Usually hardly any bacteria live in the small intestine of humans, while a large number of bacteria (100 billion to 1 billion germs per gram of stool) of various types live in the large intestine. An incorrect colonization with bacteria or fungi of the small intestine occurs when an increased number of bacteria can be detected in the small intestine (> 100,000 germs per milliliter of small intestinal juice) = disturbed microflora in the small intestine. As the various bacteria participate in the digestive process, diarrhea , fatty stools, flatulence , iron and vitamin deficiencies ( malnutrition ) can occur. As a rule, bacterial overgrowth of the small intestine occurs in patients after bowel surgery (small bowel resection), inflammatory bowel disease ( Crohn's disease ), diverticula of the small intestine or decreased bowel activity (motility disorder) due to another disease (e.g. diabetes mellitus , scleroderma, neurological diseases). Bacterial overgrowth is less common without an underlying disease being found.  

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Diseases that are often associated with SIBO:

• Short bowel syndrome

• if the ileocecal valve is defective

• in diverticula or small bowel stenosis as a result of z. B. Crohn's disease

• in chronic intestinal pseudo-obstruction

• in the syndrome of the blind or deactivated loop after operations on the small intestine

• in exocrine pancreatic insufficiency

• Peristalsis disorders, for example as a result of scleroderma or diabetic enteropathy, can also be the cause

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Partially unspecific symptoms similar to those of irritable bowel syndrome :

• stomach pain

• high level of suffering

• Loss of appetite

• nausea

• Flatulence

• Vomit

• diarrhea

• pains

• changed stool frequency and / or texture (constipation, diarrhea, or both)

• Eructation

• heartburn

• chronic fatigue

• Nutrient deficiency (vitamins D, A, E, B12)

• Leaky Gut Syndrome - SIBO can be the cause of this

• possibly protein deficiency

• Possibly Omega 3 fatty acid deficiency (alpha-linolenic acid, EPA (Eisosapentaenoic acid) & DHA (Docosahexaenoic acid))

• Unintentional weight loss / underweight

• Disruption of absorption (malassimilation syndrome) - malnutrition

• Joint pain

• Rash on the face and eczema

• acne

• Asthma and bronchial complaints

• depressions

• Steatorrhea (fatty stool)

• Anemia (anemia / lack of blood)

• Rosacea (copper rose)

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Clarifications:

• To clarify the cause, an imaging procedure, e.g. B. an MRI of the small intestine according to Sellink, or an enteroclysis (double-contrast X-ray image according to Sellink) is required

• Glucose breath test: If the glucose test is negative, a lactulose test is also required to test for SIBO in the middle and lower sections of the small intestine. It is important that this then displays methane (CH4) in addition to hydrogen (H2). Because if a lactulose test that only measured hydrogen is negative, the probability is high that the symptoms are based on increased methane formation.

• Lactulose breath test (used very often): Ideally, the test should determine hydrogen and methane as the two most common bacterial gases, as well as CO2 for quality control.

• In rare, selected cases, small intestinal juice is sucked off directly by means of a gastroscopy and processed in a complex process. Objective: to create cultures in the laboratory in order to prove an increased bacterial colonization and the existing spectrum of germs

Therapy:

The cause of SIBO must be identified and eliminated, otherwise antibiotic therapy will not help. Because if the causes persist, the microorganisms will come back.

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1) Nutritional therapy: the choice of foods to be avoided must be based on the type of bacterial overgrowth.

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A special SIBO diet may be recommended

• as one of the most effective measures for symptom relief (works up to 100%)

• to prevent relapse together with a prokinetic

• for healing of the intestinal mucosa

• for general health improvement

It is not suitable as a healing method or to remove the cause and should not be carried out for too long.

Our intestinal bacteria population is significantly influenced by diet. Nutritional therapy aims to deprive the bacteria of their nourishment. You are low in carbohydrates. Which carbohydrate foods are problematic varies from person to person. Therefore, the SIBO diets are tolerated to varying degrees. The individually tolerable diet can only be identified through systematic testing, observation and adjustment tailored to your individual needs.

The tried and tested SIBO diets include:

• SIBO Specific Food Guide (SSFG)  (Dr. Siebecker)
    –SIBO Bi-Phasic Diet (B-PD), a modification of the SSFG  (Dr. Jacobi)

• Cedars-Sinai Low Fermentation Diet (C-SD)  (Dr. Pimentel)

• Fast Tract Diet: IBS (FTD)  (Robillard)

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The continued diet should be adjusted taking into account your individual symptoms.

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2) Antimycotic therapy (against fungi) is advisable if it is a pure fungal attack.

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3) Antibiotics - often side effects and a high rate of relapse (= relapse rate)

• classic antibiotics with systemic effects (e.g. quinolones, tetracyclines)

• or antibiotics that only work in the intestine and are not absorbed into the blood (e.g. rifaximin, gentamycin / polymyxin SDD capsules)

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4) Pro- and prebiotics as a supplement to antibiotic therapy

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Why is nutritional therapy important?

