Understanding the Development of SIBO_Final

>> Welcome back. Are you ready to talk about another gut health condition that's becoming increasingly common these days? In this lecture, we're going to discuss what happens when the bacteria that does a so much good in the colon, makes its way into the small intestine where it doesn't belong. I'm talking about SIBO. SIBO stands for Small Intestinal Bacterial Overgrowth. Let's talk about what this means. The friendly bacteria we've discussed in this course live primarily in the colon. These bacteria digest soluble fiber for us and produce vitamins and minerals that the body needs. These bacteria are good, but only if they're living in the right amounts in the right environment. SIBO is what occurs when too many of these bacteria find their way into the small intestine and form an overgrowth. Researchers are discovering that SIBO may be the culprit behind many individuals' digestive disturbances. Because of its growing prevalence, it's important for Health Coaches as well as doctors and other health professionals to understand this condition. An estimated 64% of first GI specialists involve SIBO. And it has been projected that 60% of people's IBS symptoms may actually be caused or traced back to SIBO, that's a lot. So why is it bad when our microbial friends start taking up residence in the small intestine? Recall that the small intestine is the place where most of your nutrients are absorbed. Only the leftovers, the fibers your body can't break down, travel down to the colon to be digested by bacteria. When these bacteria make a home in the small intestine, they gobble up the nutrients that would normally go directly to your cells. They compete with the body for food and resources robbing it of simple carbs and sugars. This interferes with food absorption including the absorption of vitamin B12. Bacteria can easily proliferate once they find their way into the small intestine because they love sugar. Sugary foods are digested in the small intestine, so for the bacteria it's like an all you can eat buffet. They steal the simple carbs and sugars which get fermented. As a result, these trespassing microbes release gases that hurt the body by being released too far up the GI tract. This gas produces the uncomfortable symptoms that are experienced with SIBO, bloating, gas, nausea, vomiting, and cramping. Rather rude of them, isn't it? As mentioned earlier, in addition to the discomfort from the gas produced by the bacteria, SIBO also causes absorption problems which can lead to malnutrition. Fat malabsorption depletes the body of fat soluble vitamins. The bacteria eat the bile salts present in the small intestine making it harder for the body to break down fat. Carbohydrate malabsorption occurs because the sugar loving bacteria act quickly and break down the carbohydrates before the body has a chance to. Also vitamin B12 deficiency is common with SIBO. When malabsorption and vitamin B12 deficiency occur, this can show up as fatigue, anemia or issues with cognitive processing. To quickly recap what we've covered so far, SIBO occurs when bacteria find their way into the small intestine. They eat the carbs and simple sugars giving off gas as a result. Not only does this rob the body of nutrients and causes malabsorption, it also causes a variety of unpleasant GI symptoms. Again, these guys are doing their job, but they're just doing it in the wrong place which causes problems. So how does bacteria that is supposed to be in the colon make its way to the small intestine? Let's go over the five causes of SIBO. SIBO can be caused by deficiency in the migrating motor complex, a defect in the ileocecal valve, structural defects from surgery or diverticulitis, a weakened immune system, and compromised digestion due to low stomach acid and digestive enzymes. Let's go over each one in detail. First, we'll talk about the migrating motor complex known as the MMC for short. This is a series of contractions that occur in the stomach and small intestine to push out any residual food particles or bacteria. You can think of the migrating motor complex as a little cleaning service that works in between meals to scrub the stomach and small intestine. The contractions of the MMC sweep the gut clean when you're not eating pushing any remaining food particles onward through the system. But the moment you put food in your mouth, it stops. Peristalsis will move food forward while you eat, but the MMC takes a break when new food is introduced. Basically, the intestines have two modes, digesting, and cleaning. Makes sense, right? The cleaning wave happens every 90 to 120 minutes assuming you're not eating. It's about a two hour long process for this cleaning crew to move from the stomach to the ileum. This cleaning action does many things, but most importantly it sweeps bacteria out of the small intestine sending it back home to the colon. The MMC also clears out extra food particles and anything that shouldn't be in there. As you can see, the MMC is very important to the gut. It's most commonly stunted by food poisoning and diabetes. Many incidences of SIBO can be tied back to some sort of food poisoning which can introduce bacteria, a parasite, or a virus. Whatever invader cause the food poisoning can also produce a toxin that can cause nerve damage. This nerve damage can slow down the migrating motor complex. Diabetes can also damage the nerves that control the MMC slowing down motility. Anything that slows digestion, even