Small Intestinal Bacterial Overgrowth (SIBO)
I have been diagnosed with Small Intestinal Bacterial Overgrowth – SIBO (pronounced seebo). The problem bacteria are many of the “pro-biotics”. They are normally confined to the large intestine by stomach acid, which they do not tolerate.
Many years ago, I was diagnosed with inadequate stomach acid (which has a genetic cause). I have since been taking HCl supplements (hydrochloride – stomach acid in a capsule). However, the supplements are not enough to keep the pro-biotics down.
Pro-biotics are opportunistic critters that take advantage of my reduced levels of stomach acid. Bacteria that are able to venture higher up in the digestive system get first dibs on my eaten delights. They have invaded my small intestine in large numbers.
These bacteria emit gases. In the large intestine, the gases are released by farts but cause no other significant symptoms. In my small intestine my symptoms caused by these gases are more problematic. They start with nausea and heartburn, which can be temporarily relieved by extended bouts of burping, sometimes lasting 2 or 3 hours, often in the night time. This heartburn and burping burns my vocal chords which causes mucous build up which I clear by coughing. Ultimately, my symptoms are relieved by diarrhea.
Interestingly, SIBO is diagnosed by way of a breath test that tests for certain gases that are exhaled. The test works because, every time we exhale, we emit gases from both the lungs and the digestive system.
The types of gases emitted by pro-biotics include carbon dioxide, methane, hydrogen, sulphur and histamine. Most gases bubble or float up, especially carbon dioxide (think of a fizzy drink). Whether they escape out of the bottom end of the digestive system (farts) or out of the top end (exhaled, hiccupped or burped) is determined by whether they are emitted by bacteria in the large or the small intestine. The connection between the small and large intestines is an upright U-shape located at the bottom of the abdomen. This dictates the general up-direction of the gases. Though both directions include downturns, the gases are pushed through by muscle contractions.
Digression #1 – From this I’ve learned the cause of burps and hiccups. If the gases rising from the small intestine are blocked by food, muscle contractions force the gases up through the food. If the blockage is in the stomach, the contractions cause burping but if the blockage is lower down, the contractions cause hiccups. If the muscle contractions don’t happen, the gases push the food up against the top of the stomach causing heartburn, which is why heartburn can be temporarily relieved by a burp. And, though a burp often happens after a meal, that meal is typically not the cause, unless carbon dioxide was ingested. Given that the burped gases originate from bacteria that are lower down in the small intestine, they are more likely the result of a meal eaten yesterday or the day before. This is useful to know when you investigate the dietary cause of these symptoms for the purpose of following an elimination diet.
Digression #2 – Heartburn, or reflux as it is often called, is rarely caused by too much stomach acid. It is usually associated with inadequate stomach acid and the resulting SIBO. Never take a proton-pump inhibitor for this symptom. It will cause temporary relief by masking the symptom but ultimately will exacerbate the problem by reducing further the inadequate levels of stomach acid. And these drugs cause additional health problems if taken long-term.
Back on topic – The SIBO breath test does not test for carbon dioxide because it is not possible to know whether that gas was emitted by the lungs or by the digestive system. It tests for some of the gases that are emitted only by the digestive system. There are two versions of the test. My test was for methane and hydrogen. These are not the only gases emitted by SIBO bacteria, but they are gases that the test can detect and measure.
My test result was positive for methane-predominant SIBO. That does not mean that methane is the cause of my symptoms. Histamine is a known cause of my symptoms. The SIBO breath test does not test for histamine but the test result in the context of my other symptoms have resulted in a diagnosis of histamine intolerance. Other gases may also be responsible for my symptoms, but they have not been studied. I suspect carbon dioxide contributes to my symptoms because I cannot tolerate any food or beverage containing anything carbonated.
There is one antibiotic that can be prescribed by a doctor to treat SIBO – zaxine (rifaximin). However, it works in less than 50% of cases and generally does not work on methane-predominant SIBO. It was prescribed for me but it did not work.
Several herbal remedies are offered – including Candibactin BR (made by Metagenics) and Atrantil. I’ve tried these but they did not work.
