ReportWire

Tag: flatulence

  • Fiber or Low FODMAP for SIBO?  | NutritionFacts.org

    [ad_1]

    It may not be the number of bacteria growing in our small intestine, but the type of bacteria, which can be corrected with diet.

    When researchers tested more than a thousand patients suffering for longer than six months from symptoms typical with irritable bowel syndrome (IBS), such as excess gas, bloating, diarrhea, and abdominal pain, but who do not appear to have anything more serious going on, like inflammatory bowel disease, a significant percentage were found to be suffering from lactose intolerance—intolerance to the milk sugar lactose. In infancy, we have an enzyme called lactase in our small intestine that digests milk sugar, but, understandably, most of us lose it after weaning. “Although genetic mutation has led to persistence of lactase in adults, about 75% of the world’s population malabsorbs lactose after age 30” and have lactose intolerance. However, a third of the patients were diagnosed with small intestinal bacterial overgrowth (SIBO).

    “The evidence for SIBO and IBS is shrouded in controversy, predominantly because of the fact that the [breath] tests used in clinical practice to diagnose SIBO are not valid,” as I’ve explored before. As well, the implications of having more versus fewer bacteria growing in the small intestine are unclear since the number doesn’t seem to correlate with the symptoms. It turns out it isn’t the number of bugs growing in the small intestine, but the type of bugs. So, it’s “small intestinal microbial dysbiosis”—not overgrowth in general, but the wrong kind of growth—that appears to underlie symptoms associated with functional gastrointestinal disorders, like IBS.

    How can we prevent this from happening? The symptoms appear to be correlated with a significant drop in the number of Prevotella. Remember them? Prevotella are healthy fiber feeders, “suggestive of a higher fiber intake in healthy individuals,” while the bugs found more in symptomatic patients ate sugar, which “may reflect a higher dietary intake of simple sugars.” However, correlation doesn’t mean causation. To prove cause and effect, we have to put it to the test, which is exactly what researchers did.

    “Switching a group of healthy individuals who habitually ate a high­-fibre diet (>11g per 1,000 calories) to a low­-fibre diet (<10g per day) containing a high concentration of simple sugars for 7 days produced striking results. First, 80% developed de novo [new] gastrointestinal symptoms such as bloating and abdominal pain that resolved on resumption of their habitual high-fibre diet. Second, diet­-related changes in the small intestinal microbiome were predictive of symptoms (such as bloating and abdominal discomfort) and linked to an alteration in duodenal [intestinal] permeability.” In other words, they developed a leaky gut within seven days. And, while some went from SIBO positive to SIBO negative and others from SIBO negative to SIBO positive, it didn’t matter because the number of bacteria growing didn’t correlate with symptoms. It was the type of bacteria growing, as you can see below, and at 3:12 in my video Fiber vs. Low FODMAP for SIBO Symptoms.

    No wonder their guts got leaky. Levels of short-chain fatty acids plummeted. Those are the magical by-products our good gut bugs make from fiber, which “play an important role in epithelial [intestinal] barrier integrity,” meaning they keep our gut from getting leaky.

    So, while we don’t have sound data to suggest that something like a low FODMAP diet has any benefit for patients with SIBO symptoms, there have been more than a dozen randomized controlled trials that have put fiber to the test. Overall, researchers found there was a significant improvement in symptoms among those randomized to increase their fiber intake. That may help explain why “high-fiber, plant-based diets can prevent many diseases common in industrialized societies.” Such diets have this effect “on the composition and metabolic activity of the colonic microbiota.” Our good gut bugs take plant residues like fiber and produce “health-promoting and cancer-suppressing metabolites” like short-chain fatty acids, which have profound anti-inflammatory properties. “All the evidence points to a physiological need for ~50 g fiber per day, which is the amount contained in the traditional African diet and associated with the prevention of westernized diseases.” That is approximately twice the typical recommendation and three times more than what most people get on a daily basis. Perhaps it should be no surprise that we need so much. Even though we split from chimpanzees millions of years ago, “there is still broad congruency” in the composition of our respective microbiomes to this day. While they’re still eating their 98 to 99 percent plant-based diets to feed their friendly flora with fiber, we’ve largely removed fiber-rich foods from our food supply. 

