SIBO stands for small intestinal bacterial overgrowth and is an emerging cause of many different health conditions. Estimated to affect (or infect as the case may be) 3 to 30% of the population, SIBO is an area of medicine that I have believed for many years will be considered the “missing link” in the causes of many diseases.
Bacteria in the small intestine can over grow for a number of reasons however once the bacteria have established themselves it is quite difficult to get rid of them, which is inevitably what leads to the signs and symptoms caused by SIBO.
The “Father of Microbiology” Louis Pasteur’s can lend a hand here with his famous last words in 1985, “Bernard was right; the pathogen is nothing; the terrain is everything”.
After a life’s work of proving that the pathogen (bacteria, virus, parsites, yeast) is always the cause of infectious disease Pasteur was “reported” to make this encouraging statement in support of one of his rivals work. Claude Bernard’s theory on the “milieu interieur” or the terrain of the body is really what provides the environment for the pathogen to invade and grow.
Although Louis Pasteur saved millions with his work on sanitation and actually discovered the “germ theory of disease” which modern medicine still embraces today. The significance of his statement in recognizing that not all people become infected by all pathogens because of differences between peoples bodies in allowing the “pathogen(s)” to grow is astounding and very important in understanding SIBO.
Okay … enough with the history lesson, but I wholeheartedly believe in determining the cause of a disease and with SIBO affecting this many people I can guarantee that there is not only one cause we will need to consider.
The areas that needs to be explored in determining causation will vary from different digestive deficiencies, genetics, psychological causes that can change gut terrain, dietary associations, along with the predominant working theory in the cause of SIBO … post infectious gastroenteritis or post-infectious chronic gut dysfunction as outlined in the article “Postinfectious Chronic Gut Dysfunction: From bench to Bedside” published in the journal Nature in 2012.
Infectious gastroenteritis is thought to be a very shorted lived condition by most physicians. Treatment guidelines for most causes of food poisoning suggest no treatment is needed at all, stating that the disease is self-limiting and will essentially go away on it’s own. These guidelines are correct if we are taking about the severe and sometimes bloody diarrhea that results from a Campylobacter, Shigella or Salmonella infection. The problem is that in up to 30% of people that suffer from a bout of food poisoning the infection may persist, and in some cases for up to 8 years or more!
The issue with diagnosing these persistent infections is a challenging one as once the severe stage of the infection is over getting a culture positive result is near impossible!
Regardless of the dismal success of getting a culture positive result following the initial “recovery” from a bout of food poisoning my suggestion is still to consider requesting a stool culture and a parasitology test from your family doctor. Maybe you will get lucky!
Stool culturing, in brief, involves the growth of a bacterial infection on a special growth medium. The problem is that growing bacteria is already tough enough and if there are very few bacteria in the stool sample or the bacteria have infected the small intestine this is what makes the likelihood of a positive culture low following the initial infection. I have seen results come back positive though … many times; for Yersinia Enterocolitica for example and others, so it is definitely worth a try.
Another method of clearly identifying the persistence of a suspected pathogen leading to post-infectious gastroenteritis is running a stool test that includes an Enzyme Immunoassay (or EIA for short) for different infectious organisms. EIA differences from a regular culture as it can detect the presence of an antigen (an infectious organism or even the secretion of the organism) with fairly high sensitivity and specificity without having to grow the organism in a culture. Pretty cool stuff, but would require a private laboratory to run these tests, which can be expensive.
Next article …. later this week, we are going to further look at causes of SIBO! Stay tuned.