What is SIBO and why is it difficult to diagnose. How does SIBO relate to IBS. What are the main symptoms of SIBO. What causes bacterial overgrowth in the small intestine. How is SIBO diagnosed and treated. Why do SIBO symptoms often recur after treatment. What dietary changes can help manage SIBO.

What is SIBO and Why is it Often Misdiagnosed?

Small intestinal bacterial overgrowth (SIBO) is a digestive disorder characterized by excessive bacterial growth in the small intestine. Despite its prevalence, SIBO remains notoriously underdiagnosed, often mistaken for irritable bowel syndrome (IBS) or other gastrointestinal conditions. This misdiagnosis stems from the similarity of symptoms and the lack of awareness among some medical professionals.

Is SIBO a common condition? While exact prevalence is difficult to determine due to underdiagnosis, research suggests that SIBO may be present in a significant portion of patients diagnosed with IBS. Approximately 11% of people worldwide suffer from IBS, and studies indicate that SIBO could be a chief cause of these symptoms in many cases.

The Challenge of SIBO Diagnosis

Why is SIBO so difficult to diagnose? Several factors contribute to this challenge:

• Overlapping symptoms with other digestive disorders
• Lack of awareness among some healthcare providers
• Variability in diagnostic criteria and testing methods
• The complex nature of gut health and its interconnections with other bodily systems

Dr. Nirala Jacobi, a naturopathic doctor specializing in SIBO, notes that despite increased awareness efforts, many patients still struggle to receive a proper diagnosis. “I still hear from patients every day that they go to the gastroenterologist and it’s still not being recognized,” she says.

Understanding the Mechanisms of SIBO

SIBO occurs when there is an abnormal and prolific growth of bacteria or archaea in the small intestine. These microorganisms interfere with normal digestion by competing with the host for nutrients. Instead of allowing the small intestine to digest food and release nutrients into the bloodstream, the bacteria or archaea ferment the food first.

How does bacterial overgrowth affect digestion? The fermentation process leads to the production of gases:

• Hydrogen (produced by certain bacteria)
• Methane (produced by archaea)
• Hydrogen sulfide (produced by some bacteria)

These gases contribute to the characteristic bloating and other digestive symptoms associated with SIBO. Over time, this process can lead to poor nutrient absorption and damage to the intestinal lining, potentially resulting in a condition known as “leaky gut.”

SIBO vs. IMO: Understanding the Distinction

While SIBO has traditionally been used as an umbrella term for bacterial overgrowth in the small intestine, experts now differentiate between bacterial overgrowth (SIBO) and archaea overgrowth, referred to as intestinal methanogen overgrowth (IMO). This distinction is important because the type of overgrowth can influence symptoms and treatment approaches.

Common Symptoms and Health Impacts of SIBO

SIBO can manifest with a variety of symptoms, many of which overlap with other digestive disorders. This similarity in presentation often contributes to misdiagnosis or delayed diagnosis.

What are the primary symptoms of SIBO?

• Bloating and abdominal distension
• Excessive gas and belching
• Abdominal pain or discomfort
• Altered bowel habits (diarrhea, constipation, or both)
• Fatigue
• Nutrient deficiencies, particularly vitamin B12

How does SIBO affect overall health? Beyond digestive discomfort, SIBO can lead to more serious health issues if left untreated:

1. Malnutrition due to poor nutrient absorption
2. Vitamin and mineral deficiencies
3. Damage to the intestinal lining (leaky gut)
4. Increased risk of other health complications

The Root Causes of SIBO: Beyond Bacterial Overgrowth

Understanding the underlying causes of SIBO is crucial for effective treatment and prevention of recurrence. While bacterial overgrowth is the immediate issue, it’s often a symptom of another underlying problem.

What typically causes bacterial overgrowth in the small intestine? The most common root cause is motility dysfunction, which refers to the slow transit of food through the small intestine. This sluggish movement provides an opportunity for bacteria to proliferate and colonize areas where they shouldn’t be present in large numbers.

Factors Contributing to SIBO Development

Several conditions and factors can increase the risk of developing SIBO:

• Hypothyroidism (as in the case of Phoebe Lapine)
• Autoimmune disorders
• Structural abnormalities in the digestive tract
• Certain medications that affect gut motility
• Chronic stress
• Poor diet and lifestyle habits

Why is addressing the root cause important? Treating the bacterial overgrowth without addressing the underlying issue often leads to recurrence. Dr. David Borenstein of Manhattan Integrative Medicine notes that many patients experience relapse after initial treatment, with some studies suggesting relapse rates as high as 45%.

Diagnostic Approaches for SIBO

Accurate diagnosis of SIBO is crucial for effective treatment. However, the diagnostic process can be complex and may involve multiple steps.

