Hi, Leokitten,
please do not apologize! I am only on this site to help others. I am trying to get an awareness of the possibility of different subgroups caused by bacterial overgrowth. It would be unthinkable to just walk away when so many others are suffering, some of them as I was. D-Lactic symptoms when acute can be terrifying and affect every organ including the brain and continued acidosis can lead to cell damage which cannot be replaced in the brain (early dementia). Bacterial Overgrowth can make your life miserable and cause chronic fatigue and muscle pain etc. even when mild. D-La can be seen as poisoning or as an infection due to Overgrowth without any raise in temperature. It is most certainly only found in Short Bowel Syndrome and there are a list of underlying disease processes including diabetes which can cause both Bacterial Overgrowth and D-La, which are underdiagnosed because Doctors are not trained to recognize it at all!
Cheese and low Carb. Yogurt should be OK. It all depends on how bad an Overgrowth that you have. In terms of Fibre Bananas are contraindicated as high in Carbohydrates and Sugars. Low Carbohydrate Fibre fruits may be OK. I eat a small amount of apples etc. Blueberries are the preferred fruit but only in handfuls. I am still using Milk which has 5% Sugars and have only recently realized this and I am still making other mistakes, but even the reduction has had a profound effect and my symptoms are far better controlled and only return when I cannot implement the diet.
My belief is that it is the level of Metabolites produced such as D-Lactic acid due to the different levels of Carbohydrate/Sugars that will produce different levels of symptoms. Fatigue is one of the earliest symptoms when I fall ill and can happen at low levels of Carbohydrates.
I am still making a lot of mistakes with food and have had recurrence of symptoms for different reasons. I may have a high level of Overgrowth and this comes down to the underlying causation which can be numerous. I am still using milk which is 5%, but my dietitian had not removed it from my diet. I still have a long way to go and have found that there is Sucrose and Gelatin in some of the medications that I have been given.
I have found that the harder the diet and closer to 0% for Carbs and Sugars the longer I remain symptoms Free, but I have also been experimenting by adding certain foods to see if they can be included.
For many it may only involve a reduction in Carbohydrates and avoiding large Carbohydrate meals, but for those with more severe symptoms like myself, 0% is the only way. The Bacteria thrive and reproduce more quickly if they are given the opportunity.
When trying the diet it should be 0% for any trial, but your Doctor needs to be informed. The diet is similar to reducing Carbs and Sugars for Type 2 Diabetes (Diabetes can cause Bacterial Overgrowth and D-La). It may be that the high levels of Processed Meals, Carbohydrates, Sugars and Antibiotics are driving the abnormality in our Gut that Hunter Gatherers may never have experienced.
I think that it is significant that ME/CFS has increased exponentially since the introduction of antibiotics, although I have another theory, that there is the possibility that Viruses that survive in Gut Bacteria (as in the AIDs Virus), may contribute to the Overgrowth of some species of Bacteria when they use Gut Flora/Bacteria to propagate though adding DNA and RNA to Bacteria and the issues may be more complex than i am describing because there are also immune response issues (I have Hypogammaglobulinemia or low immune IgM which may be part of the whole . I was also forced to investigate my own immune problems).
Frequent use of antibiotics can lead to the decimation of natural Gut Flora and the replacement with Overgrowth of some of the Bacteria due to resistance and differences in the way that Gut Flora Species react to antibiotics.
I see this as as antibiotics selecting for Overgrowths through resistance and decimation of certain species of Natural Gut Flora. My Belief is that Probiotics should be taken after any use of antibiotics (but there are many probiotics that contain high levels of D-Lactic producing Bacteria). Urgent research is needed.
I have included part of a report below and will try to find another where there is a list of causes of Bacterial Overgrowth.
Small Intestinal Bacterial Overgrowth
A Comprehensive Review
Andrew C. Dukowicz, MD,
Brian E. Lacy, PhD, MD,
and
Gary M. Levine, MD
Author information ► Copyright and License information ► Disclaimer
This article has been
cited by other articles in PMC.
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Abstract
Small intestinal bacterial overgrowth (SIBO), defined as excessive bacteria in the small intestine, remains a poorly understood disease. Initially thought to occur in only a small number of patients, it is now apparent that this disorder is more prevalent than previously thought. Patients with SIBO vary in presentation, from being only mildly symptomatic to suffering from chronic diarrhea, weight loss, and malabsorption. A number of diagnostic tests are currently available, although the optimal treatment regimen remains elusive. Recently there has been renewed interest in SIBO and its putative association with irritable bowel syndrome. In this comprehensive review, we will discuss the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of SIBO.
