Is it SIBO Syndrome or Lyme Disease?

If you have muscle pain, suffer from recurrent joint discomfort, feel fatigued, have anxiety and insomnia, haven't had a normal bowel movement, and have had (or suspect you've had) Lyme disease and believe you've developed a chronic form of it or one of its co-infections; if antibiotics make you feel better (but you don't want to be on them all the time); if you're convinced that your gut is damaged and almost everything you eat makes you feel worse; and if you feel better after eliminating gluten and dairy from your diet, but excellent health remains elusive, in that case, small intestinal bacterial overgrowth (SIBO) syndrome could be a contributing factor.

SIBO can be easily detected via a breath test that you can perform in the comfort of your own home. It is a common diagnosis that is frequently misdiagnosed.

SIBO is a disorder in which bacteria that ordinarily reside in the large intestine migrate to the small intestine. SIBO's metabolic byproducts alter bowel motions, causing diarrhea and/or constipation. SIBO can induce discomfort in the intestines and in the muscles and joints of the body. It also causes lower back pain, inguinal pain, and migraines and contributes to menstruation disorders, typically resulting in poor hormone conjugation in the liver and in premenstrual syndrome, polycystic ovary syndrome, and fibroids. SIBO is a fundamental cause of intestinal dysbiosis that allows chronic candidiasis to develop and become resistant to treatment. Patients who require long-term antibiotics are more likely to develop Clostridium difficile infections if they already have SIBO. Recurrent Helicobacter pylori infections (stomach ulcers), halitosis (poor breath), gallstones/sludge, and recurrent yeast infections are all caused by SIBO (candidiasis).

SIBO sufferers typically suspect that their diets are to blame for a lot of their problems, but defining all of the sensitivities is difficult, and the situation seems to fluctuate without warning or is inconsistent. Gluten and dairy are particularly effective at feeding SIBO bacteria, so many people who aren't allergic to them feel better avoiding them. This is most likely the reason for the rise in the number of people opting for gluten-free diets and getting benefits from dairy- and grain-free diets (e.g., Paleo, Atkins, GAPS, bone-broth diets, etc.).

SIBO is a term that refers to a collection of big intestinal bacteria, including Escherichia coli and Klebsiella. These gut bacteria are rarely exposed to the carbs and sugars found in the small intestine. Sugars and carbs act as fertilizers, causing SIBO to become extremely active. They not only continue to proliferate, but they also obliterate your regular flora in the small intestine. SIBO also produces chemicals and gases that aren't ordinarily found in the small intestine, such as hydrogen gas, methane gas, and ammonia. Unlike the big intestine, the small intestine has a limited number of bacteria, and if their number increases, these organisms will consume nutrients that would otherwise be taken by the body. As a result, a person with SIBO may become malnourished, and a brief course of Myers nutritional IVs and daily use of a good multivitamin will help.

Dietary adjustments, particular antibiotics, botanicals, and the elemental diet are all common treatments for SIBO. After a lactulose challenge, the findings of a hydrogen/methane breath test are used to determine the optimal treatment or combination of therapies. Your doctor must also search for the causes of SIBO and manage them to prevent the condition from returning.

If you think you have Lyme disease or another tick-borne infection, have taken antibiotics, have diarrhea and/or constipation, are bloated, are gassy, have unexplained skin rashes, have hormone abnormalities, or have various food sensitivities, you should examine your SIBO status and pay attention to your gut instinct.

What are the signs and symptoms of SIBO syndrome?

SIBO symptoms are similar to those of a range of other gastrointestinal disorders, and SIBO is frequently caused by another ailment. Depending on the severity of your disease, you may suffer some or all of the following:

Pain in the abdomen
Distension in the abdomen
Nausea
Bloating
Indigestion
Gas
Diarrhea
Constipation
Weight loss that occurs unintentionally
Fatigue or exhaustion
Feeling discomfort or full after eating
Malnutrition

Symptoms of SIBO syndrome and Lyme disease and side effects of antibiotic use that overlap

SYMPTOM	LYME DISEASE	SIBO	ANTIBIOTICS
Muscle aches	Yes	Yes	Yes
Joint pain	Yes	Yes	Yes
Headache	Yes	Yes	Yes
Anxiety/Depression	Yes	Yes	Yes
Insomnia	Yes	Yes	Yes
Constipation		Yes	Yes
Diarrhea		Yes	Yes
Belching		Yes	Yes
Intestinal or lower abdominal pain		Yes	Yes
Abdominal bloating		Yes	Yes
Rashes on the skin	Yes	Yes	Yes
Flatulence		Yes	Yes
Heartburn		Yes	Yes
Nausea	Yes	Yes	Yes

When should you see a doctor?

Many intestinal issues cause bloating, nausea, and diarrhea as indications and symptoms. If you have any of the following symptoms, see your doctor for a comprehensive assessment:

Diarrhea that persists
Weight reduction that occurs quickly and unintentionally
Abdominal pain that lasts for several days

If you have severe abdominal pain, seek immediate medical care.

What are other possible causes of SIBO syndrome?

SIBO is a bacterial overgrowth in the small intestine that can be caused by various factors:

Abdominal/gastric surgery

Gastric bypass for obesity and gastrectomy for peptic ulcers and stomach cancer are two examples of abdominal surgery complications.

Adhesions

Scar tissue (intestinal adhesions) that wraps around the outside of the small bowel and bulging pouches of tissue that protrude through the small intestine wall are examples of structural issues in and around the small intestine (intestinal diverticulosis).

Medical conditions

Crohn's disease, radiation enteritis, scleroderma, celiac disease, diabetes, and other medical diseases that cause food and waste items to flow slowly through the small intestine (motility).