How is SIBO typically diagnosed? The most common diagnostic tools include:

1. Breath tests: These measure the levels of hydrogen and methane in a patient’s breath after consuming a sugar solution.
2. Small intestine aspirate and fluid culture: This more invasive method involves collecting a sample from the small intestine to test for bacterial overgrowth.
3. Comprehensive stool analysis: While not diagnostic on its own, this can provide valuable information about gut health and potential imbalances.

Why are breath tests the most common diagnostic tool for SIBO? Breath tests are non-invasive, relatively inexpensive, and can provide valuable information about the type and severity of overgrowth. However, they are not without limitations, and interpretation of results can sometimes be challenging.

The Importance of Comprehensive Evaluation

Given the complex nature of SIBO and its potential underlying causes, a comprehensive evaluation is often necessary. This may include:

• Detailed medical history
• Physical examination
• Additional tests to rule out other conditions or identify contributing factors
• Assessment of thyroid function, particularly in cases of suspected hypothyroidism

Treatment Approaches for SIBO: Addressing Overgrowth and Root Causes

Effective treatment of SIBO typically involves a multi-faceted approach that addresses both the bacterial overgrowth and the underlying factors contributing to its development.

What are the main treatment strategies for SIBO?

1. Antimicrobial therapy: This may involve prescription antibiotics or herbal antimicrobials to reduce bacterial overgrowth.
2. Dietary modifications: Specific diets, such as the low FODMAP diet or the Specific Carbohydrate Diet, may be recommended to manage symptoms and support gut healing.
3. Prokinetics: These medications or supplements help improve gut motility to prevent bacterial stasis.
4. Nutritional support: Addressing nutrient deficiencies caused by malabsorption is crucial for overall health and recovery.
5. Lifestyle modifications: Stress management, regular exercise, and other lifestyle changes can support gut health and prevent recurrence.

How long does SIBO treatment typically take? Treatment duration can vary significantly depending on the severity of the condition and individual factors. In Phoebe Lapine’s case, it took six weeks of antimicrobial treatment followed by six months of a restricted diet for her digestion to normalize.

The Challenge of SIBO Recurrence

Why do SIBO symptoms often return after treatment? Several factors can contribute to SIBO recurrence:

• Incomplete resolution of the underlying cause
• Inadequate treatment duration or intensity
• Failure to address motility issues
• Reintroduction of triggering foods too quickly
• Persistent lifestyle factors that contribute to gut dysbiosis

Addressing these factors and developing a comprehensive long-term management plan is crucial for preventing SIBO recurrence and maintaining gut health.

Dietary Strategies for Managing SIBO

Diet plays a crucial role in both the treatment and management of SIBO. While individual dietary needs may vary, certain approaches have shown promise in managing symptoms and supporting gut healing.

What dietary changes can help manage SIBO?

• Low FODMAP diet: This approach restricts fermentable carbohydrates that can feed harmful bacteria.
• Specific Carbohydrate Diet (SCD): This diet eliminates most complex carbohydrates and all grains.
• Elemental Diet: A liquid diet that provides pre-digested nutrients, allowing the gut to rest and heal.
• SIBO Specific Food Guide: Developed by Dr. Allison Siebecker, this diet combines elements of low FODMAP and SCD approaches.

Why is dietary management important in SIBO treatment? Proper dietary choices can help:

1. Reduce symptoms by limiting fermentable foods
2. Starve harmful bacteria
3. Support the growth of beneficial gut bacteria
4. Provide nutrients necessary for gut healing

The Role of Probiotics in SIBO Management

The use of probiotics in SIBO treatment is somewhat controversial. While some studies suggest potential benefits, others caution against their use, particularly during the active treatment phase.

Should probiotics be used in SIBO treatment? The decision to use probiotics should be made on a case-by-case basis, considering factors such as:

• The specific type and strain of probiotic
• The stage of SIBO treatment
• Individual patient response
• Guidance from a healthcare provider experienced in SIBO management

The Future of SIBO Research and Treatment

As awareness of SIBO grows and research advances, new insights and treatment approaches are emerging. The field of SIBO management is evolving rapidly, offering hope for more effective diagnosis and treatment options in the future.

What are some promising areas of SIBO research?

• Improved diagnostic tools and criteria
• Novel antimicrobial treatments
• Targeted probiotics and prebiotics
• Personalized dietary approaches based on individual microbiome profiles
• Better understanding of the gut-brain axis and its role in SIBO development

How might SIBO treatment evolve in the coming years? As our understanding of the gut microbiome and its interactions with host health deepens, we may see more personalized and targeted approaches to SIBO management. This could include:

1. Customized treatment protocols based on specific bacterial overgrowth profiles
2. Integration of advanced microbiome testing into routine SIBO diagnosis
3. Development of new prokinetic agents to address motility issues
4. Increased focus on preventive strategies to reduce SIBO risk in susceptible individuals

The journey to understanding and effectively treating SIBO is ongoing. As more healthcare providers become aware of this condition and its impact on overall health, patients like Phoebe Lapine may find it easier to receive timely diagnosis and appropriate care. However, the complex nature of SIBO and its potential for recurrence underscore the importance of a comprehensive, long-term approach to management that addresses both symptoms and underlying causes.

