Small Intestinal Bacterial Overgrowth (SIBO) occurs when there is an increase in the bacteria population in the small intestine. Let’s examine for a minute what this actually means.
Once you swallow the food and it’s done digesting in the stomach, it enters the small intestine. This is the area sometimes referred to as the “Kitchen” area, where the food you ate is now being absorbed into the bloodstream, to be taken all throughout the body. From the small intestine it then enters the large intestine, also known as the “Garbage” area where lots of bacteria work on it to break it down into our stool, to then be eliminated by the body.
Now, this is very important — you’re not supposed to have a lot of bacteria in the small intestines. This area has to be very clean since this is the area where you are absorbing the nutrients into the bloodstream. So it must remain fairly sterile.
And this is also both important and very interesting: the small intestine is 20 feet long. The large intestine is 5 feet long. Yet the food remains in the small intestines for only 2 hours, compared to the large intestine where the food stays there for 2 days. You must keep the food moving fairly rapidly in the small intestine so no pathogenic bacteria begins to grow.
The small intestines have very few bacteria — only 10,000 bacteria per ml of fluid. Yet the large intestine has 1 trillion live bacteria per ml of fluid.
So nature made it where we have relatively very few bacteria in the small intestine.
So let’s think how our small intestines could develop an overgrowth of bacteria. As I always state in all my videos, the causes are usually numerous and they are different in each particular person.
Today I’d like to discuss 4 main causes of SIBO, although there are probably several other contributing factors that could either cause it or add to the severity of the condition.
The first cause, which is fairly obvious, is lack of friendly bacteria residing in the intestines. They perform many functions, such as the absorption of nutrients, prevention of food allergies and autoimmune diseases, but they also prevent the growth of the pathogenic bacteria, or the bad bacteria which could harm us. These friendly bacteria are depleted by many types of pharmaceuticals, such as antibiotics, birth control pills, steroids, vaccines and acid reflux medicines.
Once they are depleted the pathogenic bacteria can start to overgrow. So in this case we want to make sure we always address our gut micro biome whenever we have to take any of these types of medications, which will prevent SIBO and other types of infections. That’s why it’s good to learn about the best probiotics, and how to make home-made yogurt, lassi, buttermilk and takra with the best yogurt starter cultures to ensure a good balance of friendly bacteria in the gut.
The second cause of SIBO is the use of acid reflux medicines. Now think about this: nature made it so once we swallow the food after chewing it, the first place it goes is the stomach. The hydrochloric acid found in the stomach not only breaks down the food into a liquid acid, but it also kills any infection coming in from the outside world.
So taking acid reflux medicines which take away the stomach acid can set the stage for infection to continue to thrive in the stomach which is then squirted into the small intestines, the kitchen area, causing many people to develop SIBO.
Listen to both my gall bladder video and my video on acid reflux, where I indicate how the better way to treat acid reflux is by stimulating the flow of bile out of the gall bladder. The bile coming out of the gall bladder moves the food downward through the gut and also alkalinizes the acids coming out of the stomach. So if the bile becomes thick like a sludge it might not squirt out when the stomach pours acid into the duodenum, the first part of the small intestine, causing the acids to turn around and move upwards into the stomach and esophagus, causing acid reflux. So in these cases we have to give all the herbs, foods and spices to thin out the bile and encourage it to move out of the gall bladder, which prevents acid reflux. This is much more effective and less risky than taking away the stomach acid.
The third reason for SIBO is lack of movement through the gut. Again, the food has to move quickly through the small intestines so infection doesn’t begin to breed in there. It is the job of the gall bladder to create two types of movement in the small intestines so the food doesn’t sit there which could cause SIBO.
Once you swallow the food the bile flows out of the gall bladder creating one type of movement called peristalsis, which are gentle muscular contractions that push the food through.
The second type of movement caused by bile flow is called the Migrating Motor Complex, or the MMC. Our gut is working 24/7, even when we’re not eating. What goes on when you’re not eating is crucial for gut health. The migrating motor complex is a wave of electrical activity whose sole purpose is to clean your gut. It’s different from regular motility in the gut because it isn’t stimulated by the presence of food in the gut. In fact, it happens 3 hours after your last meal. When you feel your stomach growling, that is the migrating motor complex. It is known as the “housekeeping wave.”
And it turns out that it is primarily the action of the gall bladder emptying the bile that stimulates the Migrating Motor Complex. So if the bile doesn’t squirt out the way it should then the food could just sit in the gut too long, developing the pathogenic bacteria.
Again, listen to my gall bladder video to make sure you always address the flow of bile since there are many instances in one’s lifetime where it may not flow correctly. And this is true even in children and babies! So the first step here is to get the bile flowing again so it can stimulate the MMC which in turn will prevent SIBO.
Before moving on to the next reason for SIBO, I would like to add here that in Ayurveda, we recognize that when we swallow the food it has to flow downwards and eventually exit out of the body in our bowel movements. But if Vata is too high and the person is nervous, anxious, worried, rushing too much during the day, stressed, going to bed late, then in all these cases the apana, which is the subdosha of Vata which is responsible for making sure that the food always moves downwards, might flow upwards, creating lack of motility in the gut, which also causes SIBO. So here you have to make sure you always address the Vata imbalances, which could be fueling the SIBO symptoms.
The fourth cause of SIBO is that food might regurgitate from the large intestine into the small intestine, or from the garbage area with all the bacteria, into the sterile kitchen area.
Again, this could happen partly due to the apana flowing upwards. It could also happen if there are some problems with digestion anywhere higher up, in the pancreas, stomach, gall bladder, or liver. If the food doesn’t digest well, the valve which separates the small intestine from the large intestine, known as the ilieo-cecal valve, could remain open, allowing the contents of the large intestine to flow back into the small intestine causing a painful situation in the right lower quadrant and causing subsequent infection to grow in the small intestine, or SIBO.
The answer to this problem lies in fixing all the problems with digestion so that the ileo-cecal valve can work the way nature intended, sealing off the kitchen area from the garbage area.
So now you can see why just taking an antibiotic to kill the SIBO infections in the small intestine may not always work. Initially you might have some relief because you just killed the infection, but if you don’t address all these other root causes, it could grow back, which it does in the large majority of the SIBO cases.
But rest assured that Ayurveda provides us with all the remedies and treatment modalities to address all the underlying conditions mentioned here, to get the gut back the way nature intended, where it automatically knows how to prevent these types of infections from growing.