcohol: Belvoir raspberry and rose cordial, Belvoir organic ginger beer, Belvoir spiced winter berry is a great alternative to mulled wine. Watch out for the ingredients list – avoid anything with glucose syrup/fructose/glucose fructose syrup.
5. There is a reason why we feel sleepy after a turkey lunch – it is high in tryptophan, that can boost serotonin levels in the brain, so its great to eat and snack on cold. For vegetarian/vegans, a nut roast does the same.
6. Sugar – avoid it where you can as your blood sugar levels may start to soar and that feeling of ‘got- to -eat- the- whole- tin’ will surface. It’s addictive stuff so try organic/over 70% cocoa products this year if you can, and read labels (don’t forget this includes corn syrup and fructose syrup as well!), If you buy a large tin of chocolates and wonder why you want to eat them all – don’t say I didn’t warn you!
7. If you’re wheat/gluten sensitive, there are now plenty of wheat free/gluten free festive treats in health stores and supermarkets – www.village-bakery.com have a good selection of mince pies, cakes and puddings. Be careful of some “free from” ranges – check the ingredients list always – some of these products are full of additives.
8. Sticking to the above will hopefully keep your blood sugar stable. When blood sugar is high, you produce more insulin which is a fat storing hormone. So keeping your blood sugar stable by eating more protein. If you add general Christmas stress and pressure into the mix this increases the hormone cortisol, which throws more sugar into the blood, (which in turn produces more insulin, which in turn stores fat). So eat protein – Keep Calm!
9. On to alcohol! – don’t forget that alcohol contains sugar – so you can put weight on if you are not used to alcohol and puddings on a regular basis! For those who really don’t want to gain weight – its better to choose either a pudding or alcohol. Keep the main course high in protein, skip a pudding and have a couple of glasses of something dry.
10. Get out into the fresh air and get some Vitamin D, which will help your immune system and if you can get some longish walks in with the family that would be even better, far healthier than slouching in front of the tv all day!
11. If you are beginning to think about goals for 2014, think about starting to reduce the amount of sugar you have in diet. Keep a food diary and see how how much you accumulate over a week – you might be shocked
12. For most of us Christmas is about family, and having a break from work – it is not about SUGAR! and to be more specific it’s not actually about too much food. However good nutritious healthy food shared with family round a table is a wonderful way of connecting and bonding. Choose the best food you can and the best food you can afford.