SIBO the Diagnosis
I’ll begin with my personal story and struggle. I have been battling nonspecific fatigue, severe constipation, IBS diagnosis, migraines, occasional bloating, food allergies and intolerances, intermittent joint pain and swelling, brain fog and weight gain. Many times over the years I have gone to my primary care doctor in search of answers. I’ve had a battery of blood tests, CT’s, swallow studies and colonoscopies. The tests have included testing my thyroid and for arthritis. All coming up essentially empty. The last two years my liver enzymes while still normal are creeping up showing signs of stress. While taking a nutritional therapy certification program I have learned about the power house that is the liver and really it’s the master detox organ in the body. Chronic constipation and bacterial overgrowth can certainly place stress on the liver amongst many other things.
Knowing what I know, and knowing that I don’t know it all, I did some research and decided to see a functional medical doctor to see if we could sort out and identify the cause of my symptoms. I have truly believed that all my symptoms are connected and likely the origination has been in my gut. I had my gallbladder removed in my mid 20’s after the birth of my third child, so clearly I have had gut issues since before that day.
I completed a lengthy health assessment in prep for my appointment. At my appointment Dr Teresa combed through my assessment asked many questions, did an exam and ordered many tests. Many tests were blood work done in the office the other 2 were take home tests. One was a saliva hormone test completed over the course of 24 hours and the one that revealed the diagnosis was a breath test. The SIBO or small intestinal bacterial overgrowth test had a 2 day prep (1 day for non constipated folks). The prep consisted of only consuming chicken, white rice and eggs. The only seasonings were salt and pepper. No oils, fats or other herbs and spices were allowed. The test sampled your breath every 20 minutes for 3 hours the day following the prep diet. You needed to be fasting from the night before and only consume water the morning of the test until completion, with the exception of a 1 time drink of a provided small cup of lactulose.
The Results
2 weeks after completing all the tests I went back to the doctor for the results. I was SIBO positive! In fact so positive that I am apparently case study worthy. I’m not sure that it’s ever a good thing to be case study worthy, LOL. Dr. Teresa did say, (which was almost tear producing), “No wonder you feel so bad!” The blood work also confirmed that I am not really absorbing my fats. I am sure this is partly due to the lack of gallbladder and the SIBO combine.
SIBO
What is SIBO? It is the over accumulation of bacteria in the small intestines. The small intestines usually have only a small number of bacteria present and when this alteration of bacteria occurs in types, numbers and/or location, all kinds of symptoms can emerge. It has largely been unrecognized in the medical community; however that position is starting to change. It is estimated that approximately 60% of people with Irritable Bowel Syndrome are suffering with SIBO.
| Symptoms of SIBO | Causes of SIBO |
| Bloating Diarrhea Cramping Constipation Chronic digestive complaints Nausea Belching Flatulence Fatigue Bad Breath Brain Fog Headaches Heartburn Joint pain Nausea Sinus Congestion Rosacea, Eczema Acne Restless Leg Syndrome Food sensitivities Chronic nutrient deficiencies (esp. Iron, Magnesium and B12) Muscle twitching (Magnesium def.) Mood symptoms (depression, anxiety) | Intestinal motility disorders (Slow stomach Emptying, constipation, Scleroderma, Muscular Dystrophy, Cystic Fibrosis, etc) Celiac Disease Low stomach acid; PPI usage Food poisoning Chronic NSAID/Opioid/Antibiotic use Alcohol abuse Hx of C-sections, appendectomy or other abdominal surgeries which may cause adhesions or damage to interstitial cells of Cajal (ICC) Ileocecal valve dysfunction Food Poisoning Gastroenteritis Gastrointestinal infection Fungus overgrowth Hypothyroid Stress Diabetes Initial poor colonization of gut bacteria at birth and infancy |
Sources of table siboinfo.com, sibotest.com and stillwaternatural.com
Why get rid of SIBO?
