Identifying Small Bowel Bacterial Overgrowth Syndrome
Small Bowel Bacterial Overgrowth (SBBO) is a relatively common gastrointestinal disorder caused by chronic low stomach acid and immune suppression and worsened by chronic constipation, high sugar intake, infant formula feeding, food sensitivities, as well as antibiotic or antacid use.
When the healthy bacteria in your bowel are out of balance, harmful and opportunistic bacteria take their place, this can linger quietly for years – often showing itself in full force when the body is immuno-compromised with illness, or immediately following a round of antibiotics.
Less commonly in the United States, SBBO can be caused by parasitic infections – perhaps because of drinking fresh water while out on a hike, or having traveled abroad and eaten the local fare.
In my opinion, SBBO is a more serious version of common symptoms many of us experience on a daily basis. Whether it’s because of food intolerances, sensitivities, or allergies, bingeing, alcohol use, chronic stress, or exhausted adrenals, each person has a unique story behind why they have dysbiosis or SBBO and therefore there is no set protocol, just guidelines, to approach practice members’ unique health circumstances.
SBBO is not necessarily a “bug” that you catch and treat with antibiotics (unless of course we’re talking about a case of Giardia or other parasitic infections). Instead, SBBO is a functional condition that can linger for years under the surface often present with irritable bowel syndrome or intestinal yeast.
Clinically it can be measured with a hydrogen breath test, but the test’s sensitivity can be limited as it may only be positive in some 60% of patients with bacterial overgrowth syndrome.
SBBO involves bacteria naturally found in the gut, that are allowed to proliferate opportunistically when your good bacteria are compromised – similar to how Staph bacteria naturally found on the skin can cause abnormal skin infections.
Testing can be performed by stool samples, breath tests, and biopsies that can indicate the balance of bacteria in the GI tract. Acupuncturists and other alternative providers may also look to the tongue to gather a sense as to how the rest of your GI tract is functioning.
Practice members with SBBO will have chronic diarrhea, poor absorption of nutrients, and may experience unintended weight loss.
Clinically, as this condition can go unrecognized…with practice members often find themselves going back and forth between specialists, where they are often scoped and biopsied, or even have their intestines resectioned to limit the space the bacteria have to grow.
One new treatment is to actually inject the stomach muscle with botox, to slow down gastric emptying. Much of this may be unnecessary & overly aggressive except in severe medical circumstances.
For most, a functional nutrition approach may work just fine – but understand that the process takes a significant lifestyle commitment & can take up to 3-6 months to reverse naturally.
Functional Nutrition Approach to SBBO
1. Identify triggers: Food allergies, sensitivities, intolerances, alcohol use, unfermented soy, legumes, chronic use of NSAIDs like ibuprofen or tylenol, and generally, the Standard American Diet etc can all cause irritation to the gastrointestinal tract. Using an elimination diet, or IgE/IgG blood or saliva test may help identify these triggers.
2. Check balance of healthy bacteria: probiotics are organisms that help us digest difficult proteins, activate our immune systems, and keep pathogens out of the GI tract. Diets high in refined sugars and carbs can lead to an imbalance of healthy bacteria. Too much protein, unbalanced by vegetable intake, can cause acidic conditions that harmful bacteria love. Trained practitioners know which strains of bacteria to use.
3. Soothe and Fuel the Intestines: Some natural therapies like aloe or licorice can give short-term relief of symptoms as they help deflame the GI tract. Even whole foods like okra, with its mucousy texture, can help support a healthy gut lining. The cells of the intestine feed on byproducts of healthy bacteria, and can become stressed when harmful bacteria have takent heir place.
Supplementing with L-Glutamine may be helpful in rebuilding a damaged or weak gut. This is partly why absorption and weight loss occur, you’re unable to digest or absorb your nutrients properly. Immune conditions can develop as well as the probiotics aren’t there as a natural defense, and the body is under a constant state of repair and surveillance against pathogens.
4. Identify and Address Co-existing problems: Celiac disease, lactose intolerance, enzyme insufficiency, thryoid disorders, weakened adrenals, and inflammatory bowel disease are often associated with SBBO. Fructose and a sugar alcohols like xylitol or sorbitol (often found in chewing gum) are less known intolerances that may play a role.
5. Improve GI motility: Stress relief, exercise, fiber intake, and hydration can all help promote movement of the bowels. The longer fecal material is allowed to sit in the gut, the more toxins and hormones that are reabsorbed, and the greater the chances that harmful bacteria will start building up.
6. Relieve Symptoms Naturally: there are a variety of essential oils, plant chemicals and other herbals that can help relieve acute symptoms and give the body’s defenses a rest while addressing the root causes of the imbalance. Peppermint oil, ginger, garlic, and aloe are just a few examples of remedies that may help provide short-term relief while you address other core issues.