It can also cause excess folic acid due to synthesis by bacteria in the small bowel. Vitamin B12 malabsorption may be caused by competitive uptake of B12 by bacteria in the small intestine. It can cause malabsorption of nutrients including iron and Vitamin B12, resulting in microcytic anemia or megaloblastic anemia. It causes increased permeability of the small intestine. Symptoms include bloating, abdominal distension, abdominal pain or discomfort, diarrhea, fatigue, weakness, and brain fog. The symptoms of SIBO can vary greatly depending on the severity and the species of bacteria populating the small intestine.
Higher levels of Enterococcus and Stretptococcus have been found in ME/CFS patients. īacteria commonly implicated in SIBO include Escherichia coli, Streptococcus, Lactobacillus, Bacteroides and Enterococcus. It is believed that this enables lipopolysaccharides from bacteria, food particles, and other undesirable substances to enter the blood stream, ultimately leading to an inflammatory response. SIBO appears to cause increased intestinal permeability, also known as Leaky Gut. SIBO cannot be diagnosed via stool testing. But this is rare due to the difficulty and cost of retrieving a sample from the small intestine. Sometimes it is diagnosed using a bacterial culture. SIBO is usually diagnosed via a Lactulose breath test. One study found that a 100% of fibromyalgia patients tested positive to a lactulose breath test, indicating SIBO, and that the degree of abnormality on the breath test correlated with the amount of pain reported. Several studies have shown that up to 84% of patients with irritable bowel syndrome have SIBO and that symptoms improve after treatment, while others fail to replicate these results. Research has found patients with CFS have alterations in microbiota, including lower levels of bifidobacteria and SIBO. Including patients with both open label and blinded treatment, it did find that those that had eradication improved compared to their baseline scores. One study of 24 CFS patients found 77% had SIBO, however it found no difference between the blinded treatment arms after treatment with neomycin, an antibiotic.
Comorbidities Īnecdotal reports suggest a high prevalence of SIBO among CFS patients. The rate of a positive lactulose test is low in healthy adults (0 to 20%).
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