Constant Burping Is A Sign Of This Harmful Bacterial Overgrowth

Small intestinal bacterial overgrowth (SIBO) is a condition that affects many people worldwide.

SIBO is commonly overlooked in the allopathic medical world but may affect a significant number of patients with IBS.

Over time, SIBO can contribute to chronic inflammation and may be associated with other health concerns, including challenges with absorbing food and nutrients.

A functional medicine approach to SIBO focuses on addressing the underlying factors that may contribute to the condition, rather than solely focusing on symptoms.

What Causes SIBO

To support healthy gut bacteria, it is important to have proper stomach acid levels and normal bowel motility. Factors that affect these components of digestion can allow bacteria to grow excessively.

Most gut bacteria live in the large intestine, the end of your digestive tract. But, in the case of SIBO, there is an overgrowth of bacteria in the small intestine.

Gut bacteria are vital to our health, but they can cause problems if they aren’t where they are supposed to be. Unlike your large intestine, your small intestine normally has relatively few bacteria due to the rapid flow of contents and the presence of bile. If the small intestine’s function slows, it may create an environment conducive to bacterial overgrowth.

Common Factors Associated with SIBO

• Low stomach acid
• Acid reducing Medications (PPIs, Tums, Pepcid, Prilosec, immunosuppressants)
• Gastroparesis
• Celiac Disease
• Chronic Constipation
• Slow digestion/motility
• Surgery (scar tissue: C section, endometriosis, hysterectomy, tummy tuck)
• Hypothyroid (low thyroid hormone)
• Stress (high cortisol)
• A diet high in sugar, processed carbs, and alcohol
• Infection (h. Pylori, e. Coli, klebsiella)
• Food poisoning (most likely with IBS-D/SIBO-D)
• Structural (ileocecal valve disorder, bariatric)

SIBO Signs and Symptoms

Two common symptoms that may be associated with SIBO are frequent burping and bloating, which can worsen after meals and at the end of the day. Many people think these are common indigestion symptoms, but to an integrative gut health practitioner, this may suggest issues with stomach acid production and possible bacterial overgrowth in the small intestine.

When stomach acid is low and motility in the small intestine is slow, it may create an environment where bacteria can thrive. Gas is produced as a by-product of fermentation, which can lead to frequent burping and bloating.

• Frequent Burping
• Bloating worse at the end of the day
• Patient feels better on Low FODMAP diet
• Patients’ symptoms may improve after certain treatments
• Feel worse after taking probiotics
• An uncomfortable feeling of fullness or gas immediately after eating
• Loose stools

Potential Complications of SIBO

Small intestinal bacterial overgrowth (SIBO) may be associated with systemic issues, including:

• Challenges with absorbing fats, carbohydrates, and proteins: Your small intestine helps break down foods, and bacterial overgrowth can interfere with this process, potentially leading to malabsorption, loose stools, gas, and bloat.
• Vitamin deficiency: A healthy small intestine lining is important for nutrient absorption.
• Weakened bones (osteoporosis): Over time, nutrient depletion, including calcium depletion, may contribute to bone health issues, such as osteoporosis.
• Kidney stones: Poor calcium absorption may eventually be associated with kidney stones.

Functional Medicine Testing for SIBO

A SIBO breath test is a common method for evaluating SIBO. This is a non-invasive at-home test that assesses bacterial overgrowth in the small intestine.

Patients begin by breathing into a tube after fasting overnight to get a base read. They then drink a specialized mixture to see if the bacteria in the small intestine releases hydrogen, methane, or a combo of both. After drinking, patients are asked to do a breath sample over a 3-hour time frame at 20 minutes, 40 minutes, 60 minutes, 90 minutes, 120 minutes, 150 minutes, and 180 minutes.

SIBO Test Results

A positive result for SIBO may be indicated if the breath test shows one of the following:

• Their hydrogen levels increase 20ppm during the 3 hours from the original starting point.
• Their Methane levels increase 12 ppm during the 3 hours from the original starting point.
• Combined (hydrogen + methane) increase 15 ppm during the 3 hours from the original starting point

Sample Report of Positive Hydrogen Dominant SIBO Report

As you can see, the patient went from a baseline of approximately 10 ppm to 60 ppm at the 90 min sample and continued to increase. This is over the increase of 20 ppm during the 3-hour test. The patient is therefore hydrogen dominant SIBO.

Functional Medicine Approaches to SIBO

Clinical management of SIBO may involve nutritional strategies, supportive therapies, and measures to help maintain gut health.

For nutritional strategies, some practitioners may suggest a Low FODMAP or Elemental Diet to help manage bacterial levels.

Low FODMAP Diet

The low FODMAP diet is a temporary eating plan. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, which are short-chain carbohydrates that ferment in the small intestine and may contribute to bacterial growth. Following a low FODMAP diet has been shown to help manage intestinal bacteria levels.

Low FODMAP is a three-step elimination diet:

• First, eliminate high FODMAP foods.
• Slowly reintroduce FODMAPs after 4 to 6 weeks to see which foods may cause discomfort.
• Once you identify the foods that cause symptoms, you can avoid or limit them while going back to enjoying the others.

Elemental Diet

Another option some practitioners may consider is the elemental diet. The elemental diet is a more restrictive approach and involves consuming a nutrient drink in place of meals for a short period. This diet aims to manage bacterial levels by limiting their food sources.

Herbal Support

Some practitioners may use herbal supplements alongside dietary changes. Patients should be aware that they may experience changes in symptoms during this time.

Approaches to managing SIBO with herbal support may depend on whether the patient is Methane or Hydrogen dominant. Common herbs used include allicin and berberine.

• Methane Dominant SIBO: Allicin
• Hydrogen Dominant SIBO: Berberine
• Methane & Hydrogen Dominant SIBO: Allicin + Berberine

Prevention

It’s important to consider factors that may have contributed to SIBO to help prevent future occurrences.

Some patients may benefit from using supplements that support motility for a period after treatment. Supporting normal motility can help maintain gut health.

Consulting with a healthcare provider about digestive enzymes and stomach acid levels may also be beneficial.

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Summary

SIBO is commonly overlooked in the medical world but may affect a significant number of patients with IBS. An at-home test can help provide insights, and appropriate management strategies may support better overall health and well-being.