SIBO damages the microvilli of the small intestines and this damage leads to malabsorption. There are several different types of bacteria that tend to colonize the small intestines. One type metabolizes bile salt that leads to compounds that cause fat malabsorption and lead to symptoms like bile acid diarrhea. Another type of bacteria metabolizes carbohydrate to short- chain fatty acids and contributes to symptoms such as gas and bloating. This means the bacteria are using the carbohydrates and fibers you eat for their own metabolism and leaving you depleted. The digestion of the foods you eat by the bacteria leads to fermentation in the gut and releases methane and hydrogen gases while increasing damage; this continued damage also potentially leads to leaky gut syndrome. This process can trigger the immune system and inflammation. The whole interaction of the fermentable fiber foods such as starch, fructose, grains, gluten, fruits and vegetables and the bacteria can cause symptoms of bloating, gas, fatigue, and hormonal imbalances just to name a few. Additionally this interaction can paralyze the villi and microvilli and slow down the movement of food through the small intestines increasing the contact time and increasing the fermentation process. This will also put a significant strain on the bodies detox pathways as well as on the lymphatic and immune systems.
Repair
The goal is to rid the SIBO and restore gut health. This is accomplished by “starving” the bacterial overgrowth and likely fungal overgrowth. Dietary modifications for this will last anywhere from 2-6 month. Along with dietary restrictions herbs, supplements, possibly antibiotics designed to stay and act locally inside the intestines will be required. Sometimes a special diet called an Elemental diet can be used for a short time to rid the intestines of the bacterial overgrowth. During this restriction the addition of pro and prebiotics will be added and aim to replace and strengthen the good/normal bacterial. After a confirmatory negative post SIBO treatment breath test is completed the goal is to grow the diet back to a regular diet without symptoms or return of SIBO.
The phase 1(early phase) of the reduce and kill plan has been tough for me. It is very restrictive and rather lacking variety. For this reason it is mentally and physically taxing. It requires planning and support. I have worked really hard to follow the plan but have slipped a few times. We have had some family celebrations that included restaurants which were very difficult to eat at with such restrictions.
I am a horrible pill swallower and there are multiple required supplements, herbs, antibiotics, and probiotics taken several times a day. So for me the goal was to find as many liquid herbs and supplements as available. Because of this I am on the restricted diet for several weeks and then will transition to the elemental diet for another 2 weeks. Hopefully after that I will be able to transition through the recovery phase and progress to normal diet. I am both not looking forward to and looking forward to the Elemental diet. I am not looking forward to it because it is a specially prepared amino acid rich meal replacement drink that is the ONLY thing you can consume other than the water for the entire 2 weeks and its expensive (I’ve heard). But I am looking forward to it because it requires far less planning and research. I have also read that the Elemental diet has about an 80-85% rate of effectiveness. I am hoping that with the restricted diet, herbs and Elemental diet I will have complete healing. There are other diets one could follow to try to clear the bacteria including the FODMOPS, AIP, GAPS, and SCD none of these diets are perfect but all can be helpful in decreasing the bacterial overgrowth and hopefully ferreting out which foods bother you and allow you to heal. For more info about the SIBO adapted diet which is a combo of FODMAPS and SCD (which is what I am following) visit www.siboinfo.com or www.theSIBOdoctor.com.
The Die Off
As the bacteria starve and start to die, there will likely be symptoms experienced. I currently feel unsure of how to assess what symptoms I am experiencing. Are they from die off or something else? I occasionally get overcome by brain fog or feel heart burn or stomach burn like. I don’t usually experience heartburn but I also don’t eat such a restricted diet. Sometimes I wonder if what I am eating is not agreeing with me. The symptoms for me are vague and occasional. The dead and dying bacteria are releasing toxins and they themselves can increase body inflammation and irritation. These reactions are also known as the Herxheimer effect. Sometimes you can feel like you are coming down with something or feeling run down. I was told if my die off reaction becomes too strong I can go back to the doctor for IV hydration and/or vitamin infusion to help support the immune system and decrease the symptoms. So far I have been ok.
For now I will continue to plug along and hope the restriction and herbs are working. I generally am not a recipe creator but with this diet I have created a few meals and will post them in my recipe section.
In Health and Healing.
References:
Coomes, Rebecca 2017, SIBO Summer Cookbook, VIC, Australia
