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.

Dr. Ruscio had a very interesting presentation on Saturday morning covering Biofilm agents, Atrantril (Compound-A) and statins.  Biofilms can be found in both the large and small intestine and can be formed by both bacteria and archaea like m.smithii.  Studies show that biofilm agents combined with herbal antibiotics can reduce H2 and combined gas levels but do not help drop the CH4 levels.   His recommendation is to use a biofilm agent with treatment if the first-line treatment alone doesn’t work which is kind of what I did in adding NAC when I was making no headway with the antibiotics.

For the methane folks (like I was) he looked at Atrantril and statins as a solution to the methane problem.   Methane causes a vicious cycle, albeit a slow one, where the methane causes slow transit and the slow transit thus allows the number of methanogens to grow, adding to the problem.   Atrantril has shown some symptom reduction in the study that used it but there have been no long-term studies done on it so again he recommended only using it for a stubborn case that won’t respond to other treatment.   Statins are being studied now by Pimentel, especially lovastatin.  Statins have known side effects and so far no real dosage has been figured out so again, hold off except for a stubborn case and maybe look at using a natural statin like Red Rice Yeast instead of the prescription drug.   There will be more on this in the coming year with the new statin drug coming out of Pimentel’s research, I’m sure it will be discussed at his Global IBS Symposium later in the year.

There was an interesting discussion on Elemental Diets at the second Q&A.  There is a new ED product out which evidently tastes good according to a friend of mine who was in Portland and got to try it.   Dr. Ruscio has found semi-elemental diets seem to work as well as a full one and are easier to deal with.  Dr. Siebecker interestingly enough changed her tune on ED with underweight patients.  She didn’t recommend it for me in 2014 since I was underweight but now she said she has found ED actually helps many people gain weight since they can finally consume a full amount of calories.  This was part of my problem when my weight loss was at its worst, I just couldn’t eat much and had a hard time getting 2000, let alone more calories.   With a palatable ED solution maybe I could have been pumping 3000 predigested calories and not lost so much weight.   Just a note, I’m still a few pounds under that weight that Dr. Siebecker thought was underweight over 2 years go.

Dr. Siebecker had a great talk on diet on Sunday afternoon.  She mostly covered general points but it is clear that diet CANNOT cure SIBO, it is there for symptom relief and prevention.  The SIBO Specific Diet wins with 75-95% symptom reduction whereas low FODMAP gives 75-85% and SCD gives only 60-75% reduction.  Regardless of diet these are a guideline and you need to experiment with yourself to find out what works for you.    She has found some basic patterns though among patients.  Commonly tolerated foods include:

• sucrose, good old table sugar, as Dr. Pimentel has stated
• cocoa – yeah, with sugar that means dark chocolate is OK
• lactose free dairy – assuming you don’t have casein issues
• clover honey – same composition as sucrose
• starch – often one type of starch is OK for a given individual, be that Amylose or Amylopectin.  You need to experiment to see what will work for you. Resistant starch is often NOT tolerated so don’t save leftover starches to re-heat.

Things often not tolerated are:

• raw or unripe foods
• polisaccaride fiber – from whole grains, beans, nuts and seeds
• oligosaccharide fibers – FOS, GOS from onion, garlic, beans, fruit and gluten grains
• coconut – even coconut oil isn’t well tolerated by many evidently
• winter squash – maybe one variety will work and others won’t

To sum it all up she had a list of tips for diet during active SIBO which seems to mesh with my own experience:

• avoid raw food and salod
• choose ripe, soft produce
• chose low FODMAP fruits and vegetables.  Amount matters so mix it up to get variety if you can’t have a large quantity of one or two items.
• avoid whole grains and beans
• be careful with nuts and seeds
• be careful with yogurt, even lactose-free as the probiotic may cause issues
• experiment with starch to find out what is tolerated, maybe white rice, maybe white potato

More later I’m sure.  I did a few other sessions but didn’t take notes on them as well.  As for me, a year after last year’s Symposium where I declared myself cured I’m still doing well SIBO wise with no relapses.  I’m evidently bucking the trend, most people relapse within 9 months. My diet has greatly expanded, I now eat salads each day and a very full Paleo diet with a few non-Paleo items tossed in occasionally.  I still can’t seem to gain any weight though.  I was up to 160 during the winter but as the weather warmed and I got more active I dropped 5 or so pounds and have been stuck regardless of how much I overeat.   I know the breathing method I’m doing now while running is built to maximize fat burning and it obviously worked since my body fat % has dropped by 2% since I started this.

I just got my blood work back this morning and, of course, my cholesterol is high number wise but when you look at all the cardiac risk factors I’m off the chart on the low end.  My fasting blood glucose was barely elevated which is odd.  I eat a bit more carb recently but nothing compared to the average American.  I’m blaming cortisol and my general sleep issues on this since cortisol can raise blood sugar levels.   Further testing could verify that if I wanted to spend the money and do it, the DUTCH test is kind of intriguing and would be what I’d go for.

There will be a 4th Annual SIBO Symposium next year, same time and in a newly air-conditioned all at NCNM.   Hopefully there will be more new stuff coming out by next year and I’ll look at the schedule to decide whether to do it live or remote.