Your symptoms improve - gas, bloating, diarrhea or constipation, pain related to eating or after meals. Weight reduction is recommended if you are overweight.

Nutritional therapy supports you in reducing your symptoms overall and thereby positively influencing your health. An energy-adjusted wholesome diet under the supervision of a certified nutritionist can lead to your long-term success. The diet is adapted to your current weight and a jointly defined goal for weight gain / or loss.

The aim is to supply all of the fatty acids, micronutrients (vitamins and minerals) that are important to you, energy and protein in the measure that your body is optimally supplied with. For this purpose, foods that promote inflammation are specifically avoided and plenty of anti-inflammatory foods are consumed.

Classification of your weight - definition and classification of weight in relation to height.

Special percentile curves apply to children and adolescents; the BMI cannot simply be used here.

BMI and interpretation: BMI: body mass index

Formula: Body weight in kg : (body height in m) 2

Underweight: <18.5

Normal weight: 18.5 - 24.9

Overweight = pre-obesity: 25-29.9

Obesity grade I: 30 - 34.9

Obesity grade II: 35-39.9

Obesity grade III:> 40 = per magna

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Blood count:

It is advisable to have your Omega 3 index checked regularly.

This provides information about the supply of valuable omega 3 fatty acids (alpha-linolenic acid, eicosapentaenoic acid and docosahexaenoic acid), which can significantly counteract inflammatory processes in the body.

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Nutritional therapy

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• Reduction of your individual complaints through a diet that is appropriate to the diet

• Measures to regulate stool, diet adapted to dietary fiber, adapted amount of liquid to drink

• Getting rid of too much air from your abdomen

• possibly reduce acid production of the stomach, with natural foods

• possibly avoid reflux

• Clarification of causes: have all illnesses / intolerances / food intolerances that might exist already been clarified? Have all tests been carried out that could rule out other diseases that show similar symptoms?

• Holistic therapy - do you have any comorbidities that need to be taken into account during the consultation?

• anti-inflammatory diets for disease prevention

• Energy-appropriate full nutrition, calculate the need for normal weight

• Body weight: If you are overweight, weight reduction is recommended depending on the severity.

• an energy-enriched / or protein-enriched diet may be useful for you.

• Avoid micronutrient deficiencies and mineral deficiencies & possibly counteract them with nutrient preparations

• Prevent protein deficiency

• Strengthen the stomach and intestines with natural foods

• Which nutrients do I need in which ratio?

• get enough fiber (> 30 g / day)

• Fiber therapy: depending on the symptoms, a therapy with 50 - 60 g fiber per day can alleviate your symptoms.

• Sufficient fluid: total fluid per day: 30 - 35 ml per kg body weight and day. Attention, this is not just a drinking liquid. The liquid from food (approx. 500 - 800 ml) must still be subtracted from this, so that an amount of approx. 1.3 - 2 l of drinking liquid is created. In the case of fiber therapy, at least 2 liters of drinking liquid

• add valuable anti-carcinogenic (anti-cancer) secondary plant substances

• A selection of foods tailored to your needs with cooking and technical information (for breakfast, snacks, lunch, dinner)

• Do you like to eat your warm meal in the evening? I am happy to cater to your individual situation and we will create a plan on how you can implement your wholesome diet into your everyday life.

• which oils are good for me? What should I watch out for in relation to the anti-inflammatory diet?

• How much fat spread (butter / margarine / vegetable fat) can I use and which products are recommended?

• How can I boost and support my metabolism with natural foods?

• Get enough Omgea-3 fatty acids and essential fatty acids

• Coordinate sensible meal frequency for your individual case - meal allocation

• Define the desired weight stabilization / normalization & the estimated period for this

• what should be considered with beverages and alcoholic beverages?

• How does exercise affect your body and thus also your diet?

• Avoid blood sugar fluctuations

• Sweetening foods - sweeteners, glucose, fructose, sugar and sugar substitutes, what can I use and in what quantities? How high is the respective sweetness of the different products?

• what should be considered when baking and cooking?

• what are cheap snacks / main meals

• Eating out - what should you watch out for?

• Vacation, boat trip or hospital stay, what should be considered?

• Complications / side effects such as nausea, gas, bloating, diarrhea, constipation, vomiting, heartburn, loss of appetite, pain related to eating, what can I do about it?

• Daily plans as an example for practical implementation in everyday life

• Enjoyment training

• Optimizing your eating situation

• long-term maintenance of a jointly defined weight

• Additional therapy options

• Food supplements - under certain circumstances, a supplement can be useful

• Dietetic products in support of nutritional therapy

• and other topics

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Any questions? I look forward to your call or email. To contact form

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Assistance:

• KISS self-help groups

• Self-help network

• Gastro league

• German irritable bowel self-help e. V.

• German Society for Digestive and Metabolic Diseases e. V.

• German Society for Neurogastroenterology and Motility V.

• German Society for Pediatric Gastroenterology and Nutrition