SIBO and Gallstones Are Not Completely Separate Conditions
If you're dealing with Sibo - excessive bacterial growth in the small intestine, or have been diagnosed with gallstones, the information I'll share in this article might be crucial for you.
While conventional medicine tends to recommend gallbladder removal surgery as an immediate solution for gallstones, it's important to understand that there are additional options. Knowledge is power, and the information here might help you avoid gallbladder removal surgery.
Gallstones don't just appear out of nowhere. Sometimes they're a sign of another digestive system problem that can be treated. When understanding the complete picture, the problem can be solved through gentler solutions before turning to surgery.
Sibo and gallstones are seemingly two separate medical conditions, but this isn't the case. You'll be surprised to learn that it's often very difficult to distinguish between them since Sibo causes various digestive system symptoms, similar to most complications related to the gallbladder. In my years working as a naturopath specializing in digestive system health, I've encountered an interesting phenomenon many times: I noticed that many of my patients who suffered from Sibo also had gallstones, and conversely, patients who suffered from gallstones developed symptoms similar to Sibo.
What Does Research Say?
My feeling about the connection between Sibo and gallstones has indeed been reinforced by recent studies confirming this:
One study found that SIBO prevalence was significantly higher among patients with gallstones (40.5%) compared to the control group.
Another study found that methane-type SIBO (CH4) or mixed SIBO (hydrogen and methane) was more common among gallstone patients compared to the group that underwent gallbladder removal.
An additional study showed that SIBO is more common among patients with gallbladder polyps, suggesting a connection between gallbladder health and SIBO.
These discoveries change our understanding of digestive system health! It turns out that if you're dealing with gallbladder problems, like gallstones, or have undergone gallbladder removal surgery, you're at a higher risk of developing bacterial imbalance that could lead to SIBO.
Let's try to understand the connection between these two conditions more deeply.
Understanding the Sibo-Gallbladder Connection
Sibo is a condition characterized by excessive bacterial growth in the small intestine. Normally, the small intestine has fewer bacteria compared to the large intestine.
In Sibo, bacteria from the large intestine migrate upward to the small intestine, where they multiply and cause fermentation of various carbohydrates and fibers, producing gases. The diagnosis of Sibo type is done through breath testing and is divided into several different types - hydrogen, methane, and hydrogen sulfide, with the key difference between them lying in the type of gas the bacteria produce during fermentation in the small intestine.
The gases released by the bacteria cause uncomfortable symptoms that many people with SIBO suffer from: abdominal cramps, heaviness and fatigue after eating, gas, alternating diarrhea and constipation, excessive bowel movements, mucus in stool, strong-smelling stool, bloated stomach, heartburn, acne, food allergies and difficulty gaining weight.
The Role of Bile Salts
Let's talk about bile salts. Bile salts are produced in the liver and travel to the small intestine, where they aid in fat digestion by increasing their solubility (a process called fat emulsification). The gallbladder plays a crucial role in storing and concentrating bile salts produced in the liver. Bile is mostly composed of water but also contains bile acids, bilirubin, phosphotidylcholine, minerals, and cholesterol.
While bile's primary role is to aid in fat digestion, its antibacterial quality also contributes to maintaining a healthy microbiome (bacterial population) in our digestive system.
Our large intestine contains enormous quantities of beneficial gut bacteria. The presence of bile salts in the small intestine inhibits the growth of harmful bacteria and the development of Sibo. Bile fluid is actually one of the body's most important defense mechanisms against infections in the small intestine.
How Do Gallstones Form?
Gallstones form in your gallbladder when substances in your bile start to harden. Think of bile as a liquid that helps digest fat - it's mostly made of water mixed with cholesterol, bile salts, and other materials. Sometimes, there's too much cholesterol in the bile. When this happens, the extra cholesterol starts to form small, hard pieces, like tiny crystals. These crystals slowly get bigger as more cholesterol and other substances stick to them. Over time, these become gallstones. Some gallstones are as small as a grain of sand, while others can grow as large as a golf ball. Most gallstones are made of hardened cholesterol, but some are made of different substances like bilirubin (a waste product from old blood cells). Many people have gallstones without knowing it because they often don't cause any pain or problems. It's only when gallstones block the normal flow of bile that they can cause discomfort and require treatment.
