consider when allergic or other sys-temic inflammatory symptoms arise. Joint pain may also stem from micro-bial imbalance and compromised gut barrier function in the small and large intestine. An overgrowth of gram neg-ative bacteria can release lipopolysac-charide (LPS), a very inflammatory component of their outer membranes. The local and systemic inflammatory response stimulated by LPS can cause and perpetuate compromised gut bar-rier integrity and lead to systemic symptoms including joint pain. 4 Stud-ies linking fibromyalgia and the pres-ence of SIBO suggest microbial endo-toxin production can lead to alterations in somatic pain tolerance and systemic inflammation. 5,6 TREATMENT OPTIONS SIBO can be difficult to treat and re-quires a multistep protocol, beginning with a two-week antimicrobial phase to kill the bacteria, followed by treatments aimed at restoring MMC and digestive function. Antimicrobial choice depends on the type and amount of microbes present (confirmed with testing) and discussion with patients regarding op-tions for pharmaceutical antibiotic or herbal antimicrobials. Rifaximin is an example of an antibiotic that is effective for treating hydrogen overgrowth as it stays local to the small intestine. 7 Exam-ples of herbal antimicrobials include garlic, berberine, thyme and/or oregano, again chosen based on type of microbes present (methane vs hydrogen). The second phase of treatment in-cludes choice of herbs or prescription prokinetics that function to restore the activity of the MMC and prolong re-mission of SIBO. Additional supportive measures should be taken based on each individual’s case, such as replen-ishing nutrient deficiencies, dietary guidance and correcting any existing underlying root causes or risk factors. Taken together, if joint pain and gas-trointestinal symptoms present together in a case, SIBO should be on the list of possible diagnosis. With appropriate screening, testing and treatments, it can effectively reduce inflammation, pain and digestive dysfunction. REFERENCES 1. Deloose, E., Janssen, P., Depoortere, I., & Tack, J. (2012). The migrating motor complex: control mechanisms and its role in health and disease. Nature reviews. Gastroenterology & hepatology, 9(5), 271–285. https://doi.org/10.1038/ nrgastro.2012.57 2. 2020. SIBO – Small Intestinal Bacterial Overgrowth. SIBO Testing Clinic 3. Rosa, A. C., & Fantozzi, R. (2013). The role of histamine in neurogenic inflammation. British journal of pharmacology, 170(1), 38–45. https://doi.org/10.1111/bph.12266 4. Huang, Z., & Kraus, V. B. (2016). Does lipopolysaccharide-mediated inflammation have a role in OA? Nature reviews. Rheumatology, 12(2), 123–129. https://doi.org/10.1038/ nrrheum.2015.158 5. Pimentel, M (2004). A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Annals of the Rheumatic Diseases, 63(4), 450–452. doi:10.1136/ard.2003.011502 6. Pimentel M, Wallace D, Hallegua D, et al. 2004. A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing Annals of the Rheumatic Diseases;63:450-452. 7. Adam D. Farmer, Emma Wood and James K. Ruffle. (2020). CMAJ March 16. 192 (11) E275-E282; DOI: https://doi. org/10.1503/cmaj.190716 Do you want to write for Chiropractic and Naturopathic Doctor? Do you have a story to share with your fellow chiropractors and naturopaths? Whether it’s an exciting case study, overview of a new technique, or business tips and tricks (or something completely different), feel free to send an email to our Editor at [email protected] to get the details of how YOU can appear in print and online! #CanadianChiropractor #CanadianNaturopath www.Cndoctor.ca CND_HouseAdwritefor_MayJune21_MLD.indd 1 May/June 2022 Chiropractic and Naturopathic Doctor 11 2021-05-06 9:10 AM
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