Or small intestine bacterial overgrowth is a condition rampant in America brought on by excessive carbohydrate consumption and chronic PPI use. When normally harmless large bowel bacteria are allowed to seed the small bowel along with normal small bowel flora a condition called SIBO occurs. It is defined as the presence of more than 100,000 bacteria per ml within the upper regions of the small bowel. At these concentrations symptoms emerge causing abdominal pain or cramps, diarrhea, constipation, gas, bloating, acid reflux,flatulence, nausea, dehydration and fatigue. This looks a lot like Stomach & Spleen Qi deficiency that we see plenty of in traditional Chinese medicine.
More severe symptoms related to SIBO can include weight loss and “failure to thrive,” steatorrhea (characterized as foul, floating, and frothy stools from the body’s inability to digest fats), anemia, bleeding or bruising, night blindness, bone pain and fractures, leaky gut syndrome, and autoimmune reactions, among others. Should you seek medical attention your run-of-the-mill DIB will more than likely prescribe Nexium and see if the symptoms improve. If so then the diagnosis of GERD is given and that’s that. Unfortunately increasing gastric pH (reducing the acidity) will only make matters worse in the end.
Your local DIB based on his training and knowledge of GERD may recommend that you avoid certain trigger foods like coffee, chocolate, spicy and fatty fried foods. The patient readily listens, avoids these foods and nothing changes. That’s because the biggest offenders are the sugars like fructose, lactose, sucrose and resistant starches and fiber. Breaded, fried foods generally coated with wheat flour are high in resistant starch as are French fries. Fruits are rich in fructose, milk is rich in lactose. The problem as Dr Robillard sees it is that most people fail to eliminate all of the sources of sugar, difficult to digest carbohydrates and resistant starches.
On analysis patients suffering from SIBO have large bowel organisms “infecting” the small bowel along with the normal small bowel flora. This new condition sets the stage for a vicious cycle wherein pathogenic bacteria generate inflammation mostly from their metabolic byproducts which causes injury to the mucosal cells lining the small bowel and the stomach. This tends to block the normally very efficient absorption of carbohydrate across the small bowel mucosal lining. These harmful bacteria feed on this abundant food supply which in turn increases their populations. The growing number of colonies generates more mucosal inflammation from the production of acid by-products, gasses, toxins, and enzymes, and further inhibits normal transmigration of nutrients across the small bowel. These nutrients especially glucose are then available as food for these pathogens which in turn generates an even greater number of bacterial colonies which generates more toxins and so on. This cycle continues as long as the conditions remain the same. What we have here in essence is a condition of bacterial overgrowth within the SI due to this abundant food supply. Cut that off and no more SIBO.
According to Dr.Robillard gasses build up in the small bowel and stomach from this unnatural condition. When enough pressure builds up it forces the gastro-esophageal (GE) sphincter to open causing reflux of stomach acid, bile and microorganisms into the goose resulting in the commonly seen symptoms of reflux esophagitis. The astute observer might say, “Timmy can tiny little bacteria generate that kind of gas pressure?” “Yes indeed Billy, meet me in the multipurpose room. I have a nice super 8 film for you.”
Dr. Robillard informs us that just one ounce of most of these pathogenic strains can generate up to ten liters of hydrogen gas as a byproduct of normal metabolism. Although I have never seen this in any theater where I’ve worked, there apparently are cases of explosions occurring in the operating room due to the patient’s own substantial volumes of flammable gas which can also be formidable. It certainly seems plausible given the electrocautery knife and its ability to easily create an arc-flash of current across whatever organ or surface you are cutting into. Cut into a gaseous toxic bowel and blam better than an IED. In fact, I’m surprised and disappointed that I haven’t seen this given the numerous cases of dead bowel I encountered at LAC-USC Medical Center. The only way to stand the horrid smell was to leave the floor or paint oil of wintergreen on your mask. Not that I have a penchant for pandemonium (one might argue that) but on one of those underwhelming call nights, when I couldn’t stay awake to save my soul. It would have been a welcome stimulus to see my favorite chief surgery resident-a rather dim-witted brute, go up in flames as he cuts into a Zeppelin of dead bowel.
I do recall a story I once read in something like Ripley’s Believe it or Not, about a man with a dreadful gas condition probably not unlike a bad case of SIBO. As he was walking by a welder one fine sunny day he passed a substantial fog of flammable bowel gas. It was not his day because right after passing his malodorous cloud a plume was ignited from the welder’s torch and before anyone could say jiminy cricket it blew him to bits giving new meaning to the term go in piece(s). I can’t tell you if the story is true but I bet that this at least could happen.
There are many studies which support this theory of Dr Robillard’s. Some of these studies demonstrate that antibiotics decrease the symptoms of GERD, other studies are able to recreate GERD by replicating SIBO-like conditions, and GERD is associated with increased gas pressure in the stomach often relieved temporarily with burping.
SIMPLE BREATH TEST
A hydrogen breath test can be done to see if you have SIBO. The patient is given a lactulose cocktail to drink. Lactulose is a sugar which cannot be digested by humans only bacteria can break the chemical bonds. During the test hydrogen gas is released as a by-product which is detected in the exhaled breath. If the patient spikes early with large amounts of hydrogen gas up to or under 90 minutes then there is the possibility of small bowel overgrowth. If the hydrogen gas spike occurs later at around two hours then we are seeing normal metabolism of lactulose by bacteria in the large intestine. There is no human process that produces hydrogen gas so when it’s detected it’s always from bacteria.
With 20% of the general population suffering from GERD and 12 billion per year in PPI sales alone, we certainly need a good explanation and treatment for this condition. The current method of treatment addicts you to PPI’s, doesn’t cure anything and introduces new disorders. Let’s see if we can’t improve on this baneful berth.
Get a copy of Dr Robillard’s ebook Fast Track Digestion ($10 on Amazon) if you suffer from frequent heartburn and or GERD. In it he lists five potential causes of GERD and the dietary changes needed to fix it:
1. Motility problems
2. Antibiotic use
3. Gastric acid secretion
4. Immune impairment
5. Carbohydrate malabsorption
In the standard American diet or SAD we commonly eat too much sugar. For the conditions of SIBO to occur we typically see eating dietary sugar along with the conditions described above-inflammation of the mucosal lining. However, you can create conditions like this from eating sugar alcohols too. Materials like sorbitol, xylitol or any number of fake sugars that are in vogue today. This is a real disaster in the making since these make readily available foods for your SI bacteria. Stay away from these fad chemicals there are numerous problems associated with them.