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Sibo symptoms forum: Do You Have SIBO? 5 Signs to Look Out For

by alexxlab

Do You Have SIBO? 5 Signs to Look Out For

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Dr Ruscio:

Hi, everyone. This is Dr. Michael Ruscio. I just want to make a quick preface that the audio that you’re about to listen to is actually the audio compendium to a video, which has appeared both on our YouTube channel and on our Instagram page for your convenience. We want to always release the audio version of a video here on the podcast. However, it’ll be evident in some videos, more so than others, that the visual aids may be heavily referenced and leaned on. In some cases, having a depiction of a concept can be very helpful in portraying and making comprehendible that concept. So in any case, if you are listening to this and you want the visual aids, please see our YouTube and/or Instagram page so you can have access to those. Okay. And here we go to the audio for today’s video.

Dr Ruscio:

SIBO, or small intestinal bacteria overgrowth, can cause digestive symptoms like bloating, constipation, diarrhea, or reflux, but it can also cause non digestive symptoms such as fatigue, brain fog, mood disturbances, and even a connection to thyroid problems. It’s crucial to understand this far reaching impact of the gut because, as I learned myself, problems in the gut very much so, including SIBO, can cause a wide array of symptoms. And this can explain why some people are frustrated and not able to figure out where their symptoms are coming from. This is Dr. Michael Ruscio and let’s detail this very important finding of small intestinal bacterial overgrowth.

Dr Ruscio:

And so what is SIBO, or small intestinal bacterial overgrowth? Well, the name gives you a pretty good indication as to what it is, but it’s an overgrowth of bacteria in the small intestine. Now, there should be some bacteria in the small intestine, however, compared to the large intestine or the colon, there should be relatively few bacteria. When these bacteria overgrow, they can lead to excessive gas because remember, like people, as bacteria eat food they sometimes release gas. And that gas can build up in one’s system, leading you to feel gassy. And this can also explain why distension, bloating, and pressure are some of the other symptoms that are associated with and caused by SIBO. Some evidence has also found that SIBO can lead to damage of the lining of the gut—leaky gut. It’s similar to what’s seen with celiac disease, actually, and can also lead to overactivation of the immune system. And remember, when the immune system reacts, there’s almost always inflammation that’s wrapped into that. So that’s the long/short on SIBO.

Dr Ruscio:

In terms of how it occurs, there are two main theories and they both have some evidence, some plausibility, and it’s probably one or the other or both for some people. Bacteria from the top—meaning the oral cavity and the stomach—make their way down into the small intestine and then overgrow. This can happen when people have lower levels of hydrochloric acid or at least presumably. So this is something that a very elegant study by gastroenterologist Richard McCollum was documented. Now the other hypothesis and way in which SIBO can occur is from the bottom up. Remember we mentioned a moment ago that the large intestine has a relatively dense colonization of bacteria. And in some cases, bacteria from the large intestine can reflux upward and seed and colonize and overgrow in the small intestine. So it can occur in either direction. Not that that’s incredibly relevant for the treatment per se, there’s some relevance, but just to address some of how SIBO occurs.

Dr Ruscio:

And why is SIBO so problematic? Well, as we outlined a moment ago, you can probably infer a number of reasons why. But to tie those to a number of reasons why, specifically, because 90% of your calories are absorbed in the small intestine. Most nutrients are absorbed in the small intestine. And the small intestine—again, where SIBO occurs—is the most immunoactive. In fact, the largest density of immune cells in the entire body resides in the small intestine. And this is where leaky gut and the connection to auto immunity come in. So a lot is happening in the small intestine. And when we have dysfunction like SIBO there, it can cause many problems.

Dr Ruscio:

Now, as a quick aside, one fairly simple way to help quell SIBO and reduce symptoms is an elemental diet reset. And we’ve put together a free guide if you wanted to obtain some advice on how to do this simple, safe therapy at home. And again, that link is in the description. Okay.

