SIBO and IBD connection

What is IBD?

Many IBD (Inflammatory bowel disease) patients experience symptoms such as fatigue, bloating, abdominal pain, loose/watery bowel movements frequently with passing blood, weight loss, joint pain, etc. (1)

IBD refers to the inflammation of the digestive system, causing severe gut symptoms. The two most common types are Crohn's disease (CD) and Ulcerative Colitis (UC). Although they have similarities in terms of the symptoms and treatment, they affect various parts of the digestive system. (2)

Crohn's disease can affect any part of the digestive tract between the mouth and anus, while Ulcerative Colitis only causes changes in the lining of the colon, starting at the rectum area and moves upward. (3)

Stool tests can rule out IBD; blood tests seek for elevated inflammatory and antibody markers. Doctors may order a colonoscopy to have a closer look.

sibo ibd connection crohns colitis

How is IBD connected with SIBO?

Many IBD patients have IBS (Irritable Bowel Syndrome) symptoms due to SIBO (Small Intestinal Bacterial Overgrowth). According to research, IBD patients have a 9x more significant risk of SIBO than the overall population. (4).

SIBO (Small Intestinal Bacterial Overgrowth) is defined as excessive bacteria in the small intestine. There are too many and/or the wrong type of bacteria present in the wrong place that should generally be found in the large intestine. The overgrowth of bacteria in the small bowel may cause digestive symptoms such as bloating, gas, reflux, diarrhea or constipation, abdominal pain, etc. (5) Read more about the different types of SIBO in my previous blog post.

The body has several protective mechanisms to prevent a potential bacterial overgrowth, such as:

  • Adequate pH of stomach acid is required not just for digesting food and absorbing minerals but also for killing any harmful organisms found in our food, such as parasites, bacteria, etc.
  • Bile flow – which also has an antibacterial effect on the intestines
  • A well-functioning migrating motor complex – that gets activated during fasting periods and clears any remaining food or bacteria out of the small intestine towards the colon. If you constantly snack, then you inhibit this clearing motion. (6)
  • intact ileocecal valve -is a sphincter located in the last section of the small intestine (ileum), connecting to the first portion of the large intestine (cecum). It opens to allow the digested food to pass downwards and closes to prevent the backflow of the colonic content, waste, and bacteria to the small intestines (ileum). (7)
  • a healthy microbiome, etc. (8)

In IBD, some of these protective barriers might be compromised, which creates a free way to SIBO. If you have undergone abdominal surgery or had strictures, your risk may be increased.

SIBO and IBD symptoms may produce similar symptoms, so it is better to test for SIBO! According to a study, IBD patients with positive SIBO tests experienced more severe gut symptoms such as bloating, gassiness, and more frequent loose stools than their SIBO-negative peers. (9)

IBD may be linked to an improper immune response triggered by various environmental variables, gut dysbiosis, leaky gut, and genetics. (10)

natural remedies for ibd sibo

How to deal with IBD symptoms naturally?

Conventional medicine uses several medicines and immunosuppressants to decrease inflammation and the autoimmune process that might be necessary.

While it is crucial to reduce the symptoms, it is equally important to identify possible root causes of IBD.

In terms of dealing with SIBO and IBD, the main focus should be on:

1. Following an anti-inflammatory diet

Diets may play an essential role in reducing symptoms and inflammation by removing triggering foods and giving a chance for the intestinal wall to heal.

Different dietary approaches have been used for managing the symptoms: Paleo diet, Vegan diet, Specific Carbohydrate Diet (SCD), GAPS diet, low-FODMAP diet, etc. (11)

LOW-FODMAP DIET

The low-FODMAP diet has also been reviewed in the literature as a potential dietary approach for IBD patients. (12)

FODMAP is an acronym for "Fermentable Oligo-, Di-, Mono-saccharides And Polyols." These are short-chain carbohydrates and sugar alcohols that are poorly absorbed in the body. The bacteria ferment these carbohydrates and create gases, resulting in abdominal pain and bloating. Some examples of high-FODMAP-containing foods are cauliflower, mango, apples, onions, wheat, sweeteners like xylitol, and so on. (13)

Generally, a low-FODMAP diet is recommended to help reduce digestive symptoms, including bloating, flatulence, abdominal cramping, and diarrhea. (14) This diet can be beneficial if IBS or SIBO is also diagnosed and other dietary approaches haven't provided improvement. (15) It also has drawbacks because the diet removes some beneficial prebiotics that would improve dysbiosis in IBD patients.

SCD DIET

SCD (Special Carbohydrate) diet is one of the most popular dietary approaches to reduce symptoms and inflammation in IBD patients. (16) (17) Originally, it was created by Dr. Sidney Haas as a treatment for celiac disease, and later, in 1987, Elaine Gottschall published her book "Breaking the Vicious Cycle" as a treatment plan for IBD.

SCD is used as an elimination diet, which aims to remove complex carbohydrates that contribute to the overgrowth of harmful bacteria. The growth of these bacteria produces byproducts that cause inflammation in the digestive tract. In this diet, bacteria's food sources are excluded ( disaccharides and most polysaccharides), such as potatoes, grains (rice, millet, quinoa, wheat, etc.), most dairy products, processed foods, and most legumes, and so on. (18)

SCD is also commonly used among SIBO patients as it removes the complex carbs that bacteria commonly feed on in the small bowel. It can also be helpful for people with a deficiency of carbohydrate enzymes.

The diet also has some pitfalls as it allows dairy, which is often not well-tolerated by many. According to a study, approximately 70% of patients with IBD have lactose intolerance. (19) The diet can be high in nuts, which may cause adverse reactions in some who have oxalate sensitivity.