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • The Validity of SIBO Tests  | NutritionFacts.org

    [ad_1]

    Even if we could accurately diagnose small intestinal bacterial overgrowth (SIBO), if there is no difference in symptoms between those testing positive and those testing negative, what’s the point?

    Gastrointestinal symptoms like abdominal pain and bloating account for millions of doctor visits every year. One of the conditions that may be considered for such a “nonspecific presentation” of symptoms is SIBO, a concept that “has gained popularity on the internet in addition to certain clinical and research circles.” SIBO is “broadly defined as excessive bacteria in the small intestine” and typically treated with antibiotics, but “dispensing antibiotics to patients with the nonspecific, common symptoms associated with SIBO is not without risks,” such as the fostering of antibiotic resistance, the emergence of side effects, and the elimination of our good bacteria that could set us up for an invasion of bad bugs like C. diff—all for a condition that may not even be real.

    Even alternative medicine journals admit that SIBO is being overdiagnosed, creating “confusion and fear.” SIBO testing “is overused and overly relied upon. Diagnoses are often handed out quickly and without adequate substantiation. Patients can be indoctrinated into thinking SIBO is a chronic condition that can not be cleared and will require lifelong management. This is simply not true for most and is an example of the damage done by overzealousness.” “The ‘monster’ that we now perceive SIBO to be may be no more than a phantom.”

    The traditional method for a diagnosis was a small bowel aspiration, an invasive test where a long tube is snaked down the throat to take a sample and count the bugs down there, as you can see at 2:10 in my video Are Small Intestinal Bacterial Overgrowth (SIBO) Tests Valid?.

    This method has been almost entirely replaced with breath tests. Normally, a sugar called glucose is almost entirely absorbed in the small intestine, so it never makes it down to the colon. So, the presence of bacterial fermentation of that sugar suggests there are bacteria in the small intestine. Fermentation can be detected because the bacteria produce specific gases that get absorbed in our bloodstream before being exhaled from our lungs, which can then be detected with a breathalyzer-type machine.

    Previously, the sugar lactulose was used, but “lactulose breath tests do not reliably detect the overgrowth of bacteria,” so researchers switched to glucose. However, when glucose was finally put to the test, it didn’t work. The bacterial load in the small intestine was similar for those testing positive or negative, so that wasn’t a useful test either. It turns out that glucose can make it down to the colon after all.

    Researchers labeled the glucose dose with a tracer and found that nearly half of the positive results from glucose breath tests were false positives because individuals were just fermenting it down in their colon, where our bacteria are supposed to be. So, “patients who are incorrectly labeled with SIBO may be prescribed multiple courses of antibiotics” for a condition they don’t even have.

    Why do experts continue to recommend breath testing? Could it be because the “experts” were at a conference supported by a breath testing company, and most had personally received funds from SIBO testing or antibiotic companies?

    Even if we could properly diagnose SIBO, does it matter? For those with digestive symptoms, there is a massive range of positivity for SIBO from approximately 4 percent to 84 percent. Researchers “found there to be no difference in overall symptom scores between those testing positive against those testing negative for SIBO…” So, a positive test result could mean anything. Who cares if some people have bacteria growing in their small intestines if it doesn’t correlate with symptoms?

    Now, antibiotics can make people with irritable bowel-type symptoms who have been diagnosed with SIBO feel better. Does that prove SIBO was the cause? No, because antibiotics can make just as many people feel better who are negative for SIBO. Currently, the antibiotic rifaximin is most often used for SIBO, but it is “not currently FDA-approved for use in this indication, and its cost can be prohibitive.” (The FDA is the U.S. Food and Drug Administration.) In fact, no drug has been approved for SIBO in the United States or Europe, so even with good insurance, it may cost as much as $50 a day in out-of-pocket expenses, and the course is typically two weeks.

