In my last blog post, Looking Beyond an IBS Diagnosis, I discussed what having IBS (Irritable Bowel Syndrome) really means, and why it's important to look beyond this diagnosis, because we now know that there are treatable conditions responsible for IBS symptoms. These are referred to the 'root causes' of IBS, and over the next series of blog posts, I will discuss the the most common IBS root causes I see in my 1:1 clients, and those who complete my IBS Protocol.
This applies to you even if you don't have an official IBS diagnosis. If you have problems with bloating, gas, diarrhea, constipation, reflux, nausea, undigested food in your poop, or autoimmunity, keep reading!
What is SIBO?
SIBO stands for Small Intestinal Bacterial Overgrowth and is defined as an increased number of bacteria in the small intestine.
What is unique about SIBO is that these bacteria move to where they don’t belong and colonise the small intestine, a region that should contain very limited numbers of bacteria.
Because these bacteria are supposed to be in the large intestine, they are mostly species that ferment carbohydrates and the byproduct is either hydrogen or methane gas both of which will result in abdominal bloating. But just like IBS, SIBO sufferers are usually divided into one of three different categories:
Hydrogen SIBO - mostly associated with diarrhea, but sometimes alternating constipating and diarrhea.
Methane SIBO - associated with constipation.
Hydrogen Sulfide SIBO - associated with rotten egg smelling gas.
From this graphic we can see that the stomach contains the least amount of bacteria and this is because it is a highly acidic condition. And then the small intestine has a little more bacteria but in comparison to the large intestines it is virtually barren. So what we see in SIBO is bacteria moves from the large intestines to the small intestine where it doesn't belong. Remember these are species that ferment carbohydrates or feed on carbohydrates creating gas as a byproduct which can result in the types of symptoms we see an IBS, like bloating indigestion gas and irritable bowels.
This is really the reason why we see such success with a low FODMAP diet when it comes to IBS because FODMAPs are fermentable carbohydrates and this is the bacteria's main food source. So by removing these foods the bacteria no longer has anything to feed on and therefore no longer produces gas. But the problem with this is that you end up starving your good guys at the same time, and when you have low levels of beneficial gut bacteria this can cause problems in itself. This is another reason why finding your root is so important so that you don't have to remain on a restrictive diet in the long-term.
Prevalence of SIBO in IBS patients
SIBO is actually a subset of IBS. Not all IBS is SIBO, but The prevalence of IBS is about 10%, so that's about one out of 10 people will have some digestive disorder that actually is IBS.
Estimation is that SIBO is about 60 to 80% of all worldwide cases of IBS, so that's a huge number, and means it's possible that we are looking at about 500 million SIBO cases worldwide, and of course the vast majority doesn't know that they have SIBO. In the past five years, every time I check PubMed, which is a research database, there's just hundreds and hundreds more research studies that are coming out, which is really exciting for you, the SIBO sufferer, to understand this condition more and successfully treat it.
Common SIBO Symptoms
So, what kind of symptoms does SIBO cause?
Here's the most common SIBO symptoms:
Cramping and abdominal pain
Constipation and/or diarrhea
Fat malabsorption (sticky, oily poo)
Leaky gut symptoms - rashes, skin problems, allergies etc
As you can see they all overlap with IBS symptoms but there is one key symptom that generally give SIBO away and that's bloating. Now you won't necessarily see all these symptoms in someone with SIBO, but bloating almost always occurs because in SIBO we know gas production is a problem and excess gas causes bloating. And this bloating can be really obvious where you are getting bloating quite soon after eating. But in some people it's harder to tell because they feel bloated most of the time. So this is the classic SIBO symptom but really SIBO and compasses all sorts of symptoms because IBS is not just bloating. It's also constipation and diarrhea which could be alternating and abdominal pain and this can be due to the gas and by products produced by the bacteria. SIBO can cause a lot of burping and flatulence as well as nausea and acid reflux. It can cause all sorts of leaky gut symptoms like rashes and food reactions and also malabsorption of fat which can present an oily sticky poos. And beyond obvious gut symptoms in SIBO we often see systemic symptoms like fatigue headaches joint pain and insomnia.
Types of SIBO
As I mentioned before, just like with IBS, we usually see three distinct types of SIBO.
