leaky gut

From SIBO to Leaky Gut: The Healing Path

Imagine your gut is a bustling metropolis at the peak of rush hour. Now, envision that all the traffic lights are stuck on green due to some mysterious reason. Chaos ensues, right? That's a bit of what happens in conditions like Small Intestinal Bacterial Overgrowth (SIBO) and Leaky Gut—two gut health predicaments that often share the stage. They can turn the orderly flow of digestion into a free-for-all, leading to discomfort and confusion for anyone caught in the jam.

You may be surprised to learn that a Leaky Gut could be at the root of your depression, anxiety, thyroid problems, skin conditions, food intolerances, autoimmune diseases, fibromyalgia, and many other chronic diseases. Healthcare providers often overlook a leaky gut as a factor in chronic health problems.

Whether you're familiar with these terms or as perplexing as a foreign language menu, we will unpack the complex connection between these two gut health challenges, explore their co-occurrence, and discuss how you can naturally navigate your way to a happier, healthier gut.

SIBO - When bacteria take the wrong exit

Small Intestinal Bacterial Overgrowth, or SIBO, is like an uninvited party crasher in the small intestine. It occurs when bacteria that should be living large in the colon decide to move uptown to the small intestine, where they aren't meant to be in large numbers. These microbial misfits then feast on your meals, fermenting foods, particularly carbohydrates, causing gassiness, chronic bloating, and an array of digestive discomfort (including diarrhea, constipation, abdominal pain, nausea, etc.)

Intestinal Methanogen Overgrowth, IMO, also belongs to this category. In this case, we talk about another type of microorganism, archaea, that can also take residence in the small intestine besides bacteria. For simplicity, we will use the term SIBO in this article.

SIBO and IMO often masquerade as other digestive disorders, which makes them tricky to diagnose. (1)

 

 

Leaky gut when the walls have holes

Leaky gut is a commonly used term for "Intestinal permeability," when the intestines' lining gets damaged.

Imagine your gut lining as a fortress wall, carefully guarding the sanctity of your bloodstream. This wall selectively allows nutrients to pass while keeping out harmful substances. However, when Leaky Gut rears its head, the wall is breached. Tight junctions, the security gates of your gut, become loose. Suddenly, it's less of a fortress and more of a sieve, letting particles slip into the bloodstream that have no business there—prompting inflammation and a whole host of immune responses.

In essence, Leaky Gut gives a green light to substances that should be shown the red. This not only disrupts your body's inner workings but also sets the stage for an ongoing health drama.

When intestinal cells are damaged, enzymes are also not produced for proper digestion. In this case, you may not absorb essential nutrients, leading to other diseases such as allergies, intolerances, asthma, acne, and mental disorders. There is not only a leaky gut but a leaky brain, etc.  (2)

Leaky gut - tight junctions
Relationship between leaky gut and ASD demonstrating the increase of calprotectin {...} (ResearchGate: Gut Pathogens (29))

The unholy alliance - How SIBO may lead to Leaky Gut

So, how do SIBO and Leaky Gut end up in the same sentence, you ask? The connection lies in the fact that the overgrown bacteria in SIBO can produce toxins and by-products as they break down food, which can irritate and weaken the gut lining. Over time, this can turn your gut wall into something resembling Swiss cheese—full of holes and not very good at containment.

What's more, the bacteria can also consume the nutrients your cells need to maintain the gut barrier, leaving the cells weak and unable to repair themselves. This weakening is like taking bricks out of the fortress wall, one by one. Eventually, even the smallest of foes can break through.

A study (3) investigated the relationship between SIBO and Leaky Gut syndrome, and researchers found that individuals with SIBO had a significantly higher incidence of Leaky Gut syndrome.

And here's a compelling thought: just as an unhealthy gut can lead to a myriad of health issues, addressing gut health can create a ripple effect of wellness throughout the body. In this case, treating SIBO could be a key to patching up a Leaky Gut.

Testing for Leaky Gut

Diagnosing Leaky Gut requires a bit of detective work. Common signs may indicate a leaky gut, but you can also test for it.

  • Intestinal Permeability Assessment: This test involves drinking a pre-measured amount of lactulose and mannitol. The levels of these sugars in the urine afterward can indicate how porous the gut lining is.
  • Measuring Zonulin levels: it is a standard marker that is checked on a stool test. Zonulin controls the opening and closing of the gate, the tight junctions in your gut, allowing nutrients to be absorbed. If zonulin levels get high, the opening may take longer or be too big, and unwanted substances can leak through, causing problems. (4)
  • Food sensitivity tests: These can identify which foods your immune system is reacting to, potentially as a result of particles slipping through the gut lining. Honestly, I am not a big fan of food sensitivity testing, but when somebody is reacting to many foods, it indicates that a Leaky gut may be in the background.

