SIBO is a disorder caused by an over-abundance of bacteria in upper intestinal tract. The symptoms (most commonly gas, bloating, diarrhea, constipation, and/or abdominal pain) can be very distressing for patients and are often misdiagnosed by doctors as IBS.
A large percentage of patients who come to my practice for treatment of intestinal symptoms have SIBO, and it is very rare that SIBO is the only condition that I diagnose them with. SIBO develops because a patient has one or more underlying medical conditions that allow for bacterial overgrowth to happen in the first place. That’s right – – SIBO is a response, not a primary diagnosis. This is why many patients who receive conventional treatment for SIBO (usually a single course of antibiotics), almost always have a re-occurrence of symptoms within weeks to months. The only way to permanently eradicate SIBO is by treating each underlying disease and dysfunction while also killing the bacteria themselves.
What conditions predispose people to SIBO? We are going to talk about them in this series, starting today with cause #1:
Low Stomach Acid –
A proper amount of acid in the stomach is a major contributor to health in a variety of ways, and it is especially important in the development of SIBO. Stomach acid helps us breakdown our food properly, and it also helps to kill bacteria that enter our system through the mouth. If acid in the stomach is low, bacteria can sneak through to the small intestine and set up residence there, thus causing SIBO. On top of this, having low acid in the stomach means that food now passes to the small intestine incompletely broken down. This food then feeds SIBO bacteria and contributes to their growth and reproduction.
Many people are taught by their doctors that high acid levels are a contributor to their symptoms, especially when talking about gastric reflux (GERD). GERD patients are usually put on acid-blocking medications, which do relieve reflux symptoms. If you don’t make much acid, then very little acid is present in the stomach to reflux back into your esophagus after you eat. But long-term use of these medications unfortunately makes patients the perfect host for SIBO.
On top of this, many patients with GERD never actually had high acid levels in the first place! This is because low acid levels can also cause GERD. How is this possible? Low acid levels in the stomach decrease the pressure gradient of the pyloric sphincter – the valve that separates the esophagus from the stomach. When the pressure gradient of the pyloric sphincter is off, the valve becomes leaky and allows for a backflow of acid into the esophagus. Even people with low acid have some acid, and when the valve is working improperly, this acid is allowed to pass back up to the esophagus and cause GERD. Antacid medications still relieve low-acid patient’s GERD symptoms (further enforcing their belief that they must have had high acid), but unfortunately these pills only make all the patient’s other problems worse, including SIBO.
In order to eradicate SIBO and not have it return, a good physician must address their patient’s stomach acidity issues. This can be a complex process if the patient is already on antacid medications, as stopping these medications cold-turkey is not advised due to rebound hyperacidity. At Thrive GI, we specialize in treating complex gastrointestinal issues including SIBO and hyper or hypoacidity. Tomorrow we will discuss the next major contributor to SIBO: impaired digestive motility.
Dr. Katie Nuckolls is a naturopathic physician and owner of Thrive GI: Natural Digestive Medicine in Vancouver, Washington. She currently sees patients that live in Washington, Oregon, and Arizona using telemedicine. For more information, visit our contact page or schedule a free 15-minute consultation online.