This week I'm sharing some new research on IBS & SIBO and highlighting the practical elements that might affect you.

Here are the 2024 studies I've reviewed:

1. Oral microbiome & digestion - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351600/ 
2. Difference in IBS and SIBO - https://www.dldjournalonline.com/article/S1590-8658(24)00876-4/fulltext 
3. SIBO subtypes - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11242202/

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The information in this podcast is not medical advice and is not designed to treat, diagnose or provide personalised health advice. This podcast content is information only and any changes you make are at the user's own risk. Please consult with your doctor or healthcare provider before implementing any new treatment.

Would you like to know which nutrients

are likely to be low if you've got SIBO?

2

Or do you wonder what the

difference is between IBS and SIBO?

3

Or maybe you're worried Well, this

week I'm sharing the findings of three

4

new research papers that I found and

I thought you would find interesting.

5

In this episode of the Inside Knowledge

podcast, you'll hear about three recent

6

science papers which have been published

7

some little pearls of information

that you can use from each one to

8

try and improve your own digestion.

9

Hello,

10

welcome to episode 71 of the Inside

Knowledge podcast for people with IBS.

11

I'm Anna Mappson.

12

This week I'm doing something a

little bit different by pulling out

13

these three unrelated papers and

just pulling out some highlights.

14

The first one I'm going to go into, and I

will put a link to all of these research

15

papers in the show notes, but the first

one is all about the oral microbiome.

16

That's your teeth, your gums, your

bacteria, and also your gut health.

17

Like, what is the connection?

18

And we're going to go through that.

19

Secondly, there's one about the

difference between SIBO and IBS, and

20

I thought this was really interesting

because there really aren't many

21

studies which specifically look

at the difference in symptoms for

22

people who've got IBS or SIBO.

23

Quite often they are in the

same pot of research . So this

24

is a really interesting paper.

25

And then thirdly, we're going to look

at some specific subtypes of SIBO.

26

So that's the hydrogen positive or

methane positive or hydrogen and methane.

27

They looked at the differences

in nutrients in the blood

28

but also in their diet.

29

And this is really interesting

and I think will be helpful for

30

lots of you if you have SIBO.

31

Right, so the first one I'm

looking at is called Oral Health

32

and Modern Digestive Diseases,

Pathophysiologic and Aetiologic Factors.

33

What a mouthful.

34

This paper is a review rather than

something where they've, you know,

35

got people in and tested on them and

then they're showing the results.

36

They're looking at the literature and

looking for links in the literature

37

between problems with people losing teeth,

having dental caries, and also dysbiosis.

38

So that includes things like IBS, but

also small intestine bacterial overgrowth,

39

SIBO, and what is just really interesting,

and I felt like I wanted to explain it a

40

bit, probably Need to do a whole episode

on oral health and your digestion.

41

That's a future episode, but also

what, what is really interesting is

42

that a lot of the studies, they do

show links between the health of your

43

mouth and the state of your digestion.

44

People who have IBS are much more

likely to have periodontitis.

45

That's like inflammation to your gums.

46

So perhaps you see bleeding

gums when you brush your teeth.

47

And your gums may even

be receding as well.

48

This can just be because you have got

a layer of bacteria living on the gum.

49

And that is interfering with the way

it should be sucked up to the teeth.

50

And should be kind of

really tightly in there.

51

But when there is a low level of

infection, it can just Cause the

52

gum to come away from the teeth a

little bit and then it creates these

53

pockets where more bacteria is kept.

54

And actually some of these specific

bacteria have been found, in SIBO

55

and can also be found in your mouth.

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There are particular bacteria

called streptococcus mutans, which

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is also involved in dental caries.

58

So that's cavities and

holes in your mouth.

59

And also another type of bacterial

species called Prevotella.

60

They are more common in the

mouths of people who've got SIBO.

61

And also we see that Klebsiella, another

type of bacteria that is also implicated

62

in people who have SIBO can also be found

in the saliva of people who have IBS.

63

Now, the interesting thing about

Klebsiella as well is that it can

64

increase the amount of histamine

that you have in your gut.

65

So, some people find that they have higher

histamine reactions and tend to have

66

higher abdominal pain levels, but also the

other histamine, Symptoms that you might

67

be getting is like runny nose, itchy eyes,

itchy skin, you know those typical sort

68

of hay fever or allergy type symptoms.

69

Those are often down to high histamine

which may be triggered in some

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part by this bacteria that actually

degrades histidine into histamine.

71

So it can increase the levels of

histamine in your digestive system.

72

There is a three way interconnection

between your mouth, your

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gut and the liver as well.

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And so the liver gets a

blood flow from the gut.

