Overgrowth of bacteria in the small intestine

Several scientific studies have shown that 4-84% of people with IBS had bacterial overgrowth in the small intestine compared with 1-40% in the control groups. (1-6)

Overgrowth of bacteria in the small intestine can be due to various factors

The use of drugs that reduce stomach acid has been shown to be linked to bacterial overgrowth in the small intestine. (7-9) Reduced intestinal motility may involve a risk of bacterial overgrowth in the small intestine (11), which is interesting since a research study showed that the gastric acid inhibitory drug omeprazole can reduce intestinal motility. (12) There are no publications that stress in itself can cause bacterial overgrowth in the human gut, but interestingly, animal studies have shown that stress can reduce both gastric acid production (13) and intestinal motility (14) and inhibit the immune system, (15) all factors with the potential to cause bacterial overgrowth in the small intestine.

Examples of symptoms of bacterial overgrowth in the small intestine (16)

Pain in the upper abdomen
Belching
Bloating
Digestive problems
Nausea
Diarrhea
Gas

General symptoms

Exhaustion
Muscle pains, fibromyalgia (18)
Skin disorders, such as Rosacea (19)

What to do in case of overgrowth of bacteria in the small intestine

It is seldom enough to just change diet and lifestyle in this problem. In most cases, antimicrobial preparations need to be taken, which can reduce the amount of bacteria in the small intestine. The most common antibiotic treatment is Xifaxan (the active substance is called rifaximin), but a study has shown that even herbal preparations with antimicrobial properties were as effective as Rifaximin (20). Please see further information below.

References

1. Ghoshal, UC et al. (2017). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut and liver, 11(2), 196–208.
2. Takakura W and Pimentel M. (2020). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update Front Psychiatry. 2020; 11: 664. Published online 2020 Jul 10
3. Bures J et al. (2010). Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28; 16(24): 2978–2990.
4. Nucera G, et al. (2005). Abnormal breath tests to lactose, fructose and sorbitol in irritable bowel syndrome may be explained by small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2005;21:1391-1395.
5. Ghoshal UC et al. (2014). Breath tests in the diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome in comparison with quantitative upper gut aspirate culture. Eur J Gastroenterol Hepatol 2014;26:753
6. Pimentel M et al. (1995). Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol 2000;95:3503-3506.
7. Shindo K and Fukumura M. (1995). Effect of H2-receptor antagonists on bile acid metabolism. J Investig Med. 1995;43:170–177.
8. Thorens J et al. (1996). Bacterial overgrowth during treatment with omeprazole compared with cimetidine: a prospective randomised double blind study. Gut. 1996;39:54–59.
9. Lewis SJ, et al. (1996). Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole. Aliment Pharmacol Ther. 1996;10:557–561
10. Wai-Kit L, and Chan WW. (2013). Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: a meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association vol. 11,5 (2013): 483-90.
11. Jacobs, C. et al. (2013). Dysmotility and proton pump inhibitor use are independent risk factors for small intestinal bacterial and/or fungal overgrowth. Alimentary pharmacology & therapeutics, 37(11), 1103–1111.
12. Lewis, S. J. et al. (1996). Altered bowel function and duodenal bacterial overgrowth in patients treated with omeprazole. Alimentary pharmacology & therapeutics, 10(4), 557–561.
13. Esplugues, J. V. et al. (1996). Inhibition of gastric acid secretion by stress: a protective reflex mediated by cerebral nitric oxide. Proceedings of the National Academy of Sciences of the United States of America, 93(25), 14839–14844. https://doi.org/10.1073/
14. Taché, Y et al. (2001). Stress and the gastrointestinal tract III. Stress-related alterations of gut motor function: role of brain corticotropin-releasing factor receptors. American journal of physiology. Gastrointestinal and liver physiology vol. 280,2 (2001): G173-7.
15. Campos-Rodríguez, R et al. (2013). Stress modulates intestinal secretory immunoglobulin A. Frontiers in integrative neuroscience vol. 7 86. 2 Dec. 2013
16. Satish RSC and Bhagatwala J. (2019). Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. Clinical and translational gastroenterology vol. 10,10 (2019): e00078.
17. Dukowicz, AC et al. (2007) Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterology & hepatology vol. 3,2 (2007): 112-22.
18. Pimentel, M., et al. (2004). A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Annals of the rheumatic diseases, 63(4), 450–452.
19. Parodi, A., et al (2008). Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 6(7), 759–764.
20. Dhalla VCS et al., (2014) Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. Glob Adv Health Med. 2014 May; 3(3): 16–24

