Swedish Egg

Swedish Egg

Tuesday, September 13, 2016

Leaky Gut and SIBO: Are they BFFs or not?

A lot of people (like me) who end up with SIBO just started out with plain old IBS. Studies have found that anywhere from a meager 10% of IBS patients all the way up to a whopping 84% (hel-lo!) will test positive for intestinal bacterial overgrowth. Not all people with IBS get SIBO, therefore, but if you have SIBO, you pretty much are guaranteed to have IBS. SIBO and IBS go together like outlaws in love.

Lots of people with IBS also test positive for increased intestinal permeability—sometimes referred to as gut barrier dysfunction, and commonly known as "leaky gut syndrome."

A leaky gut situation results from chronic irritation, inflammation and immune activation in the GI tract. Alcohol abuse, aspirin and other drugs, toxins, trauma, synthetic food additives, food allergies and food intolerances (think gluten, casein, even potatoes) are some possible causes of leaky gut syndrome.

Anyway, the other day I was wondering if I have leaky gut. My thinking was that if both leaky gut and SIBO are common in people with IBS, leaky gut might be common in people with SIBO, too. Makes sense, right? But evidently, the association is not that straightforward.

A 2009 study titled The Relationship between Small-Intestinal Bacterial Overgrowth and Intestinal Permeability in Patients with Irritable Bowel Syndrome (Park JH, et al. Gut Liver. 2009 Sep;3(3):174-9) looked into this very question.

Researchers compared the digestive tracts of 38 people with IBS and 12 healthy controls without IBS. All subjects were tested for both SIBO and leaky gut, and the results were surprising.

Yes, incidence of leaky gut was higher in subjects with IBS, as expected. However, in those people with IBS, the presence of leaky gut was NOT correlated with the occurrence of SIBO.

The researchers stated, "no significant difference in intestinal permeability was observed among the patients with IBS-D, IBS-C and IBS-A". [Note: A=Alternating Diarrhea and Constipation, but sometimes called M for Mixed.] In other words, leaky gut was equally common in IBS of all types.

Not so with SIBO. The researchers had expected SIBO and leaky gut to go together like cheese and crackers, but contrary to expectations, no significant difference in leaky gut occurrence was observed between those IBS patients with SIBO, and those without.

Take home message: If you have SIBO, 
you may or may not have leaky gut syndrome, too.


If you want to find out if you actually have leaky gut, you can take a test such as the famous Lactulose/Mannitol urine test—in use since the mid-1970s and available from places such as Genova Diagnostics. The test is pretty basic. You drink a pre-measured amount of two sugars, lactulose and mannitol, in solution, and then pee in a cup at 30-minute intervals over a 6 hour period. Typically, only mannitol, the molecularly smaller of the two sugars, is rapidly absorbed by villi in a healthy, intact small intestine, after which it is excreted in urine. The chunky disaccharide lactulose molecule is too large for normal villous absorption, and therefore should not show up in the urine, unless it managed to "leak" through the intestinal lining due to swelling, inflammation and weak gut barrier function. So depending on how much lactulose appears in the urine, leaky gut is there or not.

A nice cup of bone broth, with herbs.
If you DO have a leaky intestine, your next step is deciding how to address it.

It goes without saying that numero uno is maintaining your diet upgrade and continuing to avoid all the fermentable sugars and starches that feed SIBO bugs.

In addition, I suggest you consume bone broth made with marrow bones or meaty bones (not cartilaginous joint bones) and either drink a cup daily, or use the broth regularly in your cooking.

Leaky gut or not, bone broth is deeply nourishing for the intestinal lining.

Next, consider supplements. Interestingly, some of the so-called "top supplements" for treating leaky gut syndrome are verboten, or at least highly questionable on a SIBO-friendly diet. FIBER supplements? No, thanks! PROBIOTICS? A big question mark for SIBO peeps. (We already have too many bacteria in our guts—much of which may be the right bacteria, but in the wrong place—so adding in more doesn't necessarily make a whole lot of sense.)

