Small Bowel Bacterial Overgrowth Syndrome

Over the next cou­ple of weeks, my posts will become a lit­tle more clin­i­cally ori­ented with regards to com­mon Gas­troin­testi­nal prob­lems. I’ll explore facets of irri­ta­ble bowel syn­drome and related dis­or­ders. These are by no means exhaus­tive, but it is my chance to give some light as to the vari­ety of con­di­tions I deal with in my prac­tice, but also the alter­na­tive think­ing by which I approach these prob­lems. Those of you who have worked with me know that I’m not a huge fan of giv­ing dis­eases a “label”. Too many “con­di­tions” over­lap with one another with the same dys­func­tional pat­ters such as stress, diet, envi­ron­men­tal expo­sures, and poor thinking.

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 give indi­ca­tion of 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 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.

To Find a Cer­ti­fied Clin­i­cal Nutri­tion­ist near you, please e-mail your request to: ddc@clinicalnutrition.com

This infor­ma­tion is not intended to treat, diag­nose, cure, or pre­vent any dis­ease. All mate­r­ial in this arti­cle is pro­vided for edu­ca­tional pur­poses only. Always seek the advice of your physi­cian or other qual­i­fied health care provider with any ques­tions you have regard­ing a med­ical con­di­tion, and before under­tak­ing any diet, exer­cise, or other health program.

Dr. Alexan­der Rine­hart is a board cer­ti­fied clin­i­cal nutri­tion­ist, and Food as Med­i­cine Prac­ti­tioner. He is the owner of CoAc­tive Health in Short Hills, NJ. Dr. Rine­hart looks to how hid­den prob­lems may be ruin­ing your health. Sched­ule a free 15-minute phone con­sul­ta­tion to dis­cuss your unique health con­di­tion.