Everything You Need to Know About Hormones, and Their Connection to Gut Health Including SIBO
The SIBO hormone connection is often ignored during most treatment plans for Small Intestinal Bacterial Overgrowth (SIBO). If this is an important piece of your recovery and ignored or overlooked, a relapse with SIBO is usually inevitable. Hormone have a profound impact on gut health and vice versa. Most doctors fail to look at the Big picture when it comes to SIBO and focus most of their efforts only on killing the bacterial overgrowth and then putting patients on the Low FODMAP diet. While the Low FODMAP diet can “starve out bacteria” they can also cause a variety of hormonal problems. In today’s article, I will review some of these problems I have seen over the years with the low FODMAP diet, I will review why these problems happen, and I will review the relationship between SIBO and Hormones and why this connection is so important and not to be overlooked. Keep in mind that when I say “hormones”, I am referring to not only Sex hormones, but Thyroid Hormones, and the hormones made by the adrenal glands (cortisol). All can contribute to the development of SIBO and vice versa.
SIBO-It’s More Than Killing Bacterial Overgrowth
While it is easy to think that gut health is separate from GI health this is far from the truth of what we see in clinical practice. I encourage all my patients that when you are dealing with IBS, SIBO, Crohns, Ulcerative Colitis and other Gut problems, to think “Big Picture.” We need to think outside the bacteria box.
If you are someone who continues to relapse or you are someone who has not been able to incorporate more food into your diet, then it might be time to consider the SIBO Hormone connection. We need to think about hormones and how certain hormones affect GI motility, we need to think about the relationship between hormone balance and gut dysbiosis, we need to think about the role that certain hormones have on inflammation, we need to think about the role hormone balance has on histamine Levels, we need to think about hormones and how they affect Ileocecal valve function and finally, we need to to think about hormones affect on the Vagus nerve. In other words there are many things to think about the various connections to SIBO. If all your doctor is focusing in on is the low FODMAP diet and antibiotics or antimicrobials, you will be vulnerable to another SIBO relapse. So, let’s start unpacking this information about SIBO Hormone connection and even how the low fodmap diet could be a problem as well.
Why Most SIBO diets Including Low FODMAPS Cause Hormonal Problems- When Done Incorrectly.
Cutting out high-FODMAPs foods is effective at reducing and even eliminating gut symptoms such as bloating, distension, flatulence, gassiness and pain because you’re not eating the foods that feed the bacteria- Unfortunately, they are not done correctly most of the time and when they are not done correctly there are several problems that now need to be addressed. Heres why Low FODMAP diets can be a problem.
- SIBO diets can be too restrictive for some individuals. While they are rich in proteins and fats, they lack many of the vitamins, minerals, antioxidants that comes from carbohydrates, starches and fruits. This can cause changes to the levels of short chain fatty acids, as well as causing nutritional deficiencies and oxidative stress in the body. These deficiencies are very typical of what you would see in someone who is malnourished or someone with an eating disorder.
- SIBO Diets can be incredibly challenging from a psychological perspective and often create an unhealthy relationship with food. I encounter this daily with patients.
- Research shows that long term low FODMAP restrictions reduce intake of prebiotics which are necessary for good gut health. A low intake of prebiotics can lead to becoming more sensitive to FODMAP containing foods over time. This will cause problems when you try to reintroduce foods back into your diet.
- Starving gut bacteria for too long and they will start eating you from the inside.- Our colon is lined with a protective mucous layer that serves as a habitat and food source for some of our colonic bacteria. When there’s not enough fermentable fibre to go around, the more these bacteria feed on our mucus layer. This leads to leaky gut, inflammation and further gut dysfunction
Consequence of Oxidative Stress on the Gut Due to Malnutrition
A study was conducted on SIBO patients in 2014 showed a relationship between cytokines and antioxidants and SIBO.
A total of 120 Ulcerative Collitis, patients and 125 age and sex matched controls with no GI symptoms were enrolled. Plasma levels of IL-6, IL-8, TNF-α and IL-10 were measured in all subjects. Lipid peroxidation and Glutathione (GSH) (Markers of Oxidation were measured.)
People were tested for SIBO using lactulose and glucose hydrogen breath tests. Out of the 120 UC patients here’s what they found;
- Plasma levels of inflammatory immune markers (IL-6, IL-8, TNF-α and IL-10) in patients were significantly higher as compared to controls. (This means more inflammation)
- Lipid peroxides (oxidative stress) was significantly increased compared to controls (This means more cellular damage)
- Glutathione was significantly decreased as compared to controls. (Glutathione protects your cells)
- SIBO were significantly higher than compared to controls. (Bacterial overgrowth was greater)
- Significant correlation between SIBO with (inflammatory cytokines) IL-6, IL-8, TNF-α, and IL-10, lipid peroxides and Glutathione. (More immune Activation)
Conclusion: This study indicates that increase in cytokines and decrease in anti-oxidants in Ulcerative Colitis patients would have resulted in oxidative stress causing delayed GI motility leading to SIBO.