Dr Ruscio:

So five of the more prominent symptoms of SIBO would be digestive—including IBS, gas, bloating, constipation, diarrhea, abdominal pain, but not limited to that—fatigue, mood disorders, brain fog, and thyroid function. And let’s detail these a bit more. Now with SIBO it’s very important to understand the connection to IBS, and this will become more relevant in a moment, but let’s start with the connection between SIBO and IBS, because SIBO is a lab finding and we want to make sure to be careful that we tie a lab finding to have meaning. In essence, that this lab finding correlates with you feeling differently. Because there are lab markers that don’t really have any meaning, and one can get very easily swept up into running all these labs, especially in progressive realms of medicine that aren’t validated and really have no meaning.

Dr Ruscio:

And some of these labs, sadly, are even fraudulent and have been shut down by the FBI or the FDA. So, in 2018, a meta-analysis, which is a summary study, examining over 50 studies published in the Journal of Clinical Gastroenterology, found that more than 1/3 of IBS patients—so these patients who have digestive symptoms—tested positive for SIBO. And other data have found an even higher association between SIBO and IBS. So it’s a moderately safe inference that if you have digestive symptoms, you could have SIBO. If you have IBS, you could have SIBO. And I want to make that connection because there’s a lot of research on IBS and we’ll borrow from some of that to draw another inference in terms of what symptoms SIBO may cause because there’s more evidence on IBS. And so again, sometimes we can borrow from this to help you better understand what you can do to improve your health and to get rid of if it be brain fog or fatigue, so that you can feel better.

Dr Ruscio:

Now, one other thing we should tie in here is the connection between SIBO and gluten sensitivity. This is very important to understand that celiac patients—and this is the, of course, most severe intolerance, even auto immunity in reaction to consumption of gluten—celiac patients who were unresponsive to a gluten-free diet had two times the rate of SIBO when compared to healthy controls. And there’s even other evidence that has found that treatment of SIBO will lead to resolution of symptoms in those who are non-responsive to a gluten-free diet. So if you’ve gone gluten free and seen some result, but not complete, it could be that SIBO is present.

Dr Ruscio:

And outside of IBS—like we detailed a moment ago, the gas, the constipation, the bloating, the abdominal pain— other evidence has also tied SIBO to reflux and indigestion. A 2021 study found that 60% of chronic reflux patients had either dysbiosis and imbalance in the ratios or SIBO and overgrowth. And another 2021 study found that 71.4 [percent] of dyspepsia, or indigestion, patients tested positive for SIBO when compared to only 8% positive in healthy controls. So again, SIBO can associate to IBS, to non-responsiveness or partial responsiveness to gluten-free dieting, and also even to reflux and indigestion.

Dr Ruscio:

Now what about non-digestive or extra intestinal manifestations of SIBO? Well, in another meta-analysis it was found that more than 50% of IBS patients had fatigue. And this is not the only finding that has associated IBS to fatigue. Very important to understand that fatigue can come from your gut. And many people who have digestive symptoms, especially in the clinic will comment, “the worse my gut is (digestive symptoms) the worse my fatigue is. The better it is, the better I feel.” And importantly, interventions that help with either SIBO or IBS have been shown to improve fatigue. Namely, a low FODMAP diet has been shown to improve fatigue in IBS patients and in another study, treating leaky gut reduce fatigue in patients with chronic fatigue syndrome.

Dr Ruscio:

Now what about mood? This is something else that you watching this may have experienced—when your gut flares, your mood flares. But keep in mind that you can have silent digestive problems. And seemingly so your mood problems are coming from nowhere. This is what I experienced myself. I had brain fog, fatigue, and depression with no digestive symptoms coming from a problem ultimately in my gut. But just a flag for you here that depression and anxiety are common in IBS and also thankfully gut treatments—namely probiotics and gut friendly diets—have shown the ability in interventional and clinical trials to improve depression and anxiety. Perhaps the most robust and compelling evidence here is a 2021 meta-analysis—remember, this is a summary, in this case of 16 randomized control trials, the pinnacle of scientific evidence—looking at overall 1100 patients and they found that probiotics improve depression and anxiety. The evidence is stronger for depression, but a signal also exists for probiotics being able to improve anxiety.