What causes a Leaky gut?

There are many factors outside of diet that can cause a leaky gut, such as

  • SIBO (3),
  • Dysbiosis (imbalance between helpful and harmful bacteria in the gastrointestinal tract),
  • nutrient deficiencies (5),
  • an inflammatory diet including excess alcohol, sugar consumption, gluten (6),
  • chronic stress (7),
  • vigorous endurance training (8),
  • chronic inflammation (9),
  • environmental toxins like glyphosate, mold toxicity (10), heavy metals, etc.
  • infections (like Candida) (11) and endotoxins (12),
  • medications (especially NSAIDs like Tylenol and Advil) (13)

 Tangled connections: conditions associated with Leaky Gut

The ripple effects of Leaky Gut extend far beyond occasional discomfort; they can be associated with a variety of chronic diseases. When your intestinal barrier becomes compromised, it's like a crack in a dam, initially small and seemingly insignificant but with the potential to cause major downstream consequences. These can include:

  • Autoimmune diseases: Conditions like rheumatoid arthritis, lupus, type I diabetes, and celiac disease have been linked to increased gut permeability. It's as if Leaky Gut opens the door and, in a rush, the autoimmune disorders, where the body, confused by the influx of foreign particles, begins to attack its tissues. (14)(15)
  • Inflammatory Bowel Diseases (IBD): Crohn's disease and ulcerative colitis, types of IBD, may be exacerbated by Leaky Gut, as the gut's weakened defenses inflame the intestinal lining. (16)
  • Irritable Bowel Syndrome (IBS): Those with IBS may find that Leaky Gut intensifies their symptoms, as their gut is already a battleground for discomfort. (17)
  • Food allergies and intolerances: Like unwelcome guests slipping through a fence, food particles that breach the gut barrier can trigger allergic reactions and sensitivities. (18)
  • Skin conditions: Eczema, rosacea, and psoriasis, the irritated states of our outer shell, can also be linked to what happens within our inner tube, as the gut-skin axis suggests. (19)(20)

Listening to the whispers: signs and symptoms of Leaky Gut

A leaky gut can be a silent adversary, often presenting symptoms that whisper rather than shout. Paying attention to these whispers can be key to early detection and management. Symptoms may include (21):

  • Digestive issues: Chronic bloating, gas, diarrhea, or constipation
  • Fatigue
  • Headaches and brain fog
  • Skin irritations (acne, breakouts, eczema, etc.)
  • Mood swings (anxiety, depression)
  • Joint pain, body pain, muscle stiffness (22)

 

Leaky gut repairing remedies

Natural Healing for Leaky Gut

Dealing with SIBO and Leaky Gut can feel like navigating a labyrinth. However, there are natural strategies you can employ to guide you out of the maze:

Certain lifestyle and dietary changes can help you get back on track. These can include:

  • Learning relaxation techniques to reduce stress levels - Never underestimate the gut-brain connection. Techniques like meditation, yoga, and Tai chi can fortify your gut against the stresses of modern life.
  • Moving your body and avoiding being sedentary
  • Transforming your environment by eliminating toxins (plastics, GMOs, pollutants, mold, etc.)
  • Eating anti-inflammatory, whole foods and limiting refined carb intake and other food triggers
  • Removing gluten (protein in wheat, rye, spelt, barley, and kamut) from the diet. Gluten has been shown to increase intestinal permeability (23)
  • In case SIBO is present, a short-term low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet that aims to decrease fermentable carbohydrates may help reduce inflammation in the gut. (24)
  • Getting adequate quantity and quality of sleep
  • Chew, chew, chew: Digestion starts in the mouth. Chewing thoroughly is like laying a strong foundation for a building—it sets everything else up for success.

You can also support your gut lining healing with the following nutrients (22)(24):

  1. Bone broth or gelatin – helps the healing of the intestinal lining
  2. Prebiotics - feed good bacteria and boost the production of short-chain fatty acids (reintroduce them slowly and gradually if you have SIBO)
  3. Probiotics - help restore the gut mucous layer and prevent pathogens from overgrowth (in the case of SIBO, certain strains may work better than multistrain probiotics). Examples are L. plantarum 299v, L. rhamnosus GG, and L. acidophilus DDS-1 (24)
  4. L-Glutamine – an amino acid that helps repair the gut lining to regrow (25)
  5. Vitamins A and D - fat-soluble vitamins, have many roles, supporting the immune system (24)
  6. Zinc carnosine - unique support for the stomach and intestinal lining (26)
  7. Fish Oil – contains healthy fatty acids, such as DHA and EPA, to reduce inflammation (21)
  8. Curcumin (in Turmeric) - improves intestinal barrier function and reduces inflammation (27)
  9. Digestive enzymes - support the digestion process (24)
  10. Butyric Acid - serves as the primary fuel source for the colon's cells and for healing the lining of the colon and the small intestine. (28)

Of course, there are a lot of other great nutrients, herbs, and supplements that can help heal the gut lining.

