Are prebiotics good or bad in SIBO?

Since my previous blog about IBS and SIBO I have had so many questions from my patients wanting to know more about SIBO. What stands out to me the most is a confusion around what to eat, with the most common questions surrounding prebiotic, fibre rich foods and if they help or hinder SIBO.

What is a prebiotic food and what does our gut do to it?

A prebiotic is a non-digestible food ingredient that it is not broken down or absorbed in the higher parts of our gastrointestinal tract(1). There are a lot of foods with prebiotic properties including chickpeas, legumes, leeks, rye bread, garlic and cashews(2). They play a special role in our health - they act as food to our gut's good bacteria, increasing their numbers (lactobacilli and bifidobacteria(3)) and improving our overall health(1).  

Why do these healthy foods cause discomfort?

In SIBO, the overgrowth of bacteria causes inflammation and hurts your gut wall affecting your ability to breakdown and digest food. The bugs themselves play havoc with your own enzymes and body processes. For example there is loss/decrease in an enzyme called disaccharideses, which is important for breaking down carbohydrates and sugars. This means that any food, like a prebiotic food that contains fructose, lactose and sorbitol, may not be digested properly, resulting in those uncomfortable symptoms you experience(4).

Treating SIBO… with prebiotics?!

You may notice that some of the foods that cause your discomfort are also considered to be high FODMAP foods. FODMAP describes a group of of short-chain carbohydrates and sugar alcohols comprising of fructose, lactose, fructo- and galactooligosaccharides (fructans, and galactans), and polyols(5).

To provide symptom relief from SIBO we may suggest avoiding these high FODMAP prebiotics foods (looking at you apples, onions and garlic!) for a short period of time. It is really important to know that excluding these foods long term is not the answer and will not fix SIBO(6). A healthy gut is dependant on you eating a fibre rich, highly diversified diet so restricting these foods for a long period of time will only worsen your situation and increase your sensitivity to more foods(7). It's not uncommon that we see patients tolerating only a handful of foods and it's best to avoid this! 

Garlic, a wonderful prebiotic food.

As part of our treatment for SIBO we use certain types of prebiotics in combination with probiotics and specific antimicrobials (bug killers). These types of prebiotics have beneficial roles in our gut health that are important for restoring your gut health.

The following are four common prebiotic supplements on the market, three of which we use regularly in the treatment of SIBO. The fourth is not advised!

1. Lactulose

Lactulose is made up of two sugars, galactose and fructose, which is not broken down or absorbed in our small intestine. Lactulose increases our good bugs like bifidobacteria(8) and decreases the bad ones like clostridia(9). It is generally well tolerated, however you can take too much of it and end up with loose bowels(8). 

2. Partially Hydrolysed Guar Gum (PHGG)

PHGG is a natural water soluble fibre that has been broken down by an enzyme to make it smaller and to decrease the amount of galactomannon (10). PHGG increases the good bugs Bifidobacterium and Lactobacillus species and decreases nasty waste products such as ammonia(11). PHGG can also give softer stools to assist constipation(12). Studies also show that PHGG in combination with an antibiotic to treat SIBO was more useful in eradicating SIBO compared with the antibiotics alone(13), how amazing!

3. Galacto-oligosaccarrides (GOS)

GOS is formed by breaking down lactose, a common sugar found in dairy. GOS is known to increase the good bugs bifidobacteria and reduce the bad bugs, clostridia and bacteroides. Another benefit of GOS alone or in combination with a probiotic is that it can support our immune system. GOS used in its recommended dosage range is well tolerated. Again, too much of a good thing can lead to problems; abdominal discomfort, cramping, flatulence and diarrhoea(14). 

4. Inulin

Inulin is beneficial to out gut because it supports our good bugs bifidobacteria. However, because it is made up fructans(15), it can be really uncomfortable to consume if you have SIBO. Studies have found inulin increases flatulence, rumbling, stomach and gut cramps, and bloating(16). So best to avoid this one! 

Take home messages

Prebiotics are very powerful and beneficial for SIBO. But remember, not all prebiotics are the same.

If certain foods are causing you pain, bloating, constipation, or diarrhoea, this is your body communicating to you that your digestion system is struggling. Ironically the foods that cause discomfort are the same foods that are important to your health. Instead of excluding these foods, we need to improve your digestive system so you can tolerate these and improve your health in the long run. This can be impossible to navigate by yourself so get a professional on board to help correct your bugs, restore your gut wall and find the diet and fibre that is right for you.

