SIBO and Food Problems

SIBO and Food Sensitivities: Decoding Food Intolerances for Gut Health

Navigating food challenges can be confusing when living with Small Intestinal Bacterial Overgrowth (SIBO). Many people suspect they have food allergies or sensitivities, but the majority of those with SIBO are actually dealing with food intolerances. These distinctions are critical for understanding your symptoms and addressing them effectively.

🔎Food Allergy, Sensitivity, or Intolerance? Know the Difference.🔍

1. Food Allergies:
   A food allergy involves an immune system reaction to a protein in food. Even small exposures can trigger severe and potentially life-threatening symptoms, such as hives, swelling, or anaphylaxis. Food allergies require immediate medical attention.
   
   

2. Food Sensitivities:
   Sensitivities also involve the immune system but not in the same severe, immediate way as allergies. These reactions are delayed, making it harder to pinpoint triggers. Symptoms may not appear for 24-72 hours after ingestion, and might include headaches, fatigue, or digestive discomfort.
   
   

3. Food Intolerances:
   Intolerances result from the digestive system’s inability to properly break down certain foods. Intolerances do NOT involve the immune system whatsoever. Common examples include lactose intolerance due to insufficient lactase enzyme or FODMAP intolerance, where fermentable carbohydrates cause bloating and gas due to insufficient "brush border" enzymes in the small intestines.
   
   

For most people with SIBO, food intolerances are the main issue. Not food allergies, or food sensitivities. The inflammation that is associated with overgrowth of pathobionts in the small intestines disrupts normal digestion and the production of enzymes in the small intestine, leading to difficulty breaking down certain foods. Under normal circumstances, the brush border enzymes are produced by tall column cells that line the GI tract in the small intestine. Because the cells are elongated, they usually have plenty of room inside them for the cellular machinery that produces a variety of digestive enzymes that help us to digest most everything in nature, including dairy, grains, peels of certain fruits, the pith of citrus fruits, and the "stringy" elements that you'll find in bananas or asparagus. In cases of SIBO, where pathobionts have set off some inflammation and perhaps a localized immune system response, we can see people developing some "collateral damage" to these tall, column cells. In other words, the immune system is messy when it goes on the attack! Our systems don't just laser in on the pathobionts, but rather, they cause some cellular damage to the very cells that are near and under the pathobiont colonies in the small intestine. Over time, this can result in a shortening of the tall column cells and if we were to look at them from a side view, they would be smaller and blunted. When they are smaller and blunted, they can't house as much machinery to make enzymes to help us digest us foods. Without enough enzymes, we become intolerant of foods and many of the symptoms that ensue, like bloating, diarrhea, and gas can be the result of the pathobionts actually fermenting the very foods that we can no longer fully digest...

⁉️What Enzymes Are Affected At The Brush Border⁉️

Key brush border enzymes impacted include:

• Lactase: Breaks down lactose (milk sugar) in dairy. Its deficiency leads to lactose intolerance.

• Sucrase: Digests sucrose (table sugar). Without it, sucrose ferments in the gut, causing gas and discomfort.

• Maltase: Converts maltose (a sugar from starch) into glucose.

SIBO can also compromise the gut’s ability to regulate immune responses, exacerbating food reactions and gut inflammation.

🤔Can Supplemental Enzymes Help?🤔

Supplemental enzymes may aid digestion by compensating for deficiencies caused by SIBO. Here’s what research shows:

• Lactase Enzymes: Well-supported for alleviating lactose intolerance symptoms.

• Alpha-Galactosidase: Helps break down complex carbohydrates found in beans and cruciferous vegetables.

• Sucrase-Isomaltase Supplements: Provide relief for sucrose digestion issues but are less studied than lactase.

While these enzymes can ease symptoms, they don’t address the root cause of SIBO, and their effectiveness varies. Combining enzyme use with SIBO-specific treatments like dietary changes, antibiotics, or herbal antimicrobials is often most effective. But contrary to what the internet and Facebook ads would have you believe, they often don't well enough alone to just give you or anyone else free license to eat pizza and go hog-wild on a bowl of stir-fried veggies.

📝Tips for Managing Food Intolerances with SIBO📝

1. Follow a Low-Fermentation Diet:
   Temporarily avoid fermentable carbs like onions, garlic, and certain fruits to reduce bacterial fermentation. 🧅🧄
   

2. Incorporate Enzymes:
   Use targeted enzyme supplements, particularly for lactose or other specific intolerances. If you keep a food diary for a few days, you can note which foods or categories of foods tend to produce the most bloat, GERD, heartburn, gas, or diarrhea within a couple of hours of ingesting them. This will help you to then decide on which enzymes might be worthwhile to assist the digestive process.
   

3. Reintroduce Foods Gradually:
   Once symptoms improve as you begin to treat your intestinal overgrowth, test small portions of previously avoided foods to assess tolerance. Start low...start really low, here. Like with just 2-3 broccoli florets or 2-3 spears of asparagus. See now that goes with one meal, and if tolerable, then you can slowly increase the amount the next time you eat that food.
   

4. Focus on Gut Healing:
   Support the brush border and gut lining with nutrients like zinc, vitamin D, and L-glutamine to restore digestive enzyme production.
   

5. Work with a Specialist:
   A knowledgeable healthcare provider can guide testing, enzyme selection, and treatment tailored to your needs. 👩‍⚕️🩺
   
   

💡Key Takeaways💡

• Most SIBO sufferers deal with food intolerances, not allergies or sensitivities.

• SIBO can damage the brush border over time, impairing the production of digestive enzymes like lactase, sucrase, and maltase.🥺

• Supplemental enzymes can alleviate symptoms but should be part of a broader treatment plan, including diet and gut-healing strategies.

Next week, we’ll discuss breaking the cycle of SIBO relapse, offering practical tips for long-term gut health. Stay tuned!❤️‍🩹