Have you been struggling with SIBO?  have you been following a low FODMAP diet, taking supplements and doing everything possible yet the bloating, gas, diarrhea or constipation continues? Or perhaps your symptoms have improved (provided you don’t eat foods high in FODMAPS), but upon reintroduction your Sibo symptoms return? This is an all too familiar occurrence we hear from patients and it’s the reason for todays article. In todays article, wanted to spend some time reviewing the importance of Estrogen, how it contributes to SIBO and then give some practical tips and steps to help balance your estrogen levels. While it’s great to kill bacteria with antimicrobials, the real question that needs to be answered is….. “what is going to stop the bacteria from coming back?” unless you get to the Root Causes, SIBO will inevitably return. So lets talk about Estrogen Dominance and its connection to SIBO.

What is Estrogen Dominance?

We are going to talk about estrogen dominance and how excess estrogen sets the stage for SIBO.  Before we get started, let’s first define this term Estrogen dominance.  When you hear the word estrogen, you might be thinking that estrogen is only one hormone. Instead I want you to think about estrogen as a group of hormones. Estrogen is realy three different hormones where each one cab be pacifically measured. These three Estrogen hormones include, Estrone (E1), Estradiol (E2) and Estriol (E3)

Estrogen dominance is the condition of increased estrogen levels relative to the levels of progesterone in the body. Estrogen dominance may be the result of overproduction of estrogen by the body, changes in estrogen metabolism and excretion, or an imbalance in the estrogen to progesterone ratio. Although estrogen is an essential hormone, disproportionately high levels lead to higher rates of cancer, metabolic disease, and other complications. The most common ways I see estrogen dominance influence a woman health are in the areas of Thyroid health, Mental health, Bone health, fertility, menopausal symptoms, and Intestinal or Gut health.  Estrogen dominance can influence any of these areas and if you have been struggling with SIBO, this may be an important area worth investigating especially if you notice that your bowel movements change throughout the course of your cycle.

What Causes Estrogen Dominance- 

• Elevated stress hormones, Adrenal Fatigue
• Poor gut health- SIBO, yeast overgrowth in the intestines
• Obesity
• Elevated Blood sugar
• Medications that elevated estrogen and suppress progesterone (ie birth control pills)
• Liver and gallbladder congestion
• Environmental toxins known as xenoestrogens.
• Elevated Androgens
• Lack of ovulation or low progesterone during luteal phase.
• Elevated Beta Glucoronidase
• Thyroid disease 

Estrogen Dominance Symptoms Seen in Patients With SIBO

• Anxiety and panic attacks
• Bloating
• Breast tenderness and swelling
• Cold hands or feet
• Fatigue
• Fibrocystic lumps in your breasts
• Decrease in sex drive
• Infertility
• Irregular or abnormal menstrual periods
• Painful periods
• Hair loss
• Headaches (especially 1 week prior to menstruation)
• Memory problems or Brain fog
• Mood swings (irritability and depression)
• Trouble sleeping/insomnia
• Hot Flashes
• Weight Gain (often around the hips and belly)

Estrogen Dominance and SIBO

SIBO (Small Intestinal Bacterial Overgrowth) is defined as an increase in the number or kind of bacteria, present in the small intestines. Pay attention here…. It can be too much of the wrong kind (bad kind) or it can be too much of the RIGHT kind (good bacteria).  This means taking probiotics when you don’t need them or taking the wrong kinds of probiotics can cause bacterial overgrowth.

While the majority of SIBO treatments focus on killing bad bacteria, doing this is such an injustice to many patients because treating SIBO really requires an individualized approach that addresses the many causes behind SIBO. Killing bacteria does not stop the bacteria from coming back. Why are the bacteria there in the first place? and what are we going to do about preventing bacteria from coming back?  That should be the number one and number two question we are asking our doctors? This is why we need to address SIBO from a Functional Medicine perspective and this is also why we need to talk about hormones and the role hormones have on motility. Sex hormones like estrogen influences microbial balance in the gut which in turn can alter gut motility, visceral sensitivity, mucosal barrier function, and immune activation. When someone has estrogen dominance regardless of cause, The elevated levels of circulating estrogen alter the levels of nitric oxide. These changes in Nitric Oxide are an important regulator of gastric motility (10,11).