After this, you may even be able to handle eating delicious lentils, onion, garlic and apples!

By Naturopath Rachel Larsson

Prebiotics for health

The exciting possibilities of prebiotics for a variety of digestive, immune and mood related complaints are only just being discovered.

Prebiotics are receiving more attention with the increasing understanding of the human microbiota (all of the bacteria, viruses and fungi that live on and in us), as the two together can have an incredible impact on our health.

What are prebiotics?

Essentially, prebiotics are ingredients found in whole, unprocessed vegetables, fruits, legumes, grains, nuts and seeds which are not digestible to us, but provide the perfect food for beneficial gut bugs living within us(1). 

These ingredients are broken down by the microorganisms in the digestive tract into compounds that have a beneficial effect in multiple areas of the human body, which can include altering the activity of the same bugs that created them! Most prebiotics are carbohydrate fibres, and it’s the knock-on effect of eating them that makes them so special.

How do they relate to probiotics?

I often hear prebiotics being confused with probiotics. While they act very similarly in the gut, they are in fact different.

Probiotics are live organisms that we take in supplement form, where the species of bacteria are known and measured(2). 

Much like the gut bugs that have been living in us since the first few days of life (our microbiota), probiotics also love to munch on prebiotics.

You will often find probiotics and prebiotics in combination in a supplement to enhance the products therapeutic quality. A lot of the research around prebiotics looks at how they interact with two of the most common probiotics, Lactobacilli and Bifidobacteria species(3).

What’s the difference between fibre and prebiotics?

Most prebiotics are fibre, however not all fibres are prebiotic. Fibre is often classifie

d as insoluble or soluble, which also provides a good basis for distinguishing which ones are prebiotic.

Insoluble fibres do not get broken down by us or by our gut bugs, however they do bulk out the stool, helping to keep us regular(4). These are the stringy fibres that give a lot of foods their rough texture, such as the skin of nuts, seeds, fruits and vegetables.

Soluble fibre, found in a variety of whole foods, cannot be broken down by us, but are easily fermented by bacteria. Those that exert a proven beneficial effect on us are termed prebiotics.

Types of prebiotics

Here is a little bit of extra information for the science lovers out there. A clear cut catagorisation of what is and what isn’t a prebiotic has not yet been established as it is still a young area of science. If we consider what has the potential for prebiotic activity, the following fibres and their respective foods are included:

• Non-starch polysaccharides such as beta-glucans (mushrooms), pectins (pear, apple, plum, citrus), gums (guar gum, xanthum gum), hemicellulose (psyllium husk) and cellulose (broccoli, cabbage, kale, cauliflower).

• Non-digestible oligosaccharides such as galactans (legumes) and fructans, primarily inulin (onion, garlic, artichoke, asparagus, leek, chicory root, banana).

• The disaccharide lactulose (only found in supplement form).

• Sugar alcohols including sorbitol (pears, plums, dried fruits) and mannitol (button mushrooms).

• Resistant starch, which is starch that resists digestion in the small intestine, making it available in the large intestine for fermentation (potatoes, legumes, whole grains).

How do prebiotics improve our health?

Prebiotics selectively stimulate the growth of beneficial bacteria that are indigenous to our guts, including the well-studied Bifidobacteria and Lactobacilli species. These bacteria, when thriving, help to seal the barrier between the intestine and bloodstream, improve our immunity and keep potential bad bacteria/fungi (such as clostridia and candida) to a minimum.(3). With a healthy microbiota, improvements are noted in mood, skin, allergies and autoimmune conditions, just to name a few.

In addition, bacteria create short chain fatty acids (e.g. butyrate, propionate and acetate) from prebiotic fibres, which have beneficial effects throughout the body. For example, butyrate, made by Lachnospiraceae and Ruminococcaceae bacteria, is a major energy source for the cells that make up our colon. Propionate acts at the liver to suppress cholesterol synthesis and acetate is utilised by the heart, brain, kidneys and muscles(1).

When prebiotics can be problematic

For people that have certain intestinal issues, such as Small Intestinal Bacterial Overgrowth (SIBO) or Irritable Bowel Syndrome (IBS), eating the wrong types of prebiotics can make symptoms worse. For example, fructans and sugar alcohols (which are both considered FODMAP foods) are known to cause bloating, flatulence and discomfort in certain people(5). 

