Although SIBO appears in some people to be triggered by unavoidable intervention such as gastric surgery, in many others the cause is currently unclear although there are many factors which are linked.
Yet many people are unaware that by taking a few simple preventative measures they may be able to stop SIBO developing. However much of the advice relating to prevention is actually quite difficult to put into practice. For example the links between a possible true cause of indigestion and low stomach acid are highly likely to significantly affect bacterial growth in the intestine – in a positive way, and the general advice is to make sure your stomach acid levels are of the correct pH. Which is great advice.
Yet in the US today there is only one recognized test available to patients to test stomach acid pH and that is the Heidelberg test. This test is not widely available and patients may have a hard time tracking down a clinician who will perform it. Heidelberg Medical provide a map referencing clinicians who will refer for this test which is linked here: http://phcapsule.com/referral/ and it can be seen that there is only a limited number throughout the United States.
The test currently costs around $350 but obviously, depending on the clinician, it can vary. It is also unlikely to be available on insurance.
When I last inquired there was no recognized test available in Europe and the Heidelberg test remains unacknowledged. In Europe there is a saliva test available from a private laboratory but at this moment in time it also remains unrecognized. One of the major reasons for this is that there is simply no other test to measure it against. The test is performed by Acumen Labs and is unavailable for those in the US but it is available for most countries in Europe through a clinician or qualified naturopath, dentist, registered nutritionist or registered osteopath. The test is called the VEGF (Vascular Endothelial Growth Factor). How it works is that VEGF actually regulates the cell membrane of tight junctions in the intestine. The more stomach acid produced the more VEGF is needed. This means that if you test low for VEGF it correlates with low levels of stomach acid. The cost of this test is around £60 sterling plus the cost of the referring clinician.
So, although low stomach acid pH – usually referred to as achlorhydria (no stomach acid) or hypochlorhydria (low stomach acid) is seen as a highly significant in being a contributory factor to SIBO, actually finding out if you have it simply isn’t that easy.
Other home remedy tests for low stomach acid, include:
The Baking Soda Test
This is widely referred to although I don’t recommend it. Baking soda is alkaline and, if you have long standing low stomach acid and introduce an alkaline substance on top it can result in vomiting back the mixture within about 5 minutes. I speak from experience.
The Lemon Juice Test
I do recommend the lemon juice test which basically involves squeezing the juice of half a lemon into a half cup of water. Sip this slowly over a period of half an hour. If you feel increasing indigestion after the first few sips, then presume you have high stomach acid and do not continue. However if you feel some sort of relief, usually in the form of belching, then continue until you have finished the cup. Lemon juice is acidic and, unlike most other fruits, has a pH compatible with that of stomach acid pH. By putting an acidic substance on an alkaline substance you raise the pH and experience relief.
Betaine Hydrochloric Acid Test
The third test is the Betaine HCL test. This is another which I am not particularly fond of. If done it needs to be taken with pepsin which is an enzyme. For several reasons some people trying Betaine HCL, even when they have low stomach acid, experience more indigestion or stomach discomfort after taking it. I can only conclude that, for whatever reasons, this is not a reliable home test for low stomach acidity.
When you establish if you have low stomach acid you can take measures to prevent it. As a result you may also prevent the development of SIBO and the myriad of symptoms which are either directly or indirectly related to it.
We can see that although preventative measures can be taken against the development of SIBO, sometimes they are not easy to access. However there are other steps you can take to maintain a healthy balance of gut microflora:
Use a probiotic or yoghurt daily. There is no need to view this in any medical capacity simply incorporate a good quality food into your dietary regimen.
Try to use more fermented foods. These include things like sauerkraut or apple-cider vinegar as a dressing. Fermented foods are known to support digestive function and, in cases where people are lacking in stomach acid, can raise it without further steps being taken.
Think about taking a good quality, natural probiotic supplement and preferably one containing inulin. Inulin is a probiotic and bacteria use it to maintain numbers and strength. Candida Restore is one product which incorporates inulin in its ingredient list in addition to many other strains of bacteria and yeasts.
Another way to prevent SIBO is to at least have a basic understanding of other, possible, contributory factors and take a proactive stance toward them. These include:
Antibiotics – take only when necessary and don’t badger your clinician for a prescription for every ailment. Also remember to include probiotics or a good quality yoghurt when they are prescribed.
Alcohol – there is research available to prove an association between SIBO and alcohol consumption particularly if it is excessive. If you know you are drinking too much, try and cut back.
Birth Control Pill (Oral Contraception) – although there is a correlation between the consumption of oral contraceptives and SIBO there is no conclusive evidence relating to it being a cause. However many practitioners and patients are aware of this association and suggest other methods of contraception which are available to users until science provides them with more answers.
Antacid blockers and Proton Pump Inhibitors – these are linked to the section on low stomach acid above. Antacids are alkaline. Although such drugs may temporarily stop the symptoms of indigestion, if it keeps recurring consider the fact that you might have indigestion due to low stomach acid and not high. Proton pump inhibitors stop the release of stomach acid which we have already ascertained is essential to digesting food. The association between the use of proton pump inhibitors, low stomach acid and SIBO is quite an easy path to follow.
Antidepressants – there is little research proving that antidepressants result in SIBO. However that does not mean they do not. If your symptoms get worse while you are taking antidepressants then return to your clinician to discuss the problem.
NSAIDs – The suggested links between NSAIDs (Non-steroidal anti-inflammatory drugs) and the effects on stomach and digestive tract have been on-going since the 1990s. However even to date research undertaken has not established them as a direct cause. The association between this particular type of drug and SIBO does however exist and is considered significant1. Again this is a drug you might want to avoid unless necessary until research can provide the public with more answers.
There can be no doubt that although SIBO is considered in some medical circles to be of little significance, for many patients this is only the start to many years of ill-health and diminishing quality of life. Some people, even if they only have slight indicators of possible digestive issues may want to take action to prevent the problem becoming chronic.
1 – http://www.ncbi.nlm.nih.gov/pubmed/24417613