Diet, supplements, lifestyle factors, and mindset all play a role in healing. You can see positive results with the right strategy within a few weeks.

Which Comes First: SIBO or Leaky Gut?

The question often arises: which condition do we address first—SIBO or Leaky Gut?

The truth is the healing order can be as unique as the individual, but a general roadmap can guide us.

The symbiotic relationship between SIBO and Leaky Gut suggests that healing one can positively influence the other. However, a common strategy among functional practitioners leans towards taming SIBO first.

Here's why:

  • Quelling the bacterial tide: Addressing SIBO reduces the number of bacteria available to produce the toxins that contribute to Leaky Gut. Think of it as turning down the volume before fixing the speakers.
  • Restoring balance: Once SIBO is under control, the inflammation in the gut often decreases, making it a more hospitable environment for repairing the intestinal lining.
  • Avoiding a vicious cycle: If you focus solely on healing the Leaky Gut without resolving the underlying SIBO, it's like patching up a boat while still taking on water; the issue could recur or never fully resolve.

The steps to gut healing

Healing the gut is a process that requires patience and a strategic approach.

Here's a simplified order of operations:

  1. Eradicate SIBO: Use targeted treatments such as dietary changes, herbal antimicrobials, or prescribed antibiotics to reduce the overgrowth of bacteria in the small intestine. It is still important to uncover the possible root causes of SIBO.
  2. Soothe and repair the gut lining: After reducing bacterial overgrowth, support the gut with nutrients that promote healing of the intestinal lining, like L-glutamine, collagen peptides, vitamin A, etc.
  3. Rebalance the gut flora: Introduce or reintroduce probiotics and prebiotics to nourish and support the beneficial bacteria in your gut.
  4. Reinforce gut function: Implement lifestyle changes that support long-term gut health, including stress reduction techniques, regular exercise, and adequate sleep.
  5. Monitor and adapt: Gut healing is not linear. Regular follow-ups through testing and symptom tracking can help adjust the plan as needed.

The Importance of personalization in healing

While this sequence offers a framework, it is not a one-size-fits-all solution. The interplay between SIBO and Leaky Gut is complex, and factors such as individual health history, severity of conditions, and personal responses to treatment must shape the healing journey.

In some cases, simultaneous treatment of both conditions may be necessary, especially if symptoms are severe and quality of life is significantly impacted. For instance, a healthcare provider may recommend a gentle approach to start repairing a Leaky Gut while also treating SIBO, especially if there are strong indications of a compromised gut barrier, such as autoimmune reactions or chronic inflammation.

Closing thoughts on the healing order

Deciphering whether SIBO or Leaky Gut should be addressed first is not a universal decision. However, the prevailing thought initially steers toward gaining control over SIBO to reduce the onslaught of symptoms and create a foundation for healing the gut lining. It's a bit like calming the storm before repairing the ship.

In the voyage of gut health, understanding the healing sequence is your compass. Working with a knowledgeable healthcare provider allows you to chart a course tailored to your body's signals and needs, leading you toward smoother sailing and restoring wellness.

If you are seeking guidance in your healing journey and need personalized support, book a free SIBO Assessment call, and let's discuss the first steps toward getting back control of your body and health.

 

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

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SIBO and Thyroid dysfunctions

Gut SIBO thyroid dysfunctions hypothyroidismAre you suffering from symptoms such as fatigue, brain fog, mood swings, dry skin, slow bowel movement, and even weight gain? These could also be a sign of thyroid dysfunction. (1, 2, 3, 4, 5, 6) Your thyroid is responsible for controlling your metabolic processes. If it is under-functioning (in the case of hypothyroidism), it pushes the brake pedal and slows down the body's metabolic processes. In the case of hyperthyroidism, it pushes the gas pedal and makes the process run faster.

Even though you may have thyroid dysfunction, your thyroid-like symptoms can actually stem from your gut. On the other hand, low functioning thyroid could also be a risk factor for Small Intestinal Bacterial Overgrowth (SIBO). It means that SIBO can lead to a hypothyroidism state, but hypothyroidism can also result in bacterial overgrowth.