For those struggling with persistent digestive issues, seeking out healthcare providers with expertise in SIBO and functional gut disorders can be crucial. As research progresses and awareness grows, the hope is that more effective treatments and management strategies will emerge, offering relief to the millions affected by this challenging condition.

Why SIBO Is So Difficult to Diagnose

In 2017, shortly after she turned 32, Phoebe Lapine had just spent the previous three years overhauling her health to make up for her ailing thyroid, the result of unchecked Hashimoto’s thyroiditis. She was following a gluten-free diet, drinking kombucha and taking prebiotics, and finally feeling her best when she noticed peculiar gut symptoms starting to rear their head: burping during meals, stomach discomfort, and a bloated belly that simply would not deflate. She turned to a functional doctor who quickly gave her a diagnosis: small intestinal bacterial overgrowth (SIBO), a gut condition not uncommon for hypothyroid patients.

Lapine, who lives in New York, had never heard of it, nor had her endocrinologist warned of the possibility of developing it. The diagnosis was a relief: “It’s not all in my head; the bloating is just sticking to my body like an inner tube,” Lapine, now 36, remembers thinking. But treatment proved to be an odyssey in and of itself. It would take six weeks of antimicrobial medicines and another six months of a restricted diet for her digestion to feel normal again, and for the bloat to finally go away. Lapine, a food and health writer and chef, chronicled her SIBO journey and shared SIBO-appropriate recipes on her blog and podcast in early 2018. That’s when she learned how lucky she’d been.

“I’ve gotten many, many messages and emails from really sick, desperate people. They reach out from all over the world and are like, ‘No one here where I live knows what this is,’” Lapine says. She answered the first few notes, but when the avalanche didn’t let up, she set up an automatic response with links to online resources.

SIBO is a notoriously underdiagnosed condition, despite research suggesting it may be a chief cause of irritable bowel syndrome (IBS). Approximately 11% of people worldwide suffer from IBS, a “wastebasket diagnosis” many patients with an array of digestive issues are given when doctors can’t pinpoint a more precise cause. Their symptoms can be managed through diet and a handful of supplements and medications, but for a long time, a cure was considered to be out of the question. “People were relegated to ‘learn to live with it.’ When SIBO came along, it really offered some cures and solutions,” says Dr. Nirala Jacobi, a naturopathic doctor whose online platform “The SIBO Doctor” offers courses on the disorder for both practitioners and patients. But although Jacobi and others have led an awareness crusade, many practices fall short when it comes to SIBO diagnosis and treatment. “I still hear from patients every day that they go to the gastroenterologist and it’s still not being recognized,” says Jacobi.

SIBO is the abnormal and prolific growth of either bacteria or archaea—a single-celled organism older than bacteria—in the small intestine. The bacteria or archaea interfere with normal digestion by competing with patients for food. Instead of allowing the small intestine to digest food and release nutrients into the bloodstream, the bacteria or archaea get there first and ferment the food. In the fermentation process, the bacteria release hydrogen, and the archaea release methane, creating the appearance of bloating. Although SIBO has served as the umbrella term for both kinds of overgrowth, experts now prefer to differentiate between them and refer to archaea excess as intestinal methanogen overgrowth, or IMO. Certain bacteria can also produce another gas, hydrogen sulfide, but this type of SIBO does not have its own name. In addition to bloating, fermentation can create a range of IBS issues: usually diarrhea from hydrogen and hydrogen sulfide production, and constipation from methane, although there can be both or neither. Over time, in addition to bowel discomfort, gas production leads to poor fat, carbohydrate, and protein absorption by damaging the intestinal wall lining, creating what’s called “leaky gut.” This also causes vitamin deficiencies, the most acute of which are B-12 deficiencies, leading to weakness and fatigue (and in advanced cases, mental confusion).

Read More: What We Know About Leaky Gut Syndrome

Understanding how and why bacteria or archaea start to overgrow in the small intestine is crucial to treating SIBO and IMO. Although they are digestive disorders, they’re almost always a symptom of another underlying issue: motility dysfunction, or the slow transit of food through the small intestine.

Getting to the root cause

By the time patients call up Dr. David Borenstein’s clinic at Manhattan Integrative Medicine, they’ve consulted three GIs before him, on average, without success. Either treatments were ineffective, or after a temporary reprieve, the SIBO or IMO relapsed. According to some studies, relapse rates are as high as 45%.