Dr Ruscio:

Hi, everyone. If you are in need of help, we have a number of resources for you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is the clinic—the Ruscio Institute for Functional Medicine—and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path, health coaching support calls every other week, and also we offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, etc. There’s also the store that has our Elemental Diet line, our probiotics, and other gut health and health-supportive supplements. And for clinicians, there is our FFMR—the Future of Functional Medicine Review—database which contains case studies from our clinic, research reviews, and practice guidelines. Visit DrRuscio.com/resources to learn more.

Dr Ruscio:

And what about brain fog? Well, brain fog is somewhat common in on either SIBO or IBS. And again, more good news, a randomized control trial found that probiotics improve cognitive performance in those with mild cognitive impairment. Rifaximin, an antibiotic that is FDA approved to treat SIBO, has also been demonstrated to improve cognitive function. And there’s an interesting connection here in that this occurs predominantly in what’s known as hepatic encephalopathy. And what this means is that when the liver is burdened and can’t adequately filter the blood, toxins in the blood make their way into the brain, and this causes cognitive impairment. And Rifaximin, which treats SIBO and improves gut health, has been shown to reduce this whole cascade because the gut drains to the liver and if you fix a problem in the gut, you fix a problem in the liver. And in this case, gut affects liver, affects toxins affects brain. And this is how Rifaximin has been shown at least in a handful of trials to improve this hepatic encephalopathy, right? It’s the gut-liver-brain connection.

Dr Ruscio:

And what about hypothyroidism? This is actually a bit of a newer finding over the past maybe three to four years. You’ve been seeing this breadcrumb trail of evidence being published. One of the more compelling studies was in a grouping of over 1800 patients and they found that hypothyroidism was the condition most tightly associated with small intestinal bacterial overgrowth. What was shocking about this finding was the researchers were expecting acid-lowering drug use, intestinal surgery to be the most tightly associated with SIBO. And what they found was being hypothyroid was the most tightly associated. So this was a fairly landmark finding.

Dr Ruscio:

And another seminal paper in this regard found that probiotics may reduce the need for thyroid medication. And to quote this paper, “TSH (or thyroid-stimulating hormone) concentrations, levothyroxin dose, and fatigue severity all decreased after a intervention on probiotics.” So very compelling. And likely what’s happening here is those who are taking thyroid hormone, levothyroxin, have a degree of impaired absorption of that medication and the probiotics, through potentially addressing SIBO and/or at least improving gut health and therefore improving absorption (as a study found) reduced TSH while also needing less of a dose. Meaning you took less medication and the medication worked more effectively at lowering TSH. And also you saw improvements in fatigue. So very, very interesting information here.

Dr Ruscio:

And I also wanted to draw your attention to this one graph. This is a patient’s TSH over time. Now, ideally when on thyroid hormone medication, the TSH should be 2. 5 or below. And what you’re seeing in this graph is I drew in a green line showing you the 2.5 cutoff. And month over month over month over month, this patient (and this is a published case study by the way) was unable to get their TSH into the normative range until they took Rifaximin, which again, treats SIBO. And then they were able to see improvements in their TSH levels. And finally, see the normalized. In fact, just yesterday, we went through the final draft of a six-patient case series that we will be publishing in a peer-reviewed medical journal, if it’s accepted, showing this sort of thing in a number of cases where improving the gut was actually the final missing piece allowing a patient to then respond more fully to their thyroid care.

Dr Ruscio:

Okay. So in close, remember that SIBO can cause digestive symptoms, bloating, constipation, diarrhea, reflux, et cetera, but it can also cause non digestive symptoms like fatigue, brain fog, mood disturbances, and even thyroid problems. And when we understand this, we can hopefully uncover the root cause of our symptoms and then have a path forward to address them. I hope this helps. And I’d also be curious to hear what your experience has been with SIBO, with gut health, and if you have any other questions or are looking for advice on your path forward. Okay, again, this is Dr. Michael Ruscio and I hope this helps.

