When good bugs turn bad
Small intestinal overgrowth (SBO) is a condition of the small intestine that allows too many bacteria, typically Lactobacillus, to develop and thrive. “So what?” you ask yourself. Well, the “so what” is that Lactobacillus bacteria are not welcome in that area. They compete with the host (which would be you) for food, and the bacteria usually win the fight. Remember that bully in grade school who always stole your PB&J? You are very hungry at the end of the day, aren’t you? It is so with SBO because if the bacteria eat your lunch repeatedly, you risk malnutrition and a host of unpleasant symptoms.
The small intestine is where the digestion and absorption of food occurs. Digestion breaks down your meals into the basic macronutrients of carbohydrates, fats, and proteins that a healthy body needs to function at optimal efficiency. As food moves from the first part of the small intestine (duodenum) through the middle (jejunum) and last parts of the small intestine (ileum), the bacteria increase from relatively small numbers until they reach their highest levels. in the large intestine, the colon. In the small intestine, enzymes, acids, hormones, and other chemicals made by the body are added to the food mixture (now called chyme) and are there to aid digestion and absorption. The presence of these digestive juices, especially the acid, is the reason why only a few bacteria would be expected to be found in a healthy small intestine.
The colon is where all the unusable material from food is collected and where bacteria are most numerous. The water content of this material is approximately ¾ of the total mass. Of the remaining ¼, approximately 30% are bacteria by weight. The bacteria would include lactobacillus and other probiotic species, as well as approximately 400 other species. The weight of all the bacteria in the intestine is about 15 pounds. The large intestine is where the bacteria belong.
The beneficial effects of this large biomass on human health cannot be underestimated. The bacteria promote cleansing of the intestinal cells, manufacture some vitamins such as riboflavin, thiamine, B-12, and perhaps most importantly, produce vitamin K, which is important in blood clotting and bone formation. Short-chain fatty acids (used as fuel for colon cells) are also produced. The downside to all this bacterial activity is the amount of toxic waste that is produced while the bacteria are working for us. If the toxins build up, it would definitely qualify as a Superfund site.
In a normally healthy gut, when intestinal cells are functioning optimally, the cells can absorb bacterial toxins and neutralize them directly or pass them on to other sites in the body for detoxification. We get sick when cells and the body can no longer neutralize poisons, such as when pathogenic bacteria are present in overwhelming numbers (Moctezuma’s Revenge) or when the normal ratio of “good vs. bad” bacteria is disrupted (dysbiosis). If toxins accumulate unchecked, and the acid/base balance in the colon is significantly disturbed and disrupted, serious diseases such as cancer can result.
We see a decrease in the number of good bacteria and the development of dysbiosis, in those cases where there is excessive use of antibiotics, antacids, NSAIDs, poor diet, lack of proper nutrition, stress, or in association with hidden food allergies. . When colonic dysbiosis occurs, the symptoms you see would include the typical nonspecific bloating, gas, diarrhea (sometimes constipation), nausea, and general malaise. There are cases in intestinal ecology where, due to changes in the intestinal environment, bacterial populations, especially the probiotic Lactobacillus, can migrate to the small intestine. Environmental changes in the intestine can occur due to aging when gastric acid production is in decline. As stomach acid is reduced, more Lactobacillus survive the journey through the stomach and into the upper intestine and it is easier for them to thrive there. The elderly are more prone to SBO than a younger population and, as a result, develop more problems with nutritional deficiencies. Environmental changes can also occur in cases of pancreatic insufficiency with diseases such as pancreatitis or liver diseases such as hepatitis. Diabetes, cirrhosis of the liver, Crohn’s disease, irritable bowel syndrome, intestinal surgeries, and scleroderma are also suspected to contribute to SBO.
When SBO occurs, symptoms would include the typical non-specific findings of bloating, gas, diarrhea, nausea, and malaise. Sounds familiar? The symptoms are pretty much the same as you would see in colonic dysbiosis and even Irritable Bowel Syndrome or a Candida overgrowth. Furthermore, severe cases of SBO can indirectly lead to malnutrition by decreasing the intestine’s ability to digest fat and ultimately protein and carbohydrates. With severe and chronic SBO we also see weight loss, B-12 deficiency induced anemia, softening of the bones, and impaired night vision as the body is unable to absorb the vitamins due to diarrhea. In fact, chronic diarrhea is considered to be the hallmark of SBO. A recent study in the Journal of Gastroenterology and Hepatology shows that SBO is the causative factor of chronic diarrhea in up to 67% of reported cases. In another study in the same journal, 48% of cases were diagnosed with SBO. A separate study showed that up to 83% of patients diagnosed with irritable bowel syndrome had SBO instead. SBO is definitely good mistakes gone wrong.
So how do you know if you have SBO? How is it diagnosed? More importantly, if you have it, what do you do about it? If you have the symptoms described above and these symptoms persist for more than several weeks, you should see a doctor who is familiar with functional testing. As the name implies, functional tests refer to laboratory tests that help determine the function and interaction of a total organ system rather than an isolated part of that system. Functional tests ask the question “Why”! Traditional tests ask “What”! When you ask “what” is wrong, you only allow control of the symptoms. By asking “why” it is wrong, it allows full management of the cause of the symptoms.
There are several types of important functional tests in SBO. An invasive procedure cultures a bacterial sample taken directly from the contents of the duodenum. Stool microbiology offered by some laboratories identifies bacterial overgrowth by direct observation of bacteria grown from a stool sample. There is also a breath test that indirectly identifies the metabolic waste of the bacteria. Lastly, your doctor may order an evaluation of your collected urine first thing in the morning. This test directly analyzes the waste products emitted by the bacteria. If SBO is present, several of these waste products will be elevated.
Once diagnosed, your doctor can determine the next steps to take. You certainly don’t want to take probiotic supplements that contain Lactobacillus until the overgrowth is controlled. You’re just fueling the fire if you do. In some severe cases, antibiotics may be necessary to control SBO. In less severe cases, the natural compound approach may be better. This could include various bactericidal herbs such as oregano, goldenseal, and garlic. Adding digestive aids like proteolytics, pancreatic enzymes, and betaine HCl can be beneficial. It is recommended to change your diet to temporarily exclude lacto-fermented and “aged” foods, as well as reduce high-glycemic carbohydrates. It would be important to resolve the underlying cause of the excessive growth if possible. If the condition that allowed the excessive growth to occur in the first place is not considered, the above dietary changes will only offer temporary relief. Once the overgrowth is reduced to normal and the causative factors are controlled, you are fine and it is wise to reintroduce fermented foods and probiotics into your diet.
So while you may not have heard much about SBO, it masquerades as various other conditions, such as irritable bowel syndrome and candida, it contributes to the symptom picture in many other conditions, and its proper management can certainly make you much easier. life.