    What’s more, while antibiotics may help in the short term, they may make matters worse in the long term. Those “who are given a course of antibiotics are more than three times as likely to report more bowel symptoms 4 months later than controls.” So, what can we do for these kinds of symptoms? That’s exactly what I’m going to turn to next.

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • Bloating 101: Why You Feel Bloated

    Bloating 101: Why You Feel Bloated

    [ad_1]

    Bloating 101: Why You Feel Bloated

    Bloating, gassiness, and abdominal discomfort aren’t limited to the occasional holiday feast. It can happen even if you haven’t eaten a large meal. In some cases, bloating can even cause distention, or a perceptible swelling of the abdomen.

    Bloating and gas are usually not signs of a serious health problem. They’re tied to what and how you eat, so a few simple changes may help.

    Keep Bloating at Bay

    Here are three common causes of bloating, and how you can avoid them.

    1. Overeating is probably the most common cause of bloating. Smaller portions should ease the pain.

    2. Eating rich and fatty food can make you feel uncomfortably stuffed. Fat takes longer to digest than protein or carbohydrates, so it keeps the stomach full longer. Avoid bloating by limiting fats in your everyday diet.

    3. Eating too fast adds to the risk of bloating after a meal. The remedy is simple -&#8209; eat more slowly. Satiety signals can take up to 20 minutes to reach the brain and ease your appetite. Many weight loss experts believe that eating slowly helps prevent overeating.

     

    Reducing Gassiness

    The second most common cause of temporary bloating is gas in the abdomen. About half of gas in the digestive system is swallowed air. The rest is produced by bacteria in the gut that help digest food. If the gastrointestinal tract does not move it through efficiently, gas builds up in the intestines, causing bloating and discomfort.

    If you often experience bloating caused by gas, avoid these habits that make you swallow more air:

    • drinking through a straw

    • chewing gum

    • guzzling carbonated beverages

    • sucking on hard candy.

    Some people swallow more air when they’re nervous. It’s possible that practicing ways to reduce stress and anxiety, such as breathing exercises or progressive muscle relaxation, may help reduce excess gas and bloating.

    Avoid Bloat-Inducing Foods

    Difficult-to-digest foods can cause gassiness and bloating. These are some familiar culprits.

    1. Beans and lentils are very healthy foods that contain indigestible sugars called oligosaccharides. These sugars must be broken down by bacteria in the intestines.


    2. Fruits and vegetables such as Brussels sprouts, cabbage, cauliflower, carrots, prunes, and apricots. These items contain sugars and starches that may cause gassiness and bloating, even though these foods are good for you.

    3. Sweeteners can also cause gas and bloating. Sorbitol, an artificial sweetener, can’t be digested. Fructose, a natural sugar added to many processed foods, is hard for many people to digest. To avoid bloating, be aware of these sweeteners in the foods you eat and limit the amount you consume.

    4. Dairy products can be a source of intestinal distress and bloating if you have trouble digesting lactose, or milk sugar.

    5. Whole grains, recommended for their many health benefits, can sometimes cause bloating and gas problems. One reason whole grains are so healthy is their high fiber content. But fiber is an indigestible carbohydrate. Abruptly increasing the amount of fiber you eat can cause gas, bloating, and constipation. Nutritionists recommend slowly adding more fiber into your diet to allow your body time to adjust. At the same time, drink plenty of water with high-fiber foods, says nutritionist Joanne L. Slavin, PhD, RD, professor of food science and nutrition at the University of Minnesota. “All fiber absorbs water,” she says. Drinking liquids helps fiber move through the digestive system and prevents bloating and constipation.

     

    [ad_2]

    Source link