I’ve been lately discussing the issue of small intestinal bacterial overgrowth, or SIBO, a situation in which bowel microorganisms (especially of the undesirable Enterobacteriaceae variety such as E. coli and Shigella) ascend up from the colon and colonize the ileum, jejunum, duodenum, and stomach. This has numerous health implications that are only beginning to be appreciated: irritable bowel syndrome (IBS), fibromyalgia, psoriasis and other skin rashes, restless leg syndrome, diverticular disease, heightened body-wide inflammation, increased risk for colon cancer—SIBO is either synonymous with these conditions or at least a major contributor.
I was discussing these issues with two radiologist friends recently who told me that, when they review CT scans, they have been witnessing a dramatic increase in a finding called fecalization. Feces retained in the colon has a characteristic appearance on CT scans (with oral contrast agent given) and it should only appear in the colon. But they have been seeing an increasing number of people with fecalization appearing in the small intestine where it should not be seen. Small intestinal fecalization has a limited number of causes, such as small bowel obstruction, which is an emergency, exquisitely painful, and life-threatening. But the majority of these people in which fecalization is being observed are young (twenties and thirties) and are not acutely ill, but have chronic abdominal complaints such as urgency, diarrhea, and bloating.
Fecalization of the small bowel is a sign that SIBO is present, i.e., fecal organisms have ascended up the small intestine. The observations of my two radiologist friends that the frequency of fecalization is on the rise is consistent with the explosion of SIBO nationwide. Because it is becoming clear, for instance, that the majority, perhaps all, the people with IBS also have SIBO, then that adds around 30 million people to the list with SIBO. Throw in fibromyalgia, autoimmune conditions, psoriasis, etc. and the number of Americans with SIBO is likely something like 60 million or more, an epidemic on a par with overweight/obesity and type 2 diabetes.
What is driving this apparent epidemic of fecalization/SIBO? This list of causes is long and includes:
- Delivery by c-section, no or brief period of breastfeeding
- Antibiotic residues in dairy and meats
- Pesticide and herbicide residues in produce
- Bt toxin and glyphosate residues in genetically-modified foods
- Acid-suppressing drugs like Prilosec and Protonix. (There are probably plenty of other drugs that disrupt bowel flora, but this is almost never explored and documentation is not required for FDA approval.)
- Chlorinated/fluoridated drinking water
- Change in bowel flora that allow proliferation of undesirable species
- Synthetic sweeteners aspartame, sucralose, saccharine
- Emulsifying agents such as polysorbate 80 and carboxymethylcellulose
It also doesn’t help that we have soaps and toiletries for every surface and orifice and consume inadequate quantities of lactate-fermented foods and prebiotic fibers.
Chronic diseases are on the rise such that nearly half of all Americans now have one, if not several, chronic diseases. While there are many reasons for this trend (e.g., sugar consumption, smoking, sedentary lifestyles, etc.), I believe that the above factors that lead to SIBO are a big contributor. As you’d expect, reversing SIBO and not allowing yourself to be fecalized is associated with reversal or improvement of many chronic health conditions. For these reasons, SIBO is a hot topic of conversation in our Undoctored Inner Circle and our Virtual Meetups (two-way video meetings).