6 Steps to Treating SIBO When You Are Estrogen Dominant

Step 1– Support your liver. Remember, too much estrogen in the body—will impact your liver and gallbladder. If you have liver/gallbladder dysfunction and you don’t make enough bile you are going to be more prone to bacterial overgrowth. I like using the 14 day Core Restore by Orthomolecular. The Core Restore Kit provides three active formulas – Core Support, Alpha Base, and PhytoCore – which function synergistically to support Phase I and Phase II pathways of liver detoxification to help neutralize environmental pollutants, hormone disruptors, unhealthy estrogen metabolites, xenoestrogens (synthetic compounds that imitate estrogen), and other harmful toxins. This powerful trio of specialized formulas provides essential micronutrients, phytonutrients, and a source of easily digested, low- allergen protein that purify the liver and fuel optimal biotransformation.

Step 2- Correct Nutrient deficiencies. Vitamins and minerals serve as important cofactors that can affect the ability to produce and metabolize hormones such as estrogen and progesterone. The liver is also dependent on various enzymes and pathways to metabolize toxins. Detoxification has two very important phases. In phase I detoxification, the liver needs, glutathione, antioxidants, Vitamin E and vitamin C. In Phase II detoxification the liver uses selenium, and sulfur based amino caids like taurine and cysteine as well as glycine and glutamine. So, add these supplements into your SIBO regiment. If you suspect low HCL follow these 5 ways to improve your HCL levels

Step 3– People with SIBO often are majorly deficient in B12, folate and many other B vitamins like folate. It turns out that a deficiency in B vitamins also causes a worsening of estrogen dominance symptoms.

Step 4- Minimize and avoid endocrine disruptors. Woman often lather many kinds of chemicals on their body throughout the day. Start paying attention to not only what you eat but also what you put on your body.

Step 5– If you have a menstrual cycle, keep a journal of your gut symptoms and your hormone symptoms. Are your symptoms worse when your period starts? worse when you are expecting your period to come or worse around ovulation? These all serve vital clues to your functional medicine doctor.

Step 6- In addition to supporting your liver and gallbladder, supplemental hydrochloric acid (HCL) can be very helpful- Just don’t take HCL if you have an active ulcer (instead follow some of the other suggestions in this article). SIBO is often caused by a previous bout of food poisoning. In addition to Bile, HCL is another way of protecting and preventing an overgrowth of bacteria in the gut.

If you suspect that you are Estrogen dominant all while having symptoms of SIBO/IBS, ask your Functional Medicine Doctor if checking your estrogen, progesterone and Sex Hormone Binding Globulin levels is a good idea. I know with many of female SIBO patients, testing for estrogen dominance is an important piece of the puzzle.

Liver and Gallbladder Health- How These Affect SIBO

While we have been talking about estrogen dominance, there are couple of additional problems in which Estrogen dominance and SIBO cross paths, namely the gallbladder. We know that having estrogen dominance is a common cause for gallbladder disease and liver inflammation

Estrogen dominance is seen in a number of gut disorders, including  gastro-esophageal reflux (GERD), nausea, vomiting, constipation, bloating, delayed gastric emptying and gall bladder dysfunction(1).

When you don’t have free flowing bile you cannot absorb and digest fats and you are at increased risk of developing gallbladder disease.

Gall bladder disease is common in patients with SIBO.  

Patients with SIBO have nutrient deficiencies consistent with fat soluble vitamins (vitamins A, D, E, K) as well as problems with cholesterol. Check this article out for a more comprehensive review of this topic. 

If you have estrogen dominance, the symptoms of SIBO are often not only more difficult to treat but many of the symptoms are often amplified.