“Most of the people who do treat it are gastroenterologists,” says Borenstein, an integrative and functional doctor. “They’ll give you an antibiotic. A lot of the time, it helps, but the SIBO will come right back because they’re not treating the root cause of the problem. ”

Diagnosing SIBO and IMO is simple. A breath test is a noninvasive procedure that measures hydrogen and methane gas levels (hydrogen sulfide too, depending on the kind of test) by having patients blow into plastic tubes or bags every 30 minutes for three hours after ingesting a lactulose substrate. Narrowing down the conditions underlying SIBO and IMO may require a few more tests, but a patient history is the best place to start.

A bad episode of food poisoning—or several—can have damaged the patient’s migrating motor complex (MMC), a system that sweeps the small intestine clean like a dishwasher every 90 minutes and which, if impaired, may leave food debris and bacteria behind, allowing them to multiply. The IBS Smart test looks in the blood for anti-CdtB and anti-vinculin, antibodies produced to fight food poisoning. Their presence can indicate post-infectious IBS and suggest that the MMC has been weakened.

Proton pump inhibitors—a common reflux medication that decreases the amount of acid the stomach produces—can have compromised the stomach’s capacity to kill bacteria. In that case, stomach acid levels should be checked. An underperforming thyroid can have slowed a patient’s MMC, so a full thyroid panel ought to be done. Abdominal surgery—a hysterectomy, a laparoscopy to explore possible endometriosis, a hernia—can have produced scar tissue on the small intestine wall that pinches the intestine and obstructs flow, like a kink in a garden hose. Imaging and further exploration can detect that.

Then a solution can be tailored to the patient. Many involve prescribing a prokinetic agent, a medication that enhances motility.

In the meantime, the excess bacteria and archaea can be eliminated one of three ways. The first option many doctors opt for is a two-week regimen of antibiotics—specifically rifaximin, the first and only U.S. Food and Drug Administration–approved IBS drug, for SIBO, or a combination of rifaximin with either neomycin or metronidazole for IMO, since archaea resist rifaximin alone. For a gentler approach, some practitioners prefer to prescribe herbal antimicrobials such as allicin, oregano, berberine, neem, and cinnamon for four to six weeks. For especially recalcitrant cases, some resort to the elemental diet, a liquid formula of predigested nutrients that gives the digestive tract a break, starving the bacteria or archaea in the process. The elemental diet is the nuclear option, as it’s the most challenging one for patients, considering they can’t eat solid food or drink anything besides water for two to three weeks.

A medical and holistic alliance

The origins of SIBO research trace back to our improved understanding of the microbiome and, specifically, to advances presented by Dr. Mark Pimentel, a gastroenterologist and executive director of the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai Medical Center. In 1999—before the term microbiome had even gone mainstream—Pimentel published a paper showing that IBS was not a psychological disorder, as was commonly believed at the time; rather, it was the result of bacterial dysbiosis, or an imbalance of the gut’s microbial community.

Pimentel and his team at Cedars-Sinai have spent the past two decades characterizing the major bacteria in the small intestine. Last year, they published a paper that showed the sequences of the microbiome in the duodenum, the jejunum, the ileum and the colon for the first time. And they homed in on SIBO as an important contributing factor to IBS.

Pimentel’s research caught the attention of Allison Siebecker, a naturopathic physician who had been conducting her own SIBO research and leading awareness campaigns in the holistic community. In 2010, she became one of the first SIBO experts to create an online resource, SIBOinfo.com, with information about the disorder for both physicians and patients. She invited Pimentel to speak at the 2015 SIBO Symposium, an annual conference she’d started organizing a year prior, where the leading U.S. SIBO researchers presented their findings on the disorder and treatments. Pimentel and Siebecker have continued to collaborate since then.

“What’s interesting in the naturopathic community is that they tend to see patients that a lot of Western physicians aren’t able to sort out, and I think that was the case for IBS and SIBO in the beginning,” Pimentel says. “The naturopathic community was seeing a lot of these patients and then also recognizing the treatments sooner than Western medicine.”

While Pimentel pioneered the use of rifaximin as both an IBS and a SIBO treatment, naturopaths like Siebecker had already been touting herbal antimicrobials as an equally effective treatment method.

More awareness

Medical schools are beginning to include more material on the microbiome and dysbiosis, but practicing doctors may not have received that education.

“I trained to be a doctor 20 years ago, and at the time, SIBO was not known,” explains Dr. Ana Esteban, an intensive-care doctor who now specializes in SIBO. “No one talked about the microbiome. So my generation is training the next generation of doctors. Professionals like me are informing ourselves, but we have to specialize on our own, paying for courses out of pocket, finding the time and resources, because we want to. There’s no institutional help.”

