I finish up my second break week this week in the Mullen Protocol and am ready to start my last round of it in the morning, I organized my pills this morning. I really debated whether or not to even do this last few weeks since I’ve been feeling so much better but I decided that it wouldn’t hurt just to get in a last 10-12 days and see if I can knock this stuff out all the way. This break week went well, I only did one of the S.boulardii caps a day instead of two and had no bad reaction to that. I have had pretty much no SIBO symptoms all week long, just a bit of deeper stuff very occasionally late in the evening and even that is nothing.
Category Archives: SIBO
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:
- SIBOInfo.com – site maintained by Dr. Allison Siebecker
- Natural Functional Medicine – site of Dr. Melanie Keller, also of the SIBO Center, who I see via Skype.
- SIBO: Often-Ignored cause of IBS – good overview article by Drs. Siebecker and Sandberg-Lewis of the SIBO Center.
- Sibo Support Group – We Cured It and So Can You on Facebook
- SIBO Discussion/Support Group on Facebook
- Western Washington SIBO Support Group – Facebook group for a local SIBO support group I am trying to put together. We are trying to meet once a month locally. If you want to join, send an invite from the page and I’ll add you assuming you live in the Puget Sound region.
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.
Done with round 2 but why is my weight down?
Today I’m finishing up round two of the three round Mullen Protocol and get to take a break next week again. This time around I’m only doing one single S.boulardii capsule a day instead of two in case that caused my reaction last break week. Only one more round to go on this treatment protocol and then I retest in 3 weeks. Overall my gut has been pretty stable this past week and I’m eating somewhat high on the FODMAP chart. The only things I’m really avoiding at the moment are onions and garlic, I’m eating most other non-nightshade veggies and quite a bit of fruits even trying some apple which seemed OK in small amounts.
Halfway through the Mullen Protocol
Today I finish up another week of the Mullen protocol which means I’m half done with the second round and half done with the entire 8 week protocol. I definitely have improved since last Saturday when I was having issues with the S.boulardii but I’m not 100% over this yet. I am starting to think that my issues may not be the SIBO as much as either the blasto or some other basic colon imbalance at this point since I don’t start having any discomfort until about 2.5-4 hours after eating dinner at night which makes me think things are lower down. Every night when I’m about ready to go to bed some churning starts down deep and bugs me into the night, last night I woke up at 12:30 and my gut was still going. Maybe all these antimicrobials have finally just done in the flora I need but I’m still afraid to add in probiotics to see if that makes a difference, at least not until I get a clear test. I was hoping to get in a call to Dr. Keller to discuss this next week but there are no openings until May 1st and I’ll be almost past my next break week by then.
Is S.boulardii the devil?
Finishing up break week this week and it hasn’t been as easy as my last break week was. This time I took S.boulardii 2x a day and as the week has gone on I’ve had an increasing amount of gut distress. It started out a few hours after dinner mid-week, I figured it was the sweet potatoes I ate for dinner that night since the are a bit on the risky side. Next day same thing even though I stuck to true low FODMAP AIP. By yesterday it started after lunch and by an hour after dinner I was not feeling well at all and the gut churn continued until I fell asleep and was still going strong at about 1 a.m. when I woke up. I’m stopping the little yeastie beasties today in hopes that they will start to clear out of my system in over the next few days.
Starting a break week, neuropathy, sleep and chili recipes
Two weeks of the Mullen Protocol done today, now I get to take a break from the giant handful of pills with each meal. For this week I’ll just be doing two capsules of Saccharomyces Boulardii a day, assuming I can tolerate it. This is a yeast that is not a typical gut flora component and will just build up while taking it and then go away after a few days stopping but it will keep bad stuff from overgrowing while I’m not on the antibiotic herbs. We’ll see what happens. I am still doing my basic prokiinetic regime too with Iberogast at each meal and then at night MotilPro and 4.5mg of LDN. I’m down to 250mg of Mag at night which seems to be plenty these days to keep things moving. After the week break I’m onto Round 2 starting on the 12th. I’ve still got just about 6 weeks until I re-do my SIBO test in May.
Nightshades revisited
After my food allergy test I decide to start adding back in a few new foods to se what happened and in my last post mentioned I was adding in nightshades. Last week I had some eggplant, that seemed OK. On Sunday I had Venison Chili which was AWESOME. I had another bowl of the chili last night to finish it off. The results – today my weird arm symptoms and general brain fog are back with a vengeance. My upper arms feel like I just did about 100 push-ups, like they did months ago before I bit the bullet and went AIP. My head just is not all there and I haven’t experienced this for months on AIP either. So, I think the answer to the question on the tomatoes is Not to Eat for me.
Mullen protocol one week in
My meal-time pile o’ pills
I am now a week into the protocol devised by Dr. Gerard Mullen from John Hopkins. It is sort of funny that I end up on his protocol given that when all this digestive hell began 18 months ago one of the first books I read was The Inside Tract by Dr. Mullen. That book was the first clue that maybe diet changes could solve this problem ultimately. Obviously there are times diet can’t do it all and thus Dr. Mullen developed this protocol and has studied it and proven it more effective than the standard anti-biotic treatment for SIBO.
Food Allegies
A few weeks ago I did a huge food allergy test, the Cyrex Panel #10, to see what I was really allergic/reacting to. Originally I had planned to do Panel #4 for gluten cross-reactivity but didn’t want to have to eat some gluten-free bread to challenge my system first so Dr. Keller recommended this test instead plus it covers way more foods than the cross-reactivity test. I cared most about a few foods – eggs, coffee, chocolate and rice, all of which are on the cross-reactive test too but also nightshades and some other things that were also covered on the Panel #10. I had been trying to test some of these foods using the Bulletproof FoodDetective app on my iPhone but results seemed kind of inconclusive using the heart rate change test.
Mixing it up some more
A new pile of Biotics Research herbs to try
Three weeks ago I switched from my AlliMed/Neem/Berberine protocol to a new one using Metagenics CandiBactin-AR and -BR. This was some potent stuff and I definitely felt a change within 24 hours. First, it gave me diarrhea, something that I never or very rarely have dealt with through the course of SIBO since I have the constipation type. This lasted about 2-3 days and then shifted to where I had more solid stools but they were like ruins, they sort of fell apart on flushing. I called Dr. Keller and she said this seemed to be a normal transition people went through so I wasn’t too concerned. I finished up the 15 days of CandiBactin treatment and as the time went on noticed I could suddenly eat a bit more food and my symptoms were for the most part gone.
New protocol, new foods, new happenings, …
I finished three weeks of my usual AlliMed/Neem/Berberine treatment this week and even had stopped the Berberine for the last week to give my gut a break from it before switching over to a new protocol for the next 15 days. Yesterday I began the Metagenics CandiBactin-AR and -BR herbals, a potent combination of oregano and thyme oil and berberine. The oregano appears to be especially potent, within minutes I’m burping up what seems like an entire heavily spiced Italian meal. I had some definite gut rumblings going on yesterday after the first dose and again after the second evening dose so we’ll see how well I can tolerate this but I figure it is worth powering through for 15 days to see if it can help eradicate the last of the SIBO. One nice thing is that this is a lot less pills to swallow, only 4 pills at breakfast and dinner instead of 6 pills at each meal.