The SIBO & PCOS Connection
There is no doubt that when my digestive issues were at their worst, my PCOS symptoms were too.
After eating my stomach would be bloated and I would get acid reflux.
Throughout the day, my hair would be shedding a ton and new, painful cysts would have appeared on my face.
I didn't know at the time, but hormonal and gut imbalances tend to go hand in hand.
Turns out I had 2 parasites, yeast, several pathogenic bacteria strains and also Small Intestinal Bacterial Overgrowth (SIBO) which had developed after two back-to-back episodes of food poisoning.
At the time, my diet wasn't great and I was also on the birth control pill which meant that my immune system and gut was already compromised.
I managed to clear the yeast and parasites pretty easily within a couple of months, with antibiotic and herbal treatment, however SIBO was the one issue that I really struggled to overcome for a long while.
This is because I wasn't focused on addressing the root causes of this gut imbalance. I was too myopically focused on 'killing' these gut bugs, and was overlooking the rest of my body.
You may be thinking...
What the hell is SIBO?!...
Small intestinal bacterial overgrowth (SIBO) is a condition when the gut bacteria which normally reside in the LARGE intestine, translocate into the SMALL intestine - where they shouldn't live!
Relatively few bacteria normally live in the small bowel (less than 10,000 bacteria per milliliter of fluid) when compared with the large bowel, or colon (at least 1,000,000,000 bacteria per milliliter of fluid).
Our small intestine is where we digest and absorb our food, plus it contains a large amount of immune tissue, known as 'gut associated lymphoid tissue' (GALT). If our small intestine is taken over by bacteria (whether they're good or bad), this can therefore affect the digestion of food, absorption of nutrients and creates chronic inflammation and immune activation.
This damages the cells lining the small intestine (mucosa) potentially leading to intestinal hyper-permeability (aka 'leaky gut). When the intestinal barrier becomes permeable, this allows large protein molecules from partially digested food or bacterial fragments to leak into the bloodstream.
'Leaky gut' has been linked to many chronic health conditions such as autoimmune diseases like Multiple Sclerosis (MS) and Rheumatoid Arthritis, neurological degeneration, Inflammatory Bowel Disease (IBD) and even cancer.
What are the symptoms?...
Common digestive symptoms include...
bloating soon after eating
Even if you don't have any gut based symptoms, you can still be dealing with SIBO. Non-gut related symptoms that can be caused by SIBO include...
skin problems (eczema, acne, psoriasis etc)
weight gain/weight loss
Symptoms can be widespread, affecting many different body systems, mainly due to the inflammation and nutrient deficiencies created by SIBO.
What causes SIBO?
There isn't just one cause of SIBO, however there are a number of risk factors that can increase your likelihood of developing this condition, including...
The abnormally slow movement of the digestive system (often due to hypothyroidism, obstructions or nerve damage in gut which can be associated with type 1 and 2 diabetes)
Low production of stomach acid and digestive enzymes (often caused by stress, h.pylori overgrowth, certain medications especially PPI's or nutrient deficiencies such as B1, B6 zinc and chloride - from high quality salt)
Physical abnormalities of the small intestine (often due to prior bowel surgery, celiac disease, abdominal adhesions. etc)
A weakened immune system (often due to stress, multiple courses of antibiotics, nutrient deficiencies, poor diet and other health conditions)
Medication use (including the oral contraceptive pill, NSAID's, antibiotic, stomach acid lowering drugs, immune suppressants,
High levels of stress (may be mental/emotional, physical, biochemical or structural)
Single or short-term events are known to trigger SIBO in some cases. The most common is see are food poisoning or gastroenteritis, acute stress such as death of a loved one, or medication use such as proton-pump inhibitors, which inhibit gastric acid secretions.
How do I know if I have SIBO?...
It is estimated that between 6 to 15% of healthy, asymptomatic people have SIBO, while up to 80% of people with irritable bowel syndrome (IBS) have SIBO.
If you have IBS-like symptoms (that don't resolve after improving your diet), and PCOS, I highly recommend you consider testing for SIBO as a driver of your hormonal imbalance.
A big tell tale sign for me is someone who says that they cannot tolerate high FODMAP containing foods (such as beans, apples, garlic, onions, cauliflower), that their symptoms worsen as the day goes on and have more bloating/gut issues when they consume more fibre and 'healthy' plant foods.
The test for SIBO is a breath test, which measures the production of methane and hydrogen gas in your small intestine, after consuming a lactulose solution drink.
In some cases, false negatives can occur, therefore I recommend working with a skilled health practitioner who can take both your current symptoms, health history and lab results into consideration.
It is important to test if you believe you have SIBO as you need to know which bacteria types are overgrown (methane or hydrogen producing) and the degree of overgrowth (based on gas volume). This determines which antibiotics or herbal antimicrobials should be used and for how long.
But how does SIBO relate to PCOS?...
#1 Malabsorption of nutrients
If we have an overgrowth of bacteria in our gut, stealing our nutrients and preventing us from digesting and absorbing food correctly, then this can lead to nutrient depletion.
Women with PCOS are more prone to nutrient deficiencies in the first place, therefore this could make things a whole lot worse! We need nutrients such as zinc, magnesium, amino acids and B vitamins to create, transport, utilise and eliminate our sex hormones like oestrogen and testosterone.
#2 Chronic Inflammation
Can you imagine how stressed the immune tissue of the small intestine is with all those bacteria and gases present? This will trigger chronic inflammation, which often leads to the production of stress hormones like cortisol and adrenaline from the adrenal glands.
Inflammation and high cortisol can also lead to (or worsen) insulin resistance. These 3 factors are the common ROOT CAUSES of PCOS for most women, to some degree.
#3 Intestinal permeability
As I mentioned, an overgrowth of bacteria in the small intestine can damage the delicate lining of the colon, which separates the contents of our intestine from our bloodstream! This can lead to a condition known as intestinal hyper-permeability (aka 'leaky gut'), which can create a lot of issues within the body.
It is estimated that 25% of women with PCOS have a thyroid issue. Not only can this make them more prone to developing SIBO, because of slow motility, but having intestinal permeability puts them at further risk of developing the autoimmune thyroid condition, Hashimotos Thyroiditis.
#4 Weight gain
Although a lot of people with SIBO lose weight, mainly due to nutrient malabsorption, diarrhoea or dietary restriction (to manage symptoms), a subset of people actually GAIN WEIGHT because of SIBO. This is believed to be due to certain bacterial strains that are overgrown, harvesting extra energy and calories from the food we consume.
Weight gain and excess body fat are known drivers of hormonal imbalance and worsening of PCOS symptoms. Studies have even showed that a reduction of 5-10% of body weight can reduce insulin resistance by around 50%. Although this may be great news, it may be near impossible to achieve, when you are dealing with chronic inflammation from a gut issue.