Skip to main content

Predictive risk of Small Intestinal Bacterial Overgrowth (SIBO) in large cohort retrospective study

Predictive risk of Small Intestinal Bacterial Overgrowth (SIBO) in large cohort retrospective study . A total of 1809 patients who tested positive for SIBO using a Lactulose Hydrogen Breath test (Brechmann, Sperlbaum, & Schmeigel, 2017). The study looked at which pathophysiological exposures had the most predictive risk of SIBO.

They used a statistic called odds ratio (OR) . An odds ratio (OR) is a measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. For example you can see that being exposed to proton pump therapy makes you 1.4 times more likely than those non-exposed to proton pump therapy to develop SIBO.  This is a great study in that addresses the mechanisms that would lead to impaired clearance of bacteria from the small intestine and the subsequent development of SIBO. 

Surprisingly that being exposed to levothyroxine (a common thyroid medication) made subjects 3.0 times more likely to test positive for SIBO. Some of the other findings are highly explainable but I believe thyroid disorder which is being diagnosed more frequently is often overlooked as risk factor for SIBO. Makes sense because gut motility is influenced by thyroid metabolism.

Pathophysiologic Exposure
Odds Ratio of Positive Lactulose Hydrogen Breath Test
Impaired gastric barrier

Gastrectomy
3.5
Proton Pump Therapy
1.4
Impairments of Intestinal Clearance

Resecting gastric surgery
2.4
Colonic resection
1.9
Stenosis
3.4
Gastroparesis
3.4
Neuropathy
2.2
Immune suppression

Drug induced immunosuppression
1.8
Thyroid Gland Metabolism and Endocrine Disorders

Hypothyroidism
2.6
Levothyroxine therapy
3.0
Diabetes mellitus
1.9

Chart adapted from: (Brechmann, Sperlbaum, & Schmeigel, 2017)

This is a useful study in that it points out some more mechanisms on how to find SIBO, how to treat it, and how to prevent it from coming back. Also I am fairly confident that its the thyroid disorder and not the levothyroxine that is making SIBO more likely in hypothyroid patients. However it would be interesting if a different medication like Armour Thyroid would be more effective in clearing SIBO in the hypothyroid patient.

All of the above impairments are valid approaches to consider in treating SIBO and preventing recurrence. Including improving gut lining, improving gut clearance, improving immune function, improving endocrine function.  If you have SIBO or are dealing with another functional motility disorder like IBS a well rounded assessment  and treatment approach can be employed stabilize your digestion.

Adam Rinde, ND is a licensed Naturopathic Physician seeing patients in Kirkland, Washington in the Seattle Puget Sound region. He can be reached at www.soundintegrative.com 

Comments

Post a Comment

Popular posts from this blog

Plateauing

Plateauing in the process of change. I have experienced and you have experienced it. Things are going well and then we hit a flat point of progress. The typical  response to the plateau that  I have seen is to "do more" ,"add more", and "be more". It makes sense,right? Or does it? You're climbing a mountain after learning, growing, acquiring skills, and carrying  more responsibility, motivation, and discipline. It  seems worth it because you're seeing your health improve, relationships improve, mental health improve, and  spiritual health improve. Then you suddenly you're at a flat point. Things are not quite where they need to be and you have acquired new things, skills, tools that require maintenance and nurturing. If you don't continue them you would... well....fall back down the mountain. Or would you? So we add more stuff, more noise, more ideas, more skills, and suddenly we look like a pack mule climbing to our asc
2 comments
Read more

HPA Management: How to decrease anxiety?

This post is about Hypothalamic Pituitary Adrenal gland Axis (HPA) management. Specifically how to decrease anxiety. How do we decrease anxiety? Ask people to be clear of what is expected of us. And upon hearing what's expected be honest with ourselves and others about what is possible. If we you have expectations from others and for ourselves that have no boundaries; then we are likely going to experience an arousal state in the brain. This trickles down to anxiety related symptoms. Vice versa by not setting expectations we can reak havoc on our inner self relationships and outer self relationships. Of course I could write all day about lifestyle changes and herbal interventions that might help but the inner game of anxiety is so much more.
2 comments
Read more

The Economy of Inflammation

The economy of Inflammation I spend much of my day talking about inflammation. Why? Simply because I feel inflammation is the marker of the economy of the body.  If we are overly inflamed the economy begins to deteriorate and we start to first see belly fat, stiffness, fatigue,  skin changes, mood changes, and this progresses to  high cholesterol, insulin resistance, and/or hypertension. If the economy takes a hit for too prolonged period we see the body express imbalance in a degree where we see conditions such as Diabetes, Gout, Chronic Kidney Disease,  Fatty Liver Disease, Osteoarthritis, Depression, Fibromyalgia, and yes, sometimes Cancer. This is so much of what I see happening in my practice that I have thought about changing my practice to the Sound Inflammation Clinic. The remedy to inflammation are plants in our diet, omega-3’s and other healthy fats, mild exercise, stress release, sound sleep, and a whole array of herbal and nutritional supplements. You have hear
1 comment
Read more