Hopefully you are following along with this 5 Part Series. Although each part has a different focus they are all rooted in one thing… the gut.
In fact, Part 3 identified a very specific imbalance called small intestinal bacterial overgrowth(SIBO). Therefore, Part 4 is going deeper into SIBO and its connection with weight.
What is SIBO?
SIBO is an abundance of bacteria residing in the small intestines instead of the colon. This creates many uncomfortable, sometimes embarrassing symptoms. For some the symptoms are very obvious and easy to pinpoint. Others it requires a skilled detective to connect the dots. Below are some very common symptoms, but this list is more detailed.
Symptoms of SIBO:
- excess gas, sometimes foul smelling
- frequent bloating
- constipation, diarrhea or both
- vitamin deficiencies, especially A, D, E & B12
- chronic illness
- skin issues
- heartburn or indigestion
- food intolerances
- fatty stools
As you can see, many symptoms overlap with other gut imbalances we discussed in Part 3. Treating one doesn’t solve the others. For this reason, identifying the root cause of your symptoms is the ultimate goal. So let’s chat about the actual causes SIBO?
Surprisingly, the causes are plentiful and this extensive list includes all the research links! But we’ll talk about the most common causes.
Common causes SIBO?
- food poisoning is the most common reason
- structural issues like adhesions from surgery including bariatric surgery
- medication such as antibiotics, steroids & proton-pump inhibitors(PPI)
- low stomach acid
- diabetes, hypothyroid, IBS
In fact, research shows SIBO is present in 15% of obese individuals in general. Whereas after gastric bypass it increases to 40%. In addition, another small study showed more than 80% of the gastric bypass & sleeve gastrectomy patients had a positive breath test 1 year post surgery.
How does SIBO impact weight after WLS?
SIBO is quite interesting. In some cases it can actually cause weight loss, but let’s look at some intriguing evidence.
Researchers took testing a little further and found a couple of connections to weight. In fact, the first connection showed a weight gain relapse in the positive gastric bypass SIBO group compared to the negative SIBO group. The second connection was a positive SIBO test after gastric bypass was associated with lower weight loss.
So what do you do if you have SIBO symptoms? First off you need determine if it is actually SIBO.
How to find out if you have SIBO
Unfortunately, there isn’t a perfect test for diagnosing SIBO. Currently, the gold standard is a hydrogen & methane breath test. This test has you consume either a lactulose or glucose solution.
The purpose is to measure the hydrogen & methane gases that the bacteria produce after the lactulose or glucose solution is consumed. Typically positive hydrogen gases result in more diarrhea and methane more constipation.
This is where it gets a little sticky after WLS. The glucose test is considered more accurate than lactulose at diagnosing bacterial overgrowth . Unfortunately, the glucose test requires a 75 gram of glucose(sugar) solution to be consumed.
This makes it difficult for gastric bypass patients to use without having dumping syndrome.
One research group evaluated the accuracy using the lactulose breath test after gastric bypass and found when combined with a small bowel follow-through allowed for more accurate results and treatment. Unfortunately this adds additional tests and expense.
Because SIBO testing has flaws, most practitioners use the philosophy to treat regardless of a negative test when appropriate symptoms are present. As well as if enough symptoms are present, treat without testing. So what are your treatment options?
3 SIBO treatment options
- Prescription antibiotics with a SIBO diet
- Anti-microbial herbs with a SIBO diet
- Elemental diet
All 3 strategies can work. It just comes down to preference and commitment. Some want to avoid antibiotics so they choose the anti-microbial herb option. Whereas others want a prescription because their insurance will cover it.
No matter which treatment option you choose a SIBO diet should be followed. Many conventional practitioners leave the diet piece out, which is unfortunate. In fact, finding the right SIBO diet will help lessen your symptoms providing relief much quicker. In addition it will allow your gut to heal faster. So let’s talk about SIBO diet options.
- Low FODMAP
- Specific Carbohydrate Diet(SCD)
- Low FODMAP in combination with SCD
- SIBO Bi-phasic
- Low Histamine SIBO Bi-phasic diet
- Gut & Psychology Syndrome diet(GAPS)
- Cedars-Sinai Diet
- Low Sulphur Diet
- Fast Track Diet
Choosing the right diet to not feed the bacteria is the ultimate goal. You have to feed the human and starve the bacteria. Which is not always easy.
The unfortunate reality is studies show the reoccurrence rate can be as high as 50% so a perfect reason to work with a skilled practitioner to help prevent relapse.
Unquestionably, SIBO treatments take longer to resolve if trying to figure it out by experimenting with different medication, supplements and diets to resolve your symptoms. Yet another reason to hire a skilled practitioner to help you in this process.
In conclusion, when trying to identify the imbalance causing weight gain after WLS consider SIBO. Review the symptoms and reach out to a skilled practitioner to help you get to the root of the problem. Check out Part 5 Surprising causes of weight gain after WLS: Leaky Gut