Alternative Treatment of Small Intestinal Bacterial Overgrowth (SIBO)

ABSTRACT

Small Intestinal bacterial overgrowth occurs when there is an abnormal increase in the bacterial population in the small intestines. Small intestines or small bowel is an organ in the gastrointestinal tract where absorption of nutrients takes place. It is 18 feet long and is longer than large intestines hence known as small intestines due to its narrower diameter. It has three parts- The duodenum, Jejunum and the Ileum. The duodenum is the shortest where there is finger like villi present and prepare for absorption, The jejunum is lined by enterocytes where absorption takes place and main function of the ileum is to absorb vitamin B12 and bile salts which is not absorbed by jejunum. The small intestine receives a blood supply from the celiac trunk and superior mesenteric artery, it develops from the midgut of the primitive gut tube, ileum begins to grow longer at faster rate and is U shaped fold known as primary intestinal loop. The main function is to take food from the stomach to duodenum through the pylorus by a muscle named pyloric sphincter. The small intestine is where most of the digestion takes place, many digestive enzymes act in the intestine secreted by pancreas and liver which enter through the pancreatic duct. In this article we are going to discuss in detail about its causes, treatment and its ayurvedic aspect further in this topic.

INTRODUCTION

SIBO (SMALL INTESTINAL BACTERIAL OVERGROWTH) is a serious condition which mainly affects the small intestine and leads to occurrence of increased number of bacterial populations in the small intestines. It is known as bacterial overgrowth, small bowel bacterial overgrowth syndrome (SBBOS). It is the increased number of bacteria measured via hydrogen and methane gas following the ingestion of glucose.  It can also be related to Irritable bowel syndrome (IBS). Mainly Gastric acid, Biles and enzymes are the chemicals which are controlling bacteria in the small intestines. The emptying of the food contents from small intestines to large intestines is the cleansing mechanism and when this mechanism is impaired the bacteria grow in the small intestines and grow more and bacteria begin to move upward. This bacteria in small intestines digests the carbohydrates and converts into gas and short fatty acids,when there is more bacteria it will undergo more gas formation which further triggers the diarrhea. This leads to poor absorption of the nutrients and results in malnutrition and causes deficiencies which leads to damage to various organs parts.

FACTS

1. SIBO is not an infection but it is associated with the underlying condition.
2. SIBO can be accurately cured
3. Probiotics for SIBO may be part of the problem but not a solution
4. The enteric nervous system or second brain is made up of over 100 million cells which monitors the whole digestive system from esophagus to anus. It controls the gut independently and is in constant communication with the brain.
5. The ileum (part of small intestine) is the final section of the gut and there is presence of ileocecal valve which is a one direction portal that remains at the chyme and moves to the large intestine. This is the only junction where absorption of vitamin B12 takes place.

CAUSES

1. Low stomach acid (hypochlorhydria) reduces the ability of the body to moderate the bacterial growth. It includes-
2. H. pylori infection
3. Prolonged use of medications such as proton pump inhibitors
4. Gastric bypass surgery.
5. Small intestinal dysmotility- The waste is retained for too long in small intestines before emptying. It includes-
6. Gastroparesis
7. Hypothyroidism
8. Intestinal pseudo obstruction
9. Structural problems in small intestines- This inhibits the motility and regular cleansing of residual bacteria. This is caused by gastrointestinal diseases such as –
10. Small bowel diverticulosis
11. Abdominal adhesions
12. Obstruction in a small bowel.
13. Certain Medications- It upsets the flora and it includes-
14. Antibiotics
15. Narcotics
16. Gastric acid suppressants
17. Various other disease such as –
18. Viral gastroenteritis
19. Celiac disease
20. Crohn’s disease
21. pH changes in small bowel
22. Portal hypertension
23. Irritable bowel syndrome