You can try any of the following preparations that according to some studies have been shown to have a positive effect on the intestinal flora

GutClear®

GutClear® is a gluten-free dietary supplement with antimicrobial effects for reducing bacteria in the small intestine developed by Gutfeeling Labs AB and contains a combination of various plant substances (so-called botanicals) with antimicrobial properties. The content consists of a powder of psyllium seeds, bark from the jatoba and magnolia tree and the root of rose root. GutClear® can pave the way for your dietary fiber to the colon where these dietary fibers have their positive effects. Please read more here: gutfeelinglabs.se

Jatoba

Jatoba, (Hymenaea courbaril in latin) was described by Carl von Linné and belongs to the family of pea plants. In a review study, Jatoba has been found to be used in the treatment of cough, diarrhea, colic, asthma, anemia, sore throat, kidney problems, urinary tract infections, etc. (1) of which an experimental study showed that Jatoba could be used in inflammatory conditions, asthma, diarrhea and bacterial infections and that phenolic compounds such as flavonoids and tannins possess the bioactive properties. (2) Research is underway to characterize substances from Jatoba with the antibacterial properties detected against E. coli, for example. (2,3) In addition to antibacterial effects, Jatoba has also shown the potential to kill fungi (4).

Rose root

Rose root has in animal experimental studies been shown to balance the intestinal flora by reducing the levels of so-called proteobacteria (including Escherichia, Salmonella, Vibrio and Helicobacter, all with the potential to cause inflammation of the intestinal mucosa). In the same study it was shown that rose root could increase levels of beneficial bacteria such as Akkermansia (6) and in two more studies it could be shown that rose root reduced the amount of Stafylococcus aureus (7) and Pseudomonas aeruginosa. (8)

Chicory

Chicory (Cichorium intybus in Latin) has historically been used as a salad, coffee substitute and as a remedy for gout. Since ancient times, the root has been used to improve digestion and has shown antibacterial effect against Bacteroides in animal experimental studies. (9) In animal studies, Chicory has also been shown to reduce excessive appetite (10) and strengthen the barrier function of the intestinal mucosa. (11)

Reasons not to take supplements

Rose root: Hypersensitivity to the active substance or to any additive.

Chicory: Do not take if you have vascular disease, varicose veins, or hemorrhoids. Caution in asthma.

GutClear®: In case of hypersensitivity to psyllium seeds (Plantago ovata) GutClear® should not be taken.

When taking blood-thinning treatment, especially with Waran and to some extent with Plavix or acetylsalicylic acid and when taking sedatives (such as Benzodiazepines) at daytime always consult a doctor.

GutClear® can not be taken during pregnancy or breast-feeding.

GutClear® can not be taken if the colon has been surgically removed (kolectomy).

GutClear® is not recommended for children.

If you are unsure, contact us at info@gutfeelinglabs.se, your doctor or other healthcare professional to ensure that the supplement works together with your possible illnesses and / or medications.

About the products GutClear®, Jatoba, Rose root and Chicory root

It may be considered beneficial to start with GutClear® for 10 days. If you wish to take a control test of the intestinal flora, the sample should be taken 1-2 days after the end of GutClear®.

