Massage & Bodywork

MAY | JUNE 2019

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Changes in Intestinal Chemistry If the chemical environment of the proximal intestine is abnormal, unwelcome bacteria can fl ourish. This may happen with the use of proton pump inhibitors (PPIs) that change gastric secretions, or cirrhosis, pancreatitis, and diabetes, all of which can alter the secretions that enter the duodenum. Immune System Defi ciency Any situation that impairs immune system function may open the door to SIBO. HIV and AIDS, treatment for autoimmune diseases, and chemotherapy are all contributors to immune system challenges. Any one or any combination of these factors may tip the balance so bacteria in the proximal intestine proliferate. If these microorganisms become aggressive, they can produce metabolic wastes that damage the villi, interfere with the action of bile, and cause the transformation of normal nutrients into toxic metabolites. The result: pain, gas, bloating, diarrhea, and potentially dangerous malabsorption with defi ciencies of important vitamins and minerals. SIBO can become life-threatening, especially if the patient is very young, very old, or constitutionally weak. We see it as a particular threat for older people with chronic diarrhea, neonates who are malnourished, and those with chronic conditions that interfere with digestive function, like scleroderma or diabetes. SIBO SIGNS, SYMPTOMS, AND COMPLICATIONS The simplest signs and symptoms of SIBO can be fairly subtle: gastrointestinal discomfort, mild gas, and diarrhea. Weakness and fatigue follow. Food exacerbates symptoms, and the person cannot normally absorb nutrients. Symptoms typically worsen over time. Left untreated, and especially if the person has other contributing factors, SIBO can lead to some serious complications. People with SIBO may become anemic, for several reasons. With impaired absorption, it is impossible to get enough iron, folate, and other blood building blocks from the diet. A defi ciency in vitamin B12 eventually causes neuropathy, heart palpitations, problems walking, and vision loss. The wastes excreted by gut bacteria can interfere with the function of bile, leading to steatorrhea, the presence of fat in the stools, while important fat-soluble vitamins like A, D, E, and K are inaccessible. Vitamin A defi ciency leads to night-blindness; lack of D vitamins can contribute to fatigue, depression, hair loss, bone density loss, and more; defi ciency of vitamin E means we lose a major source of antioxidant activity; and lack of vitamin K can cause excessive bleeding. Lack of access to calcium can cause muscle cramps and eventual osteopenia. In addition, the nutrient defi ciencies seen with SIBO are associated with dermatitis, rosacea, and many other conditions. DIAGNOSTIC CHALLENGES This condition is sometimes identifi ed through carbohydrate or lactulose breath tests, although these tests have been shown to be potentially inaccurate, with a high rate of both false positives and false negatives. Extracting fl uid from the duodenum or jejunum to count bacterial colonies is intrusive and complicated, and typically isn't recommended unless an endoscopy is already being conducted. Consequently, many doctors rely on patient-reported symptoms, tests for nutritional defi ciencies, and an attempt to rule out conditions with similar presentations, such as celiac disease, Crohn's disease, and irritable bowel syndrome. This is a special challenge, because SIBO can and frequently does occur simultaneously with these other causes of chronic digestive system dysfunction. TREATMENT The goals of treatment for SIBO are fourfold: to interrupt any possible contributing factors, to treat the bacterial overgrowth, to supplement needed nutrients, and to restore a healthy gut microbiome. This turns out to be a lot harder than it sounds. Interrupting contributing factors may be the simplest part of SIBO treatment. This means identifying whether the patient is using medications like PPIs or narcotics that might change the intestinal environment, or whether they are successfully treating conditions like diabetes or hypothyroidism that can interfere with proper gut motility. Addressing bacterial overgrowth in the intestines is challenging for many patients. Different antibiotics are used for aerobic bacteria than for anaerobic bacteria, so a fi rst attempt may not be successful. Further, antibiotics Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 37 Watch "Fun with the Gut Microbiome"

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