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So if you've got bacteria that you're

swallowing in your mouth and some bacteria

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like one that's called, Porphyromanos

gingivalis in your bloodstream, it

77

can actually survive the stomach acid.

78

So often like stomach acid is one

of the first lines of defense for

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stopping bacteria that's coming

through the mouth in, in our food

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and stopping it reach the intestines.

81

But if you've got low levels of stomach

acid, perhaps you're taking a PPI, perhaps

82

you're chronically stressed and your

stomach acid is particularly low, then

83

this may increase the amount of bacteria

that is going into the small intestine

84

and it may also just survive, even if

you've got high levels of stomach acid.

85

So, some of the bacteria can get into

your small intestine and if there is a

86

case of Dysbiosis in the small or large

intestine, that means that the mucus

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lining of your digestive tract is not

as strong as it was and bacteria from

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the mouth can actually start to colonize

it or start to get involved and change

89

the ecology of bacteria in the gut.

90

In animal studies, both of those

bacteria, the Streptococcus mutans

91

and the Porphyromannus gingivalis

have been shown to affect liver health

92

as well and also to change the gut

microbiome, so basically to kill off

93

some species and encourage others.

94

Basically, when they've added

that bacteria to the guts of

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mice in experiments, it has had a

negative effect on their digestion.

96

The reason I wanted to include this study

is just because The one thing that you

97

can take from this is it is important to

go to your dentist, get your hygienist

98

appointments where they scrape and

clean your teeth and really to brush

99

your teeth properly for two minutes

every day and actually do it properly.

100

Just really keep up the oral

microbiome health because there's

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a knock on impact, not just on your

digestion, but on other organs and

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inflammatory processes in the body.

103

So really important.

104

And that is one of the

reasons I picked it.

105

Right, let's move on.

106

The second study is called Differences

in Clinical Manifestations and

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the Fecal Microbiome between

Irritable Bowel Syndrome and Small

108

Intestinal Bacterial Overgrowth.

109

This was a relatively small study, but it

had groups of Chinese patients, who had

110

IBS, some had SIBO, and then they had a

group of healthy controls, and there was

111

between 70 and 80 people in each group.

112

The people in the IBS group did not

have SIBO and they were ruled negative

113

for SIBO by a lactulose breath test.

114

And then the people who had SIBO

had a positive test and then the

115

healthy controls didn't have IBS

symptoms or they didn't have SIBO.

116

The thing about this test that I

liked is that they separated out

117

the difference between IBS and SIBO

and often that's not ruled out.

118

So people are just there.

119

In this research study, people are in

a grouping saying they've got IBS, but

120

we don't know whether they've got SIBO

as well because it hasn't been tested.

121

So this was helpful.

122

In terms of symptoms, people who had

IBS generally had higher abdominal pain,

123

more frequent diarrhoea, and actually

worse symptoms when they were self rating

124

their symptoms than people who had SIBO.

125

In terms of their diet, They

found people who had IBS ate

126

more protein and ate less fibre.

127

And in contrast, the people who

had SIBO ate a higher fat diet

128

and they were low carb, generally.

129

So not necessarily just

fibre, but just low carb.

130

And then they also did a gut

microbiome test as well, looking

131

at the faecal microbial signatures

of people who had IBS and SIBO.

132

This is looking at the microbes in the

large intestine, and actually You know,

133

we, we can only get a sample of what's in

the large intestine because this is what's

134

coming out in the waste, but there's

a really important picture showing

135

that a lot of bacteria is not released

in the waste and actually lives in the

136

mucous lining of the large intestine

and may never come out in the poo.

137

And so sometimes you have bacteria

that do not show up in a stool test.

138

However, what they did show, that

there was a difference between

139

people who had IBS and SIBO.

140

Um, obviously the people who had

SIBO, you might, you might think

141

it's kind of natural, they had

much more gas producing bacteria.

142

People who had SIBO also were more likely

to have another bacterial group called

143

Christensenellaeaceae, which is associated

with a longer intestinal transit time.

144

So, of course, if you think about

SIBO, . You're getting that overgrowth

145

because of a slow transit time through

the small and large intestine and

146

that is allowing the bacteria to grow.

147

So, of course, it makes sense that

you have more of these bacteria, but

148

also they had bacteria which may be

affecting carbohydrate breakdown.

149

And so it kind of, again, makes

sense that people who had SIBO

150

were going on a low carb diet in

order to manage their symptoms.

151

In the people who had IBS, they had a

lower gut diversity, so less variety

152

in the types of microbes that were

available in their stool samples.

153

And they had higher

incidence of bacteria like E.

154

coli, Enterobacti, and then

another group called Doreae.

