Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the practical application of health information. Nutrition. Exercise. Diet. Supplementation. I look at the science behind them, and let you know whether it’s something to consider or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
We know that microbes like probiotics are supposed to be in the large intestine. That's where they do their job so to speak. We also know that there is a microbiome for just about every location in the body. In other words, each has its own microbiome. The skin has its own microbiome and it can change depending on the location on the body. We know that the ear canal, the nasal cavity, the upper lungs, and the lower lungs all have their own microbiome. It doesn't mean that they have the same variety or type of microbes as does the large intestine. Each has its own friendly microbes that remain in balance to one another.
But what if there is a shift in the microbiome within a specific location? I'm specifically talking about the small intestine. While it does have its own microbiome as well, what if things begin to grow uncontrollably? The result could be a problem for the person whose microbiome in the small intestine is out of whack. I’m going to talk about small intestinal bacterial overgrowth or SIBO for short in this podcast.
In the small intestine, there are rarely more then 1000 different organisms. Contrast that with the large intestine which at last count, has at least 6000 different microbes, and some of the bacteria have numerous species. So leaving it at 1000 seems really low, at least it appears that way.
What limits the amount of microbes in the small intestine? It appears there are two things: first is the acidity of the stomach. It's a very hostile atmosphere and it extends slightly beyond the stomach into the upper realm of the small intestine. We know well that if there is an overproduction of stomach acid, it can result in ulcers, either of the stomach or the small intestine. But what if the acidity of the stomach is too low? A little more on the stomach first.
There are other natural safeguards in place that limit bacterial growth in the small intestine. Bile acids, used in the digestion of fats, also limit the growth of bacteria. And then finally, digestive enzymes also have a role to play. They are naturally released by the pancreas to digest protein, carbohydrates, and fats. If a person doesn't naturally produce enough digestive enzymes, it can contribute to an overgrowth of undesirable bacteria in the small intestine.
The second factor that limits the growth of bacteria in the small intestine is what's called anti grade motility. In other words, because of the peristaltic movement of the digestive system, food only moves in one direction and that's away from the stomach, through the small intestine, on towards the large intestine.
What's the result of SIBO? Generally, the simplest types of symptoms are going to be bloating especially in the upper abdominal area, closest to the stomach. But it doesn't stop there. It can also cause severe pain and discomfort, contribute to constipation or diarrhea depending on the types of bacteria that take hold. In effect, it can leave people feeling miserable. SIBO is now one of the common diagnostic considerations when people experience these types of symptoms.
What causes the lack of acidity in the stomach? It could be the use of proton-pump inhibitors that people take because they've over produced acid in the past. I use them occasionally if I manage to eat too late. My solution was to really limit how often I do that—and I try to keep that to zero. Those types of medications are really designed to be used for only 14 days. That's why they're often sold in 14 day packs. Yet some people need them on a regular basis. Paula does and her dad did as well. Genetically, they just seemed to over produce stomach acid. So that's one contributing factor.
Another contributing factor could also be the lack of production of digestive enzymes by the pancreas. If food doesn't get broken down well in the small intestine, it leaves more for bacteria to ferment. Fermentation equals the production of gas and that definitely can cause bloating. How it progresses to become more serious with more significant symptoms has to do with diet and the types of bacteria that may be present.
When it comes to the type of bacteria, research has identified multiple species in SIBO. The most common species include Streptococcus, Escherichia coli AKA E coli, Lactobacillus and Bacteroides. The fact that the bacteria are present doesn't always equal out of control growth. Having occasional bloating when certain foods are eaten doesn't seem to be all that serious nor enough to warrant a visit to a specialist. But that doesn't mean that if a poor diet continues and the lack of production of stomach acid and digestive enzymes continues unchecked, that things couldn't get serious. You probably noticed that I said that a strain of E coli is one of the bacteria that has been associated with SIBO. Under normal conditions, the rest of the microbes keep it in check. It's only when the negative bacteria can grow uncontrolled that the more severe symptoms can occur.
I've spent a lot of time explaining what SIBO is. What can you do about it? First step should always be to get a diagnosis from a physician. That can be tricky because there is no single test available at the present time. The most common test is a breath test to check the amount of hydrogen or methane you’re producing. But the breath test is not always accurate so it's probably going to be symptom driven by the degree of discomfort and bloating as well as the more serious symptoms that are considered. Think of it as a process of elimination. You eliminate the most serious digestive issues like irritable bowel syndrome or Crohn's disease, and then you are left with the possible. I know it seems like a backward way to diagnose something that could end up being serious but that seems to be the state of the art at the present time.
How do they typically help people with SIBO? Typically, they may use a course of very specific antibiotics to knock out the overgrowth. For some people, a physician may recommend the use of digestive enzymes if there is a pancreatic insufficiency.
Then, the attempt to control it may utilize what's called the FODMAP diet. For those of you who've had digestive issues, I'll bet you were just waiting for me to say FODMAP diet. It seems like everybody has had to be on that diet at one point or another—and yes, that includes my wife Paula as well.
So exactly what is the FODMAP diet? It stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. I think that the operative word is fermentable. That's typically the way that the bacteria of the microbiome function in the large intestine. But that wasn't the design of the small intestine. So when the microbes that don't belong there or are stimulated to grow by the lack of stomach acid as well as possibly the lack of digestive enzymes, the fermentation process causes the overgrowth and the subsequent symptoms. And when you consider that list, it's many types of carbohydrate that you might want to eat which are short chain carbohydrates and sugar alcohols.
FODMAPs occur in some foods naturally or as additives. The real bummer is that inulin, my favorite type of fiber/prebiotic, can’t be used because it’s highly fermentable as it’s both a fiber and prebiotic that feeds bacteria. The list of foods in that plan far exceed what I can tell you in this podcast. Simply search fodmap in a search engine and you’ll find it easily. The other thing is that you should not follow it unless your doctor tells you to. It's not that it's dangerous in any way. It's just that there are some things that you have to do along the way that require significant explanation if you're going to do it properly. And the goal is for you to feel better.
That's SIBO. It can be simple discomfort or it could significantly impact your life. As I said earlier, never play games. If you feel it's an issue, get a diagnosis so that you know what you're dealing with. Then you will be able to do the things from a diet perspective that may help restore the balance in the microbiome within the small intestine. After all, it’s all about balance on the road to better health. That’s it for this episode. Until next time, this is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