But there are a few SIBO-friendly supplements that I really do like for treating leaky gut syndrome. Two favorites are L-Glutamine powder and Hydrolyzed Collagen powder—supplements that can be stirred into water and taken daily to help heal your inflamed intestinal lining. I also recommend taking digestive support with meals, both to help promote proper food digestion and breakdown, and to help minimize the chances of large undigested food particles traveling too far down the digestive tract where they can interact with and irritate your gut lining.

L-Glutamine is an amino acid that directly enhances gut barrier function and protects the endothelial cells lining your small and large intestines. Glutamine has been shown to help support the rapid turnover, healthy reproduction and maintenance of these cells. Glutamine also has an anti-inflammatory effect on the gut lining, to help further promote healing.

Collagen is a short chain protein, or peptide, that occurs naturally throughout the body as a building block of connective tissue. Collagen peptides are present in hair, skin, nails, bones, joints, cartilage and the endothelial cells lining both vascular and intestinal tissues. Collagen contains high levels of the amino acids proline and glycine which, along with L-glutamine, are critical players in repairing a damaged intestinal lining.

Digestive Enzymes supplement the function of your pancreas, an organ designed to secrete digestive enzymes every time we eat. Pancreatic enzymes are required to help us break down fats, proteins and carbohydrates. However, pancreatic function decreases with stress and age, and many of us just don't produce a sufficient quantity to do the job. Taking supplemental pancreatic enzymes or plant-based digestive enzymes can make a HUGE difference in how well you digest your meals.

Betaine HCl is a form of hydrochloric acid (HCl). Hydrochloric acid is naturally produced in the stomach to initiate protein digestion and to kill pathogenic microbes every time you eat, but again, production decreases as we age, or may be impaired by medications such as proton pump inhibitors prescribed for reflux. Many people with IBS and SIBO have hypochlorhydria, a fancy term for low stomach acid production. Taking extra helps.

I have not been tested for leaky gut syndrome and don't know if I have it, but I am currently taking a few supplements to help support digestion and promote intestinal comfort. Since readers often ask what I personally am eating or taking to treat my SIBO, I'm sharing this short list with you in friendliness, not as a prescription. (For a prescription, please email me to set up an appointment!)

Pancreatin Select is a broad-spectrum digestive enzyme that contains pancreatic digestive enzymes along with extra lipase, ox bile, digestive bitters and betaine HCl. It's fantastic. I take one or two per meal. And I'll take an additional capsule or two of straight up Betaine HCl if I'm eating a large protein meal. These two supplements are fantastic for increasing digestive power and vitality.

I also just started taking a Hydrolyzed Collagen supplement which, surprisingly, tastes awesome—kind of like whey protein. I'm hoping it will help fortify my gut lining, but other researched benefits include stronger bones, stronger joints and improved skin tone and texture, so we'll see how that goes!

Finally, I've been enjoying a drink of GI Select at least a few times a week. This product combines L-glutamine with other gut healing ingredients, comes in a powder you mix with water and tastes like lemonade. I find it to have a very soothing effect on my gut while being refreshing and hydrating. (Drinking enough water is always an issue for me, so anything that makes water taste better gets two thumbs up from Sexy Sibo.)



  1. I was under the impression that collagen was a high fodmap food and problematic for SIBO.

    1. Anonymous, you are correct in that natural collagen extract contains carbohydrates, primarily glucose and galactose. However, hydrolyzed collagen powder does not contain significant amounts of these sugars, if it contains any at all. Depending on the product, hydrolyzed collagen contains almost 100% protein, making it low FODMAP. The fermentation process used to make the hydrolyzed collage removes the sugars! You can read more about it here in this 1941 study: nvlpubs.nist.gov/nistpubs/jres/27/jresv27n6p507_A1b.pdf Best, Diana

    2. Hydrolyzed collagen, not collage, lol.

      P.S. Copy and paste that link into your browser and the pdf will download.