As more online resources like Siebecker’s and Jacobi’s crop up, patients are increasingly turning down wastebasket diagnoses and seeking out doctors who will truly probe their digestive issues.

“A lot of people are still told to eat fiber and learn to live with their IBS,” says Jacobi. “Now because of the Internet and social media, people are just not willing to put up with that anymore and are looking for answers.”

Contact us at [email protected].

SIBO Bloating & How to Overcome It

Does your stomach swell up so much after eating a meal that you struggle to button your pants? Or maybe you wake up with a flat tummy, only to look 6 months pregnant by the end of the day! If you struggle with bloating and gas on a regular basis, you know how uncomfortable, embarrassing, and even painful bloating can be. It can interfere with your social life and self-esteem and could be bad news for your health in general if not properly addressed.

The truth is, any amount of bloating is a sign of inflammation in your gut. In my practice, I’ve found that the number one cause of bloating is a gut infection known as SIBO, or small intestinal bacterial overgrowth. This kind of bacterial overgrowth requires a particular probiotic to help you maintain a healthy balance of microflora in your gut.

I know that by overcoming SIBO, you can say goodbye to bloating and start feeling your best again!

What is SIBO?

10 Signs You Have SIBO

How Does SIBO Cause Bloating?

How to Treat SIBO & Be Rid of Bloating for Good

5
Free eBook

What is SIBO?

So, what is SIBO? Your gut is home to trillions of microorganisms that play a role in your digestive function and immune health. Even your mood is affected! Most of the bacteria in your digestive tract are located in your colon and large intestine. A small amount lives in your small intestine.

When something causes an imbalance in your gut (known as dysbiosis), the bacteria in your colon and large intestine can overgrow into your small intestine. This can wreak all sorts of digestive havoc, and soon turn into a whole-body issue.

10 Signs You Have SIBO

1. Gas, bloating, and diarrhea

2. Abdominal pain or cramping

3. Constipation (much less common than diarrhea)

4. Diagnosis of irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD)

5. Food intolerances such as gluten, casein, lactose, fructose, and particularly histamine intolerance

6. Chronic illnesses such as fibromyalgia, chronic fatigue syndrome, diabetes, neuromuscular disorders, and autoimmune diseases

7. Vitamin and mineral deficiencies, including vitamins A, B12, D, and E

8. Fat malabsorption (signified by pale, bulky, and malodorous stools)

9. Rosacea and other skin rashes

10. Leaky gut

Causes of SIBO

The main culprits behind developing SIBO include:

• Diets high in sugar, alcohol, and carbohydrates (which feed the bacteria)
• Hypothyroidism, which can slow your metabolism and cause a buildup of bacteria in your small intestine
• Low stomach acid, which leads to undigested food that feeds the bacteria
• Certain medications that disrupt your microbiome, including antibiotics, birth control, acid-blocking drugs, and steroids
• Stress, which messes with your digestion and causes dysbiosis
• Physical obstructions in the gut that can lead to an abnormal buildup of bacteria, such as diverticuli or scarring from surgeries or Crohn’s disease
• Dysmotility caused by diabetes, scleroderma, or neurological conditions such as Parkinson’s, ALS, or multiple sclerosis

How SIBO, (Small Intestinal Bacterial Overgrowth) Produces Gas, a common SIBO symptom – Infographic – Amy Myers MD®
Dr. Amy Myers

September 12th, 2018
https://content.amymyersmd.com/article/sibo-bloating/How SIBO Produces Gases and Causes Bloating – Infographic – Amy Myers MD®

How Does SIBO Cause Bloating?

The overgrown bacteria in your gut feed off of the undigested food in your small intestine—specifically carbohydrates. This feeding process ferments the carbohydrates and produces hydrogen gas as a byproduct.

In turn, that hydrogen can feed single-celled organisms in your small intestine known as archaea. These then produce methane gas as a byproduct. So when you have SIBO you have excess levels of hydrogen, methane, or both in your digestive system.

The effect of all this excess gas in your gut is exactly what you might imagine: severe bloating, belching, and flatulence. SIBO bloating can turn something as simple as going out to dinner with a friend into an uncomfortable, stressful event.

The good news is overcoming SIBO and restoring the microbial balance in your gut can eliminate bloating and other frustrating symptoms. You can once again enjoy worry-free meals with your friends and family.

3 Steps to Elimating SIBO – Infographic – Amy Myers MD®
Dr. Amy Myers

September 12th, 2018
https://content.amymyersmd.com/article/sibo-bloating/The 3 Steps to eliminating SIBO – Infographic – Amy Myers MD®

How to Treat SIBO & Be Rid of Bloating for Good

Diagnosing SIBO can be done with the proper tests. However, I often determined the presence of SIBO by carefully evaluating the symptoms. Once you know that SIBO is causing your bloating and GI distress, I recommend following a 3-step approach. This will get the bacteria under control and restore your gut’s natural balance.

