SIBO as a diagnosis…and why it’s a problem.

I feel like everyone remembers the moment they received their SIBO diagnoses. After dealing with the incompetence of conventional MDs who were adamant that “it was just IBS,” I felt a wave of intense gratification when my functional medicine practitioner diagnosed me with SIBO. All my intuitions that there had to be a cause for my GI complaints were right! And who doesn’t love being right, especially when it seems like the whole world just thinks you are crazy.

The SIBO diagnoses seemed like the answer I had been so desperately looking for. It gave me hope by giving me a place to start. My functional practitioner reassured me that I should be feeling much better after we cleared the bacteria from my small intestine. In my mind, I had found the root cause of my issues and I was ready to dive into treatment.

But, after months of FODMAPing, antimicrobial agents and continued research, I realized that focusing on  bacterial clearance didn’t come close to resolving my problems. In fact, many of my issues seemed worse than ever. I was beyond frustrated.

At this point, my mindset changed. What if my SIBO wasn’t the root of my health woes, but rather a symptom? I realized that I needed to put my detective cap back on to figure out the root of my SIBO. I think treating SIBO as a diagnoses is a huge problem in both the conventional and functional medicine communities right now.

The 3 Main Problems with treating SIBO as a diagnoses (and not a symptom):

 

Problem #1: Not focusing treatment on correcting DELAYED MOTILITY or dysfunctional Migrating Motor Complexes (which is at the heart of almost all SIBO cases).

The MMC are cleansing waves that stimulate peristalsis in the smooth muscles of our GI tract. More simply put, the MMC keeps things moving, so that foods we eat are not sitting in the GI tract. You can think of the MMC as a housekeeper that sweeps the small intestine clean of undigested food stuff. If the MMC is dysfunctional, SIBO will usually develop and persist until the MMC is addressed. Therefore, SIBO appears to be a consequence of nervous system dysfunction.

By labeling SIBO as a diagnoses, I feel that it has narrowed the clinical focus on the “overgrowth” rather than the disturbances in motility. I think that the medical communities need to start viewing SIBO as a SYMPTOM of a brain-gut axis issue.

Instead, many practitioners and SIBO sufferers focus primarily on treatment strategies that starve and kill bacteria and less on rebuilding the damaged MMCs. Yes, I know many SIBO protocols and treatment plans do use prokinetics, but is this enough? While prokinetics are helpful by stimulating the MMC, they don’t repair existing problems in the MMC. A past food poisoning, IC valve issues, hypothyroidism, liver diseases, stress, colonic dysbiosis, lack of sleep and autoimmunity can all impair MMC function. The MMC disrupters need to be addressed in order to truly repair the brain-gut communication to prevent chronic SIBO from occurring.

Datis Kharrazian is one of the few popular practitioners that focuses PRIMARILY on treating the brain-gut axis in chronic SIBO cases. He recommends exercises that activates the brain and vagus nerve like gargling, gagging exercises and coffee enemas to strengthen the signaling between the brain and the gut to repair motility in the GI tract.

I first heard about vagus nerve exercises for SIBO from my first functional medicine practitioner. The practice would send out tons of information via email that you were supposed to thoroughly review. Being a busy lady, I seemed to have missed the email on the vagus nerve and my practitioner failed to mention the vagus in our conversations that seemed primarily centered on hashing out the FODMAP diet and deciding on an antimicrobial protocol. He brought up the vagus briefly almost as an afterthought in one of our sessions, but I of course was to wrapped up in my battle with the beasties in my small intestine to add anything extra to my routine. In my opinion, brain-gut axis repair should be at the forefront of SIBO treatment, not an afterthought that gets lost in the shuffle.

Personally, I experienced positive results when I stopped fearing FODMAPs and bombing my gut with antimicrobials, but instead focused on my brain and vagus nerve health. I did some hard core gargling exercises in the past and noticed an increase in gut sounds and motility in just a couple of weeks. I felt like my bowels were being turned on after a long hibernation!

