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Signs and Symptoms of SIBO

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Initially the signs and symptoms of SIBO appear to be a temporary inconvenience rather than being indicative of a chronic condition which will disrupt quality of life long term.

Since the problem starts with gut issues it is unsurprising that many people find they have:

  • Increased gas
  • Diarrhea
  • Constipation
  • Abdominal distension

Because these symptoms are directly linked to digestive issues they tend to get looked at in isolation despite the fact that many other symptoms exist concurrently in thousands of SIBO sufferers.

Some of the common conditions which many SIBO sufferers have in common include:

  • Vitamin deficiencies particularly B12, D3 and folate (vitamin B9)
  • Iron deficiency
  • Food intolerances including gluten, lactose and fructose.
  • Fibromyalgia
  • Irritable bowel syndrome (IBS)
  • Chronic fatigue syndrome (CFS)
  • Autoimmune disorders
  • Fat malabsorption

Despite the fact that many of the conditions listed above would indicate a problem with digestion, such as the vitamin, iron and fat disorders, rarely do clinicians take a holistic view of such problems in light of the original digestive dysfunction.

Another problem which arises is the lack of understanding by medical professionals of what injury certain deficiencies cause. Many are seen to be ‘simple’ deficiencies which are ‘easily’ treated, for example:

Vitamin B12 deficiency causes neurological damage irrespective of any anemia being present and, although the anemia symptom, if it appears at all, can be easily rectified by returning blood levels to normal, normalization of blood levels will neither stop nor reverse neurological damage. This nerve damage can be so severe it results in permanent disability in 6% of patients suffering from it1. In fact, back in the late 1800s and early 1900s the majority of patients dying from this condition (and no one survived) actually died of neurological damage and not anemia.

Precious few patients today will be aware of the real damage a B12 deficiency can cause. They will also not be aware that in most cases returning their B12 levels to normal will not rectify their symptoms – yet all this can result from digestive dysfunction.

Another ‘simple’ vitamin deficiency which can cause multiple problems is that of folate:

Folate (Vitamin B9) deficiency results in high homocysteine levels which have been implicated in cardiac arrest. However folate should never be given without also taking adequate amounts of B12 to balance out the increased folate intake.

Note: Folic acid is not folate. It is the synthetic version and is not metabolized by the body in the same way as naturally occurring folate.

Without clinicians being aware of what ‘simple’ vitamin deficiencies are really capable of, then it can be assumed that when conditions such as SIBO arise and malabsorption results, they are not going to recognize the true implications of the possible outcomes should that condition be allowed to develop into a chronic disease. Which quite possibly accounts for many doctors failing to realize the serious implications of digestive dysfunction.

Another confusing situation which arises is when patients develop further symptoms they may have their original diagnosis of SIBO quashed and a revised version provided. So for example if they start to suffer debilitating fatigue they may get an alternative diagnosis of chronic fatigue syndrome. If they start to suffer from low mood or depression they may return a revised diagnosis of IBS. Or if they start to suffer joint pain they may get a diagnosis of fibromyalgia. The progression of one illness into another seems rarely to be taken into consideration. Yet the illnesses are defined by scientists, who, it has to be said, rarely state emphatically what causes the illness, what the symptoms are and how these may develop.

A fine example of how an illness which manifests in many different ways can be interpreted is shown us in Dr Oliver Sacks book, Awakenings (Picador 1990). Back in the early 1900s when the illness we now know as encephalitis lethargica spread around the world, it produced such a diverse range of symptoms of variable severity that it was thought to be many diseases. Concurrently at the time it was known as:

  • Borulism
  • Toxic Opthalmoplegia
  • Epidemic stupor
  • Epidemic lethargic encephalitis
  • Acute polioencephalitis
  • Heine-Medin disease
  • Bulbar paralysis
  • Hystero-epilepsy
  • Acute dementia

This situation occurred simply because the illness manifested in many different ways with many different symptoms and in varying stages of progression – although there were several, such as the varying degrees of lethargy, which were noted in all patients. Yet no one at the time, despite all the research and observation of these patients by scientists and physicians around the world, made the connection that they were one and the same illness. This pandemic continued for a decade and, it is estimated that at least 5 million people were affected or died.

Considering the broad range of systemic functions affected by an inability not only to absorb nutrients effectively from our food but also how an overgrowth of certain bacteria can directly affect our immune system, it is unsurprising that so many symptoms result.

Yet the one thing that all these illness have in common, whether that be a B12 deficiency, IBS, SIBO or fibromyalgia, is that they are of ‘unknown cause,’ and as yet, medicine has not found effective ways to either treat the cause or to treat the symptoms permanently and effectively. However the end result of ‘achieving’ a diagnosis is important not only to clinicians but also to patients despite the fact that little can be done by contemporary medicine and even if in reality it means the patient is spiraling down in a whirlpool of ill health.

References

1 – http://www.bmj.com/content/349/bmj.g5226/article-info
(search with ‘pdf’ to find full)

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