SYMPTOMS

1. Loss of appetite
2. Nausea
3. Bloating
4. Malnutrition
5. Abdominal pain after intake of food
6. Indigestion
7. Cramps
8. Gas
9. Diarrhea or constipation
10. Unintentional weight loss

DIAGNOSIS

1.  Lactulose breath Tests
2. Small intestine aspirate and fluid culture
3. Blood tests
4. Stool tests
5. X ray
6. CT Scan
7. MRI

RISK FACTORS

1. Gastric surgery for obesity
2. Structural defect in small intestines
3. Fistula between two segments of bowel ‘
4. Diabetes
5. Diverticulosis of the small intestines
6. Crohn’s disease
7. Injury to small intestines  

TREATMENT

1. Antibiotic Therapy
2. Nutritional Support- It improves vitamin deficiencies which reduces the intestinal distress and helps in gaining weight. It includes-
3. Nutritional supplements
4. Lactose free diet
5. Probiotics and fecal microbiota transplants
6. Low FODMAP Diet  

COMPLICATIONS

1. Poor absorption of fats, carbohydrates and proteins
2. Vitamin deficiency
3. Osteoporosis (weakening of bones)
4. Kidney stones
5. Anemia
6. Electrolyte imbalance

AYURVEDIC MANAGEMENT

SIBO (small intestinal bacterial overgrowth) is a disease which is considered as kapha and pittaj vyadhi. As in this kapha doshas remains aggravated and pitta doshas get vitiated. Pitta has fire dominating factor whereas kapha has water dominating factor. The balance between these doshas keeps the mind healthy and imbalance of these doshas leads to various diseases. According to ayurveda, it is also related with Aama. On eating heavy undigested food, and eating incompatible food, it leads to low digestive fire (agni) which causes first dhatu ras to not form properly and remains in the Amashaya (stomach) for a long period of time and undergoes fermentation. This Aam leads to various symptoms like indigestion, lethargy and loss of strength. 

CAUSATIVE FACTORS FOR AAM

1. Guru Bhojan (heavy food which is difficult to digest)
2. Ruksha Bhojana (dry foods)
3. Ashuchi Bhojana (contaminated foods)
4. Akala Bhojana (untimely food intake)
5. Vidahi Bhojana (food that causes burning sensation)
6. Moha (confusion)
7. Lobha (greed)  

HERBS USEFUL FOR SIBO (small intestinal bacterial overgrowth)

1. BILVA

Bilva (Aegle Marmelos) has anti-inflammatory properties, useful in hemorrhoids and in treatment of basti. Bilva helps to balance vata and kapha doshas, has katu (pungent), tikta (bitter) taste. It helps to improve digestion so helpful in gastritis indigestion, cold and in sinusitis. Bilva balances pitta related disorders which helps in ulcers and infections, used to control the proper functioning of the heart and in the cardiovascular system.

2. NEEM

Neem (Azadirachta indica) is light to digest and has cold potency. It undergoes digestion and helps in absorption which cleans up the wounded ulcers. It increases vata dosha, relieves thirst, and coughs. Has antimicrobial properties hence useful in many skin disorders. Neem helps to lower down the blood glucose level hence maintains the blood sugar levels.

3. GARLIC

Garlic (Allium Sativum) has anti aging properties so is used as cardiac tonic, improves the quality of hair, useful in diseases like cough and in asthma. Garlic usually balances vata and kapha doshas, which undergo a pungent taste after digestion. Relieves the worm infestation, helps in various skin disorders and in abdominal tumors. Garlic has tissue cell rejuvenative property which relieves constipation and abdominal colic pain.

4. DARUHARIDRA

Daruharidra (Berberis aristata) is helpful in various skin disorders and urinary tract diseases. It also possesses antibacterial, antidiarrheal, anticancer properties. As it has antibacterial properties it usually accumulates in the cells of bacteria which attacks the DNA of bacteria which further leads to death of bacteria. Balances pitta and kapha doshas.

