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SIBO and Chronic Fatigue: The B12 Connection- The Many Ways SIBO Robs Your Energy and Vitality

One of the biggest problems that we see in our clinic for those patients who have Small Intestinal Bacterial Overgrowth (SIBO) is chronic fatigue. There are many reasons why people who have SIBO struggle with chronic fatigue and in today’s article/video Im going to review a few that I see regularly. B12 deficiency is just one common reason for fatigue, but if you hang around, I’m going to go over the many reasons why this fatigue doesn’t just go away even after taking B12 supplements

How to Making Fatigue Disappear 

While it would be nice to assume that if you could just get rid of the SIBO, your energy levels would return and you could just go back to living life. Unfortunately, if you have worked with enough patients who have SIBO, what you often see is that even after you successfully treat SIBO as indicated by testing, many patients still struggle with fatigue.

Long term SIBO snowballs into many other problems and leaves a wake of destruction behind. If you are reading this article or watching this video, and you have been treated for SIBO, you know exactly what I am talking about. Hang around and you will have a better understanding of why you still suffer with fatigue and brain fog.

I’m Dr Hagmeyer and in today’s videos I want to specially shed some light on SIBO small intestinal bacterial overgrowth  more specifically the different ways it can cause chronic fatigue and nutrient deficiencies.

One of the nutrients that I want to specifically talk about today, one that often is deficient in more than 90% of my patients that have SIBO is vitamin B12. Not only is it important to test vitamin B12 levels when you have Small Intestinal Bacterial Overgrowth (SIBO), but if you have a B12 deficiency this can certainly lead to chronic fatigue as well as so many other B12 symptoms like headaches, migraines and numbness in hands and feet.

What Is SIBO

SIBO stands for Small Intestinal Bacterial Overgrowth. It is a condition characterized by an excessive growth of bacteria in the small intestine. Normally, the small intestine contains a relatively low population of bacteria compared to the large intestine. However, in SIBO, there is an imbalance in the gut microbiota, leading to an overgrowth of bacteria in the small intestine.

This overgrowth can disrupt the normal digestive processes, impair nutrient absorption, and cause a range of uncomfortable symptoms. Common symptoms of SIBO may include bloating, abdominal pain, gas, diarrhea, and malabsorption issues. Small Intestinal Bacterial Overgrowth (SIBO) can also be associated with other conditions, such as irritable bowel syndrome (IBS) and certain gastrointestinal disorders including inflammatory Bowel disease.

Vitamin B12 and Chronic Fatigue?

Vitamin B12 is necessary for red blood cell production and red blood cells carry oxygen throughout your body and anything that increases oxygen in the body, helps keep you energized mentally, physically, and even emotionally. One thing I really want to stress to you is that if you have a low red blood cell count resulting from a B12 deficiency, it may not be as simple as just taking B12 to help with your chronic fatigue, here’s why.

Many of my SIBO patients also have thyroid disease, have heavy menstrual cycles,  they are taking medications that deplete B12 levels like antacids, diabetes medication, antidepressants, proton pump inhibitors, Histamine blockers…. again, all problems that many people with SIBO also have- This creates a cycle.

Some of your current health problems, and even some of your medications are not only contributing to your SIBO but in addition are causing your body to be B12 deficient.

When it comes to Small Intestinal Bacterial Overgrowth (SIBO), there has been a dramatic change and dramatic shift in the normal bacterial flora, which in turn effect nutritional status and nutritional absorption in many ways. If you are interested in learning more about these nutritional imbalances, I wrote an article right here, that goes through all the most common nutrient imbalances I see.

Reasons You Suffer With Fatigue When You Have SIBO.

How SIBO Causes Chronic Fatigue

I already mentioned that people with bacterial overgrowth or yeast overgrowth often have a B12 deficiency. But many of the medications that the vast majority of the population are taking are known to induce vitamin B12 deficiencies. So this is one way Small Intestinal Bacterial Overgrowth (SIBO) causes Fatigue, but its not the only way we see patients who have SIBO also suffer with chronic fatigue syndrome.

Reason #2 Competition

When you have Small Intestinal Bacterial Overgrowth (SIBO), the bacteria compete with you for other critical nutrients, nutrients from the food you eat, never make it into your own cells. Heres’ what’s happening.

The bacteria in the small intestines are like little thieves. Bacteria don’t belong in the small intestines. They belong in the large intestines, so when these bacteria are in the small intestines, they are robbing your body of nutrients like B12 to feed themselves.

Food should be absorbed in the large intestines, but instead the bacteria are in the small intestines where they are getting access to those nutrients first!

If you aren’t absorbing your nutrients, because the bacteria are getting to it first, it should come as no surprise as to why you feel so sluggish, exhausted, and chronically fatigued, brain fogged, depressed all the time-Even though you might be eating a balanced diet getting enough calories, it doesn’t necessarily mean that you’re able to absorb all the nutrients from your food.

Reason #3 Bloating and Diarrhea

Another cause of not having enough energy and feeling fatigued is a reduced appetite due to bloating, feeling full all the time or having diarrhea.

Bloating and diarrhea present unique challenges- if your bloated and full all the time, guess what you don’t feel like eating, many times I hear from patients, “Dr Hagmeyer I’m just not hungry” …..and this can make it difficult to eat hit the nutrient requirements needed throughout the day.

Diarrhea on the other hand, very common symptom in those patients with Hydrogen producing bacteria, they also find themselves tired and run down because food is going through their gut too quickly, whereby nutrients don’t have enough time to get absorbed, these patients often will see undigested food and supplements in the toilet. These patients can find themselves in a dangerous situation because of serious malabsorption and malnutrition. They are losing so much weight and they are essentially wilting a way.