The first is methane dominant SIBO which is associated with constipation. This is sometimes referred to as SIBO - C, similar to IBS - C. And this type of SIBO is not technically caused by bacteria but a single celled organism called archaea. The archaea feed off the hydrogen produced by bacteria during the fermentation of carbohydrates and produce the byproduct methane and methane gas is known to slow transit time in the gastrointestinal tract which leads to constipation and constipation allows more bacteria to grow which causes more methane and more constipation, you get the picture.
SIBO - D is associated with hydrogen production and diarrhea or in some cases alternating constipation and diarrhea. This is the most common form of SIBO and it is the result of carbohydrate fermenting bacteria that produces hydrogen gas in the small intestine. That gas leads to chronic diarrhea, bloating and abdominal pain.
We then have a third type, hydrogen sulfide dominant SIBO, which unfortunately we don't have a test for yet but the symptoms are quite distinct and generally someone with all the symptoms and a negative test result will fall into this category. This type of SIBO occurs through Sulfate reducing bacteria in the small intestine produce hydrogen sulfide which is a highly toxic gas to the cells of the intestinal wall and it's best known for it's distinctively foul odour of rotten eggs.
How SIBO affects your gastrointestinal tract
We now know what SIBO is and what symptoms it results in, but the biggest health issues you are likely to face if you suffer from SIBO are as a result of improper digestion and absorption of vitamins and nutrients. this can occur in multiple different ways. firstly by causing damage to the intestinal wall or intestinal mucosa, which it is sometimes referred to as and this happens because the bacteria and their biofilms and their toxic by products can all damage the microvilli which are the hair like protrusions that line the small and intestines. It can also damage what is known as brush border enzymes which are released by the microvilli, as well as damaging bile acids which are needed to break down and absorb fat.
The other way damage can occur is through bacteria essentially stealing nutrients from your own cells. Most digestion happens in the small intestine while most bacteria lives in the large intestine. But, if you have an overgrowth of bacteria in the small intestine, this creates competition between your own cells and the bacteria. The bacteria may take up certain vitamins such as B12 and minerals such as magnesium, iron and calcium before your own cells have the chance. The bacteria may also consume amino acids from protein which are the building blocks for growth and repair. Therefore, it becomes very difficult to heal and recover in general. Malnutrition is particularly common for SIBO - D sufferers as a common side effect from gut irritation. Food is essentially leaving your body before you have time to absorb any of the good stuff.
The final problem with untreated SIBO is that it can damage your migrating motor complex or MMC in small intestine, and the job of this is to produce wave like motions through the small intestine so that bacteria which is not supposed to be there is moved. This is a big problem in SIBO because it often causes people to relapse unless you correct the problem with the MMC.
So, as you can see there are a lot of problems with SIBO, beyond the symptoms alone which is why for your long-term health managing conditions like this with an indefinite low FODMAP diet is a bad idea.
What about SIFO?
Because our microbiome is not just bacteria there are other types of organisms which can produce similar symptoms but they won't be picked up on through standard testing and may not get better with the standard treatment. Fungi as one of these organisms, Candida being the most common. And a lot of you may have heard of Candida before as it's the same type of fungi causes thrush. It is actually normal to have some amounts of this fungi but in SIFO just like in SIBO, the problem occurs when this fungi overgrows in the small intestine.
The confusing part of this is that the symptoms of practically identical but typical treatment for SIBO may not work for SIFO because treatment is based around killing bacteria instead of fungi. Because there is no test for SIFO you should strongly suspect it if you have a history of yeast infections, rashes, histamine intolerance and if you notice sugar makes your symptoms worse. Or if you are not responding to SIBO treatment then this is when we would consider SIFO as well.
If you suspect you have SIBO, testing and treatment is the next step. In my next blog post, I will be discussing the Gold Standard SIBO testing method I use with my 1:1 clients + my proven method for treating SIBO.
If you want to get the ball rolling now and start your healing journey, book a free 20 min chat with me so we can discuss how I can help you to identify and overcome the root cause of your gut issues.