155

And all of those types of

bacteria are associated with

156

inflammation to the gut lining.

157

So, these are potentially the causes

of that abdominal pain, the bloating,

158

and these are also, some of them

are linked to previous infections.

159

So we know that post infectious IBS is a

really common cause of IBS and potentially

160

these pathogenic bacteria such as E.

161

coli or Shigella, these are more likely to

be raised in people who have IBS, showing

162

that potentially that is one of the causes

of IBS, caused by an acute infection.

163

Like food poisoning or something.

164

If you want to know more about the

mechanics of how that works, listen

165

to episode 10 when I talked about

post infectious IBS as a common cause

166

of your irritable bowel syndrome.

167

And the reason I wanted to bring

this study to your attention

168

is just to highlight the

importance of testing for SIBO.

169

If you feel that you may have SIBO,

it's really important to understand

170

if that is the trigger for your, if

that is the driver of your symptoms.

171

So, Do speak to your doctor about

getting tested to rule out SIBO

172

as a cause because if you have got

SIBO, it's something you can treat.

173

It's tricky and it's difficult,

but I would definitely go ahead

174

and try to look at SIBO as one

of the causes of your symptoms.

175

The third study I want to cover today is

called Identification of SIBO subtypes

176

along with nutritional status and

diet as key elements of SIBO therapy.

177

The aim of this study was to

look at correlations between SIBO

178

subtypes, so that's hydrogen,

methane, or hydrogen and methane.

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And whether it impacts on your nutritional

status and your dietary intake.

180

It was a very small study,

so unfortunately that is

181

one of the key drawbacks.

182

It only included 67 people who

were newly diagnosed with SIBO.

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And this is also a drawback because

these people haven't had SIBO for years.

184

And so this may have affected some

of their dietary choices which

185

we'll come back to at the end.

186

So those are the kind of drawbacks.

187

But what I liked about it is it's in

people, it's real human study, and it

188

is specifically looking at nutrients and

diet, because if you've got SIBO and you

189

belong to any SIBO groups online, you will

see a lot of, concern and panic in some

190

cases about nutritional deficiencies and

how these are influenced by the presence

191

of bacteria in the small intestine.

192

So in this study, 51 percent had hydrogen

and methane, 31 percent had just methane,

193

and 18 percent had hydrogen only.

194

So these are quite small numbers,

bearing in mind, like, 67 people,

195

you're only really looking at a group

of 30 who had those main symptoms,

196

and that's how they've done their

nutritional analysis, so we're

197

looking at quite a small closed group.

198

The key headlines were, people

who had hydrogen and methane, had

199

low serum vitamin D, low serum

ferritin, that's your iron stores.

200

And a low fibre intake.

201

And these were clinically

significant results.

202

So these were not caused by something else

that could have confounded the results.

203

So if we get a bit more into the

detail of each of the nutrients.

204

In vitamin D, what was interesting

is they called optimal between 30

205

and 50 nanograms per milliliter.

206

But actually some might argue that

optimal is actually over 50, and

207

that is not particularly high.

208

So in the UK, we don't necessarily

consider over 50 to be high.

209

We actually say, in the NHS that

between 50 and 75 is adequate,

210

and optimum is actually over 75.

211

So when you use those markers, in this

study, everybody was less than optimum

212

in terms of their vitamin D status.

213

They also found is that the people who

had higher levels of hydrogen also had

214

lower levels of their serum vitamin D.

215

So there was a correlation between

the more SIBO that you had,

216

the worse your vitamin D was.

217

Looking at the vitamin B12, assessments

around 50 percent of people who

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are hydrogen positive SIBO showed

borderline levels of vitamin B12.

219

So that's borderline deficiency.

220

And yet again, they've used quite

low levels as the cutoff for what

221

is optimal and what is deficient.

222

The interesting things I want to bring

in is firstly, these were newly diagnosed

223

people with SIBO who may not have had

it for too long, and When they looked at

224

the dietary intake, 58 percent of people

who had that hydrogen positive SIBO did

225

not meet their vitamin B12 requirements.

226

So they weren't eating enough

of the vitamin B rich foods in

227

order to get their levels up.

228

So yes, they were taking quite a

low cut off point for deficient, and

229

I, you know, if we'd used optimal

levels, might have been even higher.

230

However If you look at whether they're

eating enough, you can't expect to

231

have high levels of vitamin B12 if

you're not actually eating very much.

232

It might be possible that the B12 is

not getting absorbed because bacteria in

233

the small intestine are competing with

you for the nutrients, so they're taking

234

your B12, or bacteria could be damaging

one of the sites, that cobalamin, that's

235

like the part of B12 that we absorb, that

could be damaged on the cells by, the

236

bacteria just being there or upsetting

the mucous lining of your small intestine.