The gut-thyroid connection

Some studies have found that thyroid symptoms improved after treating the gut. These gut issues can come from Helicobacter pylori (7,8), parasites (9), fungal infection (Candida) (10), SIBO (11), or food intolerances (12), etc.

Studies estimate that around 30% of people with hypothyroidism have low stomach acid (13). Stomach acid is essential to kill pathogens and prevent the overgrowth of bacteria. If this protective mechanism fails, then it can easily lead to SIBO. (14) This is why using stomach acid blockers (Proton-pump inhibitors) unnecessarily can be problematic and may also lead to SIBO. Here you can read more about the types of SIBO.

The other reason is that overgrowth of bad bacteria can lead to issues with the conversion of thyroid hormones, namely T4 (inactive form) to T3 (active form). (15) Much of the thyroid hormone is released by the thyroid gland in the inactive type known as T4 (thyroxine), but it must be converted to an active form known as T3 (triiodothyronine) for the cells to use it. (16) Around 20% of T4 can be converted to T3 in the gut by good gut bacteria.

But most of the conversion is done by the liver, which can also be sluggish for many reasons. A sluggish liver and gallbladder cannot remove hormones efficiently, such as estrogen. Elevated estrogen levels can also negatively influence the conversion rate of thyroid hormones. (17)

The other issue can be when T4 converts to reverse T3 (rT3), the inactive form. A higher level of reverse T3 can be produced if someone went through a major life event, a trauma (emotional or physical stress like a surgery), or having chronic stress (illness, inflammation). (18,19) In some cases, other factors such as diet, not just a diet high in sugars and processed foods, but also a ketogenic or very low carb diet, can cause elevated levels of rT3. (20, 21)

So making sure that you have a well-functioning gut and liver, the gallbladder is vital to ensure proper conversion of thyroid hormones.

The immune system-thyroid connection

There are 70% of the body's immune cells located in the gut. The immune response in this part of the body is called GALT, or gut-associated lymphoid tissue. The GALT contains several forms of immune cells, such as T and B cells, that detect and respond to antigens as potential threats that trigger immune system reactions.

Problems arise when any one of these intestinal barriers is weakened. When the small intestine's tight junctions loosen (in case of "leaky gut syndrome"), undigested food particles, microorganisms, toxins, or larger proteins enter the bloodstream. The immune system sees these particles as unwanted intruders and starts an inflammation process to rid of them. Leaky gut can be one of the underlying causes of autoimmune diseases, such as Hashimoto-Thyroiditis, an autoimmune form of hypothyroidism. If you have a leaky gut, the immune system can keep attacking the thyroid and cause continued problems. (22, 23)

What might help to support your body?

Focusing on gut health is an essential part of any treatment process as it is also connected to your immune system and thyroid autoimmunity, and thyroid functions. But concentrating on the thyroid function is also crucial.

If you are experiencing symptoms of thyroid dysfunction and SIBO, you can do the following steps:

  1. Do the necessary testing to find out what the issue is behind your symptoms: ask for a SIBO breath test and a full thyroid panel from your Practitioner
  2. Taking thyroid medication may help with motility and considering eliminating SIBO or other infections if present
  3. Choose a customized diet that eliminates inflammatory foods such as sugar, processed foods, gluten, refined carbohydrates, refined oils, artificial sweeteners, etc.
  4. Eat a whole food diet – including organic meats, vegetables, fruits, nuts, seeds based on your tolerance
  5. Apply lifestyle changes that help you manage your daily stress
  6. Take intestinal lining healing nutrients, boost motility

 

 

*This post is only for informational purposes; and not meant to diagnose, or treat any disease. I advise consulting with your healthcare practitioner regarding any treatment options or dietary changes.

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Consider SIBO testing if you suffer from constant bloating

SIBO testing

What is SIBO & SIBO testing?

First of all, what is SIBO? SIBO stands for Small Intestinal Bacterial Overgrowth. It is defined as the presence of excessive bacteria in the small intestine. The problem is that there are too much bacteria and/or the wrong type of bacteria present in the wrong place.

Symptoms can be excess/trapped gas, bloating, diarrhea and/or constipation, abdominal pain or cramping, food sensitivities, chronic fatigue, brain fog, and the list goes on. (1)(2)

Before getting tested

Before getting to SIBO testing, many people try different methods to relieve their symptoms. These approaches may include lifestyle changes (e.g., reducing sugar/junk and processed food consumption; stress; getting more sleep) or eating more fiber, prebiotic foods, and herbs. However, if these changes don’t bring the expected results or make the current symptoms worsen, then it might be time to visit the GI doctor to have some tests.

