Yeast,Your Gut and Paleo
Modifying Paleo: Small Intestinal Bacterial Overgrowth
Small Intestinal Bacterial Overgrowth (or SIBO) is a
chronic bacterial (and/or yeast) infection of the small intestine,
characterized by excessive number and/or abnormal type of bacteria (and yeast) growing
in a part of the gastrointestinal tract that normal contains relatively few
microorganisms. These bacteria can cause
a variety of problems by interfering with digestion and absorption of nutrients
and by damaging the lining of the gut, causing a “leaky gut” (I addressed the
many health problems that can arise from a leaky gut in this post).
The most common symptoms of bacterial overgrowth include
abdominal pain, nausea, bloating, gas, belching, flatulence, chronic diarrhea,
and chronic constipation. These symptoms
are due to the large volume of bacteria the digestive tract (alive and dead, as
they read the end of their lifecycle) and the large amount of gas and metabolic
waste that they produce. Many more
symptoms of SIBO are a direct effect of nutrient malabsorption. This arises either from the bacteria
metabolizing those nutrients before we can absorb them or by the bacteria
causing enough inflammation in the lining of the gut that it the gut can’t work
properly anymore. For example, the bacteria
preferentially consume iron and vitamin B12, causing anemia. The bacteria decrease fat absorption by
deconjugating bile leading to deficiencies of vitamins A & D and causing steatorrhea
(fatty stools). As the gut lining
becomes increasingly inflamed and leaky, larger and not fully digested food
particles enter the body, causing an immune reaction which leads to food
allergies and food sensitivities.
Bacteria themselves can enter the blood stream causing systemic
inflammation and immune reactions that can lead to autoantibody formation and
autoimmune diseases (for a comprehensive review article see the footnote).
SIBO was only described in the late 1990s and is still
grossly underdiagnosed. This is partly because many patients don’t seek medical
attention for their SIBO symptoms, because many doctors aren’t aware of its
prevalence and don’t consider it in their differential diagnostics, and because
the tests for SIBO still have fairly high false negative rates (where you have
the disease but the test says you don’t).
As SIBO becomes more recognized, it is also becoming inextricably linked
with many other diseases. Many
physicians and scientists now believe that Irritable Bowel Syndrome (the cause
of which has never been properly defined) is actually a group of symptoms
caused by SIBO (see the book The New IBS Solution). SIBO is also often associated with Crohn’s
disease, Celiac disease, short bowel disease, various liver diseases, some
autoimmune diseases (such as scleroderma, diabetes, fibromyalgia, lymphoma, and
chronic lymphocytic leukaemia) and even rosacea (for a fantastic summary of confirmed
related diseases, see http://www.siboinfo.com/associated-diseases.html). Whether SIBO is a causal factor or a symptom
of these diseases remains to be determined.
Given how new all of this science is (and how prevalent SIBO actually
is!), I suspect that over the next few years many more health conditions will
linked with SIBO.
How do you
know if you have SIBO? If you have
digestive symptoms, especially if they persist after adopting a strict paleo
diet, SIBO is a possibility. You can opt
to get tested (there are several different test options which can be ordered by
your primary care physician), however know that the current testing methods are
not 100% reliable. One of the easiest
ways to determine whether you have SIBO is to see if diet modifications aimed
at treating it make you feel better.
How can you
fix SIBO? There are two diets (very
similar to each other) that have been developed with the intention of starving
the bacteria in the small intestine and healing the damaged lining of the
gut. These are the GAPS
(Gut and Psychology Syndrome) diet (see Gut and Psychology Syndrome
) and the
SCD (SpecificCarbohydrate Diet) diet (see Breaking the Vicious Cycle
). The general approach to these
diets is to eliminate any dietary sugars that are not monosaccharides. Monosaccharides are simple sugars like
glucose and fructose and are the most easily absorbed in the digestive
tract. More complex sugar molecules like
sucrose (i.e., table sugar which is a disaccharide) and starches have to be
broken down into monosaccharides before they can be absorbed. This means that the sugar takes longer to be
digested, which means it travels farther down the digestive tract before being
completely absorbed, which means that some of it reaches the abnormal bacteria
growing in the small intestine and provides a food source for them. These diets also focus on consuming healing
foods such as bone broth, conjugated linoleic acid found in the fats from
grass-fed animals, and coconut oil. I
recommend combining one of these diets with a paleo diet for the most rapid and
effective reversal of SIBO.
A standard paleo diet is typically not enough to treat
and reverse SIBO. Attention also needs
to be paid to the amount and types of carbohydrates being consumed. I recommend following a paleo diet with
modifications disallowing starchy vegetables and high sugar foods as per the
SCD and GAPS diets (see my post Fruits and Starchy Vegetables with SmallIntestinal Bacterial Overgrowth). Many
people may find taking Apple Cider Vinegar before meals (as outlined in TheStomach Acid Connection) is helpful. For
more severe cases digestive supplements may be beneficial (I am not familiar
enough with these to recommend a particular brand, type or dose. Recommendations can be found in The Paleo Solution, It Starts With Food, and this post from Chris Kresser. If you need personalized recommendations, I
suggest contacting Diane Sanfilippo at www.balancedbites.com). You may also find some good information in my
posts Repairing the Gut and What Should You Eat to Heal a Leaky Gut? I also want to mention that stress management
is very important (see my post How Mood and Gut Health Are Linked). Homemade bone broth and a source of Vitamin D
(sunshine, liver, supplement) are particularly important to promote healing.
A source of diverse probiotics (from fermented foods like Sauerkraut,
coconut milk kefir, or Kombucha and/or from a high quality supplement) help to
restore normal gut microflora (it’s better to keep the dose of these beneficial
bacteria on the low side, at least at first, since they can add to the high
volume of bacteria and increase symptoms if you’re too aggressive). In extreme cases, a doctor may recommend a
course of potent antibiotics followed by a gut-healing protocol (exactly what
is outlined above) and probiotics. For
those with symptoms indicating the early phases of autoimmune conditions (see
my post You May Have an Autoimmune Disease But Don’t Know It), following the Autoimmune Protocol for the first 1-3 months may be very beneficial.
Correcting SIBO can take up to 2 years. However, you should see improvement in your
symptoms fairly quickly with gradual and continuous improvement (if you don’t,
it’s worthwhile considering a FODMAP sensitivity as a confounding factor, which
I will be discussing in my an upcoming post). Stress,
poor sleep, infections and poor diet choices can all create setbacks. It is always difficult to commit to more
restrictive forms of a paleo diet (which can be tough enough as it is!). I have what I believe is a mild case of
SIBO. Because I follow the Autoimmune Protocol, I rarely have issues now.
However if I slip and eat a high carbohydrate food, I fairly rapidly
suffer intense bloating followed by days of gas pains and constipation. It’s not fun to follow such a restrictive
diet, but is it worth it!
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