A sluggish gallbladder contributes to SIBO because bile prevents bacteria from the colon from colonizing the small intestine. You can learn more about the importance of Healthy liver and Gallbladder function here. 

Bile is your body’s natural defense to prevent SIBO. Bile is bacteriostatic. This means that bile kills bacteria.  

Bile also protects the liver, and it eliminates waste products from the body as it is excreted in your bowel movement. In short, bile helps you from becoming toxic! While there are many underlying root causes of SIBO, having a sluggish gallbladder slows down your bile flow. From the studies I have reviewed, gallbladder disease is is increased in the methane dominant SIBO as well as patients who test positive for both hydrogen and methane dominant SIBO. (11)

Estrogen can cause a relaxation in smooth muscles of the gall bladder (1), trachea (2), urinary bladder (3), blood vessels (4) and colon (5,6) which in turn create an environment conducive to bacterial overgrowth

Estrogen relaxes vascular smooth muscle via a process involving nitric oxide production (nNOS) this leads to bacterial overgrowth (5,6)

Estrogen increases Gallbladder disease amongst post menopausal woman- this leads to SIBO  (7,8)

Exogenous estrogens, estrogen that is taken either orally or in a transdermal application (cream), favored gallstone formation (9,10)

Check Out These Videos on How Estrogen Dominance caused by The Pill, HRT Can Cause Your SIBO/IBS Symptoms

References

1- Mulak A, Taché Y and Larauche M: Sex hormones in the modulation of irritable bowel syndrome. World J Gastroenterol. 20:2433–2448. 2014. View Article : Google Scholar : PubMed/NCBI

2-Riezzo G, Pezzolla F, Darconza G and Giorgio I: Gastric myoelectrical activity in the first trimester of pregnancy: A cutaneous electrogastrographic study. Am J Gastroenterol. 87:702–707. 1992.PubMed/NCBI

3- Dambros M, van Koeveringe GA, Bast A and van Kerrebroeck PE: Relaxant effects of estradiol through non-genomic pathways in male and female pig bladder smooth muscle. Pharmacology. 72:121–127. 2004. View Article : Google Scholar : PubMed/NCBI

4-Ma Y, Qiao X, Falone AE, Reslan OM, Sheppard SJ and Khalil RA: Gender-specific reduction in contraction is associated with increased estrogen receptor expression in single vascular smooth muscle cells of female rat. Cell Physiol Biochem. 26:457–470. 2010. View Article : Google Scholar : PubMed/NCBI

5- Hogan AM, Kennelly R, Collins D, Baird AW and Winter DC: Oestrogen inhibits human colonic motility by a non-genomic cell membrane receptor-dependent mechanism. Br J Surg. 96:817–822. 2009. View Article : Google Scholar : PubMed/NCBI

6- Zielińska M, Fichna J, Bashashati M, Habibi S, Sibaev A, Timmermans JP and Storr M: G protein-coupled estrogen receptor and estrogen receptor ligands regulate colonic motility and visceral pain. Neurogastroenterol Motil. 29:e130252017. View Article : Google Scholar

7-The characteristics of small intestinal bacterial overgrowth in patients with gallstone diseases View Article

8 Uhler ML, Marks JW, Voigt BJ, Judd HL. Comparison of the impact of transdermal versus oral estrogens on biliary markers of gallstone formation in postmenopausal women.  J Clin Endocrinol Metab. 1998;83:410-4149467549 Google ScholarCrossref

9-George ED, Schluger LK. Special women’s health issues in hepatobiliary diseases.  Clinics in Family Practice. 2000;2:155-169 Google ScholarCrossref

10. Grodstein F, Colditz GA, Stampfer MJ. Postmenopausal hormone use and cholecystectomy in a large prospective study.  Obstet Gynecol. 1994;83:5-118272307 Google Scholar

11. https://onlinelibrary.wiley.com/doi/abs/10.1111/jgh.14113

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