I have been treating patients for over 32 years. 75% of everything I treat in the office and around the world is GI-related. SIBO and H. pylori are the bulk of what I see. Treating SIBO is way more complicated than following a low FODMAP diet. Discovering the underlying “why” behind its development is key to SIBO’s handling and to prevent future relapses. Yes, just treating SIBO without fixing the “why” just sets you up for relapse. Please feel free to contact me for a complimentary 15-minute consultation to see if we’re a good fit and if what you have going on is something I can help with – 714-639-4360.
Small intestinal bacterial overgrowth (SIBO).
During the fasting state, the upper gastrointestinal tract exhibits a specific periodic migrating contraction pattern that is known as the migrating motor complex (MMC). This mechanism is controlled via the hormone motilin and the vagus nerve.
- Questions I will ask you: Do you eat three meals per day and snack in between meals? Do you intermittent fast? Are you locked in a “fight-flight response chronically? Do you fall asleep quickly? Do you exercise regularly?
The Migrating Motor Complex (MMC) has been considered an “intestinal housekeeper” that prevents SIBO. SIBO is usually determined by glucose or lactulose breath test, or by aspirate cultures from the small intestine, and is defined by the presence of excessive (>105 colony forming units/ml) bacterial growth in the small intestine (33). Common symptoms associated with SIBO are abdominal bloating, diarrhea (80%), constipation (20%), and abdominal pain (45). One of the main contributors to the development of SIBO is small intestinal dysmotility. It has been shown repeatedly that an absent or disordered pattern of the MMC is associated with SIBO (27, 41, 57). Moreover, disruption of the MMC in rats has shown that an absent MMC predisposes to both bacterial growth and translocation, indicating that the MMC is an important mechanism in controlling bacterial flora in the small intestine (38). No direct involvement of motilin has been reported in the development of SIBO. One paper reported on increased motilin plasma levels in scleroderma patients with bacterial overgrowth, but the clinical significance thereof is unclear (48). The protective effect of the MMC against SIBO is probably due to the migrating band of small intestinal contractions that clear out the luminal content toward the lower intestines.
Although the MMC is necessary to control the growth of bacterial flora in the small intestine, SIBO, the gut microbiome also plays a role in the functionality of the MMC. Germ-free rats have been reported to have longer cycle lengths and fewer activity fronts that reach the midpoint (28). It has been suggested that this decreased motility in germ-free animals is caused by the reduced excitability of neurons in the myenteric plexus (36). It seems that a delicate balance needs to be maintained between the intestinal flora and the MMC to maintain a healthy gut.
- Questions I will ask you: Do you burp more than you think you should? Do you feel pain under your left rib cage? Do you take a probiotic? Do you take enzymes or HCL with meals?
SIBO Associated Symptoms or Conditions:
- Brain Fog
- Chronic Fatigue
- Leaky Gut, Malabsorption, Weight Loss, Thinning Hair
- Alternating Bowel Habits from Constipation to Diarrhea
- Skin Diseases – Psoriasis, Eczema, Rashes, Acne