Restrictive Diets (Cause Nutritional Deficiencies, this leads to oxidative stress, High levels of Oxidative Stress Deplete Glutathione levels, leading to Inflammation, Cellular Damage, And Greater Bacterial Overgrowth.
As a result of Oxidative Stress, the patient is likely to experience a more severe form of SIBO and its symptoms- Does this sound familiar? Glultathione is the master anti-oxidant and one of the ways we see low glutathione showing up is with elevated levels of 8-hydroxy-2-deoxyguanosine. This reaffirms one of the reasons, I am such a big proponent of liposomal Glutathione! It helps reduce oxidative stress.
Low FODMAP Diets Can Affect Blood Sugar and Cortisol Levels
There are a number of negative consequences that your body goes through when your carb intake is inadequate as often is the case with low carb/Low FODMAP diets that are not properly supervised.
To begin with, when you excessively skip meals, restrict carbs for too long or exercise to intensely on an empty stomach, your blood sugar (glucose) levels will plunge. Since low glucose is seen as a threat to the body, the body’s defense to this is the release of Cortisol.
Cortisol levels when elevated, are catabolic, meaning they break down muscle tissue and stored glycogen for energy use. High cortisol will cause your body to burn or break down muscle and store fat. The end result is energy crashes, sugar cravings and weight gain and host of other hormonal problems. Keep in mind that cortisol is released in terms of stress and for this reason is known as the body’s “fight or flight” hormone. This hormone activates the Sympathetic Nerve Syste and is counteractive to the entire digestive process.
High cortisol a sign that the body is in a heightened stress state and is not conducive to the state of digestion. The process of Digestion requires is Parasympathetic Nerve system activity which includes proper Vagus Nerve tone.
A person who finds themselves struggling with ongoing Gut issues is often struggling with a scenario of cortisol imbalances and adrenal problems.
High cortisol doesn’t only affect blood sugar, high cortisol also has the ability to block Thyroid hormones, estrogen, progesterone and testosterone levels. High cortisol blocks Thyroid Hormone conversion and lead to low T3 and often elevated levels of Reverse T3. When this happens, the individual is likely to suffer from hypothyroidism or normal thyroid with low thyroid symptoms (subclinical hypothyroidism).
Symptoms of low thyroid are all too common in people with SIBO. Low Thyroid symptoms include fatigue, irritation, bloating and constipation. Other symptoms common to low thyroid hormone levels include hair loss, brittle nails, unexplained weight gain and skin dryness.
High Cortisol Lowers Estrogen Levels
High cortisol also lowers estrogen levels, which can result in the deposition of fat, also sometimes called that “menopausal middle.” When estrogen is lowered from unrelenting stress and cortisol production, all the female hormone imbalance symptoms such as hot flashes, night sweats, sleep problem, and mood swings can get worse.
High cortisol levels from stress also reduce serotonin levels, so a woman may be even more moody, depressed, and have trouble sleeping.
All of this can happen when you fail to eat sufficient amount of carbs for your body and sufficient carbs for cellular energy. The carbohydrate set point or the amount of carbs needed varies from person to person. SIBO diets like Low FODMAP, Elemental, SCD can exacerbate an underlying hormonal problem when they are too restrictive for too long a period of time or not supervised properly.
I am not anti Low FODMAP diet at all, in fact, I often prescribe low FODMAP diet for patients with SIBO, IBS and IBD. But the difference is that my patients are also under the guidance of my Certified Functional Nutritionists who are monitoring what the patient is eating, monitoring nutrients and catching and correcting any problems that arise. I also don’t have patients on Low FODMAP diets for long period of time. Our Goal is to always integrate a variety of foods back into our patients lives as quickly as possible. Most of what I see are patients who come to me who have been on Low FODMAP diets or other SIBO diets for 6 month, 8 months 12 months and longer.
Key Point- Maintaining appropriate cortisol levels (Adrenal Hormones), Sex and Thyroid hormones is crucial For Effective SIBO Treatment and Excessive Low Carb Diets can sabotage these Hormones
If you want to make sure that you are implementing a diet properly, I recommend that you work with one of my Certified Functional Nutritionists.
How Hashimotos and Hypothyroidism Causes SIBO and IBS
If you have SIBO don’t overlook the Thyroid! It has been reported that SIBO may be present in more than half of patients with hypothyroidism. I’ve talked about this in several articles as well as videos. But as a quick reminder, if you have Hypothyroidism or Hashimotos disease, this low thyroid state impacts gut function in many ways;
- Low Thyroid reduces stomach acid production
- Low Thyroid reduces bile or pancreatic enzymes production
- Low Thyroid reduces Vagus Nerve Function.
