Small Intestine Bacterial Ovegrworth, or SIBO, is a chronic bacterial infection of the small intestine that I have been dealing with since the fall of 2013. These are not necessarily bad bacteria and are typically beneficial bacteria but they have moved up from the colon into the small intestine where they interfere with digestion and damage the lining of the intestine causing leaky gut syndrome and possibly auto-immune disorders. In my case I quickly developed a severe gluten and casein intolerance, peripheral neuropathy in my feet and malnutrition/vitamin deficiencies that contributed to a sharp drop in weight.
Symptoms of SIBO include abdominal bloating and pain, constipation or diarrhea, and a feeling that one is basically allergic to food, especially carbohydrates. Many other symptoms are also possible depending on the severity. With leaky gut one can have fatigue, food sensitivities, headaches, and “brain fog”, I had all of these at the beginning. With malabsorption syndrome one can have weight loss, I lost close to 35 pounds in a matter of a few months. If left unchecked SIBO can lead to many auto-immune disorders or fibromyalgia.
SIBO is found with a lactulose breath test which measures the levels of hydrogen and methane in your breath. These gases are not created by our human cells and can only be present if bacteria are producing them. The test, spaced at 20-minute intervals over a 3 hour period can pinpoint where the bacteria are located in the small intestine.
SIBO is typically treated with one or more rounds of antibiotics, usually Rifaxamin and, if you have methane producing bacteria, Neomycin or Flagyl. These antibiotics were too strong for me and I was in the unlucky 10% that experience severe side effects and I had to stop taking them before the full course was done. Instead I had to use multiple rounds of herbal antibiotics – AlliMed and Neem Plus – to start to drop the bacterial levels. I have also been using Metagenics CandiBactin-AR and -BR as well as FC-Cidal, Dysbiocide, ADP and Berberine HCL from Biotics Research. Diet is also important in controlling SIBO and one must stick to a low FODMAP version of the Paleo or Specific Carbohydrate Diet. The diet that worked best for me was developed by Dr. Allison Siebecker at the SIBO Center in Portland and it is SIBO Specific based on a low FODMAP version of SCD.
Some resources for those dealing with SIBO that I have found helpful include:
SIBO App – I developed this iOS app in conjunction with Dr. Allison Siebecker of the SIBO Center. It includes an interactive version of her SIBO Specific Food Guide which can be searched, sorted and filtered. Free on the AppStore.
The following blog posts cover my ongoing journey with SIBO from the beginning.
Another year gone by already and what a year it was. I spent a lot of this year dealing with a relapse of SIBO and some other health issues but still managed to get outside every single day, got in a lot of hunting and fishing and had quite a few good trips locally, to the LA area and to British Columbia. So much, in fact, I couldn’t even really get it all in the picture grid.
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After failing to knock out the SIBO relapse with a month of herbals I decided to try something new – Atrantil. Atrantil was designed by a GI doctor in Texas specifically for methane dominant SIBO. It is a combination of three herbs that is reported to block the ability of methanogens to actually create methane thus give relief from symptoms. Studies show it works about 80% of the time in tough to treat cases but it is unclear whether it just stops symptoms or actually kills off the bacteria.
About a two months ago I started having some symptoms that reminded me of when I first started getting SIBO back in 2013 – a dull full feeling under my right rib-cage, bloating, burping, etc… After a few weeks of it I decided to just start treating it in hopes of knocking it out quickly so did a month of AlliMed/Neem/Berberine. I had my ups and downs over the month and settled into a strict Paleo diet and felt better thinking that maybe I had licked it. I decide to test and see where I was actually at and was stunned at the results:
Worst test result I’ve had to date, high of 62 when my previous high had been in the 49 and that took nearly two years to clear out. My baseline was off the charts high so it makes me think my system is simply full of m.smithii again.
Frustrating and depressing to say the least especially on top of this whole hormone mess I’m dealing with at the moment and I’m sure the two are somewhat related. I’m not sure what direction to go with this. I can:
I’ll sync up with my ND in a week or so, summer vacations, and try to come up with a plan of attack to see if I can get these numbers back down and not feel like crap again. Until then I know I’m sticking to a lower FODMAP Paleo diet since I definitely feel better eating that way than the expanded gluten-free diet I had been on.
Well if there is one thing that is for certain it is that the SIBO world in changing at rapid speed these days and Dr. Mark Pimentel of Cedars-Sinai dropped a few bombshells at the recent SIBO Symposium. I didn’t attend this year’s Symposium but I got a good summary from Shari so I’m just going to paste her notes here and then comment:
This is a question that has come up a LOT on the Facebook SIBO group and I thought I’d give my opinions on the matter having been a vegan and having suffered through SIBO. I was on the spectrum from vegan to pescatarian most of my adult life, I think the last red meat or poultry I ate was at 18 years old until I got SIBO at 53. This was a decision made for religious reasons as well as moral reasons to try and help save the planet and it wasn’t one made lightly. Originally I was hard-core vegan living on rice and soy for the most part then switched to adding dairy and eggs to my diet with some occasional fish. For many years we lived this way, eating fish often when traveling, otherwise maybe a few times a month. Sometime a few years before I got SIBO I started having problems with dairy and went back to being vegan.
2016 turned out to be a much better your than even 2015 was for me and really was shaped by our new family member – an Australian Labradoodle puppy we named Lira (river in Aboriginal Australian). Catherine and I had been talking about getting a dog again and I wanted one that could hunt since I got back into hunting as well as be a good family dog. We also wanted a non-shedding dog if possible. This narrowed our options down to basically two breeds – a Pudelpointer or a Labradoodle. We were on waiting lists for Pudelpointers when I found a breeder that had hunting doodles as well as Pudelpointers and after talking to her decided that the doodle would be a better dog for us.
Another record breaking hot weekend in early June must mean it is time for the annual SIBO Symposium in Portland. This year I decided not to attend the symposium live though and instead did some of the sessions from the comfort of my air-conditioned home where I could be at my stand up desk instead of stuck in a chair all day. I didn’t attend too many sessions live and will watch the rest of them over the next few weeks as I have time. Instead I focused on some areas of interest and here are my notes. For a good writeup of the top takeaways of the whole symposium see this great post by Riley Wimminger.
A year ago I finally stopped taking antimicrobials for SIBO after a solid year of trying hard to eradicate it with first prescription antibiotics, then herbals and diet. I never got a totally negative test last May but it was low enough that we all decided it was not worth trying to keep chasing down the last few points. After the Symposium in June I decided that maybe I would never test negative due to large amounts of m.smithii in the colon so changed tactics to work on my colon flora and ignore the SIBO.
SIBO can be a very isolating illness. Suddenly you can’t go out to eat with your friends since you are sensitive to everything. You can’t really go out to a bar with your friends either, drinking is not recommended. Often you just don’t feel like even leaving the couch when your gut is churning and you aren’t sure when you’ll next need to run to the bathroom. Friends and family rarely can understand what is going on since until you experience SIBO you really don’t get it. All of that can leave you feeling alone and a bit depressed, I know it did me. I think the only person I saw outside of my immediate family for months was a string of doctors as I was trying to figure out what exactly was wrong and what to do about it.
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.