Did you know that what happens in your gut can affect your periods and hormones?
In episode twelve of my podcast and Youtube video, I discuss small intestinal bacterial overgrowth (SIBO) and its role in IBS; how SIBO can drive or exacerbate endometriosis, insulin resistance, premenstrual mood symptoms, and the fibromyalgia of perimenopause; plus how to treat SIBO.
Also available where you get your podcasts.
Transcript
Welcome to the podcast. I’m your host Lara Briden, a naturopathic doctor and author of the books Period Repair Manual and Hormone Repair Manual. It’s autumn in New Zealand, and I’ve just returned from a multi-day walk in Abel Tasman national park, where I even managed to do some swimming in the ocean. It’s a welcome break because I’m working on my third book, which is about metabolic health troubleshooting for women. Not just diet and exercise but all factors, including, of course, digestive health — which is today’s topic.
In my latest podcast and Youtube video, I look at IBS and SIBO and how it can affect women’s health problems like endometriosis, PCOS, premenstrual mood symptoms, and perimenopause.
Now, when it comes to IBS or irritable bowel syndrome and the menstrual cycle, there is a lot of information out there about how IBS symptoms worsen during the premenstrual phase of the menstrual cycle. Which makes sense because the drop in estrogen and progesterone at the end of the cycle alters gut motility, alters the microbiome, and increases inflammation, all of which lead to worsening IBS symptoms.
But in this podcast, I want to look at everything in the opposite direction. Specifically, I want to look at how an underlying IBS or SIBO problem can drive or exacerbate certain women’s health conditions, especially endometriosis, PCOS, premenstrual mood symptoms, and the fibromyalgia of perimenopause.
If you haven’t heard of SIBO, it means small intestinal bacterial overgrowth and is the common situation of having too many bacteria in the small intestine where they shouldn’t be. Most healthy gut bacteria should be in the large intestine, doing their jobs there. Having too much bacteria — even the good kind — in the small intestine can cause pain, bloating or distension, and — importantly — can cause increased intestinal permeability, also called “leaky gut,” which if which is the partial leakage of intestinal contents, including bacterial toxins, into the body. We’ll get back to intestinal permeability in a minute.
But first, let’s recognize that SIBO symptoms — especially pain and distension — are quite similar to IBS symptoms. And in fact, SIBO and other types of intestinal dysbiosis appear to be the underlying cause of many IBS, but not all IBS. And that’s because IBS isn’t one thing but rather an “umbrella diagnosis,” meaning that the term IBS really just describes a range of digestive symptoms that can result from different underlying biological conditions. drivers or mechanisms.
In that sense, the diagnosis of IBS doesn’t really mean anything but just a label for symptoms. The best approach for IBS is to try to identify and address the underlying biological driver, such as food sensitivities and/or today’s topic: SIBO.
Now, I mentioned that SIBO can increase intestinal permeability. Please understand that increased permeability can cause immune dysfunction and inflammation. And that is the mechanism by which SIBO can drive or exacerbate women’s health conditions.
Especially endometriosis, which we looked at in episode 4 of the podcast, called “Endometriosis is a disease of immune dysfunction.” In that episode, I talked about new research that found endometriosis may be driven by immune dysfunction caused, in part, by bacterial toxins entering the pelvis through “intestinal permeability and gut microbiota-derived extracellular vesicles” – ie, intestinal permeability. That makes sense because most women with endometriosis also have IBS, or, in many cases, SIBO, which according to that research, may be driving their endo. Although to be fair, the tight link between endo and IBS can also work in the opposite direction, where the endometriosis lesions themselves affect the bowel and cause IBS symptoms.
Next, SIBO and intestinal permeability can contribute to the insulin resistance of PCOS or polycystic ovary syndrome. That’s because of something called metabolic endotoxemia, which is a low-level elevation of circulating bacterial toxins — called endotoxins — that can cause or worsen insulin resistance. And, of course, insulin resistance can be a big part of PCOS. The bigger picture, metabolic endotoxemia can cause or exacerbate insulin resistance in everyone—including people without PCOS. That makes addressing SIBO and intestinal permeability an important part of a metabolic health or weight loss strategy potentially for anyone with insulin resistance, but especially for women in our 40s—or perimenopause—when we’re more vulnerable to intestinal permeability. , insulin resistance, and abdominal weight gain.