However, complete avoidance of prebiotics deprives healthy gut bugs of food and can make the situation worse in the long run. If you fall into the SIBO or IBS, or are unsure, working with a practitioner can help minimise symptoms while still making sure your good bugs are fed! 

By Naturopath Lucy Mason

Why your IBS could actually be SIBO

Picture this.

For years you have been suffering from Irritable Bowel Syndrome (IBS).  You may have experienced abdominal pain, discomfort and bloating, frustrating bowel motions and reactions to ‘healthy’ food.  You have tried diets, supplements and medications yet you are still suffering. How frustrating!!

But perhaps there is something else going on.

In our experience, many of our patients don't just have IBS but actually have Small Intestinal Bacterial Overgrowth (SIBO), which can be tested for and treated. Symptoms of SIBO are similar to symptoms of IBS, which is why it may have been overlooked (1).

SIBO explained

SIBO occurs when there is an increased number of bacteria in your small intestine (1). Having an increased bacterial load can cause havoc to your gut wall and can lead to trouble with digestion, poor nutrient absorption, immune dysfunction and reactions to food (2).  SIBO left untreated has also been linked to nutrient deficiencies, depression, anxiety (3), fibromyalgia (4), hypothyroidism (5) and rosacea (6).

How did I get this?

The risk factors for developing SIBO are far and wide and are commonplace in today’s society. They include low stomach acid, which can naturally happens as we get older or through nutrient deficiencies that may occur if you have an underlying gut issue, chronic illness or poor diet. You also increase your risk of developing SIBO if you have used antibiotics or the oral contraceptive pill, if you drink alcohol or experience stress (1). 

Can you relate to one or two of these?

How can I find out if I have SIBO?

In clinic, I regularly hear patients say things like ‘after a meal I look and feel four months pregnant’ or ‘I react to so many foods’. These statements make me consider SIBO as part of the their problem. The SIBO test is wonderful as it identifies its presence and helps us choose the most appropriate treatment for you. It is a test that can be performed at home or in a laboratory. After drinking a sugar, the breath test measures hydrogen gas and methane gas when you exhale, which indicates if SIBO is present, the type you have (methane dominant or hydrogen dominant) and how severe SIBO is for you.

To get SIBO under control we use a gentle combination of herbal, nutritional and dietary interventions. We follow a principle of 'do no harm' and we make sure we are supporting you and any the good bugs that are already in your gut. In addition we address risk factors that caused your SIBO to give you the best chance of it never returning and to live a life free of digestive distress. 

By Naturopath Rachel Larsson

Fermented Beet Kvass

One of our favourite gut loving recipes is beet kvass. Beet kvass is type of fermented drink, you know, similar to kefir or kombucha. Kvass has so many health benefits and is great for your gut. Due to it's fermentation process it is a wonderful source of probiotics which can help the health of your gut and immune system, it is also rich in antioxidants with is excellent for your liver. Using beetroot is traditionally known for it's blood cleansing properties, in addition to being a great source of nutrients.

Kvass typically has a tangy, salty flavour which can be an acquired taste. Using beetroot also gives it a wonderful earthy flavour. If beetroot isn't your thing, you can use other foods to ferment like fruits (strawberries and raisins) and herbs (mint). 

 Ingredients        

• 2-4 organic beetroot
• 1-2 tsp sea salt or Himalayan salt
• Filtered water
• A few tablespoons whey, dripped from yoghurt or milk kefir (optional)
• 1-1.5 litre glass jar

Directions

1. Wash unpeeled beets and chop into large cubes

2. Place beets in a jar and add salt and optional whey (if not using whey add an extra tsp of salt)

3. Fill jar with filtered water, you want to cover the beetroot by at least two inches

4. Seal with lid and leave on the counter at room temperature for 4-7 days to ferment (4-5 days in summer)

5. Transfer to fridge

6. Have about ¼ cup daily on own or dilute with water

Image: Courtesy of CERES Fair Food.

How your gut is connected to hay fever and allergies

I bet you are wondering, ‘how can my water eyes, running nose and sneezing be connected to my gut?’. As you may have noticed today, there are studies coming out linking all sorts of conditions and diseases to the health of your gut. Allergic rhinitis, commonly known as hay fever, is no different. 

