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.
Ha!
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.)
xo
