The Case:

• Melissa is 35 woman experiencing daily stomach discomfort.
• As each day progressed she got more bloated, gassy, and uncomfortable belly distention.
• She tried elimination diets and even antibiotics but the bloating kept coming back.

The Investigation

When Melissa came to me she had already been diagnosed with SIBO (Small Intestine Bacterial Overgrowth). Her doctor prescribed antibiotics and that worked, at first. But, the symptoms came back so I knew we had to get to the root of the problem if we were going to help Melissa stop feeling like she was 4 months pregnant.

SIBO is an excessive amount of bacteria in the small intestine. This can cause a variety of symptoms and if left unchecked can lead to more serious concerns. SIBO can also be caused by more serious health concerns. Once considered to be rare, SIBO is now easier to diagnose and it is estimated to affect up to 15% of otherwise healthy people.

Dr. Seth Osgood is a board certified family nurse practitioner and Institute of Functional Medicine Certified Practitioner. He specializes in Autoimmune Disorders with specific emphasis on digestive health. It was his own family’s chronic gut issues that swayed him from his traditional medicine path to a functional medicine approach.

Bacteria Belongs in the Large Intestine

There is a lot of talk about healthy bacteria in the gut. This flora should mainly  live in the large intestine. When it moves into the small intestine, the body is not set up to deal with it and so it ferments and produces gases. This is what causes bloating and that sense that you feel or look pregnant because of the distended belly.

Symptoms Range

Melissa’s main complaints are common symptoms of SIBO - gas, bloating, and an uncomfortable distended belly. Additional symptoms include diarrhea, constipation, belching, skin irregularities (eczema, rosacea, acne, and weird rashes), abdominal discomfort (sometimes diagnosed as IBS), and weight loss or weight gain.  

SIBO is Seldom the Primary Issue

A more holistic approach to SIBO will look for the root cause of the bacterial overgrowth. A common cause is low stomach acid (creating an inability to breakdown food). A low functioning thyroid, stress, impaired vagal nerve dysfunction (parasympathetic response), autoimmune issue or nutritional deficiencies can also contribute to the development of SIBO. Low levels of pancreatic enzymes can also make it difficult to breakdown food which leaves the food to putrefy and breed bacteria.

Some Pharmaceutical Use Can Lead SIBO

Chronic use of antibiotics, non-steroidal anti-inflammatories (like aspirin and ibuprofen) can lead to dysbiosis (a microbial imbalance.  PPI (proton pump inhibitors) is a commonly prescribed acid blocker that decrease the amount of acid in the stomach, so extended use of these can also contribute to SIBO.

How to Diagnose SIBO

There are a few tests that can be done to confirm SIBO. The gold standard is a three-hour hydrogen breath test. After consuming a sugary water (fuel for the bacteria), the time it takes to produce methane and hydrogen indicates where the bacteria are living - in the large or small intestine. The concentration of the gases is also telling. Additionally, an organic acid test will help determine if the issue is bacterial or fungal or both. A stool test may also help provide a bigger picture of digestive issues.

You Can’t Fix SIBO if You’re Not Pooping

Failure to clear your bowels on a regular basis leaves too much fuel for bacteria in your small intestine. For some, low motility is a symptom of SIBO but it can also be a contributing factor. In order to solve the gut imbalance, the bowels need to be moving regularly.

Options for Treatment

Once you have the whole picture and understand (and have dealt with) the root cause, there are several options for treatment. Dr. Osgood and I prefer an herbal approach. There are several combinations but the right one for you is going to be based on what’s working for your body. There is not a one size fits all and finding the right combination will require some testing. Temporarily following a specific diet (like the elemental or low fodmap diet) may help speed up recovery.

Treating SIBO is Tricky

For many people the first stop they make is to their traditional doctor and potential a gastroenterologist. And while SIBO can be diagnosed, the traditional approach is to treat SIBO with medication. This often will kill off the overgrowth but it doesn’t really deal with how the overgrowth happened in the first place. As a result, patients will often have a recurrence like Melissa did.

Prevent SIBO Relapses

Getting your gut bacteria back in balance is never a permanent state, you have to work at maintaining that balance. The keys to avoiding a relapse are maintaining stress levels, taking advantage of probiotics (find the right one for you as some may irritate your system), stimulate the parasympathetic tone with vagus nerve exercises, eating a clean diet, and encouraging good motility.  

Mystery Solved

We did some further testing with Melissa and were able to narrow down the details of her SIBO and identify a food allergy that she was unaware of. We also had to deal with her constipation which we did with Calcium Magnesium Citrate and Paleo Fiber. We stimulated her stomach acid production with supplements and started doing vagal nerve exercises so that she could better produce the acid without supplements. She was then ready for a cleanse. She responded well to a low fodmap diet and implemented some natural antimicrobials. Six weeks later, she was feeling better and took some maintenance and support supplements for a few more months to help her avoid an immediate relapse. The supplements used are listed below.   

Eliminating Health Mysteries

For Melissa we were able to determine that just dealing with the gut bacteria wasn’t enough for long-term health. We found all of the pieces to her digestive issues and she was thrilled to be feeling better (and fitting into those skinny jeans again). Could gut imbalance or SIBO be the missing clue for you or someone in your life? Share this episode with them and take action to restore a healthy microbiome in your belly.

Links:

Thanks to my guest Dr. Seth Osgood. You can connect with him through his business Grassroots Functional Medicine: https://grassrootsfunctionalmedicine.com/. Or connect with him on Facebook or Instagram.

Want to see more SIBO research? Here is a prominent study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/

Mentioned Supplements:

FC Cidal

GI MicrobX

Allicillin

Motil Pro

Cal/Mag Citrate

Paleo Fiber

Bitter X

Digestzymes

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