The three steps to eliminating SIBO are:

Step 1: Starve the Overgrown Bacteria

First, remove the foods that feed the bacteria in your small intestine — namely sugar, alcohol, and carbohydrates. In addition to the usual suspects, such as bread, cookies, cake, and cocktails, you’ll want to eliminate complex carbohydrates including whole grains and legumes. These foods get broken down into sugar in your gut, feeding the bacteria just as regular sugar would.

Instead, you’ll eat plenty of non-starchy vegetables, leafy greens, lean proteins, and healthy fats, with minimal fruit. Berries are a good low-carb, low-sugar option if you need to satisfy your sweet tooth.

Step 2: Prune the Bacteria

In my practice, I typically used the antibiotics Xifaxan and Neomyacin to attack the bad bacteria. Xifaxan is more effective against hydrogen-dominant SIBO, and Neomyacin tends to be more successful with methane-dominant SIBO. These antibiotics work exceptionally well to kill the pathogenic bacteria with the least amount of disruption to your good bacteria.

I’ve also helped thousands of people successfully treat SIBO at home. For self-treating, I recommend Microb-Clear®. It’s a blend of magnesium caprylate, berberine, and extracts from tribulus, sweet wormwood, barberry, bearberry, and black walnut.

These ingredients kill off the bacteria naturally. While they aren’t specific to pathogenic bacteria and can disrupt your good bacteria, they aren’t as harsh as broad-spectrum prescription antibiotics. Those can completely wipe out good bacteria and bad bacteria alike. Microb Clear® is a much more natural and gentle approach.

Step 3: Restore Your Good Bacteria

Finally, you’ll want to restore the good bacteria in your gut. This will help you support a strong immune system as well as optimal digestion and nutrient absorption. You have to be careful when treating SIBO though, as taking certain probiotics could just be throwing fuel on the fire.

That’s because the species of bacteria involved in SIBO are typically lactobacillus or bifidobacterium. The majority of probiotic supplements out there contain these same strains. These probiotics can be beneficial for those who don’t have SIBO. If you do have SIBO, they may feed the overgrowth and delay your progress.

For this reason, while dealing with SIBO I recommend using a soil-based probiotic such as Primal Earth®. It contains spore-forming bacterial strains that won’t colonize the small intestine.

Instead, these hardy probiotics have a seed-like structure that protects them from stomach acid, bile salts, and digestive enzymes. This enables them to survive the journey through your stomach. They’ll head straight to the colon and large intestine where they can support vibrant health.

I take Primal Earth® probiotics every day in addition to my regular probiotic supplement. That way I can make sure I maintain a healthy balance of bacteria in my gut.

Taking back your health—and fitting into your jeans—is only three simple steps away. As you begin to clear your body of SIBO, you’ll realize that the bloating you were experiencing is NOT normal. You will also start enjoying meals once again without the fear of gas, cramping, and abdominal distension.

90,000 Miller named those responsible for high gas prices | Economy news | Izvestia

The head of Gazprom, Alexei Miller, said on June 16 that “many thanks” for high gas prices should be said to European regulators.

“We have witnessed extremely high volatility in commodity markets and very high inflation. But all this did not start yesterday, not today – and here we must say “many thanks” to foreign regulators, in particular European ones,” he said during his speech at the session “World Oil and Gas Market Today and Tomorrow” at the St. Petersburg International Economic Forum (SPIEF).

He noted that Gazprom had repeatedly warned Europe that gas was not a commodity.

“We warned, we said why would you do this when gas, unlike oil, is not a classic commodity. As a result, spot exchange platforms are illiquid,” he stressed.

According to him, Gazprom has successfully overcome the period of sharp declines and growth in demand for gas. In addition, he noted that the company is not offended by Europe for reducing gas supplies.

“Yes, we have a decrease in gas supplies to Europe by several tens of percent. Only prices rose not by tens of percent, but by several times. Therefore, if I say that we are not offended by anyone, then I will not pretend, ”he stressed.

Miller also pointed out that Nord Stream 2 is ready to go at any moment. He stressed that, unlike the gas pipeline, the Russian economy does not stand still, so the unclaimed capacity of SP-2 was redirected.

“Unclaimed capacities for Nord Stream 2 were redirected for supplies from the North-Western District. All the governors applauded us, they said that we would build production,” he said.

He also added that Russia is getting a new window of opportunity in redistributing the world’s energy resources for a fair supply.

In his opinion, the world financial system has lost control over the flow of goods and has itself become a generator of a powerful inflationary impulse.