I would also like to make it clear that I am not saying that you should ignore the overgrowth completely and only focus on the brain-gut dysfunction. In fact, inflammation from small intestine bacteria can lead to a continual break down of the brain-gut axis. But, in my opinion, we often have horse blinders on the overgrowth and we fail to spend much time at all on the brain-gut aspect. And again, I can’t say this enough, SIBO IS A SYMPTOM of a motility issue! I think in my next post I am going to do a write up specifically the brain-gut axis that will go more in-depth, so stay tuned for that!

Problem #2: Blaming every symptom on SIBO.

I think another problem with a SIBO diagnoses is that many people start to blame everything on the SIBO. I was a very guilty of this. When ever I was hungry, foggy-brained, moody or just didn’t feel well I would blame my gut bugs. You know that Jamie Foxx ft. T Pain song “Blame It on the Alcohol“….well I was blaming everything on the wee beasties in my gut!

By just blaming everything on the gut bugs, I failed to see these symptoms as clues to other problems (in particular cortisol dysregulation, blood sugar and thyroid problems). This was especially true when I went lower carb to try to starve the gut bacteria. I felt horrible, but of course I justified that it was just a die off reaction. I was just making the gut bugs angry. In reality, this shift to a low carb diet caused my already elevated cortisol levels to rise even more and my thyroid hormones to fall leading to blood sugar instability, fatigue, moodiness and brain fog.

As I mentioned above, stress and thyroid issues can delay motility, which can only exacerbate SIBO. I remember craving carbs and thinking “oh that is just my hungry gut bugs trying to get me to crack and feed them.” Even my functional practitioner told me to resist the cravings. But, my body was just trying to tell me that I needed more carbs to support my hormones. By avoiding my cravings, I was only making matters worse.

I also blamed any amount of bloating on SIBO, when large intestine imbalances were actually to blame. Again my functional practitioner seemed to think that any amount of bloating indicated SIBO, which is pretty absurd looking back on everything (I don’t go to that practitioner anymore thankfully).

We can’t treat SIBO in isolation, the whole body needs to be supported in order to eliminate the overgrowth. In my case, other hormonal issues and large intestinal dysbiosis seemed to be responsible for a majority of my symptoms and even my disturbed motility. By narrowly focusing on the overgrowth, you can fail to truly see other problems that need to be fixed.

Problem # 3: Fosters a “gut bacteria is the enemy” mentality in SIBO sufferers leading to overtreatment.

By labeling a bacterial overgrowth as a diagnoses and not a symptom, many sufferers and practitioners alike fall into a “kill at all cost” mentality that can be incredibly detrimental to long term outcomes in treating SIBO. This bacteria is the enemy mentality can lead to abuse of antibiotics and overly restrictive diets, which can deplete colonic bacteria.

As I have mentioned in past posts, large intestine bacteria communicate to the brain to stimulate the MMC. Without a healthy population of colonic microbes, motility will be disturbed and SIBO recovery will be next to impossible. Therefore, there is a narrow window to treat SIBO. You want to reduce the bacterial load in the small intestine without doing too much damage to the large intestine. Relying on cyclical antibiotic treatments and diets to kill and starve the bacteria will usually temporarily take care of an overgrowth, but will also cause long-term issues with motility. We need to support the health of the entire GI tract to achieve a successful SIBO recovery.

If SIBO was viewed as a symptom of a brain-gut dysfunction diagnoses, I think it would be easier to avoid falling into this overtreatment trap. We can’t lose sight of gut bacteria’s central role in rebooting our MMC activity.

Bottom Line:

As a former marketer, I understand the power of words to drive attitudes and perceptions. When we use the label small intestine bacterial overgrowth as a diagnoses, we naturally view the disorder as a bacterial problem. But, usually the overgrowth is rooted in brain-gut axis disturbances (from a variety of different causes). By labeling the disease as a brain-gut disorder, we naturally can focus on the root cause of the overgrowth. I hope in the future we can shift away from using SIBO as a diagnosis.

Thanks for reading!!! I have been crazy busy with school the last couple months, but will be increasing my posts through the summer! So stay tuned!

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