 

SIBO – need help and advice

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GilmoreGirl, 

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GilmoreGirl
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Hi all,

Im so fed up! I have been suffering with sibo symptoms for a long time, but they got really bad last year after taking morphine for a couple months for an unrelated painful injury. My gp and I discovered that antibiotics seem to make me feel better. I did the breath test and was SUPER positive (>70 units) for methane sibo. Ive been on rifaximin alone twice, metronidazole alone once, and metronidazole + rifaximin once – all times my symptoms seem to improve, but then are back a week after stopping the antibiotics. Im now on a herbal antimicrobial protocol (including allimax) but my symptoms are just getting worse and worse as the days since I stopped taking the antibiotics go on.

Ive tried everything – extreme low carb dieting (which I continue to do), elemental diet (could not last more than two days – caused vomiting), etc. I have a prescription for a prokinetic but my naturopath says to wait until weve completed a few rounds of antimicrobials to start it.

I also have the STRANGEST cyclical symptoms that come and go extremely regularly. My gp and naturopath dont know what to make of this. My symptoms go as follows:

– all of a sudden (normally in the evening) get really gassy, lose appetite, have extreme fatigue and get dizzy easily
– next day gas continues – it gets worse and is extreme – huge flatulence every few minutes 24/7 with foul odour. Lots of bloating and pain and discomfort along with this. I also have sudden onset of constipation – when I do go it is very greasy and loose
– this continues for about two days. Then gas starts to subside, appetite and energy returns.
– next day bowel movements are normal and I feel much better
– I feel good for 2-3 days then the symptoms return

Its been cycling like this since June. Im going nuts. I feel so gross and horrible. Cant go to school or work reliably because I can never predict how Im going to feel. Has anyone had any luck actually getting rid of their sibo? Will this ever stop? Has anyone had similar symptoms in that they are cyclical like this?

Im honestly finding it hard to continue on like this – if you have any advice I would really appreciate hearing it.

Thanks everyone!

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Hi, I was diagnosed with hydrogen dominant SIBO finally after going to doctors for 8 months with symptoms. I had been a recurrent C Diff sufferer and had a fecal transplant in March 2017. About 8 weeks later I started with symptoms. I had so many tests run on me, and finally I asked for a SIBO test.
Because of my c Diff risk (I will likely always be a carrier) they recommended I see a nutritionist for the herbal protocol instead of taking Rifaximin. What herbal regimen are you doing?
I swear I cant find a thorough competent practitioner to save my life, literally. This nutritionist started me on a protocol, then a week later randomly emails me and says she is altering it to include some other drug… then that made me sick, I had to drop my dosage and start over… she seems like shes just guessing. My GI doc that referred me to her now has left the practice.
This crossover between conventional and naturopathic medicine is scary, because none of them seem really knowledgeable.

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Hi, thanks for your reply! Sorry youre suffering too, its totally debilitating. The protocol my naturopath has me on started with two weeks of rifaximin + flagyl. We then started alimax (2 pills 3x daily with food) and an sibo tincture that includes berberine and some other ingredients (cant remember now – but I can dm you later with the exact details. As well, I take a biofilm disruptor. Im in the middle of this part now, and shes just switched me to a more powerful biofilm disruptor – the idea being that I have had this for so long that the bacteria have really set up shop. After two weeks of this I will switch to a different anyimicrobial protocol for two weeks, then alternate back. The idea is to continue this until my symptoms start to improve (including maybe repeating antibiotics) and then add in the prokinetic (prucalopride).

I gotta day Im a scientist and a lot of this stuff seemed a little far fetched to me (biofilm lol?) but I have done some research and it is all pretty well supported by the limited research and studies that are out there

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I’ve had similar symptoms for over 3 years. . VERY high methane levels as well. Nothing has eliminated it. Tried multiple rounds of antibiotics. Multiple types of diets. The best I experienced was temporary relief from symptoms while on the first course of antibiotics. Subsequent courses weren’t as successful. Only had minor relief.

