The Connection Between SIBO and NMS Symptoms

Chronic neuro-musculo-skeletal (NMS) symptoms almost always have an underlying cause or there is an underlying imbalance that is fueling the symptoms. To resolve the symptoms, it’s crucial to uncover that root cause.

In Functional, Chinese and Integrative medicine the saying goes, "if in doubt start with the gut". That's because the gut is the root of the problem, 90% of the time. There can be many digestive conditions to consider, but what can we do from a physiotherapy perspective to help?

Well, initially it is important to understand and develop the thinking around the relationship between digestion and NMS symptoms. With the base for all chronic conditions being imbalanced inflammation, oxidative stress and immune function.

One digestive condition that is particularly interesting is SIBO (small intestine bacterial overgrowth). The normal small bowel, which connects the stomach to the large bowel, is approximately 20 feet long. Bacteria are normally present throughout the entire gastrointestinal tract, but in varied amounts. Relatively few bacteria normally live in the small bowel (less than 10,000 bacteria per milliliter of fluid) when compared with the large bowel, or colon (at least 1,000,000,000 bacteria per milliliter of fluid). And, the types of bacteria normally present in the small bowel are different from those in the colon.

The small bowel plays an important role in digesting food and absorbing nutrients.

The normal (beneficial) bacteria that are an essential part of the healthy small bowel also perform important functions. These beneficial microorganisms help protect against bad (i.e. pathogenic) bacteria and yeast that are ingested. They help the body absorb nutrients, and also produce several nutrients (such as short chain fatty acids) and vitamins like folate and vitamin K.

SIBO, is defined as an increase in the number of bacteria, and/or changes in the types of bacteria present in the small bowel. In most patients, SIBO is not caused by a single type of bacteria, but is an overgrowth of the various types of bacteria that should normally be found in the colon. Less commonly, SIBO results from an increase in the otherwise normal bacteria of the small bowel.

SIBO has been shown to negatively affect both the structure and function of the small bowel. It has been known to have a number of potential complications including immune reactions that cause food sensitivities, generalized inflammation, oxidative stress and autoimmune diseases. All of which can add fuel to the fire of the NMS symptoms of your patient.

The body has several different ways of preventing SIBO. These include gastric acid secretion (maintaining an acidic environment), waves of bowel wall muscular activity, immunoglobulins in the intestinal fluid, and a valve that normally allows the flow of contents into the large bowel but prevents them from re-fluxing back into the small bowel.

Risk factors for SIBO include:

  • Low stomach acid

  • Low stomach acid is often caused by stress, generalized pain, sympathetic NS dysfunction, and food sensitivities.

Relieving the body, through your different therapy skills that address pain, stress and autonomic NS dysfunction, can have a massive influence on low stomach acid and hence SIBO. Eliminating intolerant foods, using apple cider vinegar, adding betaine HCL supplements, meditation and deep breathing techniques can also help.