Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome

By Dr. Susanne Booth

Irritable Bowel Syndrome (IBS) is considered a diagnosis of exclusion, which means no specific cause can be found for the person who suffers. And suffer they do, often having bouts of constipation and diarrhea, cramping pain, gas and bloating.

Some people find relief with food elimination; gluten and/or dairy are often culprits of these complaints. There may be something else that is causing a problem--Small Intestinal Bacterial Overgrowth (SIBO).

Normally we have a large amount of bacteria in our large intestine and just a small amount in the small intestine. Various causes can disrupt this balance. Surgery can result in blockages of the small bowel. Diseases such as diabetes and scleroderma can decrease movement of the small intestine.

In my practice, I often see another cause--stress. When our bodies are under stress we produce more cortisol (also called adrenaline). It is important; the increased cortisol gives us the ability to stand and fight or run away quickly from the stress. It also acts on our stomach cells resulting in less acid production. There is a very good reason for this. When we need to fight or flight, we don't need to be spending energy digesting food; we need the energy to run.

When there is less stomach acid, the pH of the stomach goes up from its normal pH of about 2. The increased pH when we are stressed may allow bacteria to survive and get through to the small intestine, bacteria that would normally be killed off in the lower pH. These bacteria set up shop and stay in the small intestine reeking havoc.

The symptoms of SIBO include bloating or abdominal gas, abdominal pain and cramps, constipation or diarrhea or an alternation between the two, heartburn, nausea, malabsorption and systemic inflammation that may cause headaches, joint pain and fatigue. This can look a lot like irritable bowel syndrome.

The bacteria in the small intestine cause all these symptoms because of their production of methane or hydrogen gases. These gases lead to distension, pain and flatulence. The increased gas can also affect the ability of the intestines to contract in order to eliminate fecal matter, resulting in constipation or diarrhea.

Treatments for SIBO traditionally consisted of prescription antibiotics, which could lead to the issue of the overgrowth of bad bacteria in the large intestine. However, there are other treatment options. More natural treatments are multifaceted. Eradication of SIBO can be accomplished with diet changes, antimicrobial herbs that do not disrupt the large intestinal bacteria, and certain types of probiotics.

Of course, the most important thing is to stop the bacteria from getting into the small intestine in the first place. We can manage the stomach pH with supplements, but at times we all need to look at the stress we are enduring and see if we can eliminate some of it or find productive ways to manage it.

Dr. Susanne Booth is a Naturopathic Doctor and Physical Therapist at Sojourns Community Health Clinic. For more information please contact Sojourns Community Health Clinic, at (802) 722-4023, 4923 US Route 5, Westminster, VT

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