SIBO

 Our colon contains billions of bacteria. Ideally, the small intestine inhabits "Gram-positive" bacteria (such as Blautia, Rumminococcaceae, etc.),  that we live with in peace, and even enjoy their beneficial effect on our health. In a state of imbalance, a proliferation of "Gram-negative" bacteria (such as Enterobacteriaceae, escherichia coli, klebsiella, etc.) begins in the small intestine, as well as "Gram-positive" bacteria that should not be inhabited (such as the Enterococous species, Staphylococcus Streptococcus, etc.).

Some of these bacteria are naturally found in the colon as well as in our mouth, but their presence in the small intestine can certainly be detrimental to our health. This unwanted bacteria usually finds its way from the colon and mouth to the small intestine due to stasis (intestinal immobility), a condition in which there's no normal and smooth movement of food from the small intestine to the large intestine, which naturally raises the level of bacteria in the small intestine. This also causes the migration of bacteria from the large intestine to the small one. 

Stasis can be caused by several conditions:

• Gastroparesis - a disease in which there is a slow gastric emptying process.

• Celiac disease (wheat allergy)

• High levels of LPS - which are toxins that secrete Gram-negative bacteria. These toxins penetrate the brain and impair intestinal motility through the secretion of TNF alpha pro-inflammatory protein. Study 1, Study 2, Study 3. (Read more about LPS).

Every day trillions of bacteria flow from the mouth into the stomach through ingestion of food and saliva, but most of them are eliminated by the hydrochloric acid secreted in the stomach. Hydrochloric acid is a powerful antibacterial acid that protects us from bacteria and infections that enter our mouths. 

When there is an impairment in the production mechanism of the acid, a state of sub acidity is created in the stomach, i.e. an environment that allows bacteria to survive in the stomach and not move on to the small intestine. The main reasons for Hypochloridria are:

• The presence of the bacterium Helicobacter pylori which secretes ammonia and raises the pH of the stomach (reduces acidity). Study 

• Antacids pills.

• Stress.

• Magnesium and zinc deficiency.

Bile is a fluid that is produced in the liver and stored in the gallbladder. When food reaches the small intestine, the gallbladder secretes bile to help break down food and neutralize the acid that comes from the stomach. Naturally, due to the antibacterial and antimicrobial quality of bile, its proper flow is supposed to eliminate bacteria and infections that manage to survive in the stomach environment. The reason why bacteria that invades the body still manages to survive in the small intestine is an insufficient amount and flow of bile. 

The main causes of וmpaired excretion of bile juices are:

• Liver diseases, like fatty liver, hepatitis, or any other liver damage.

• Bile duct obstruction or gallbladder resection.

Impaired flow of bile into the small intestine produces a vicious cycle - an overgrowth of Gram-negative bacteria, which causes the secretion of LPS, their leakage into the bloodstream, damage to the liver and to the bile production what leads to impaired flow of bile into the small intestine and so forth.