Katika chapisho langu la mwisho, Kuangalia Zaidi ya Ugonjwa wa IBS, nilijadili nini kuwa na IBS (Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa wa Ugonjwa). "Hizi ni ""sababishi za msingi"" za IBS, na katika safu inayofuata ya machapisho ya blogi, nitajadili sababu za msingi za IBS za kawaida ambazo ninaona katika wateja wangu wa 1: 1 na wale ambao wanakamilisha IBS Protocol yangu." Hii inatumika hata kama huna IBS rasmi. Ikiwa una matatizo ya kuvimba, gesi, kuhara, upungufu wa damu, reflux, kichefuchefu, chakula kisichotafunwa katika kinyesi chako, au kinga ya mwili, endelea kusoma! SIBO ni nini? SIBO (Small Intestinal Bacterial Overgrowth) ni ugonjwa wa kuongezeka kwa bakteria katika matumbo madogo. Jambo la kipekee kuhusu SIBO ni kwamba bakteria hizi husafiri mahali ambapo hazihusiani na kuhamia matumbo madogo, eneo ambalo linapaswa kuwa na idadi ndogo sana ya bakteria. Kwa sababu bakteria hizi zinapaswa kuwa katika matumbo makubwa, wao ni aina nyingi ambazo huchemka wanga na bidhaa ni ama hidrojeni au gesi ya methani ambayo yote mawili itasababisha kuvimba kwa tumbo. Kwa mfano, ugonjwa wa IBS unaweza kugawanywa katika makundi matatu: Hydrogen Sibo (HSS), ambayo ni ugonjwa wa kuhara, na constipation. Methane SIBO - inayohusishwa na uvimbe. Hydrogen Sulfide SIBO - inayohusishwa na gesi yenye harufu ya mayai yaliyooza. Katika picha hii, tumepata kwamba tumbo lina bakteria chache kuliko sehemu nyingine za mwili, na hii ni kwa sababu tumbo ni asidi sana. Matumbo madogo yana bakteria nyingi lakini kwa kulinganisha na matumbo makubwa, matumbo madogo hayana bakteria. Katika ugonjwa wa SIBO, bakteria huanza kuhamia kutoka kwenye matumbo makubwa hadi kwenye matumbo madogo. "Kumbuka, hizi ni spishi ambazo huchemka wanga au kulisha wanga na kuunda gesi kama bidhaa ya ziada ambayo inaweza kusababisha aina ya dalili tunazoona katika IBS, kama vile ""mvuke"" gesi ya kuganda na matumbo ya kukasirika." Kwa sababu hii, kwa kawaida, chakula cha chini cha FODMAP kinaweza kuathiri IBS, kwa sababu FODMAP ni wanga unaoweza kuyeyushwa na ndio chanzo kikuu cha chakula cha bakteria. Kwa hivyo kwa kuondoa vyakula hivi bakteria hazina tena chochote cha kula na kwa hivyo hazitokezi gesi tena. Lakini tatizo ni kwamba wewe ni kukimbia njaa ya watu wako mzuri wakati huo huo, na wakati una viwango vya chini ya bakteria faida ya matumbo hii inaweza kusababisha matatizo yenyewe. Hii ni sababu nyingine kwa nini ni muhimu sana kupata mizizi yako ili usiwe na kukaa kwenye lishe kali kwa muda mrefu. Ugonjwa wa IBS unajulikana kama IBS (IBS) kwa sababu ni sehemu ya ugonjwa wa IBS. IBS ni ugonjwa wa kawaida, lakini kwa kawaida ni karibu 10%, kwa hivyo ni karibu mtu mmoja kati ya watu 10 atakuwa na ugonjwa wa kumeng'enya chakula ambao kwa kweli ni IBS. "Kulingana na takwimu za utafiti, Sibo ni asilimia 60 hadi 80 ya watu wote duniani wanaosumbuliwa na ugonjwa wa IBS, na idadi hiyo ni kubwa sana, na inawezekana kwamba kuna takriban watu milioni 500 duniani kote wanaosumbuliwa na ugonjwa huo, na wengi wao hawajui kwamba wana ugonjwa huo.""" Katika miaka mitano iliyopita, kila wakati ninapochunguza PubMed, ambayo ni hifadhidata ya utafiti, kuna mamia na mamia ya masomo zaidi ya utafiti yanayokuja, ambayo