237

In other studies, they've also shown

that people who have methane predominant

238

symptoms do not necessarily have a B12

deficiency, and that is potentially

239

because certain types of methane producing

microbes, like Methanobrevibacter smithii,

240

for example, has actually got the ability

to synthesize cobalamin for itself.

241

So they can almost make their own B12

because they, they do need it to survive.

242

But they don't need to steal your B12.

243

So that's where there could be a

bit of a difference between people

244

who have hydrogen and people

who have methane predominance.

245

Um, that's not in this study, but

in other studies, they've just shown

246

that B12 is not necessarily low for

people who are methane predominant.

247

So that is a really important

factor to take into account.

248

When they looked at iron, the

methane positive group had low

249

ferritin levels, that's your

iron stores, which is indicative

250

of early iron deficiency anemia.

251

Dietary intake was actually okay, so

they were eating enough, but their

252

actual iron stores were quite low.

253

Iron is actually really important

for your large intestine bacteria.

254

Some of it's absorbed in your small

intestine and gets used up in the body.

255

Some of the iron travels to

the large intestine where it

256

is used by your gut bacteria.

257

When you've got low, uh, Certain gut

bacteria can thrive and actually these

258

includes Klebsiella, Salmonella and E.

259

coli.

260

So remember going back to the

previous study where we looked

261

at those were likely to be higher

bacteria in people who had IBS.

262

Those thrive when you've got a low iron

environment, but also certain bacteria

263

can change the acid profile of the gut and

we want it to be a little bit more acidic

264

so that you can absorb the more iron.

265

And one of the possible reasons for

Iron being low in people who have

266

high methane is that the methane

microbes, or they're called archaea,

267

they actually use iron to grow.

268

So that's where we have that correlation.

269

Remember back those people who had

methane positive SIBO were actually

270

more likely to be deficient in

their iron stores in their body.

271

So Their bacteria is using

the iron instead of them.

272

Part of the reason I wanted to bring

out this study, is that what was

273

really also important, I feel, is

that over 50 percent of the people

274

in this study were not meeting their

total energy intake requirements.

275

So they were not eating enough calories

and enough food and nearly all of

276

them were not eating enough fibre.

277

The people who had methane dominant SIBO

were eating a bit more fibre But the

278

majority of people were not eating enough

fibre Now when you don't have good levels

279

of fibre in your gut, you will struggle

to form a good gut a solid bowel movement.

280

So you might have more

diarrhea or more constipation.

281

And these are the key elements

of either the hydrogen or the

282

methane positive type of SIBO.

283

The authors of the study also say that

decreasing your fibre intake could be

284

increasing the risk of SIBO development

by slowing down your gut motility

285

and disrupting the bacterial balance.

286

So they are really Clearly pulling

out and I would really stress to you

287

as well that cutting fibre out of

your diet could be making symptoms

288

worse and lasting for longer.

289

That is part of my reason for bringing

this study to you really, is to first

290

of all suggest that you go and get a

blood test and actually test whether

291

your levels are okay for vitamin D,

B12, iron and your folate levels.

292

It's helpful that information to

know whether you are eating enough

293

of these foods in the first place

in order to get sufficient levels.

294

And if you are eating enough, but you're

not absorbing them, maybe it could be down

295

to the bacteria in your small or large

intestine affecting your absorption rates.

296

So that would be the first bit of advice

if you're worried about your nutritional

297

status, is to go and get it tested.

298

You can do this privately or your

doctor should do a full blood

299

panel if you go and ask them.

300

Then, also the fibre was too

low in the majority of people in

301

this study, and it is something

I see in my clients all the time.

302

People who don't eat enough fibre

because you're trying to manage symptoms,

303

but actually it could be exacerbating

things and making things worse.

304

And then the third bit of

information was that their energy

305

intake was generally too low.

306

So they weren't eating enough calories.

307

to keep them going and probably not enough

diversity as well, is what I would assume.

308

However, that wasn't a

metric in this study.

309

I hope you found those three

little study overviews interesting.

310

I'm always reading science papers about

SIBO and IBS and general gut health

311

stuff to see if there's anything new and

interesting that I can translate into

312

practical applications for my clients.

313

I thought those three things together

give you something practical that you can

314

think about whether it affects you or not.

315

If you've been enjoying

my podcast, please, please

316

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317

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318

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can just leave a rating.

319

It would really help me if you

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320

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321

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322

But thanks for listening to this

episode of the Inside Knowledge podcast.

323

Better digestion for everyone.