Symptoms usually appear when the stones are large enough to block the bile ducts and include severe abdominal pain known as "gallbladder attacks," nausea and vomiting, jaundice, gallbladder inflammation, and bile duct obstruction.
How Do Gallstones Cause Sibo?
As I mentioned earlier, bile is not just a substance that helps digest fats as previously thought - it's actually a powerful antibacterial agent that helps maintain bacterial balance in the small intestine.
Gallstones can cause Sibo through several mechanisms:
Impaired Bile Salt Flow to the Small Intestine
Gallstones create physical blockages in the bile ducts, impair the gallbladder's contractility, cause inflammation and scarring, and damage the nervous system that regulates bile secretion. All of these lead to a significant decrease in the amount of bile salts reaching the small intestine, resulting in reduced antimicrobial activity in the small intestine and leading to an increased risk of uncontrolled bacterial proliferation.
Changes in Bile Composition
When you have gallstones, they can change how your bile works in two main ways. First, they can make your bile become thicker, like honey instead of water. Second, gallstones often lead to low levels of an important substance called phosphatidylcholine - this is a natural compound that normally keeps bile thin and flowing smoothly. When there is not enough phosphatidylcholine, the bile becomes thicker and moves more slowly so less of it reaches the small intestine. This creates perfect conditions for bacteria to grow where they shouldn't, leading to Sibo.
Damage to the Cleaning Mechanism that Removes Bacteria
Bile plays an important role in regulating the MMC (Migrating Motor Complex), which is a motor wave mechanism that works between meals to remove excess bacteria from the small intestine. Studies show that bile plays a key role in regulating this mechanism. Gallstones disrupt bile flow and impair the efficiency of this cleaning system, allowing bacteria to establish and thrive in places where they shouldn't be.
Impaired Fat Digestion
Poor bile flow impairs fat digestion and creates an environment that promotes the growth of unwanted bacteria. Poorly digested fats undergo fermentation by bacteria in the intestine. This process creates various byproducts, including short-chain fatty acids and gases, which alter the chemical environment in the intestine. This change in the intestinal environment causes several problems: attraction of additional bacteria that feed on undigested fats, disruption of normal intestinal motility, changes in intestinal pH levels, and creation of a more friendly environment for harmful bacteria.
This creates a vicious cycle where the problem feeds itself: the less bile there is, the more bacteria there are, and the more bacteria there are, the more disruption there is to the normal function of bile and intestines.
How Does Sibo Cause Gallstones?
One of the most fascinating discoveries is that the connection between gallbladder problems and Sibo is bidirectional. Sibo is not just a result of gallstones, but also a factor capable of disrupting bile salt metabolism and accelerating gallstone formation.
This happens in two main ways: First, they change the chemical composition of bile and make it more saturated with cholesterol, which increases the risk of stone formation. Second, bacteria secrete inflammatory substances that directly affect the gallbladder and bile ducts, disrupt the gallbladder's ability to contract, and promote increased accumulation of cholesterol and pigments. This creates a vicious cycle: as Sibo worsens, the risk of gallbladder problems increases, and as the gallbladder condition deteriorates, Sibo worsens.
Summary
The conclusion is that there is a close connection between Sibo and gallstones, meaning if there is a diagnosis of one condition, it's advisable to perform tests to rule out the other condition. If there is a diagnosis of both Sibo and gallstones, they should not be separated and treated individually, but rather treated simultaneously by improving both gallbladder function and balancing intestinal bacteria.
Instead of rushing to remove the gallbladder through aggressive, irreversible surgical intervention, it's worth first considering treatment that combines personalized nutrition, antibacterial dietary supplements, herbs that support the gallbladder, and probiotic and prebiotic supplements to balance intestinal bacteria. From my experience, naturopathic treatment that combines a holistic approach treating both the intestine and gallbladder comprehensively and deeply helps in many cases to significantly reduce the symptoms and complications of both problems. Early identification of the problem and intervention in the initial stages, while treating the digestive system as a whole, can not only prevent the need for surgery but also improve overall quality of life and prevent future complications.