Although having the symptoms mentioned above doesn’t mean that you have 100% SIBO. It is crucial to rule out other diseases (like endometriosis, Crohn’s/ Colitis) and get a proper diagnosis by your healthcare practitioner. There can be many different diseases, which could cause the same symptoms.

Suppose you have already been diagnosed with IBS (Irritable Bowel Syndrome). In that case, it is definitely worth getting SIBO testing because, according to a study, up to 84% of patients with IBS actually have SIBO. (3)

It may also happen that a person thought SIBO was causing the symptoms, but then the culprit turned out to be Celiac disease. (4) If you start using an antimicrobial treatment for assumed SIBO without any proper diagnoses, then it may cause more harm than good. So testing is essential, which can help define the treatment plan.

SIBO testing method #1: SIBO breath test

The three-hour lactulose or glucose breath test is generally used for diagnosing SIBO, which detects the different types of gases that bacteria produce in the small intestine. It checks for hydrogen and methane gas. (5) There is now a new test available in the US: the TrioSmart test that can detect the third type of gas: hydrogen sulfide. (6) I wrote about the different types of SIBO.

The bacteria in our intestines ferment specific carbohydrates, and they produce gases as a byproduct. The breath test involves drinking a sugar solution (lactulose or glucose, a type of carbohydrate) that feeds the bacteria in the gut, and they start making gases. Then these gases are absorbed in the intestines and get into our blood, from where the gases are delivered to our lungs and exhaled in our breath. That is what the breath test intended to capture.

The breath test is done for 3 hours, while breath samples are taken at 20-minute intervals. The first two hours represent the small intestine, and the last hour is usually the large intestine. Measuring the level of those gases is also important to determine how severe the bacterial overgrowth is and what treatment would suit the best.
Be aware that a prep diet is required to be followed before SIBO testing. It involves following a low-fiber diet and fasting for 14 hours. (When you order a test, you should receive instruction on the prep diet). (7)

A hydrogen breath test is also used for testing carbohydrate malabsorption issues when dietary sugars are not absorbed well, such as lactose (sugar in milk), fructose (sugar in fruit), sorbitol, and sucrose. (8)

 

Can you trust the SIBO breath tests?

While the breath test is considered the most practical SIBO testing method, it certainly has its limitations.
A meta-analysis of the breath test accuracy showed that lactulose substrate might provide a higher number of false-positive results than the glucose test. Glucose breath test seems to work better than lactulose breath test for diagnosing SIBO. It seems glucose testing has better sensitivity and specificity. (9) (10) In this case, clinicians may need to evaluate the results more carefully before giving out a diagnosis, and it would be worth doing a test for both types of substrates.

Other problems can be:
• the missing consensus on the interpretation of breath test results
• Individual’s motility can influence the test results – transit time may differ from person to person (11)

Other types of tests

If you have IBS-D or IBS-M/SIBO-D, you experience mainly diarrhea symptoms; then an IBS-SMART test is available to diagnose post-infectious IBS (PI-IBS). It is a blood test that looks for the markers of food poisoning (one of the leading causes of SIBO), which is the result of auto-antibodies forming in a lot of people and starting an auto-immune process. The antibodies measured in the blood are anti-CdtB toxin and anti-vinculin. These antibodies can attack the nerves of the gut and impair the cleaning wave, the Migrating Motor Complex. (12)(13)

What tests are not suitable to diagnose SIBO?

  • Stool tests because the results represent mainly the end of the large intestine, although they might indicate some issues in the small intestine but cannot diagnose SIBO. Overgrowth of bacteria in a stool can show dysbiosis.
  • Organic Acid Tests (OAT) check the urine for byproducts of yeast or bacteria in the small intestine, which can be very useful but cannot tell whether your SIBO is hydrogen/ hydrogen-sulfide or methane-dominant. (14)

Conclusions

Using SIBO testing (a breath test) has its advantages and disadvantages, but it can still be the most practical approach to diagnosing SIBO. Metanalysis showed that a glucose breath test might provide a more accurate diagnosis than a lactulose breath test. Having a SIBO diagnosis can be crucial as it can define the best treatment options (each type of gas requires different strategies).

Bear in mind that diagnosing SIBO might be just the first step because it will not tell you what caused SIBO in the first place. However, finding the underlying cause is crucial to prevent relapsing.

If you have questions regarding SIBO or need help finding out your root cause and support on your healing journey, then feel free to book a free consultation call!

 

 

* This post is only for informational purposes and not meant to diagnose or treat any disease.  I advise consulting with your healthcare practitioner regarding any treatment options or dietary changes.

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