If you prefer to try Jatoba or Rosenrot, this can be taken for 1-2 weeks. If you wish to take a control test of the intestinal flora, this can be done starting 1-2 days after the last capsules.
GutClear®, Jatoba and Rosenrot may be taken continuously during 30 days. After this, it is possible to take these dietary supplements episodically during 1-4 days if necessary.
Chicory contains 50% inulin (the rest consists of various bioactive substances) and can be taken after GutClear®, Jatoba and Rosenrot during a longer period.
Dosage of Jatoba, Rose root and Chicory
For GutClear®, it is most optimal to take a sachet on an empty stomach in the morning and then wait 15 minutes, but preferably 30 minutes with breakfast (see gutfeelinglabs.se). Capsules of Jatoba and Rosenrot are taken with a small meal, such as breakfast.
Jatoba: An excellent way to take Jatoba is along with crushed psyllium seeds (if you can tolerate psyllium seeds). Pour in 1 teaspoon (5 ml) crushed psyllium seeds and empty 1-2 capsules of Jatoba in an empty glass and mix the powders. Then add ½ dl cold water and whisk with a fork until it starts to thicken slightly and then add 1 dl water or juice and whisk together. Drink the solution immediately before it becomes too thick, followed by another glass of water or juice. Wait at least 30 minutes before eating anything afterwards.
The dosage is 1 capsule on the 1st day followed by 2 capsules on days 2-30. Thereafter, Jatoba can be taken as needed for 1-4 days. Order via info@derivatamedicus.se
Enter your name, postal address and mobile number and quantity (60 capsules for SEK 292 and 120 capsules for SEK 438 plus shipping).
Rose root: Take either 1 capsule daily with a meal or the conntent of 1 capsule with crushed psyllium seeds as above. Total dose 30 capsules. Rose root can then be taken if needed for 1-4 days. Order via info@derivatamedicus.se
Enter your name, postal address and mobile number and quantity (60 capsules for 256 SEK plus shipping)
Chicory: Pour boiling water over ½-1 tablespoon chicory root powder and whisk out the powder. After drinking this, you can have a light breakfast. * Maximum dose is 1 tablespoon daily. Chicory can be taken over a longer period of time.
Can be obtained via: https://www.ortagubben.se/orter/torkade-orter/cikoria-pulver-100-g
You should not eat foods containing fermented products such as yogurt, kefir, film milk at the same time as Jatoba, Rose Root or Chicory. However, fermented products can be ingested at any other time of the day with these supplements.
Feel free to contact us at info@gutfeelinglabs.se if you want to discuss effects and if you have done a new analysis and want to discuss the results.

References

JATOBA

1. Boniface, PK et al. (2017) Current state of knowledge on the traditional uses, phytochemistry, and pharmacology of the genus Hymenaea, Journal of Ethnopharmacology, Volume 206, 2017, Pages 193-223

2. Rocha LS, et al. (2018). Data on elemental composition of the medicinal plant Hymenaea martiana Hayne (Jatobá). Data Brief. 2018;19:959-964. Published 2018 May 31.

3. Marinho CGS et al. (2018). Antibacterial Evaluation of ethnolic extracts of Hymenaea Clebaril L. cases front Escherichia coli. Journal of Microbiome, 2018, 1:5.

4. Souza, ACM et al. (2010). Antimicrobial activity of Hymenaea martiana towards dermatophytes and Cryptococcus neoformans. Mycoses vol. 53,6 (2010): 500-3.

ROSENROT

5. Hung, SK et al. (2011). The effectiveness and efficacy of Rhodiola rosea, a systematic review of randomized clinical trials.” Phytomedicine : international journal of phytotherapy and phytopharmacology vol. 18,4 (2011): 235-44.

6. https://www.sciencedirect.com/science/article/abs/pii/S0278691519300079

7. Ming DS. et al. (2005). Bioactive compounds from Rhodiola rosea (Crassulaceae) Phytoher. Res. 2005;19:740–743.

8. Bany J. et al. (2009). The effect of Rhodiola rosea extracts on the bacterial infection in mice. Cent. Eur. J. Immunol. 2009;34:35–37.

CIKORIA

9. Li X.et al. (2019). The Mode of Action of Chicory Roots on Skatole Production in Entire Male Pigs is neither via reducing the population of skatole-producing bacteria nor via increased butyrate production in the hindgut. Applied and Environmental Microbiology Mar 2019, 85 (6) e02327-18.

10. Fouré M. et al. (2018). Chicory Roots for Prebiotics and Appetite Regulation: A Pilot Study in Mice. Journal of Agricultural and Food Chemistry 2018 66 (25), 6439-6449

11. Pham VT. et al. (2018). The effects of fermentation products of prebiotic fibres on gut barrier and immune functions in vitro [published correction appears in PeerJ. 2018 Aug 17;6]. PeerJ. 2018;6:e5288. Published 2018 Aug 10.