For starters our digestive system plays a huge role in the balance of our immune system. Almost 70% of our entire immune system is located in our gut(1). For hay fever and other allergic diseases the ‘hygiene hypothesis’ was thought to have a role in the increase in allergies, with the lack of exposure to microbes in early life increasing the risk of allergies in later life(2). Now something called the 'microbiota hypothesis' is thought to play a role, meaning a change in our gut bugs influence the development of our immune system(3). Although allergies are also influenced by genetics, some of the environmental and lifestyle factors that change your gut bacteria and increase your risk for allergies include infant use of antibiotics, formula feeding and being born by caesarean section(4,5). Oppositely, growing up with pets(6), growing up on a farm(7), being born through vaginal delivery and being breast fed has been linked to positively influencing your gut’s flora to include more ‘protective strains’(4,5).

What your body does in an allergic reaction

For an allergy to exist, allergen sensitisation must first occur. Special immune cells present in the mucosal surfaces of the body such as nose, lungs and gastrointestinal tract, detect the allergen. One type of immune cells comes into contact with the allergen which are then displayed on the cell's surface. This cell then lets other immune cells know to produce antibodies (IgE) specific to the allergen. From then on, if you are exposed to that allergen, an allergic response is triggered. The allergen is identified by antibodies (IgE) causing immune cells to release inflammatory mediators, such as histamine (8). Histamine is responsible for the itchy nose and runny nose, red watery eyes and dry cough.

The gut-lung connection

The lining of your gut is structurally very similar to lining of your lungs. If you are someone with allergies, inflammation will tend to happen in both areas, as it is thought that leaky gut may have a role in 'leaky lungs'. Our gut flora are also likely have a major impact on the integrity of the lung tissue(9).

Histamine and your gut

You may think histamine is the bad guy because it is linked to your allergies, but in fact is extremely important for mood, stomach acid, blood vessels, and muscle functions (10). The problem with histamine is for some people they can be suffering from histamine intolerance. This means they produce excess histamine and/or have a deficiency in the enzyme that breaks it down. When it comes to our gut, some of our microbes are capable of producing histamine. These microbes produce an enzyme, which converts histidine into histamine. The more of these microbes you have, and the more histidine you consume, the higher the amount of histamine you can produce. Histamine can be then be absorbed and taken around the body, exacerbating allergic symptoms (11).

How to improve your allergy symptoms

1. Heal your gut. Gut health and healing isn't straight forward and may require a professional to guide you. There may be other gut issues at play, like Small Intestinal Bowel Overgrowth (SIBO) driving gut inflammation and increased intestinal permeability (leaky gut), which will also need to be addressed.

2. Balancing gut flora can balance your immune system. This means probiotics from capsules or fermented foods. Be careful with fermented foods if you are histamine sensitive though, as they are a source of histamine. If you feel worse on bone broths or foods like sauerkraut then get in touch with a trained professional to help you refine your diet and introduce these gut healing foods slowly. Some strains that can help reduce histamine include Bifidobacteria infantis and Lactobacillus plantarum (12, 13).

3. Eat fermentable fibre. Eat a diet full of complex, fermentable fibre as it helps intestinal microbiota make short chain fatty acids (SCFAs). SCFAs help regulate the immune system and decrease allergic airway inflammation (14). 

4. Try eating low-histamine diet. Following a low-histamine diet can help reduce the severity of allergy symptoms. Foods to avoids that are high in histamines include canned and ready meals, fermented foods, aged and matured foods like cheese, fish, shellfish, avocados, spinach, cocoa and leftover meat (15).

5. Eat foods high in quercetin or take a supplement. Quercetin is a natural antihistamine and can be found in foods like grapefruit, onions, apples, black tea, leafy green vegetables and beans. Some herbs like Ginkgo biloba and Sambucus spp. are also sources.

6. Zinc. Zinc is a key nutrient involved in maintaining a healthy immune system. It is also necessary in healing and maintaining a healthy gut wall. Supplementing with zinc could significantly help in the healing of leaky gut(16). To find out your zinc levels and get the safest, and get most appropriate zinc supplement, see one of our professionals. Eating foods rich in zinc can also help including grass-fed beef, oysters, lamb, chickpeas, pumpkin seeds, cashews, chicken, spinach and mushrooms.

7. Eat local, raw honey. Raw honey contains both beneficial bacteria and trace amounts of pollen picked up by the bees from local plants. By eating raw honey, you can 'educate' your immune system to tolerate these local pollens (16). By local we mean the neighbouring suburbs, postcode or city. Australian honey isn't considered 'local' as the plants in Perth are very different to that in Melbourne, for example. 

8. For symptom relief try clearing your nasal passage using a neti pot. If any allergens are stuck in the passage this can clear them out and give some temporary relief.