- Low Thyroid shuts down the Migrating Motor Complex Activity.
Once gut motility and the MMC is slowed down, you are now at increased risk for bacterial overgrowth, fermentation, and putrefaction of the food.
This delayed MMC function, results in symptoms like gas, bloating, pain, heartburn, abdominal pain and inflammation.
In past articles, I have talked about Inflammation and how this inflammation is your thyroids worst enemy! Inflammation in the gut has been shown to reduce T4-T3 conversion and so The more gut inflammation you have have the more thyroid dysfunction you will experience and the worse your SIBO is.
- Learn more about IBS/SIBO Thyroid relationship
- For more information on Natural Thyroid Treatment.
- For more information on Natural Hashimotos Treatment
How Stress Hormones Like Cortisol Cause SIBO and IBS
Stress and more specifically Cortisol and adrenaline affect the gut in a variety of ways. Chronic stress affects numerous physiologic functions of the gastrointestinal tract including gastric secretions, gut motility, mucosal permeability and mucosal blood flow. Studies have shown that stress changes the microbiome.
To test the theory for their JPGN study, Dr. Maltz and his colleague, Michael Bailey, PhD, a principal investigator in the Center for Microbial Pathogenesis at The Research Institute at Nationwide Children’s, and their research team used mice who were either exposed to stress or left undisturbed, then infected with Citrobacter rodentium, a bacterial strain similar to E. coli in humans. The researchers studied the effect stress had on the microbiome, the levels of short chain fatty acids produced in the GI tract and the degree of inflammation. They examined colonic inflammation and attempted to identify correlations between inflammation, stress exposure and the levels of a range of bacteria and metabolites.
“When we exposed the mice to stress and infection at the same time, it significantly worsened the amount of inflammation seen in the colon,” says Dr. Maltz, who is also an assistant professor of Clinical Pediatrics at The Ohio State University and a principal investigator in the Center for Microbial Pathogenesis at The Research Institute at Nationwide Children’s. “At the same time, mice exposed to stress had very different microbiomes than those that weren’t exposed to stress.”
Some types of bacteria increased in the presence of both stress and infection while others — such as Parabacteroides, which are known to be low in patients with active IBD and potentially serve a protective role against inflammation — decreased. Furthermore, levels of short chain fatty acids decreased when exposed to only stress and the expression of their receptors changed in the presence of both stress and infection.
In short, stress altered the microbiome, which in turn increased the level of colonic inflammation
Stress- Cortisol and The MMC
The MMC (Migrating Motor Complex) helps keep the small intestine relatively clean by functioning like a street sweeper, moving food, bacteria and other debris from the small intestine into the large intestine. Cortisol (our stress hormone) increases blood sugar, causing it to crash and ultimately food cravings. If we give into those food craving or eat too frequently, we continue to reset the MMC.
Bottom line, when addressing SIBO, stress must be addressed to prevent recurrence.
A Weak Vagus Nerve
Patients with IBS and IBD have been shown to have weaker vagus nerve and both stress from the brain and inflammation in the gut can be responsible for it. This is why it is important that you manage stress as well as address the gut inflammation as it happens both happen to be dependent on each other.
Endotoxins (LPS) in the body is known to raise the cortisol levels and activate the HPA axis. There are receptors or signals in the gut that examine the environment for endotoxins and metabolite levels before communicating it to the brain with the help of the vagus nerve.
Probiotics can reduce the stress response and stress hormones and can easily change the gut environment with the vagus nerve activation. To ensure that the cortisol levels are optimized, the stress and the gut function should be in order.
How Sex Hormones Cause SIBO and IBS Symptoms?
Hormone Imbalance And Beta-glucuronidase
As discussed earlier, SIBO patients are likely to have low libido, vaginal dryness and irregular menstrual cycle. Furthermore, conditions such as infertility and PMS can also be triggered by SIBO.
Your gut bacteria produce an enzyme called Beta-glucuronidase. This enzyme has the the ability to break the bond between toxins and glucuronic acid. This enzyme needs to be present just the right amount–not too little and not too much. When bacteria produce too much beta-glucuronidase, the bonds between toxins and glucuronic acid are broken, and toxins and hormones that were meant to be excreted are then reabsorbed into the body.
At DrHagmeyer.com we often test for beta-glucuronidase levels in a home-based stool test. This information surprises a lot of people because this SIBO hormone connection has not been talked about much.
Apart from Estrogen, the Testosterone levels can also be effected in case of a gut inflammation. Leaky Gut, a condition associated with gut inflammation, leads to the movement of endotoxins from the gut to the testes, which will cause a decrease in testosterone levels and hence a low sex-drive in an individual.
Our Personal SIBO Recovery Program is a great place to start
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