You can read more information about this diet in Elaine Gottschall's book "Breaking the Vicious Cycle."

ELEMENTAL DIET

When some of the anti-inflammatory diets fail to reduce symptoms, especially when someone is in the middle of a flare-up, then the Elemental Diet can be an excellent reset tool.

An elemental diet is an anti-inflammatory meal replacement formula that is quickly absorbed in the first section of the small intestine and includes all the necessary macronutrients, minerals, and vitamins in a broken-down form. This way, the gut has some pause from digesting whole foods and time to heal. Research showed that it could effectively reduce intestinal inflammation and maintain remission. (20)

An elemental diet is usually used for 2-3 weeks in case of severe digestive symptoms, such as IBD (21), IBD or SIBO (22), or Celiac disease (23).

2. Lifestyle modifications

Stress, especially chronic stress, puts a massive burden on the body by activating the sympathetic nervous system and getting us into the fight-or-flight response. Getting stuck in the fight-or-flight response shuts down digestion and the immune system, among other organs' functions.  Healing the body is only possible when you are in the rest-and-digest response when the parasympathetic nervous system is activated.

Flare-ups usually happen when somebody goes through a stressful period. Managing stress & shifting the mindset should be crucial elements in achieving optimal wellness.

According to studies, applying relaxation or stress management techniques can improve the quality of IBD patients' lives and reduce inflammation, anxiety, and pain. (24)

Some of these techniques involve:

  • Meditation
  • Breathing techniques
  • Gentle exercises, yoga, tai chi
  • Aromatherapy
  • Music or art therapy
  • Massage
  • Biofeedback therapy

3. Supporting the gut with specific supplements

  • High-potency probiotics – different strains were found to be effective in the active phase of IBD and the maintenance of the remission phase. (25)
  • Saccharomyces boulardii, which is a beneficial yeast, showed a decrease in symptoms. (26)
  • Omega-3 fatty acids coming from sources such as fish oils were found to reduce inflammation effectively. (27)
  • Vitamin D – In IBD, low vitamin D levels were associated with increased inflammation (higher fecal calprotectin and higher CRP levels), flare-ups, and medical treatment. (28)(29)
  • Curcumin is a potent antioxidant and has anti-inflammatory properties that can be found in turmeric roots. Curcumin used at a high dosage (3g/day) in Ulcerative Colitis patients with mild/moderate disease activity was shown to reduce inflammation and achieve remission. (30)

Conclusion

Many IBD patients may suffer from symptoms similar to IBS. Studies showed that SIBO (Small Intestinal Bacterial Overgrowth) is more common among people with IBD than the general population due to the compromised protective mechanisms.

It is essential to determine whether SIBO contributes to the severity of the symptoms by requesting a lactulose breath test.

A variety of diets can assist IBD patients in controlling their digestive symptoms. SCD or low-FODMAP are among the most popular diets. However, these dietary approaches might not be suitable for everyone with inflammatory bowel disease. Unique health history, intolerances, and sensitivities need to be considered to find the best-customized diet plan.

IBD symptoms can also be reduced with the right lifestyle changes and supplements.

 

*This post is only for informational purposes and is not meant to diagnose, treat or cure any disease. I recommend consulting with your healthcare practitioner always before trying any treatment or dietary changes.

References
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  2. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390(10114):2769-78.

  3. Ranasinghe, I. R., & Hsu, R. (2021). Crohn Disease. In StatPearls. StatPearls Publishing.

  4. Shah A .(2019), et al. Aliment Pharmacol Thera; Small intestine bacterial overgrowth prevalence drastically higher in patients with IBD. Helalio Gastroenterology. doi:10.1111/apt.15133. https://www.healio.com/news/gastroenterology/20190215/small-intestine-bacterial-overgrowth-prevalence-drastically-higher-in-patients-with-ibd

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  2. Deloose, E., & Tack, J. (2016). Redefining the functional roles of the gastrointestinal migrating motor complex and motilin in small bacterial overgrowth and hunger signaling. American journal of physiology. Gastrointestinal and liver physiology, 310(4), G228–G233. https://doi.org/10.1152/ajpgi.00212.2015

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  12. Suskind, D. L., Lee, D., Kim, Y. M., Wahbeh, G., Singh, N., Braly, K., Nuding, M., Nicora, C. D., Purvine, S. O., Lipton, M. S., Jansson, J. K., & Nelson, W. C. (2020). The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn's Disease: A Randomized Diet Controlled Trial. Nutrients, 12(12), 3749. https://doi.org/10.3390/nu12123749

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  14. Gottschall E. Breaking the Vicious Cycle. Baltimore, Ontario: The Kirkton Press; 2012.

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  23. Calder P. C. (2015). Marine omega-3 fatty acids and inflammatory processes: Effects, mechanisms and clinical relevance. Biochimica et biophysica acta, 1851(4), 469–484. https://doi.org/10.1016/j.bbalip.2014.08.010

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  26. Lang, A., Salomon, N., Wu, J. C., Kopylov, U., Lahat, A., Har-Noy, O., Ching, J. Y., Cheong, P. K., Avidan, B., Gamus, D., Kaimakliotis, I., Eliakim, R., Ng, S. C., & Ben-Horin, S. (2015). Curcumin in Combination With Mesalamine Induces Remission in Patients With Mild-to-Moderate Ulcerative Colitis in a Randomized Controlled Trial. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 13(8), 1444–9.e1. https://doi.org/10.1016/j.cgh.2015.02.019

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