We've said it once, and we will say it again, life is all about balance - both on the outside of our body and on the inside. And with 39 trillion cells in our microbiome alone, getting to understand your gut is a critical part of any healing journey because 39 trillion cells are a lot of cells to *not* be working in your favor.

Microbes (also known as tiny living things found all around us and within us) inhabit all parts of our human bodies. Some of them are good (like good bacteria), but some are bad. Understanding the concept of good and bad bacteria and microbes is a critical part of understanding the health of our microbiome because it is when the bad bacteria start to outrun the good, or go into parts of the body that they shouldn't, that problems can start to arise.

Enter stage right, SIBO.

For those of you who don't know, it stands for Small Intestinal Bacterial Overgrowth. Today, we are getting into what SIBO is, what follow-on impacts it has, and the insanely fascinating connection that being stressed can have on driving your SIBO symptoms.

What is SIBO?

A great question to start, SIBO is a condition when bacteria that are typically present in the large intestine starts to grow elsewhere, particularly in the small intestine.

This means that bacterial strands not generally found in that part of the digestive tract take up residency and make a home there. Taking it one step further, the medical explanation of SIBO is "​​the presence of an abnormally high number of coliform bacteria in the small bowel".

Over the last three decades, SIBO has predominantly been connected and understood to be most related to post-surgical intervention in the bowel area, but today, it is now understood that this small intestinal bacterial overgrowth can be present in many other people and many other conditions and circumstances too.

In fact, some studies indicate that up to 80% of people with irritable bowel syndrome (IBS) may have SIBO in addition to, or actually as the cause of some of their IBS symptoms.

What are the symptoms of SIBO?

Symptoms include ongoing digestive issues, diarrhea, flatulence and wind, abdominal pain and bloating, often erratic, sporadic, or chronic.

Testing to diagnose SIBO is currently weak and lacks clarity, with breath tests and biochemical tests being the current test of choice. These look at the bacterial metabolism of substrates that are present within the GI tract.

Despite weak testing modalities, the overwhelming treatment approach for SIBO at present is to aim to:

*look for underlying causes of disease;

*assess for underlying infection:

*eradicate infection and overgrowth;

*restore bacterial health and balance; and

*address nutritional deficiencies that may be exacerbating the problem.

This 'problem-focused approach' looks at ultimately wanting to bring the bowel back to balance, as it was meant to be - but this approach often doesn't deliver,

Despite following super aggressive treatment protocols, for many who struggle with SIBO, overhauling their diet and incorporating a ton of supplements does very little - or at least not for long.

It is thought that nearly two thirds of SIBO cases and conditions are chronic and ongoing or relapsing in nature.

So what next?

A great deal of new research shows that stress, childhood and adulthood trauma, and the resulting dysfunction of our nervous systems may play a much bigger part in driving SIBO and SIBO-conducive conditions than initially was ever given credit.

So, SIBO & stress - let's get into it. 

The link between the HPA Axis and the Gut Microbiome

In case you aren't familiar, the HPA axis is a part of the body known as a 'dynamic system'. It is made up of the pituitary and hypothalamus (found in the brain) and the adrenal glands (located on your kidneys). This system regulates how your body responds to stress, cortisol, and ultimately  stressful situations .

When your body is stressed out, the HPA axis is turned on, which starts a ton of communication, messaging, and signals to release hormones and neurotransmitters to help handle the situation.

As we all know with 'fight or flight', this is actually a protective system (built to help us to escape in times of caveman stress) - but over time, as is very common in today's society, if it is constantly switched 'on', it can be damaging to wider body, our physiology, and the gut microbiome, making it particularly detrimental to the environment that is conducive to developing SIBO.

So there is a connection between stress, gut bacteria and the HPA axis?

Absolutely, and this has now been well documented.

Research suggests that hormones produced by our body during stressful situations can very quickly impact our gut microbiome, but, fascinatingly, it's not only the stress response that can send the gut bacteria out of whack.

Actually, it is thought that an out of whack / imbalanced suite of gut bacteria can also provoke a stress response within the body on its own accord. Let's take a moment to let that sink in.

Research is showing that if the gut bacteria is out of balance, metabolites such as lipopolysaccharides are often created which, as a follow on impact, may provoke inflammation in the wider central nervous system.

What this means is that an imbalanced microbiome can work to further drive your body into a stress response. A two way street.

Something else that is equally as fascinating is that gut microbes also create a ton of other hormones and neurotransmitters which can really mess with the HPA axis.

Why?

The crazy reason for this is that some gut microbes can create the *EXACT* same substances (think hormones, neurotransmitters etc) created by the HPA axis.

What this means in practice? The gut and the substances it creates can interfere, impact, drive and change the function of the axis by almost mimicking the substances. And one step further? The gut can trigger a stress response.

What this means is that infection within the gut is only one potential part of the SIBO jigsaw - chronic HPA axis activation and ongoing stress must also be addressed because, together, they promote a vicious cycle that will keep looping until the trigger cycle is broken.

But how does stress ACTUALLY impact the gut?

Good question. The answer is that when the HPA axis is firing or dysfunctioning overtime, this can result in:

• The reduction of gastric acid and stomach acid production;
• Impairment of motility within the GI tract;
• Reduction in gut mucosal immunity; and in turn
• This leads to the development of enhanced bacterial overgrowth, virulencel; and
• The formation of damaging and protective biofilms.

Understanding the science behind what is going on inside of our bodies is critical. So, let's get into these in more depth

The connection between stress and a SIBO favorable environment

1. Stress & Stomach Acid / Gastric Acid Production

Stomach acid is hugely overlooked in the battle for health. It is a critical part of our immune function and kills bacteria before they can enter the small intestine.

