What a weekend. I got back last night from several days attending the SIBO Symposium in Portland and crashed hard all night after a few nights of too little sleep, too much sitting, a ton of information and a lot of good food and fun times with friends. I’m going to try and summarize what I learned and how it applies to my case in particular.
On Friday my local ND Christine Bowen, my friend and fellow blogger Shari (sibobreakup.blogspot.com) and I did the drive down to Portland to start the adventure. There we met a few friends from Facebook who were also attending the symposium. We all stayed at the very funky Jupiter Hotel, the only hotel I’ve been in so far that gives you a free condom on your bedside table.
Saturday was a very long day at the conference, we arrived to register a little after 8 a.m. and we didn’t leave until about 5:30 p.m. and it was HOT. No AC at NCNM and by mid-afternoon it was getting a bit unbearable in there. A lot of the morning and early afternoon was taken by Dr. Mark Pimentel from Cedars Sinai since he was leaving in the late afternoon to head back to LA. Dr. Pimentel is one of the leading authorities on SIBO and has been responsible for much of the research into IBS, SIBO and their underlying causes. Part of what he had to say was a repeat for me but some of it was new information.
The big thing which was kind of recap from the IBS Symposium last summer is that the majority of IBS is really SIBO and the majority (around 60%) of SIBO is an autoimmune condition where the enterinervous system is attacked causing a slowing of the Migrating Motor Complex (MMC) that drives the cleansing wave of the small intestine which keeps bacteria down in the colon where it belongs. This autoimmune condition is brought on by a bout of food poisoning, specifically the Cytolethal Distending Toxin (CDT) found in all of the major food poisoning bugs. They know this is the culprit because if they remove that toxin from e.coli then infect critters with the altered e.coli they do not end up with SIBO. We get hit with e.coli or salmonella, it releases it’s CDT and we then develop anti-cdtB antibodies. Unfortunately thanks to molecular mimicry, in some percentage of people that develop the anti-cdtB they will also develop anti-vinculin antibodies which attack a protein in the enteric nervous system. Once the vinculin is destroyed by the immune system it reduces the number of Interstitial Cells of Cajal (ICC) which drive the MMC and thus slow gut motility. The new IBS-Chek blood test looks for both of these antibodies and it will let someone know if they have the autoimmune version of SIBO. This is useful information because the level of antibodies relates to the severity of the SIBO and you can follow a hopeful reduction in antibodies over time which is really the only way to “cure” SIBO fully. It also is important if you have these antibodies to really watch the risk of food poisoning again because that will increase them even further and exacerbate the condition. You will be more susceptible to food poisoning too because of the already slowed motility so this could turn into a vicious cycle pretty easily.
The good news out of all this is that the ICC cells that regulate motility will regenerate within about 3-4 weeks IF the antibodies go away. Now I’ve seen my gluten and casein antibodies drop like a rock over this past year so I know antibody levels can go down in time if you avoid the substance that gets them going. My Gliadin Ab. SIgA were at 47 a year ago, really high given a positive for gluten intolerance is 15, but this year they were 3 a very low negative. It could be that my antibody level are already down somewhat from where they were when I got sick. The real fix for this would be a way to remove or reduce these antibodies sooner but as far as I know no one has really done that with other antibodies yet. I suspect I fall into this autoimmune camp though given my travel history and the fact I picked up at least a few parasites along the way in Mexico or somewhere in the Caribbean. I have an IBS-Chek test on order and will know soon enough.
Another interesting tidbit from Pimentel in this underlying causes talk was that you can have <3 methane levels in a breath test but still have constipation going on if you have a >10^4 concentration of m.smithii in your stool. I had a very high level of m.smithii, off the chart literally, in my stool as well as a 44 on my breath test so I was getting methane from both the small and large intestine. This could also explain my high baselines all the time. In light of this, I think that my new goal of balancing my colon flora is probably the right move to be making, more on gut balance later from the symposium. In fact, in light of this, by the end of Sunday I looked over at Dr. Bowen and said “I’m going to just consider my last test negative and blame what levels I have on the colon m.smithii.” My last breath test had a baseline of 4 and a rise only to 9. After 120 minutes when it should have been in the colon the levels were 8 so I think my real SI level is pretty low and my H2 levels were indeed a negative test. The problem isn’t in my SI right now, it is in my colon and I need to crowd out some m.smithii with some good bacteria. The more I eat sauerkraut and kombucha the better I feel so I think there is something to this theory.
That was only the first talk. As you can tell, it was a full weekend. The other talks I took good notes on during Saturday were the Prokinetics and a bit on Elemental Diet. I haven’t tried Elemental Diet yet but it is effective in reducing numbers big-time. Interestingly the Vivonex approach doesn’t seem to work as well with methane cases as the Siebecker homemade formula. If I ever do it I’d do the homemade anyway, not about to do a bunch of GMO corn and soy.
On the prokinetic front this is an area where we could really use some new drugs until the MMC problem can be really repaired. Right now Resolor is the best bet, it works the best followed by low dose Erythromycin. Most of the other prokinetic prescription agents have been taken off the market due to cardiac problems and no new ones are being developed. Now I’m afraid of anything with “mycin” in the name and Resolor still isn’t approved even in the EU for men so I’m leery of it even though all doctors on stage appear to be prescribing it for men in the US via Canada. Low dose Naltrexone (LDN) is a semi-pharmaceutical option and I’m taking it now, it helps with inflammation and motility, what’s not to like. On the totally natural side ginger or MotilPro and Iberogast came up from Drs. Keller and Siebecker. I’m doing ginger at 1500mg a day and Iberogast with each meal. I’m thinking of adding Iberogast at night too now since that was discussed by Dr. Siebecker, it can’t hurt. Dr. Mullen from John Hopkins spoke too about all natural pro kinetics – 1500mg Ginger, 100mg of d-limonene and Iberogast.
Sunday morning’s talk by Dr. Mullen was one I was really looking forward to. Unfortunately he was a webcast and not live so he could not be questioned. Still, I did his protocol and so was interested in this more natural approach. He went over their herbal protocol which I knew, their dietary protocol which was mostly low FODMAPs but then he went on to talk about the importance of balancing the gut which is the first time I’ve heard this from a “real” SIBO doctor. This is what Dr. Bowen has been saying all along, we need to balance my gut. Dr. Mullen over and over said that “shifting the micro biome is the key” for SIBO and I believe it. He recommends not only probiotic foods such as kraut, kimchee, kefir, kombucha, pickled vegetables and cheeses but also prebiotic foods to give these good bacteria food. This is exactly the Gut Health Protocol approach and what I kind of intuitively decided to do a few weeks ago and seems to be working for me.
Those were the highlights to me. Listened to a lot of case studies, some of them really difficult cases and some from people I actually know. Learned about test interpretation which was good in that I now can explain some of my weird tests a bit better than before. The talk on LDN was interesting in that if this is indeed an autoimmune disorder then LDN probably has multiple benefits.
There will be another blog post on the food, Paleo Portland II coming soon since I did get to hit another good restaurant and a few old favorites on this trip.