ni ya kufurahisha sana kwako, mgonjwa wa SIBO, kuelewa hali hii zaidi na kuitibu kwa mafanikio. Sifa za kawaida za SIBO: Ni nini kinachosababisha SIBO? Ugonjwa wa IBS una dalili kama vile maumivu ya tumbo, constipation, na dysentery, na dalili za tumbo la ndani (kuvu, mafuta, na poo) na dalili za tumbo la nje (kuvu, ngozi, allergies, na dalili za IBS) ambazo zinaweza kuathiri dalili za IBS. Si lazima mtu mwenye ugonjwa wa SIBO awe na dalili hizi zote, lakini mara nyingi huonekana kuwa na uvimbe kwa sababu katika ugonjwa huo tunajua kwamba kutokezwa kwa gesi ni tatizo na gesi nyingi husababisha uvimbe. Uvimbe huu unaweza kuonekana wazi wakati unapopata pumzi mara tu baada ya kula. Lakini kwa watu wengine ni vigumu kujua kwa sababu wanahisi umajimaji wakati mwingi. Hii ni dalili ya kawaida ya SIDS, lakini kwa kweli ni dalili ya kawaida ya SIDS na inajumuisha dalili zote kwa sababu IBS si tu bloating. Pia kuna ugonjwa wa kuhara na kuhara, na maumivu ya tumbo, ambayo yanaweza kuwa kutokana na gesi na bidhaa zinazozalishwa na bakteria. SIBO inaweza kusababisha burping na flatulence, pamoja na kichefuchefu na reflux ya asidi. Inaweza kusababisha aina zote za dalili za matumbo ya kuvuja kama vile mlipuko na athari za chakula na pia malabsorption ya mafuta ambayo inaweza kuwasilisha poses mafuta na sticky. Zaidi ya dalili za kawaida za tumbo, SIBO pia ina dalili za mfumo kama uchovu, maumivu ya kichwa, maumivu ya viungo, na kukosa usingizi. Aina ya Sibo: Kama ilivyoelezwa hapo awali, kuna aina tatu za Sibo. Mfano wa kwanza ni ugonjwa wa methane-dominant Sibo, ambao unahusishwa na uvimbe. Hii mara nyingi huitwa SIBO-C, sawa na IBS-C, na aina hii ya SIBO haisababishwi na bakteria lakini kiumbe cha chembe moja kinachoitwa archaea. Archaea huchukua hidrojeni inayotokezwa na bakteria wakati wa uchemchemi wa wanga na kuzalisha methane na gesi ya methane, ambayo huongeza muda wa usafirishaji katika mfumo wa gastrointestinal, na kusababisha uvimbe na uvimbe, na kuwezesha bakteria zaidi kukua. SIBO - D inahusishwa na uzalishaji wa hidrojeni na kuhara au katika visa fulani kubadilishana constipation na kuhara. Hii ni aina ya kawaida ya ugonjwa wa SIBO na ni matokeo ya bakteria ya fermentation ya wanga ambayo inazalisha gesi ya hidrojeni katika matumbo madogo. Gesi hiyo husababisha kuhara kwa muda mrefu, kuvimba na maumivu ya tumbo. Aina ya tatu ya ugonjwa wa SIBO ni sulfurididi hidrojeni, ambayo kwa bahati mbaya bado haijapatikana kwa ajili ya mtihani, lakini dalili zake ni tofauti na kwa ujumla mtu mwenye dalili zote na matokeo ya mtihani ni hasi ataingia katika jamii hii. Aina hii ya ugonjwa wa siri hutokea kwa bakteria zinazopunguza sulfate katika matumbo madogo zinazozalisha hidrojeni sulfidi, ambayo ni gesi yenye sumu sana kwa seli za ukuta wa matumbo na inajulikana zaidi kwa harufu mbaya ya mayai yaliyoharibika. SIBO: Jinsi Inavyoathiri Mfumo Wako wa Matumbo Sasa tunajua nini SIBO na ni dalili gani zinazosababisha, lakini matatizo makubwa ya afya unayoweza kukabili ikiwa unakabiliwa na SIBO ni matokeo ya kumeng'enya na kunyonya vyakula na virutubisho. Hii inaweza kutokea kwa njia nyingi tofauti. Ugonjwa huu huathiri sana utando wa matumbo, ambayo mara nyingi huitwa mucosa ya