Me with puffed out cheeks doing my breathing
SIBO may be happening in your small intestine but in many cases it is specifically a motility problem and thus tied to the enteric nervous system in the gut. The most common cause of SIBO is actually an auto-immune reaction where the body destroys a key protein that is part of this enteric nervous system and drives the migrating motor complex, the MMC. The MMC fires the small intestine’s cleansing wave to flush any unwanted bacteria out. If this protein, vinculin, is destroyed then the cleansing waves to do not fire as strongly and bacteria can back up in the small intestine causing the symptoms of SIBO. The MMC can also be compromised if there is an issue in the vagus nerve, the main nerve bundle between the brain and the gut. The vagus nerve and the enteric nervous system is so important that the gut is known as the ‘second brain’. In fact, there are more neurotransmitters in the gut than in the brain itself, 95% of the serotonin in the body is produced in the gut and serotonin is a key transmitter in the MMC.
When I was struggling with SIBO that seemed intractable I ended up meeting several people, doctors included, who told me that if I just kept focusing on killing the bacteria that I was never going to get over it. They all suggested that I needed to be focusing on motility at the same time and in several cases that I needed to be working on my vagus nerve tone since it probably was not firing efficiently. This makes sense because even if I didn’t start out having poor vagus tone I probably ended up with it thanks to SIBO. Especially for methane producers you end up in a vicious cycle where something alters motility that allows the m.smithii methanogens to overgrow in the small intestine and then the methane gas produced by them further slows motility and could possibly even cause issues with the vagus nerve. Drs. Keller and Siebecker both see neuropathy in a good number of methane dominant patients and claim that the methane can cause the nerve issues, my neurologist wasn’t so sure about this though. I ended up working on the MMC through prokinetic agents like MotilPro and Iberogast but also with some things to help the vagus nerve.
So what is one to do about vagal tone? According to Dr. Datis Kharrazian and his book Why Isn’t My Brain Working? one can do several things to increase vagal tone including vigorous gargling, gagging oneself with a tongue depressor and singing loudly. If you don’t feel like gagging yourself then here is a list of 32 ways you can stimulate your vagus nerve that includes things I do like chanting and meditation as well as breathing techniques taught in yoga. I’m convinced my daily sitting and chanting played a role in getting better and evidence is mounting that it can indeed help vagal tone. A recent study shows that yoga may work to treat some conditions by its effect on the parasympathetic nervous system and specifically on increasing vagal tone. Specifically it appears that yogic practices like pranayama significantly increase vagal tone, especially ‘resistance breathing’ such as practicing the Ujjayi breath. Other things I have read show that any time the out breath is longer than the in breath there is a stimulation of the vagal nerve. So, maybe it is possible to breath you way out of SIBO after all, you just have to do the right type of breathing.
A few months back I met a woman online who actually claimed to cure her SIBO through breathing. We did a Skype call and she explained her technique to me and I decided to give it a try, what could it hurt and it was cheaper than more AlliMed. I had already stopped treating my SIBO at the time but was still having some occasional symptoms but after I started this breathing practice my symptoms decreased further and now I really have no symptoms and feel my SIBO is totally cured. Granted, I was doing probiotics and fermented foods during this time too but I also cut out most of my pro-kinetic drugs during this time so it is hard to say what really made the difference or if it was a combination of everything but it worked for me.
So, what was this exercise? It is a combination of resistance breathing and a very long exhale period done in a relaxed state. There is also some spinal manipulation involved which I wasn’t so sure about until my PT has me doing the same exact thing to deal with my disc issues and another PT friend explained that this component is opening up the dural tube that the nerves run through and thus could be helping the vagus nerve to fire better. Maybe this person hit on the ideal breathing exercise for SIBO after all and it isn’t something that is a traditional yogic breathing practice.
How do you do it? Pretty simple really. She said she practices what she calls “Stop, Drop and Relax” multiple times a day and that is what I started doing. You start by lying down in corpse pose on the floor and relaxing, I mean really relaxing. You want to especially relax your gut which could be tied up in knots from SIBO. Just breath normally a bit until you feel some unwinding and you have relaxed into the pose. Now the fun begins. Inhale through the nose, just a good full inhale into your lungs trying to really fill them but not tensing up your body in doing so. When your lungs are full puff up your cheeks and the area around your mouth to cause resistance to the breath and just let the air very slowly escape from your mouth. You don’t really blow out the breath as much as you just let it escape through your lips, like you are on a deep free dive and need to slowly release the breath. This is giving you a very long exhale with resistance, both things that are shown to increase the vagal tone. I found that after a while I could spend a minute breathing out. Now, you can do a few of these and then your CO2 has built up a bit so you may have to take a break and catch your breath for a few normal breaths but I try to do 10 minutes of this breathing at a time with maybe a few normal breaths thrown in two or three times.
Once you get the breathing part down you can add in the spinal part to stretch the dural tube. You’ll notice as you lie on the ground that your body has three arches or ‘bridges’ that have formed – one in back of your legs by the ankles, one in your low back and one at your neck. She called this ‘lowering the bridges’ and the way I do it as taught by my PT is to start at the feet and pull the toes back so that the arch in the back of the leg goes down, feel this energy line go up your legs and then push the low back down, continue upward and finally to the neck. In my case I can’t get my neck anywhere near flat thanks to decades of bike commuting and computer work with bad posture but I can get it to lower somewhat. I do this as I start the exhale and hold this active corpse pose through the exhale then relax totally again for the next inhale.
Like I said, I can’t tell if this really worked for me or not since I was doing other things at the time but after doing this breathing for a time the last of my symptoms did pretty much disappear. Your mileage may vary but it is worth a try, it is at least relaxing compared to gargling yourself to tears and doesn’t cost anything but 10-20 minutes of your time each day.