SIBO is a disorder that is 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, but it is very rare that SIBO is the only condition that I diagnose them with. This is because SIBO typically develops after a patient has one or more chronic underlying medical conditions that allow bacteria to be able overgrow 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 to treat each underlying disease and dysfunction while also killing the SIBO bacteria.

What conditions predispose people to developing SIBO? We are talking about them in this series, and here is cause #2:

Migrating Motor Complex Dysfunction:

The migrating motor complex (MMC for short) is a series of electrical waves that is responsible for moving food and other matter through your digestive tract. It begins in the stomach and extends throughout the entire small intestine, ending where the small intestine dumps into the colon.

The MMC stimulates peristalsis, which is the involuntary contraction and relaxation of the smooth muscles of the gut. Tese wave-like contractions move food through the small intestine and push it into the colon. If the MMC is sluggish, food and also bacteria will stay in the stomach and small intestine much longer than they are supposed to. This stagnation can lead to feelings of indigestion and excessive fullness, and it also can lead to the development of bacterial overgrowth. Very often when people have a SIBO relapse after responding to antibiotic treatment, it is because the MMC dysfunction was never directly treated.  

What causes the migrating motor complex to slow down? Here are some of the top reasons

Stress: While it seems like stress can be tied to almost any health condition, the tie between stress and MMC dysfunction is incredibly important. Stress causes the MMC to significantly slow, as the body naturally de-prioritizes all digestive functions when in “fight or flight” mode (1).

Snacking: The MMC only functions when you are not actively eating. When you are eating, the digestive tract is focused instead on breaking down food and absorbing nutrients. Only in a fasted state does the body move food through the intestinal tract. A full cycle of MMC contractions takes between 2-5 hours to complete. This means that if we are consistently snacking between meals, we are interrupting the MMC’s critical activity. To keep food and bacteria from stagnating in the gut, doctors often recommending spacing meals at least four hours apart. An overnight fast of at least 12 hours is also recommended.

Thyroid disorders: Hypothyroidism is a very common condition that results in the slowing of a patient’s metabolism, which includes the MMC (2,3). Hypothyroid patients with constipation and chronic intestinal symptoms should always be evaluated for SIBO for this reason.

Diabetes: An unfortunate side effect of unmanaged diabetes is neuropathy (small nerve inflammation and damage). While most people think of diabetic neuropathy as something that occurs only in the hands and feet, it can also affect the tiny nerves supplying the GI tract — your MMC. Diabetes is also associated with a higher risk of gastroparesis, a condition where food sits too long in the stomach before emptying into the small intestine. All of this increases a diabetic’s chances of developing SIBO (4).  

Intestinal Infections/Food Poisoning: some intestinal infections release toxins into the gut that injure the MMC. This is reversible with treatment, but it is not always reversible on its own.

In conclusion, if a SIBO protocol is not addressing migrating motor complex dysfunction, then it is very likely that patients will experience relapse after antibiotic treatment. Looking at the whole picture and treating ALL associated conditions leads to the best SIBO outcomes.

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.  

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