“Game is over because the demand for raw materials replaces the demand for foreign exchange reserves. ‹…› This gives us a window of opportunity in terms of production and distribution of energy resources in terms of the most efficient energy supply,” he explained.

Miller is sure that the outline of the new economic structure will be determined by Russia.

Thus, as of June 16, gas prices in Europe for the first time since the beginning of April exceeded $1.5 thousand per 1 thousand cubic meters. m. On Thursday, July trading on the index of the European hub TTF opened at $ 1,334.9. By the middle of the day, the rise in prices accelerated and reached a maximum of $1519.

A day earlier, The Wall Street Journal reported that rising gas prices could be the root of a split in the united Western front towards Russia. As the authors of the material noted, the countries of Europe and the United States adhered to a single rhetoric regarding Russia, but recent events may radically change the policy of Western states.

Back in April, Russian President Vladimir Putin said that the refusal of a number of Western countries from normal cooperation with Russia, as well as from part of Russian energy resources, had already hit Western countries. Prices are rising everywhere, and inflation is going through the roof, according to the Russian leader, for these countries it is absolutely unprecedented.

On March 23, Putin announced that the country would switch to paying for gas supplies to unfriendly states in rubles. On March 31, a corresponding decree was signed, after which the buyers had to open ruble accounts from which gas payments would be made. A number of Western countries have stated that they are not going to follow this requirement.

Western countries began to tighten sanctions against Moscow against the background of Russia’s special operation to protect the civilian population of Donbass, which was announced on 24 February.

For more up-to-date videos and details about the situation in Donbass, watch the Izvestia TV channel.

A skewer in the back The gas pipeline bypassing Russia will be launched on Russia Day. Thanks to Turkey and Azerbaijan It is considered an alternative to the Russian gas supply project to Europe, namely the Turkish Stream, but due to the relatively small capacity of TANAP, Moscow is not afraid of increased competition in the southern direction.

Meanwhile, Ankara has set a course for creating an energy bridge between East and West and, together with Azerbaijan, is building a new gas pipeline. Turkish gas revival – in the material “Lenta.ru”.

Another Day of Russia

Vitaly Beglyarbekov, vice-president of the Azerbaijani state oil company SOCAR, said in February that the launch of the Trans-Anatolian Natural Gas Pipeline (TANAP) is scheduled for July 2018. But in early May, Azerbaijan announced that the opening of the new pipeline would take place on June 19. Later, the launch date was again postponed and now, by a sudden coincidence, the presidents of Turkey and Azerbaijan – Recep Tayyip Erdogan and Ilham Aliyev – will hold a ceremony for the commissioning of a new gas pipeline to Europe on June 12, Russia Day. The haste is explained simply – on June 24, early presidential and parliamentary elections will be held in Turkey.

Photo: Patrick Pleul / Globallookpress.com

TANAP has been built ahead of schedule and was originally scheduled to launch in 2019. The start of the project was announced in 2012, and pipe-laying work began in March 2015. A controlling stake (51 percent) in TANAP belongs to the Azerbaijani state company SOCAR, Turkish Botas (30 percent) and British BP (12 percent) also own shares. The remaining seven percent belong to SOCAR’s Turkish subsidiary, SOCAR Turkey Enerji. The cost of the project is about eight billion dollars.

Related materials:

The initial capacity of the 1,850 km gas pipeline will be 16 billion cubic meters of fuel per year. It is assumed that about six billion cubic meters of Azerbaijani gas will be supplied to Turkey, and the rest – to Europe. In the future, the capacity of the pipeline will be increased to 24 billion cubic meters of gas per year, and then to 31 billion cubic meters. “The commissioning of TANAP is the key to the continuation of Ankara’s active energy policy,” Turkish Minister of Energy and Natural Resources Berat Albayrak noted on May 11.

Corridor to Europe

The Trans-Anatolian Gas Pipeline is an integral part of the Southern Gas Corridor (SGC). The SGC project also includes the development of the second stage of the Shah Deniz gas field in the Caspian Sea, the expansion of the already operating Baku-Tbilisi-Erzurum pipeline and the Trans Adriatic Pipeline (TAP), which will stretch through Greece and Albania, then along the bottom of the Adriatic sea ​​to southern Italy. Azerbaijani SOCAR is confident that gas exports to Europe via the Southern Gas Corridor will begin in the coming years. “Now we can say that the Southern Gas Corridor will be launched on time – in 2020,” Beglyarbekov said.

Image: TANAP

Israel has shown interest in the TANAP project. In July 2017, the Minister of National Infrastructure, Energy and Water Supply of the Jewish State, Yuval Steinitz, announced that by the end of the year the countries intend to sign an agreement on the construction of a pipeline to supply gas from Mediterranean fields to the European Union. In March of this year, Steinitz said that negotiations were ongoing, but, judging by the sharply aggravated relations between Ankara and Tel Aviv due to the opening of the US embassy in Jerusalem, they failed.