matumbo, na kwa sababu bakteria na biofilms zao na bidhaa zao za sumu zinaweza kuharibu microvilli, ambayo ni nywele kama protrusions ambayo line ndogo na matumbo. Pia inaweza kuharibu kile kinachojulikana kama brush border enzymes ambayo hutolewa na microvilli, pamoja na kuharibu asidi za bile ambazo zinahitajika kuvunja na kunyonya mafuta. Njia nyingine ya uharibifu inaweza kutokea ni kupitia bakteria kimsingi kuiba virutubisho kutoka kwa seli zako mwenyewe. Uchemchemi mwingi hutukia katika matumbo madogo huku bakteria nyingi zikiishi katika matumbo makubwa. Lakini, ikiwa una ukuaji wa kupita kiasi wa bakteria katika matumbo madogo, hii huunda ushindani kati ya seli zako mwenyewe na bakteria. Bakteria inaweza kuchukua vitamini fulani kama vile B12 na madini kama vile magnesiamu, chuma na kalsiamu kabla ya chembe zako mwenyewe kuwa na nafasi. Bakteria pia zinaweza kula asidi za amino kutoka kwa protini ambazo ni vitalu vya ukuaji na ukarabati. Kwa hiyo, inakuwa vigumu sana kuponya na kupona kwa ujumla. Ulemavu wa lishe ni jambo la kawaida hasa kwa wagonjwa wa SIBO - D kama athari ya kawaida ya kuchochea matumbo. Chakula ni kuondoka mwili wako kabla ya wewe kuwa na muda wa kunyonya yoyote ya vitu vizuri. Ugonjwa wa SIBO unaoweza kuharibu mfumo wa kusafiri wa motor (MMC) katika utumbo mwembamba, na kazi yake ni kutokeza mawimbi kama mwendo kupitia utumbo mwembamba ili bakteria ambayo haipaswi kuwa huko. Hii ni tatizo kubwa katika SIBO kwa sababu mara nyingi husababisha watu kurudi nyuma isipokuwa wewe kurekebisha tatizo na MMC. Kama unavyoona, kuna matatizo mengi na SIBO, zaidi ya dalili peke yake, na kwa nini kwa afya yako ya muda mrefu kusimamia hali kama hii na chakula cha muda mrefu cha chini ya FODMAP ni wazo mbaya. Vipi kuhusu SIFO? Kwa sababu microbiome yetu si bakteria tu kuna aina nyingine za viumbe vinavyoweza kuzalisha dalili kama hizo lakini hazitaonekana kupitia upimaji wa kawaida na haziwezi kuwa bora na matibabu ya kawaida. Fungi ni mojawapo ya viumbe hao, na Candida ndiyo inayojulikana zaidi. Wengi wenu huenda mmesikia kuhusu Candida, aina ya kuvu inayosababisha ugonjwa wa kuvu. Kwa kawaida kuna aina fulani ya kuvu, lakini katika ugonjwa wa SIPH kama vile katika ugonjwa wa SIPH, tatizo hutokea wakati kuvu hukua sana katika matumbo madogo. Kwa sababu ya hali hii, dalili za matibabu ya kawaida ya Sibo zinaweza kuwa tofauti na dalili za matibabu ya kawaida ya Sibo, kwa sababu matibabu ya Sibo yanategemea kuua bakteria badala ya kuua kuvu. Kwa sababu hakuna mtihani wa SIFO, unapaswa kuhoji sana ikiwa una historia ya maambukizi ya kucha, kuvu, kutovumilia histamine, na ikiwa unaona sukari inazidisha dalili zako. Ikiwa wewe ni mgonjwa wa ugonjwa wa Sibo, basi ni muhimu kuzingatia matibabu ya Sibo. Ikiwa una shaka ya kuwa na ugonjwa wa SIBO, hatua inayofuata ni kupima na kutibu. Katika chapisho langu la pili, nitazungumzia mbinu ya Gold Standard ya kupima SIBO ambayo ninatumia na wateja wangu wa 1: 1 + mbinu yangu iliyothibitishwa ya kutibu SIBO. Ikiwa unataka kuanza mpira sasa na kuanza safari yako ya uponyaji, kitabu mazungumzo ya bure ya dakika 20 na mimi ili tuweze kujadili jinsi ninavyoweza kukusaidia kutambua na kushinda sababu ya msingi ya shida zako za matumbo.