The HPA axis controls the production of this gastric acid. This driver was created to help primitive humans who, if they found themselves in a stressful situation, wouldn't want to be wasting precious energy on creating stomach acid - when they were more likely to just be focusing on survival.

What this means is that if you are stressed (either sporadically or chronically), your HPA axis will not be functioning properly. This, in turn, is going to impact the levels of stomach acid that are being produced.

Lower levels of gastric / stomach acid mean that more bacteria can pass into the stomach and GI tract than really should, which, over time means that they can pass through the digestive tract and into the small intestine, where they are not supposed to be.

Cue, SIBO. A condition exacerbated by stress and low stomach acid.

2. Stress & Gut Motility

Gut motility is an electromechanical activity that sweeps through the digestive tract (particularly through the intestine) between meals. Think of it as your housekeeper.

When the body is stressed, this motor complex is reduced - and when this function and motor complex is reduced, food can stagnate and get stuck in places it shouldn't which can further create a playground for SIBO.  

This isn't a new phenomenon, it was first noted in the early 19th century when the 'Father of Gastric Physiology', William Beaumont said that emotions such as fear and anger 'or whatever depresses and disturbs the nervous system' was a key driver of lack of GI movement and impaired digestion.

So, stress can stop the intestine moving as it is meant to - which in turn can lead to increased likelihood of SIBO taking place and taking a hold. 

As well as this reduction in motor complex and reduced gut motility, blood sugar swings, frequent snacking and frequent hunger (all driven by chronic stress) can reduce gut motility further because constant eating means the body does not have time to do its housekeeping as it needs to.

Suffering from SIBO? Perhaps consider intermittent fasting and/or not snacking unless necessary. Working with an at-home glucose-monitor can also help monitor your blood sugar swings.

 3. Stress & Reducing Immunity 

We all know that a huge amount of immunity is derived from our gut and, in 2013, a powerful report was released confirming this. It explained that stress and the body's stress response actually reduces SIgA (an immunoglobulin that helps maintain immunity on mucosal membranes), including those in the digestive tract.

What this means is that stress reduces the strength of these mucosal membranes which may increase the likelihood of SIBO being able to proliferate.

4. Stress & Bacterial Growth

On top of all of the above, not only can stress cause a breeding ground for SIBO to proliferate, but stress hormones can also favor the direct growth of the bacteria and microbes themselves.

A 2015 report looking at the interconnection between the microbiome and the endocrine system (think: hormones) showed that stress hormones like epinephrine and norepinephrine (as well as other catecholamines) actually increase the likelihood of bacterial attachment to host tissues.

In short, stress enhances bacterial overgrowth and susceptibility to infection.

It's not only the formation of bacterial attachment to host tissues that we should be worried about though because stress can also promote the formation of 'biofilms'.

5. Stress & Biofilm Formation

Biofilms are another community of microorganisms that we can't ignore, and they're another group of microorganisms that stick to each other and surfaces. What this means is that these biofilms can create 'hard to bust' walls around substances - and help bacteria, for example, to be protected from antimicrobial agents or medicines.

Our body usually works in our favor, trying to help us and heal us, but sometimes these protective biofilms get in the way.

A number of studies looking into microbial endocrinology, linked here and here have documented not only how how stress influences susceptibility to infection - but also how stress response hormones and mediators (like cortisol and the catecholamines that we mentioned earlier) can actually PROMOTE this biofilm formation!

And what does this mean in practice? It means that pathogenic bacteria can access nutrients that they need to thrive and survive. Bad news - particularly for SIBO sufferers who want these pathogenic bacteria to be reducing, not proliferating.

Ok. So, what next?

If you are anything like us - learning about the complexity of the connection between the body's stress response and the health of our GI tract is a major turning point in your healing journey. 

And, if you are a SIBO sufferer, you might be thinking - something needs to change.

And you're right.

If that's you, the first part of your healing journey is to understand the difference between your sympathetic and parasympathetic states of your nervous system.

The difference between sympathetic and parasympathetic

Both 'states' belong and are connected to the autonomic nervous system (often known as the ANS), but it is important to understand the difference between the two. The main difference between the sympathetic and parasympathetic nervous states is that the sympathetic nervous system prepares the body for intense physical activity (think stress response, fight or flight, high alert), whereas the parasympathetic nervous system relaxes the body by inhibiting high energy functions (think rest and digest, calm and nurturing).

The parasympathetic system is activated by the vagus nerve (connected between your brain & your gut), and so people with SIBO, and high chronic stress levels, often have weak vagus nerve function (or tone) - making them more stuck in their fight or flight state,

Therefore, getting your body out of a fight or flight and into its rest and digest state is needed to beat SIBO.

So how do I get into the parasympathetic state?

That's the million-dollar question - particularly in today's busy, high functioning, stressful environment that taxes our nervous system far more than it was built to be.

Key areas like deep breathing, meditating, human connection, epsom salt baths & more can help you to transition out of the sympathetic and into your parasympathetic states and this, in turn, can ensure that you are building out an environment that does not exacerbate SIBO or your SIBO related symptoms any more than is needed.

For a full rundown on the top holistic health hacks that can really help you transition the state of your nervous system, head here - I've documented the top 8 at-home wellness tips that can really help you get started on this journey to calm not only your nervous system but also your gut issues.

***THESE STATEMENTS HAVE NOT BEEN APPROVED OR REGULATED BY THE FDA.  WE ARE NOT DOCTORS, THEREFORE ALWAYS CONSULT WITH YOUR DOCTOR FIRST**