HERBAL REMEDIES FOR SIBO BY PLANET AYURVEDA (small intestinal bacterial overgrowth)

Planet Ayurveda is a clinic which provides the great treatment with many great results, the formulations which are provided by planet ayurveda are strictly made under the guidance of M.D experts. These formulations are free from preservatives, resin and colors. For this disease planet ayurveda provided effective remedies which provides great results without causing any side effects.

PRODUCTS LIST

1. MAHASHANKH VATI
2. SANJIVANI VATI
3. BELGIRI POWDER
4. PRAVAL PANCHAMRIT
5. DIGESTION SUPPORT

PRODUCTS DESCRIPTION 

1. Mahashankh Vati

Mahashankh Vati are herbal tablets formulated by planet Ayurveda using ingredients such as Shunthi (Zingiber officinale), Pippali (Piper longum), Shankha Bhasma and many more. These tablets help in managing various digestive issues and help in reducing the bacterial infection hence increases the appetite and balances the abdominal pH. Mahashankh Vati has antimicrobial and anti parasitic action.

Dosage- 1-2 tablets twice daily with lukewarm water.

2. Sanjivani Vati

Sanjivani Vati are herbal tablets formulated by planet ayurveda using ingredients such as Vidanga (Embelia ribes), Amalaki (Emblica officinalis), Shuddh Vatsnabh (Aconitum ferox), Guduchi (Tinospora cordifolia) and many more. These tablets help to remove the toxic wastes from the liver and kidney and have antibacterial and manage the various digestive disorders. Sanjivani Vati balances the vata and kapha dosha in the body and removes the blockages in the channels.

Dosage- 1-2 tablets twice daily with lukewarm water.

3. Belgiri Powder

Belgiri Powder is a single herb churna formulation which is prepared by planet Ayurveda using unripe Bilva (Aegle marmelos) fruit. This herbal powder helps to balance the tridoshas and helps in strengthening the digestion. It has antipyretic properties which help in fighting against various bacteria. Belgiri powder helps to maintain the healthy blood glucose level and supports respiratory health.

Dosage- ½ to 1 teaspoon daily with plain water after meals.

4. Praval Panchamrit

Praval Panchamrit is classical ayurvedic tablets formulated by planet ayurveda using ingredients such as Praval Bhasma (Calx of Coral), Mukta Bhasma (Calx of Pearl) and many more. These tablets are useful in the treatment of diarrhea and bloating. Praval Panchamrit is useful in malabsorption syndrome, urinary tract disorders and fight against urine infection. It helps to balance pitta doshas so eliminates the Aam doshas from the body and has rejuvenating properties.

Dosage– 1-2 tablets twice daily

5. Digestion Support

Digestion Support are polyherbal capsules formulated by planet ayurveda using ingredients such as Jeerak (Cyminum cuminum), Pippali (Piper longum), Dhania (Coriander sativum) and many more. These capsules help to stimulate the digestive juice which helps in digestion of food. Digestion support helps to relieve gas and constipation. Balances the vata and kapha doshas increase pitta doshas which helps in eliminating the aam from the body.

Dosage– 1-2 capsules twice daily after meals.

CONCLUSION

Small Intestinal bacterial overgrowth occurs when there is an abnormal increase in the bacterial population in the small intestines. It is known as bacterial overgrowth, small bowel bacterial overgrowth syndrome (SBBOS). This bacteria in small intestines digests the carbohydrates and converts into gas and short fatty acids,when there is more bacteria it will undergo more gas formation which further triggers the diarrhea. This leads to poor absorption of the nutrients and results in malnutrition and causes deficiencies which leads to damage to various organs parts. SIBO (small intestinal bacterial overgrowth) is a disease which is considered as kapha and pittaj vyadhi, and is also related with Aama. To eliminate the Aam and various toxins out of the body, to balance the normal flora in the intestines planet ayurveda provided herbal remedies which provides great results without causing any harmful effects.