Next, SIBO and intestinal permeability can drive or exacerbate premenstrual mood symptoms. I discuss that in episode 7 of the podcast when I talk about the role of mast cell activation and histamine in premenstrual mood symptoms. With the understanding that histamine is not just an immune signaling amine; it is also a stimulating neurotransmitter that can cause restlessness, anxiety, and headaches, i.e. premenstrual symptoms. And yes, SIBO can cause mast cell activation and high histamine, thereby contributing to premenstrual mood symptoms. Of particular interest is the relationship between mast cell activation, histamine, and estrogen. Check out my blog post, The strange link between estrogen, mast cells, and histamine— link to show notes.
As I describe in the episode about premenstrual mood symptoms, histamine isn’t the only thing going on. There are also some very interesting dynamics with other neurotransmitters such as GABA and serotonin, but even they can be influenced by what is happening in the gut through the gut-brain axis. There’s also the fact that the gut microbiome strongly influences estrogen metabolism, which is a topic for another day.
Finally, I will say a few words about perimenopause, specifically about muscle pain or fibromyalgia that can appear during women’s 40s, i.e. perimenopause. Some of that tendency toward muscle soreness may simply be the result of perimenopausal disturbed sleep and/or loss of the natural anti-inflammatory benefits of progesterone and estrogen.
But SIBO and intestinal permeability can also play a role, especially because:
- Intestinal permeability has been suggested as the main underlying cause of fibromyalgia (I’ll put that citing show notes), and
- changing hormone levels—especially falling estrogen—can significantly increase the risk of intestinal permeability. That’s because estrogen usually helps to maintain a healthy intestinal barrier through several mechanisms, including by thickening the mucus layer.
So. If you are suffering from the later stage of perimenopause with weight gain, mood symptoms, and fibromyalgia, please consider whether SIBO and intestinal permeability may be playing a role. And know that by adjusting what’s going on in your gut, you can improve many symptoms.
The diagnosis of SIBO is primarily based on symptoms such as pain, diarrhea, constipation, fatigue, nausea, itching, and most commonly, stomach bleeding or coughing shortly after eating, especially after eating fermentables. carbohydrates, ie. FODMAPs. That’s why SIBO is the most common cause of FODMAP intolerance.
The diagnosis of SIBO can also be made through a breath test, which measures levels of hydrogen and methane, gases produced by bacteria.
In terms of treating SIBO, well, that will be its own episode! And also quite a large section in my upcoming book.
In broad strokes, conventional SIBO treatment usually involves a 10- to 14-day course of the antibiotic Rifaximin, followed, in some cases, by a prokinetic or motility agent.
Natural treatment of SIBO is more multi-pronged and diverse, using antimicrobial strategies such as the popular herbal medicine berberine, as well as antimicrobial probiotics such as Saccharomyces boulardii and antimicrobial diet changes such as the low FODMAP diet. Followed by or in conjunction with strategies to reduce inflammation, such as curcumin and strategies to promote healthy intestinal motility, such as HCl digestive enzymes and/or fasting for at least four hours between Foods. Fasting improves motility by activating something called migrating motor complexwhich helps clean the small intestine of any leftover food or bacteria that may be present after digestion and absorption have taken place.
Another natural approach for SIBO is to boost the neurotransmitter acetylcholine, which improves gut motility—just one of the many interesting ways that acetylcholine improves metabolic health, by the way. If you follow me on social media, you may have seen some of my posts about the nutrient choline and how it boosts acetylcholine. Other ways to boost acetylcholine include getting enough thiamine or vitamin B1 and supporting the vagus nerve and parasympathetic tone. Finally, one of the more popular natural prokinetic or motility agents is the herbal mix Iberogast, which, if you have IBS, you may have tried.
In closing, I’ll just say how well gut repair can improve menstrual problems and metabolic health. Because the gut is accessible and so responsive and repairable it can really be a game changer for overall health.
As usual, there is a section on my LaraBriden.com forum to discuss the episode. Enter there your knowledge, experience, questions, and your favorite SIBO resources and treatment protocols.
Hope this helps, and thanks so much for listening. Please share and leave a review. And see you next time when I tackle the oh-so-controversial topic of food addiction.