Related materials:

Europe welcomes the Southern Corridor project and calls it strategic. According to the vice-president of the European Commission Maros Sefcovic, the significance of the SGC for the energy security of Europe is great and will only increase in the future. “The EU imports 69 percent of its natural gas and 89 percent of its oil. Now we receive the main part of energy resources from Russia, Norway and Algeria. However, we, of course, want to diversify the sources of gas supplies, give preference to new partners, new routes,” he said during a visit to Baku at the beginning of the year. To ensure energy security, each member or partner of the European Union must have access to at least three different sources of gas, Sefcovic stressed.

Neither friend nor foe

The Azerbaijani-Turkish gas pipeline TANAP is considered an alternative to the Turkish Stream project being implemented by Russia’s Gazprom. According to the plans, the Turkish Stream should consist of two lines, through which 15. 75 billion cubic meters of gas will be pumped annually. One of them is almost ready – at the end of April, the first line of the offshore section of the pipe under construction reached Turkey, the concern said. It is assumed that it will supply gas to Turkish consumers. Now Moscow and Ankara are negotiating the route of the second – transit to the south of Europe – thread of the Turkish Stream.

Pioneering Spirit pipe-laying vessel in operation near Anapa

Photo: Sergei Guneev / RIA Novosti

Turkey is the second largest export market for Russian gas. According to Reuters, in the first quarter of this year, Gazprom supplied the country with 7.917 billion cubic meters of fuel, in 2017 – more than 29 billion cubic meters. It is planned that the capacity of both lines of the Turkish Stream will be approximately twice the capacity of the Trans-Anatolian Stream. That is why Russia does not consider TANAP a serious competitor. In addition, they point to relatively small gas reserves in the Azerbaijani Shah Deniz field.

Mercy, Baku!

Azerbaijan started gas production at the Caspian Shah Deniz field in 2006. The shareholders of the project are British BP, which owns almost 29 percent of the shares, Turkish Türkiye Petrolleri – 19 percent, Azerbaijani SOCAR – 17 percent, Malaysian Petronas – 15 percent, Russian Lukoil – 10 percent and Iranian NICO also with 10 percent.

The capacity of the first stage of Shah Deniz is estimated at eight billion cubic meters. The second stage of the field will be commissioned in 2018. According to Azerbaijan’s estimates, the volume of annual gas production at the field will increase from nine to 25 billion cubic meters. Baku does not exclude the expansion of gas production through the development of new fields. Among the promising ones are the development of the Absheron field together with the French Total, the Umid-Babek block, the Karabakh section together with the Norwegian Statoil, as well as the next phase of Shah Deniz, SOCAR Vice President Vitaly Beglyarbekov said.

Photo: Anton Denisov / RIA Novosti

Absheron, which has reserves of 350 billion cubic meters of gas and 45 million tons of condensate, will start production in 2020. The reserves of the Umid field are estimated at 200 billion cubic meters of gas and 30 million tons of condensate, the reserves of Babek are 400 billion cubic meters of gas and 80 million tons of condensate. Gas deposits at the Karabakh site amount to 28 billion cubic meters.

With the help of the Trans-Anatolian gas pipeline, Azerbaijan seeks to resolve several issues, Baku’s energy policy will change. If earlier the republic concentrated on oil supplies to the world market, now the necessary infrastructure will be built with the help of the TANAP project for Azerbaijani gas to enter the Turkish and European markets. The pipeline is controlled by an Azerbaijani state company, thus increasing the share of security guarantees for Baku.

Turkey on the way to revenge

For thousands of years, Asia Minor, or Anatolia, has been a bridge connecting Europe and Asia. On trade routes from East to West, the cities of Ancient Greece, and then the Byzantine and Ottoman empires, grew rich. The decline of Turkey in the XVII-XIX centuries is associated with the movement of trade routes. But at the beginning of the 21st century, fortune turned to face Turkey, and the country again became a strategic place – a new bridge for the supply of oil and gas from the countries of the East to the rich market of the European Union. At the groundbreaking ceremony for the Trans-Anatolian pipeline in March 2015, Turkish President Recep Tayyip Erdogan said he intended to turn the country into an energy distribution center. Ankara hopes that with the launch of the Southern Gas Corridor, Turkey will become a transit corridor and one of the most important energy hubs on the way to Europe.

Related materials:

Natural gas consumption in Turkey in 2017 increased by 16 percent compared to the previous year and amounted to a record 53.5 billion cubic meters. At the same time, gas purchases from Russia increased by 17 percent, to 28.