Why does SIBO syndrome occur?

The small intestine, which is nearly 20 feet long, is the longest segment of your digestive tract (6.1 meters). Food combines with digestive juices in the small intestine, where nutrients are absorbed into the bloodstream.

Because of the quick flow of contents and the presence of bile, your small intestine has fewer microorganisms than your large intestine (colon). In SIBO, however, stationary food in the small intestine serves as a great breeding environment for bacteria. Toxins may be produced by the bacteria, and they may also obstruct nutrient absorption. Food breakdown products caused by bacterial digestion can also cause diarrhea.

The following factors increase the risk for SIBO:

Abdominal/gastric surgery
Certain medical conditions, particularly gastrointestinal diseases
Obesity or ulcers may necessitate gastric surgery
A small intestine structural defect or damage to the small intestine
A fistula is an irregular channel connecting two intestinal segments.
The small intestine is affected by Crohn's disease, intestinal lymphoma, or scleroderma.
Radiation therapy to the abdomen in the past
Diverticulosis of the small intestine
Diabetes
Previous abdominal surgery-related adhesions

What are the complications of SIBO syndrome?

SIBO can lead to a slew of issues, including:

Malabsorption: Fats, carbs, and proteins are poorly absorbed. Excess bacteria in the small intestine break down bile salts, which are normally needed to digest fats, resulting in inadequate fat digestion and diarrhea. Bacterial compounds can also affect the mucous lining (mucosa) of the small intestine, causing carbohydrate and protein absorption to be reduced.

Bacteria can compete for food that is available. In addition, chemicals produced by bacteria while breaking down stationary food might cause diarrhea. Diarrhea, malnutrition, and weight loss are all symptoms of bacterial overgrowth when combined.

Deficiencies: Your body cannot properly absorb fat-soluble vitamins A, D, E, and K because of insufficient fat absorption. Vitamin B12 is synthesized and used by bacteria in the small intestine, and it is necessary for the correct functioning of your nervous system, as well as the formation of blood cells and DNA.

Vitamin B12 deficiency: Bacterial overgrowth can cause B12 deficiency, which can cause weakness, weariness, tingling, and numbness in your hands and feet, as well as mental confusion in severe cases. B12 deficiency can cause irreparable damage to your central nervous system.

Osteoporosis: Bones that have weakened can easily fracture (osteoporosis). Damage to your intestine caused by aberrant bacterial growth leads to inadequate calcium absorption over time, which can lead to bone problems including osteoporosis.

Renal stones (stones in the kidneys): Kidney stones can develop as a result of poor calcium absorption.

How is SIBO syndrome diagnosed?

You may have to undergo tests to check for bacterial overgrowth in your small intestine, poor fat absorption, or other abnormalities that may be causing or contributing to your symptoms to identify SIBO. The following are examples of common tests:

Breath analysis: This noninvasive test determines how much hydrogen or methane you exhale after consuming a glucose and water mixture. Exhaled hydrogen or methane levels that rise quickly could suggest bacterial overgrowth in your small intestine. Breath testing is less specific than other types of tests for identifying bacterial overgrowth, despite its widespread availability.

Fluid culture and aspiration of the small intestine: This is the gold standard test for bacterial overgrowth at the moment. A long, flexible tube (endoscope) is sent down your neck and across your upper digestive tract to your small intestine to retrieve the fluid sample. A sample of intestinal fluid is taken and analyzed in a laboratory for bacterial growth.

In addition to these tests, your doctor may suggest blood tests to check for vitamin deficiencies or a stool test to check for fat malabsorption. To examine for structural abnormalities of the intestine, your doctor may recommend imaging tests such as X-rays, computed tomography (CT), or magnetic resonance imaging (MRI).

How is SIBO syndrome treated?

Doctors treat SIBO by addressing the underlying issue if possible, such as by surgically correcting a postoperative loop, stricture, or fistula. However, reversing a loop is not always possible. In that instance, the focus of treatment is on addressing nutritional deficits and bacterial overgrowth.

Antibiotic treatment

Antibiotics are usually the first line of defense against bacterial overgrowth in most people. Even if test findings are ambiguous or no testing is done, doctors may begin this treatment if your symptoms and medical history strongly suggest bacterial overgrowth as the cause. If antibiotic treatment is ineffective, testing may be done.

Antibiotics can typically drastically decrease the number of aberrant microorganisms in a short period. However, bacteria can resurface if the antibiotic is stopped; thus, treatment may be required for a long time. Some people with a loop in their small intestine may not require antibiotics for a long time, while others may require them on a regular basis.

To help minimize bacterial resistance, doctors may alternate between medicines. Antibiotics kill most bacteria in the intestine, both normal and pathological. As a result, antibiotics might exacerbate some of the conditions they're supposed to treat, such as diarrhea. This problem can be avoided by switching between various medicines.

Nutritional assistance

Correcting nutritional inadequacies is an important element of managing SIBO, especially in patients who have lost a lot of weight. Malnutrition is treatable, but the harm it causes is not always reversible.

The following may help with weight gain, nutritional shortages, and digestive distress:

Supplements for nutrition: Vitamin B12 intramuscular injections, oral vitamins, calcium, and iron supplements may be required for those with SIBO.

Lactose-free diet: You may lose the capacity to digest milk sugar if your small intestine is damaged (lactose). In that scenario, most lactose-containing foods should be avoided, or lactase preparations that aid in the digestion of milk sugar should be used.

Because the bacteria used in the culturing process naturally break down lactose, some people with the condition may be able to digest yoghurt.

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