Damage to Absorptive Mucosa, Gut inflammation, and Leaky Gut

#4 Damage to Absorptive Mucosa, Gut inflammation, and Leaky Gut

The small intestine normally has a relatively low bacterial population compared to the large intestine. When bacteria from the large intestine migrate to and colonize the small intestine, as seen in SIBO, these bacteria especially methane and hydrogen sulfide producing bacteria can damage the absorptive Mucosa. Hydrogen sulfide bacteria include Desulfovibrio and Bilophila. Both are associated not only with SIBO but also with gut inflammation as seen in Inflammatory Bowel Disease or IBD.

Hydrogen sulfide can induce oxidative stress in the gut mucosa. Oxidative stress occurs when there is an imbalance between the production of reactive oxygen species (ROS) and the body’s ability to neutralize them. Excess ROS can damage cells and tissues, including the gut mucosa, leading to inflammation, cell death, and impaired tissue repair. Once the mucosa and barrier has been insulted, their is a release of pro-inflammatory cytokines and other immune mediators that further amplify the immune response, perpetuating the cycle of inflammation and injury to the gut leading to increased intestinal permeability or leaky gut. Since the absorptive Mucosa is now damaged, absorption of amino acids, proteins, and carbohydrates leading to weight loss as well as deficiencies in  B12, Iron, and Zinc. One of the symptoms most frequently experienced is fatigue.

Reducing hydrogen sulfide production by following a low Sulfur and addressing the underlying dysbiosis is important for managing gut health. This may involve dietary modifications such as following a low sulfur diet, probiotic supplementation, targeting specific bacterial overgrowth, and overall gut health support.

#5 Enterotoxins.

Small Intestinal Bacterial Overgrowth (SIBO) and the bacteria are capable of producing enterotoxins. Enterotoxins are toxins produced by certain bacteria that primarily affect the cells lining the intestines. These toxins are responsible for various gastrointestinal symptoms and can cause illness. Enterotoxins typically target and disrupt the function of the intestinal epithelial cells, which are responsible for nutrient absorption and maintaining the integrity of the gut barrier.

Enterotoxins are primarily produced by specific strains of bacteria, including but not limited to certain species of Escherichia coli (E. coli), Staphylococcus aureus, Clostridium perfringens, Bacillus cereus, and Vibrio cholerae. Not only can these bacterial toxins cause fatigue, but it can also cause nausea, abdominal cramping, watery diarrhea, brain fog, skin conditions like acne and Rosacea.

SIBO and fatigue

#6 Low Thyroid Hormones

Hypothyroidism in its own right can cause fatigue. But the problem with thyroid disease is that many of my patients who have Small Intestinal Bacterial Overgrowth (SIBO), only find out that they had thyroid disease because we tested them for it. Everyone who has SIBO should be checked for Thyroid disease including Low T3 and Hashimotos disease and that’s because thyroid disease can cause SIBO and SIBO can impact the way your thyroid makes T3 and T4. 

 SIBO can lead to chronic inflammation in the small intestine. Inflammation in the gut can disrupt the normal functioning of the thyroid gland and impair the conversion of inactive thyroid hormone (T4) to its active form (T3) in the peripheral tissues. This can result in decreased thyroid hormone levels and low thyroid function.

SIBO can lead to problems in the way your body converts T4 into T3. T3 and T4 are thyroid hormones but very often people with hypothyroidism suffer from something know as low T3.

T3 is the active form of thyroid hormones and when your thyroid hormone levels are low, you can suffer with fatigue, weight gain, depression, acne, low stomach acid production, and constipation.

SIBO has also been associated with an increased risk of autoimmune conditions, such as Hashimoto’s thyroiditis, which is the most common cause of hypothyroidism

If you have hypothyroidism and you are taking medication such as Armour or Levothyroxine, the inflammation in the small intestine caused by SIBO can interfere with absorption of your thyroid medication. 

SIBO and Thyroid fatigue

So those are two major links between Thyroid disease and Small Intestinal Bacterial Overgrowth (SIBO) you should be aware about.

So, while it may seem like a daunting task to try to address Chronic fatigue when you have SIBO based on the many causes I’ve talked about in today video, its really not once you know where the problem is.

The problem ten out of ten time is the fact that most people haven’t been properly tested and that makes it impossible to try to fix the problem. You can’t fix something if you don’t know where it is or how its broken.

Once you know what your problems are an understand what’s really at the ROOT CAUSE of your SIBO, you can now start addressing these issues one by one. Base hits win the ball game!

But you must have a game plan!

As much as I wish I could offer you a quick fix in a video. It’s not possible

Getting diagnosed and tested for Small Intestinal Bacterial Overgrowth (SIBO) that’s the easy part, but identifying all the actual root causes and the contributing factors as to why you have SIBO, that requires a more personalized approach.

Final thoughts on Treatment when it comes to SIBO and Chronic Fatigue 

Treatment for some people may involve antimicrobials/antifungals, dietary changes like a low FODMAP diet or elemental diet, in some patients with SIBO, their microbiome may be so fragile that killing the overgrowth with antimicrobials or antifungals can make the problem worse, in these patients, it might be worth considering other areas of your body to start with first.

Correcting hormone imbalances because of the impact that hormones have on motility might be a good first step, addressing nutritional imbalances or reassessing any medications you might be taking might be something to consider. In others it might be addressing problems like sleep and stress.

The point here is that our bodies are complicated, and all of our organ systems are intimately woven and interconnected. Finding healing and balance in your digestive system often involves optimizing and improving more than just your digestion! This is why I said you need to look at the Big Picture.

But I’m certain that If you work with a health care practitioner who is not only certified in Functional Medicine but has experience at looking at the BIG picture- you will find answers that you are searching for and with that you can overcome chronic fatigue and reclaim your energy and vitality.

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