Do I have SIBO?
It is a question you might ask yourself if you search the internet!
The internet is full of self diagnosed Small Intestinal Bacterial Overgrowth or SIBO cases. There are hundreds of blogs showing you how people “cured” their SIBO and hundreds of other blogs ready to tell you that you have this gastrointestinal tract condition. It seems to be the trendy diagnosis much like Candida was in the 90’s.
What is SIBO?
It is a diverse syndrome distinguished by a more than normal amount of bacteria in the small intestines- hense the name. There are two kinds of SIBO. One in which bacteria from your upper respiratory tract and mouth invade (due to the use of acid blockers such as PPI- proton pump inhibitors) and one in which the bacteria from your colon invade (this can be due to a few different reasons one of which is slower movement of food through the GI tract).
Signs and Symptoms can include but are debated in the research
bloating
gas
pain in abdominal area or discomfort
burping often
diarrhea
nutrient malabsoprtion leading to weight loss or fatty stools
joint pain
nerve degeneration which is secondary to nutrient deficiency
rosacea
anemia
Our digestive system has something called cleansing waves. It is how the food you eat, chew and swallow ends up moving from stomach to small intestines (where nutrient absorption happens) to the colon where stool is formed. There is a whole bunch of things that can go wrong with this process and in hypothyroidism, many of you experience constipation which backs things up but may also mess with this cleansing process. The process keeps things moving so the food (called chyme at this point I believe) is not sitting in the small intestine. When it is not regularly moving through, there is potential for the small number of bugs that do reside in the small intestines to take that opportunity to overpopulate.
We also secrete stomach acid which will break down food in the stomach and helps to keep things moving further down. Our pancreas secretes enzymes and our liver produces bile (stored in gallbladder) that prevents the bacteria from multiplying in the small intestines. We also have a valve between the small intestine and the colon or large intestine that keeps the bacteria from the colon in the colon. The body is just an amazing thing isn’t it!?
What puts you at risk for getting SIBO?
use of proton pump inhibitors
narcotics and opiates
partial or full removal of the stomach
chronically inflamed pancreas
digestive system muscles that do not work as they should, moving contents through the digestive tract
AIDS
diabetic neuropathy (causes an issue with moving contents of stomach)
being older than 75 years
cirrhosis and nonalcoholic fatty liver disease
IBS (irritable bowel syndrome) is often floating around as either a symptom or a cause. It is probably more common in people with IBS but should not be assumed if you have IBS that you have SIBO.
The internet proposes that a Lactulose Breath Test is how you can test for this. This measures the amount of hydrogen and methane we exhale after drinking 3 teaspoons of lactulose which is only available by prescription in the US. This testing method is patented by a doctor who at the time worked for or consulted for the pharmaceutical company that owns the patent for the antibiotic Rifaximin which is widely used to treat SIBO. In this test you consume the lactulose and then wait for 90 minutes and if you have an increase in hydrogen (20ppm or higher) it is considered positive for SIBO. This test is not very sensitive and is not super accurate. It appears to be best at seeing how long it takes for food to get from mouth to small intestine which is a type of transit time test. Something else to consider with this test is that people with Asian heritage have a quicker transit time than Caucasians which can skew the test. People with anxiety also tend to have quicker transit time rendering this test very inaccurate. Bottom line is it appears to miss a lot of cases of SIBO and should not be the only test done to verify the condition.
There is a more invasive procedure that draws fluid from the small intestine and cultures it to see what kind and amounts of bacteria are there. It is expensive and not widely used as far as I know. One problem with this test is that not all species of bacteria can be cultured and therefore get missed.
The Glucose Breath Test which is done the same way as lactulose has a much higher accuracy rate but only finds bacteria in the upper small intestine so some cases can be missed. It does have fewer false positive test results.
One way to get a more accurate test result is to do lactulose, glucose and fructose breath testing. This way if one test misses it, the others are likely to pick it up. This along with your signs and symptoms can be a big clue as to whether or not you have SIBO.
Self diagnosis or incorrect diagnosis by a health professional can lead to you being told to restrict your diet which can affect your microbiome, potential unneeded use of antibiotics which also affects your microbiome.
How is SIBO treated?
if possible, remove the opioids and narcotics (dependent upon what they are used for)
stop use of proton pump inhibitors
antibiotics are often used (Rifaximin and Metronidazole)
7 days showed a moderate reduction in SIBO
good chance of SIBO coming back after treatment
herbal antimicrobials
peppermint oil improved test results but did not get rid of SIBO
pomegranate fruit rind
garlic, fresh is more potent than capsules or tablets but high allicin ones will work
clove, thyme, oregano (oils enteric coated so they make it to the small intestine without damaging tissue in the stomach or esophagus)
berberine
tea polyphenols (astringent effect)
Galactooligosaccharides (supplement) or GOS
Partially Hydrolyzed Guar Gum
No snacking- stops those cleansing waves
Probiotics- specific strains (Bifidobacterium lactis HN019 helps GI symptoms such as gas and abdominal pain)
Glutamine
Saccharomyces cerevisiae variety boulardii Biocodex
Digestive enzymes with meals, bitters, potentially HCl
Low FODMAP diet up to 6 months.
The Specific Carbohydrate Diet and the Low FODMAP diet are suggested for treatment of SIBO. But….
SCD is based on removing foods like starches and some sugars while eating protein, fat and easy to absorb carbohydrates so the bacteria starve and die off. This is based on the assumption that all bacteria eat only carbohydrates which is not the case. This diet may reduce some symptoms but it does not mean you are killing off bacteria. Protein which gets putrified in the gut feeds bacteria too. E. coli, Bacteroides and Clostridium all are protein consuming bacteria and Bacteroides specifically is found in high amounts in people with SIBO. This diet could be reducing bifidobacteria which live in the small intestine and also in the colon and lower the bacteria that produce food for the cells of the colon.
Low FODMAP diet which reduces or eliminates many fruits, vegetables, and legumes is studied in IBS and does reduce gas symptoms. It may decrease bacteria in the small intestines and will definitely affect the make up of the bacteria in the colon (we don’t want this).
An Elemental Diet is used for some people. This is kind of like baby formula for adults. It does reduce symptoms and gives negative test results but it doesn’t have long term follow up or placebo controlled studies to show long term effectiveness.
If you are someone who has been thinking about making some changes to your diet and lifestyle, this is a great time to do it and you can get a personalized protocol and plan until June 30th for only $37. This is a great value and includes a nutritional assessment which will show me where your body is out of balance, we will chat for 15 minutes so you can have questions answered and then I send you a protocol and diet plan based on your unique situation. So far everyone who has taken me up on this offer has really enjoyed the process. This is great for someone who can just take the info and go with it. In fact, research shows that the average person sees a nutrition professional something like 1.8 times which is really sad to me because many people need 3-5 visits before they are on their way to a healthier them. You can learn more at www.outofthewoodsnutrition.com and look for Covid-19 special at the top. This is my way of giving back since so many of us, myself included are dealing with a loss of income. It is more important than ever that we get as healthy as we can so we can prevent some of the more severe conditions associated with Covid-19.
You can sign up for my newsletter on my website while you are there. I will be sending out some great information about nutrients to help your body fight the virus and a recipe. The podcast and the newsletter are where my time is being concentrated. Social media has increased anxiety in me and brought on depression so I’m pretty much off it. Too much censorship, too much hate, too much polarization and too much misinformation. My only source of news is the Epoch Times, an unbiased newspaper reporting the facts, not what their bosses want them to report on. Off my soapbox. You can leave a comment on this podcast episode on my website, search for Episode 84.
Until next time. Peace and love and an abundance of health to you all.