Here at Rhythm Health, we have been looking at the effect of our Life Shot 200 on a small group of people with small intestinal bacterial overgrowth (SIBO). Due to encouraging results on a base line reduction  we would like to widen this trial, offering five places per month to those who have recently tested positive for SIBO and are under the guidance of a registered healthcare practitioner.
Here is what’s on offer: we’ll supply you with two months worth of our Life Shot 200 high potency, dairy free kefir cultures (55 bottles) at no cost to you. In return, all we ask is that you purchase a second SIBO breath test in advance and share both the before and after test results and your feedback on our website.
Interested? Fill in the form below to enrol.

For Registration Form click HERE.

Small Intestinal Bacterial Overgrowth

As the name suggests, small intestinal bacterial overgrowth (SIBO), is a digestive health issue caused by the overgrowth of gut bacteria in the small intestine. Most commonly associated with diarrhoea, bloating and excess gas (1), SIBO is fast becoming a problematic cause of niggling health concerns. This article takes a look at what SIBO is, what it does, how to diagnose it and what to do about it.

SIBO defined

The digestive system is home to a number of beneficial bacteria and yeasts. Termed the microbiome, these organisms support wellbeing by regulating the immune system, producing specific nutrients and improving digestive function amongst others (2). Further information on the microbiome is available hereThe Microbiome

The majority of these beneficial bacteria are located in the large intestine where they ferment otherwise undigestible fibres. The small intestine contains a relatively small concentration of bacteria, if any at all (3) since this part of the digestive tract is meant for nutrient absorption. In SIBO, two things are thought to happen:

  • pathogenic or “bad” bacteria enter the small intestine (3)
  • bacteria (not necessarily bad ones) from the large intestine overgrow and enter the small intestine (4)

The reasons for these happening are unclear but some studies link it to slow motility, including constipation (5), obstructions in the digestive system, compromised immunity (6) and certain medications (4).

Symptoms

Some of the symptoms associated with SIBO include (4):

  • bloating
  • flatulence
  • diarrhoea
  • abdominal pain or discomfort
  • in extreme cases: weight loss and malnutrition
  • carbohydrate and/or dairy intolerance (7)

In addition, SIBO may also play a contributing role in IBS, rosacea and restless leg syndrome (4).

Diagnosis

The main method of SIBO diagnosis is via a breath test.
Whilst this may not seem an accurate measure at first glance, it must be noted that SIBO is extremely difficult to diagnose via conventional blood samples.
Breath testing looks at methane and hydrogen levels following carbohydrate intake. Carbohydrates such as dairy or glucose are easily digested by bacteria which in turn produce hydrogen and methane (8). The higher the levels of these gases, the more likely it is that SIBO is present.
Conventional testing uses a carbohydrate gel or syrup mixed with water. Breath samples are then collected every 20 minutes for 3 hours.
Like many other tests, breath testing can fail in certain circumstances. Antibiotic or laxative use, colonoscopy and procedures which interfere with the bowel contents such as flushes or colonic hydrotherapy can alter test results (9).

Various SIBO protocols

SIBO is most commonly treated with antibiotics, however, they may only effective in half of all cases (10).
Increasingly, research is focusing on a combined antibiotic, dietary and herbal approach with a recent case study reporting an improvement in SIBO symptoms following a low FODMAP diet and herbal antimicrobial therapy (11).
Since certain bacteria thrive on otherwise indigestible fibres, the exclusion of such fibres for a period of 4-8 weeks may be beneficial in the management of SIBO (12). The low FODMAP diet focuses on cutting out these exact fibres, including fructose, dairy, fructans, galactans and polyols. Examples of low and high FODMAP foods are available on the below link and also via the Monash University Low FODMAP diet app.
Alongside a low FODMAP diet, probiotics may be a useful addition in reducing the symptoms associated with SIBO. An Argentinian study comparing the efficacy of antibiotics vs probiotics alongside a low FODMAP diet showed an improvement in 82% of subjects with SIBO in the probiotic group vs 52% in the antibiotic group (13).
A recent review study further backs these findings, championing the use of probiotics in improving the symptoms associated with SIBO (14).
In addition, the root cause of SIBO should be evaluated. Low stomach acid, intestinal obstruction and slow motility can all be associated with SIBO (4,5,6).
For example, a review published in the Clinical Gastroenterology and Herpetology journal links stomach acid lowering medication to the occurrence of SIBO (15). Whilst proton pump inhibitors may be a necessity in certain cases, unrelated rates of low stomach acid are rising, making way for potentially higher instances of bacterial overgrowth (16).
Citrus juices such as lemon and lime as well as apple cider vinegar may boost stomach acid slightly and confer an mild antibacterial benefit (17).
In summary, SIBO may be approached with antibiotics or a combined low FODMAP diet, probiotics and by addressing underlying root causes such as the management of low stomach acid.

