probiotics

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.

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. Partically 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 Rachel Larsson

BHSc (Naturopathy), BPH (Nutrition)

Leaky Gut. Do you have it and what to do about it?

Leaky gut, also known as increased intestinal permeability, is linked to a whole bunch of common health complaints that we tend to just put up with or accept as being normal for my body. It has been linked to food intolerance's, acne and skin conditions, allergies and hay fever, asthma, fatigue and thyroid conditions. In addition to this, it can be associated with digestive symptoms such as constipation, diarrhoea and irritable bowel syndrome(1). Clearly, it is very possible that you, or someone close to you, is suffering from leaky gut.

How is this possible?

To understand how leaky gut may be at the root of your symptoms, you need to know a bit about the gut. Our gut has many roles including digestion and nutrient absorption, and is an important protective barrier that monitors our internal and external environment. It also plays a massive part in the function of our immune system. For example, did you know that about 75% of our immune cells live there(2)? It also has an intimate relationship with our nervous system. Have your ever noticed that when you feel stressed or anxious, you may experience a change in bowel movements? Nervous tummy anyone?

Why do we get leaky gut?

In a healthy gut, our gut wall cells are triggered to open up and absorb good things like nutrients and keep our bad bugs and toxins out. Our digestive system is always getting triggered to open up and close but can usually keep a happy balance and recover from any minor insults. When the gut is in contact with nasty triggers like medications, parasites, chemicals and certain foods, it’s ability to close up starts to struggle. If exposure is for a short time, the barrier can return to normal, however if these stressors continue, this barrier is strained. Then the immune system, which lies beneath the gut lining, becomes overwhelmed. It loses sense of what is self and what is a potential allergen, toxin or baddie. This dysfunction starts to cause trouble to the point of developing autoimmune conditions. Remember all the conditions mentioned at the start? Yes, the gut connection is real(3)!

Nutrient diet about leaky gut

What can I do about leaky gut?

Gut health and gut healing can be a tricky, especially if other conditions are present. A great place start would be:

1.     Probiotics

Probiotics help with leaky gut because of their beneficial role in supporting the immune system in the gut wall. This is evidence of their support in a vast array of health conditions. It’s so important to understand that not all probiotics are the same and this is where clinical expertise can really help. If you react to fermented foods (a good source of probiotics) or probiotic supplements something else maybe going on including histamine intolerance. This is why it is helpful to work with someone experienced in treating gut issues(4).  

2.     High fibre foods

After putting in all the good bugs into our system, we need to feed them. High fibre foods really means a vegetable rich diet. Great fermentable foods include sweet potato, lentils, pumpkin leek, garlic, asparagus, onion. Think high FODMAP foods. Delicious(5)!

3.     Reduce aggravating factors

We don’t want to keep giving our gut triggers that upset inflammation and immune function. Our body needs the time and environment to heal. This means limit alcohol, gluten, eat organic where possible and get rid of refined carbohydrates and sugar… put down the donut(6)

4.     Manage stress – yes this can be the hardest thing to do.

We live a lifestyle that fuels the fight and flight response and neglects our rest and digest nervous system – which is hugely important for our digestive ability.  Ever experience diarrhoea when you feel anxious or constipation when feeling stressed? Whether it is journalling, deep breathing, yoga or walking, it is important to find a way to manage your emotional and mental health(7).

5.     Eat a colourful, nutrient rich diet.

For our body to function at its best, it needs good sources of nutrients from a wide range of fresh, unprocessed foods. Fill your diet with good quality protein sources, a colourful variety of vegetables and fruits and you are on your way from getting all the nutrients and antioxidants you need for a healthy gut. We give a special shout out to amino acids like glutamine and nutrients like zinc and vitamin A, which the gut just loves.

How can I find out if I have leaky gut?

If you or someone you know suffer from the above mentioned conditions, then you should be considering the health of your gut and determining if you have leaky gut. As a practitioner who just loves all things gut health related, one of the first steps I take with my patients is testing for leaky gut. My inner nerd is thrilled by this test as it a brilliant way to measure how much healing needs to be done and can be tested again to assess progress. Once we identify if you have leaky gut, it is important to determine how to treat it holistically. Not only can you experience a positive shift in your current symptoms, but also prevent complications such as autoimmunity and chronic disease in the future. Isn’t that great?

If you are interested in finding out more about this or would like to be assessed, please get in touch. Let's get to the bottom of this!

Rachel Larsson

BHSc (Naturopathy), BPH (Nutrition)

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).

Balance Immune System

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.