So, all I can do is to continue to try to starve the bacteria by denying them their favourite foods, which leads to my next blog about the FODMAP diet.
Many years ago, I was diagnosed with inadequate stomach acid (which has a genetic cause). I have since been taking HCl supplements (hydrochloride – stomach acid in a capsule). However, the supplements are not enough to keep the pro-biotics down.
Pro-biotics are opportunistic critters that take advantage of my reduced levels of stomach acid. Bacteria that are able to venture higher up in the digestive system get first dibs on my eaten delights. They have invaded my small intestine in large numbers.
These bacteria emit gases. In the large intestine, the gases are released by farts but cause no other significant symptoms. In my small intestine my symptoms caused by these gases are more problematic. They start with nausea and heartburn, which can be temporarily relieved by extended bouts of burping, sometimes lasting 2 or 3 hours, often in the night time. This heartburn and burping burns my vocal chords which causes mucous build up which I clear by coughing. Ultimately, my symptoms are relieved by diarrhea.
Interestingly, SIBO is diagnosed by way of a breath test that tests for certain gases that are exhaled. The test works because, every time we exhale, we emit gases from both the lungs and the digestive system.
The types of gases emitted by pro-biotics include carbon dioxide, methane, hydrogen, sulphur and histamine. Most gases bubble or float up, especially carbon dioxide (think of a fizzy drink). Whether they escape out of the bottom end of the digestive system (farts) or out of the top end (exhaled, hiccupped or burped) is determined by whether they are emitted by bacteria in the large or the small intestine. The connection between the small and large intestines is an upright U-shape located at the bottom of the abdomen. This dictates the general up-direction of the gases. Though both directions include downturns, the gases are pushed through by muscle contractions.
Digression #1 – From this I’ve learned the cause of burps and hiccups. If the gases rising from the small intestine are blocked by food, muscle contractions force the gases up through the food. If the blockage is in the stomach, the contractions cause burping but if the blockage is lower down, the contractions cause hiccups. If the muscle contractions don’t happen, the gases push the food up against the top of the stomach causing heartburn, which is why heartburn can be temporarily relieved by a burp. And, though a burp often happens after a meal, that meal is typically not the cause, unless carbon dioxide was ingested. Given that the burped gases originate from bacteria that are lower down in the small intestine, they are more likely the result of a meal eaten yesterday or the day before. This is useful to know when you investigate the dietary cause of these symptoms for the purpose of following an elimination diet.
Digression #2 – Heartburn, or reflux as it is often called, is rarely caused by too much stomach acid. It is usually associated with inadequate stomach acid and the resulting SIBO. Never take a proton-pump inhibitor for this symptom. It will cause temporary relief by masking the symptom but ultimately will exacerbate the problem by reducing further the inadequate levels of stomach acid. And these drugs cause additional health problems if taken long-term.
Back on topic – The SIBO breath test does not test for carbon dioxide because it is not possible to know whether that gas was emitted by the lungs or by the digestive system. It tests for some of the gases that are emitted only by the digestive system. There are two versions of the test. My test was for methane and hydrogen. These are not the only gases emitted by SIBO bacteria, but they are gases that the test can detect and measure.
My test result was positive for methane-predominant SIBO. That does not mean that methane is the cause of my symptoms. Histamine is a known cause of my symptoms. The SIBO breath test does not test for histamine but the test result in the context of my other symptoms have resulted in a diagnosis of histamine intolerance. Other gases may also be responsible for my symptoms, but they have not been studied. I suspect carbon dioxide contributes to my symptoms because I cannot tolerate any food or beverage containing anything carbonated.
There is one antibiotic that can be prescribed by a doctor to treat SIBO – zaxine (rifaximin). However, it works in less than 50% of cases and generally does not work on methane-predominant SIBO. It was prescribed for me but it did not work.
Several herbal remedies are offered – including Candibactin BR (made by Metagenics) and Atrantil. I’ve tried these but they did not work.
So, all I can do is to continue to try to starve the bacteria by denying them their favourite foods, which leads to my next blog about the FODMAP diet.