eating too frequently can weaken the MMC waves. Remember, if you are eating, you can't be cleaning. A second cause of SIBO is a defect in the ileocecal valve. The ileocecal valve is a sphincter that separates the small intestine from the large intestine. A malfunction of this valve will allow bacteria to easily find their way up the pipe, particularly a reflux problem can occur similar to acid reflux in the esophagus. In this case, the contents of the large intestine flow backward into the small intestine. This can happen due to an infection, or parasite, or some kind of irritation caused by undigested food. Another cause of SIBO is structural issues. Structural issues can occur when pouches form in the small intestine. These pouches create nook for bacteria to make a home in and overgrow. At this time doctors aren't certain what causes these pouches, low fiber diets may contribute. Also when stool is hard and the colon has to over exert itself, this may weaken the intestinal wall setting the stage for pouches to form. Diverticulitis is a condition where inflammation occurs in these pouches. This condition may contribute to SIBO when pouches form in the small intestine. However, most cases of diverticulitis do not form in the small intestine, so this is rare. It's also interesting to note that intestinal surgery, including stomach stapling, affects the landscape of the intestines and can predispose an individual to SIBO. The fourth contributor to SIBO is a weak immune system. Normally, a proper functioning immune system can take care of bacteria that's out of place and handle any toxins they produce. But when the immune system is low, there aren't enough resources to handle the problem. With all the immune system has on its plate, you can imagine that this can be a tireless job, especially if the overgrowth is chronic due to some sort of motility problem. When the immune system is compromised, imbalance can take over and proliferate. Something to keep in mind is that chronic stress weakens the immune system, taxing it over time. A weakened immune system can leave the body susceptible to infection which can also contribute to SIBO. Infections can either affect motility directly as we mentioned or antibiotics can create a void in which opportunistic bacteria can overgrow. The fifth contributor to SIBO is low stomach acid and lack of sufficient digestive enzymes. Stomach acid can normally kill off unwanted bacteria, but when stomach acid is low, it is unable to properly do its job. As a result extra bacteria from what we ingest can collect in the small intestine. Overuse of antacids or proton pump inhibitors can also contribute to SIBO. These medications are used for acid reflux. Reflux medications may temporarily provide relief. However, any medication that lowers stomach acid goes hand in hand with SIBO. To recap, the five main contributors to SIBO are, a deficiency in the migrating motor complex, commonly food poisoning or diabetes, a defect in the ileocecal valve, structural defects, a weak immune system, and insufficient stomach acid and digestive enzymes. SIBO is often a recurring condition. One of the biggest problems with SIBO is the fact that it's stubborn and often comes back repeatedly. Some studies show a recurrence rate around 45%, that's almost half. Sometimes relapse can happen as quickly as a few days, weeks, or months. Individuals who relapse in as quickly as one to two weeks, typically, have SIBO due to some sort of adhesion or structural issue. But the majority of cases won't return that quickly. It has been proposed that as many as 70% to 80% of SIBO instances are related to an issue involving the migrating motor complex. In these cases, getting rid of the overgrowth only temporarily solves the problem, with slow motility, sooner rather than later bacteria will populate in the small intestine as the MMC won't be able to sufficiently sweep them away. If given the food to thrive, the bacteria will proliferate. Bacterial overgrowth in the small intestine can contribute to leaky gut by irritating tight junctions and affecting permeability. Bacterial overgrowth can also contribute to wear and tear on the villi which are key players in the absorption of nutrients. SIBO also contributes to inflammation and thinning of the mucosal lining. Both will subside when SIBO is treated with antibiotics. To recap, SIBO is the condition of small intestinal bacterial overgrowth. Bacteria in the colon is great, but when it sneaks up into the small intestine and starts competing with us for food, unpleasant side effects can occur. The small intestine is made to absorb nutrients, not to house a group of freeloaders. Bacteria can get into the small intestine as the result of several different breakdowns in the digestive process. Sugar widely available in the small intestine provides food for them to quickly overgrow and takeover. And poor motility due to a compromised migrating motor complex is most often the culprit behind SIBO. When this function is compromised, it stops efficiently sweeping bacteria out of the small intestine. A sluggish MMC will make SIBO difficult to treat and likely to recur. Do you know someone that has experienced SIBO? What has their experience been like? What remedies have they tried? Also, what stood out to you the most in this lecture? Do you have any lingering questions about SIBO? Head on over to the Facebook group to join the discussion where we'll support you and answer your questions. Thanks for tuning in. Bye for now.