Keywords: Bacterial overgrowth, small intestinal bacterial overgrowth, diarrhea, bloating, motility disorders, antibiotics
Small intestinal bacterial overgrowth (SIBO) is defined as the presence of excessive bacteria in the small intestine. SIBO is frequently implicated as the cause of chronic diarrhea and malabsorption. Patients with SIBO may also suffer from unintentional weight loss, nutritional deficiencies, and osteoporosis. A common misconception is that SIBO affects only a limited number of patients, such as those with an anatomic abnormality of the upper gastrointestinal (GI) tract or those with a motility disorder. However, SIBO may be more prevalent than previously thought. This apparent increase in prevalence may have occurred, in part, because readily available diagnostic tests have improved our ability to diagnose SIBO. This comprehensive review will discuss the epidemiology and pathophysiology of SIBO; review common clinical presentations, diagnostic tests, and their limitations; and discuss currently available treatment options.
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Methods
Ovid MEDLINE and PubMed databases were used to search the published literature. For Ovid MEDLINE (1966 to December 2006, English language only) three primary search terms (bacterial overgrowth, small intestine overgrowth, and small intestine bacterial overgrowth) were individually coupled with a larger number of secondary search terms (epidemiology, incidence, prevalence, populations at risk, symptoms, pathogenesis, pathophysiology, inflammation, malabsorption, complications, vitamin deficiency, motility disorders, scleroderma, gastroparesis, chronic intestinal pseudo-obstruction, celiac disease, irritable bowel syndrome, renal failure, cirrhosis, alcohol abuse, elderly, aging, diabetes, hypochlorhydria, surgery, malnutrition, diarrhea, evaluation, diagnosis, breath testing, duodenum, jejunum, aspirates, breath tests, lactulose, treatment, antibiotics, rifaximin, tetracycline, metronidazole, ciprofloxacin, amoxicillin/clavulanate, probiotics, duration, resistance). For PubMed (no time limit), a similar search process was followed. All identified articles were then manually searched for other relevant studies. Only published manuscripts are included in this review; abstracts are not included.
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Definition
SIBO is defined as a bacterial population in the small intestine exceeding 105–106organisms/mL.
1,
2 Normally, less than 103 organisms/mL are found in the upper small intestine, and the majority of these are Gram-positive organisms.
3 In addition to the absolute number of organisms, the type of microbial flora present plays an important role in the manifestation of signs and symptoms of overgrowth.
4 For example, a predominance of bacteria that metabolize bile salts to unconjugated or insoluble compounds may lead to fat malabsorption or bile acid diarrhea. In contrast, microorganisms that preferentially metabolize carbohydrates to short-chain fatty acids and gas may produce bloating without diarrhea because the metabolic products can be absorbed. Gram-negative coliforms, such as
Klebsiella species, may produce toxins that damage the mucosa, interfering with absorptive function and causing secretion, thereby mimicking tropical sprue.
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Prevalence
An extensive literature search was unable to identify a study evaluating the incidence of SIBO in healthy volunteers. Only limited data are available regarding the prevalence of SIBO in healthy populations. In a study of 294 nonhospitalized older adults in which 34 younger adults (mean age 33.6 years) served as healthy controls, the prevalence of SIBO, as determined by glucose breath test, was 5.9% in the control group versus 15.6% in the older group.
5 A study of healthy older adults from Japan (mean age 74.7 years) found no patient with SIBO using a glucose breath test;
6 an Australian study detected SIBO from duodenal aspirates in 0% of healthy controls (mean age 59), although 13% were positive for SIBO using a lactulose breath test.
7 Healthy elderly volunteers from the United Kingdom had a 14.5% prevalence rate for SIBO based on a positive glucose breath test.
8 Finally, in a study of 111 patients with irritable bowel syndrome (IBS), 20% of healthy age- and sex-matched controls were found to have an abnormal lactulose breath test suggestive of SIBO.
9 In summary, although data are limited, the prevalence rates of SIBO in young and middle-aged adults appear to be low, whereas prevalence rates appear to be consistently higher in the older patient (14.5–15.6%); these rates, however, are dependent upon the diagnostic test used (see below).
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Pathogenesis
SIBO develops when the normal homeostatic mechanisms that control enteric bacterial populations are disrupted. The two processes that most commonly predispose to bacterial overgrowth are diminished gastric acid secretion and small intestine dysmotility. Disturbances in gut immune function and anatomical abnormalities of the GI tract also increase the likelihood of developing SIBO. Once present, bacterial overgrowth may induce an inflammatory response in the intestinal mucosa, further exacerbating the typical symptoms of SIBO. Although not universally seen,
10 overgrowth of small bowel intestinal flora may result in microscopic mucosal inflammation. Analysis of small bowel biopsies in elderly patients with bacterial overgrowth revealed blunting of the intestinal villi, thinning of the mucosa and crypts, and increased intraepithelial lymphocytes, all of which reversed with antibiotic treatment.
11
Paul.