Life Shot SIBO protocol

Follow a low FODMAP diet whilst on the trial. Do not use herbal antimicrobial therapy in conjunction with the trial as it may interfere with final results. The aim of this trial to look at the effect of live fresh natural probiotic’s (not freeze dried) on a positive small intestinal bacterial overgrowth.

References

(1) Bhardwaj SB, Rana SV (2008) Small intestinal bacterial overgrowth. Scandinavian Journal of Gastroenterology, 43: 1030-1037.
(2) Stecher B, Conway T, Cohen P (2015) The roles of inflammation, nutrient availability and the commensal microbiota in enteric pathogen infection. Microbiology Spectrum, doi:10.1128/ microbiolspec.MBP-0008-2014.
(3) Quigley EMM, Abu-Shanab A (2010. Small intestinal bacterial overgrowth. Infectious Disease Clinics of North America, 24: 943-959.
(4) Sachdev AH, Pimentelcorresponding M (2013) Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance. Therapeutic Advances in Chronic Disease, 4: 223-231.
(5) Roland BC1, Ciarleglio MM, Clarke JO, Semler JR, Tomakin E, Mullin GE, Pasricha PJ (2015) Small intestinal transit time is delayed in small intestinal bacterial overgrowth. Journal of Clinical Gastroenterology, 49:571–576.
(6) Miazga A, Osiński M, Cichy W, Żaba R (2015) Current views on the etiopathogenesis, clinical manifestation, diagnostics, treatment and correlation with other nosological entities of SIBO. Advances in Medical Sciences, 60: 118-124.
(7) Perets TT, Hamouda D, Layfer O, Ashorov O, Boltin D, Levy S, Niv Y, Dickman R (2017) Small intestinal bacterial overgrowth may increase the likelihood of dairy and sorbitol but not fructose intolerance false positive diagnosis. Annals of Clinical and Laboratory Science, 47: 447-451.
(8) Saad RJ, Chey WD2 (2014) Breath testing for small intestinal bacterial overgrowth: maximizing test accuracy. Clinical Gastroenterology and Hepatology, 12: 1964-1972.
(9) Romagnuolo J, Schiller D, Bailey RJ (2002) Using breath tests wisely in a gastroenterology practice: an evidence-based review of indications and pitfalls in interpretation. American Journal of Gastroenterology, 97: 1113-1126.
(10) Shah SC, Day LW, Somsouk M, Sewell JL (2013) Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth. Alimentary Pharmacology & Therapeutics, 38: 925-934. (11) Kwiatkowski L, Rice E, Langland J (2017) Integrative treatment of chronic abdominal bloating and pain associated with overgrowth of small intestinal bacteria: a case report. Alternative Therapies in Health and Medicine, 23: 56-61.
(12) King’s College London (2017) FODMAPS. Accessed 4th of September 2017: https://www.kcl.ac.uk/lsm/research/divisions/dns/projects/fodmaps/index.aspx
(13) Soifer LO1, Peralta D, Dima G, Besasso H (2010) Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study. Acta Gastroenterologica Latinoamericana, 40: 323-327.
(14) Zhong C1, Qu C, Wang B, Liang S, Zeng B (2017) Probiotics for preventing and treating small intestinal bacterial overgrowth: a meta-analysis and systematic review of current evidence. Journal of Clinical Gastroenterology, 51: 300-311.
(15) Lo WK, Chan WW (2013) Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clinical Gastroenterology and Herpetology, 11: 483-490.
(16) Sarker SA, Ahmed T, Brüssow H (2017) Hunger and microbiology: is a low gastric acid-induced bacterial overgrowth in the small intestine a contributor to malnutrition in developing countries? Microbial Biotechnology, doi: 10.1111/1751-7915.12780.
(17) Oikeh EI, Omoregie ES, Oviasogie FE, Oriakhi K (2015) Phytochemical, antimicrobial, and antioxidant activities of different citrus juice concentrates. Food Science & Nutrition, 30: 103-109.