For the past several months, my gastroenterologist has had me on Trulance which has significantly decreased the constipation and bloating. However, I have diarrhea daily due to it. It’s the lesser of two evils for me.

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Thanks for replying jza. Sorry youve also had a tough time of it. I tried a similar medication called Constella, it did nothing but make me uncomfortable. Constipation is not my main issue – its the gas (incredible horrible amounts of gas! Im a gas producing machine). The constipation is just weird because its part of the cycle – I can tell the night before that Im going to not have my regular bm the next day by the way I start losing my appetite and begin to bloat.

Have you tried a herbal antimicrobial/biofilm disruptor protocol? Has your doctor offered any other treatment options?

Has anyone actually beat SIBO at all? I cant imagine spending the rest of my life like this (Im 25). I cant work, or even be in the same room as someone else half of the time. Terrible.

I am hoping that either the new biofilm disruptors or the next phase in the antimicrobial protocol will improve things. If not Im wondering if I should try a longer term rifaximin/flagyl course. Has anyone done this? Like for a month or more? I do have an appointment with a new gastroenterologist (after months of trying to find someone who would see me – they all thought my gp and I were nuts – long story there) so hopefully he will have some ideas.

Also – does anyone know if you can get oral neomycin in Canada? My gp said it was o key available in topical form.

Thanks all for reading.

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I was going to add here. .. I know in my reading of studies that Rifaximin with Neomycin has a higher success rate. But know nothing about Canada! I know someone who fully recovered from hydrogen SIBo, but not methane. Evidently the approach to methane SIBo has to be different. .. but the friend developed c Diff from the SIBo treatment, and was finally cured by an FMT.
What are the guidelines for FMT in Canada? Here it is still considered experimental, and usually only done for recurrent c Diff. But, there has been speculation it could treat SIBO by creating general balance with the gut microbiome.

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Thanks for your input MKW! Im certainly nervous about C Diff – scary thought. It is rarer to get it from taking rifaximin and neomycin as they are targeted antibiotics, but still possible and I have taken broad spectrum twice in the past few months.

FMT is actually becoming pretty accepted as a treatment here in Canada. My gp has mentioned it and has a patient with bad untreatable ibs who has gone for this treatment. It does require some travel to a University hospital that does research on it – but there are a few universities here that are leaders in the field. It may be an option for me at some point if other treatments fail, as I know they have used it for general ibs and tough sibo
Cases.

It is very discouraging that I have seen so little anecdotal evidence of people being cured from methane sibo. Not only this, but the relapse rates in the scientific literature are very high.

Long story short, but Ive had a year from hell. September before last I got injured – and was in extreme pain until April of last year when I finally had surgery. Then since then, Ive been dealing with this friggen sibo in one form or another. I used to be a personal trainer and grad student – now Im at least able to work out again and work on my studies from home – but this stupid disease is keeping me from starting PhD and returning to my personal training clients. And frankly, makes it tough to just live every day life without being overwhelmed with anxiety and depression.

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I was about the same age as you when I was diagnosed with SIBO-C so I definitely feel your pain. Yes, it is true the recovery rates for methane SIBO are low and the recurrence rates are very high. My gastroenterologist said my methane levels are so high, and I’ve responded so unsuccessfully to past attempts at treatment, that my best option is to use prescription laxatives for relief. She told me there are medications in development that are targeted at eliminating methane SIBO, so I have my fingers crossed that one day there will be a cure.

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Hi, so did your doctor attribute the onset of your SIBO to a particular cause? Are you told you have a motility problem that is the root cause? Was it due to your injury or treatment for your injury?… I developed my SIBO after my FMT for C Diff. So there has yet to be a determination as to the root cause for me. I feel like Im doing treatment but even if its successful that it will just come back unless the core physiological flaw is dealt with, unless it was caused by bacteria going into my small intestine from the stool transplant. Its a possibility but now a common outcome of colonoscopy FMT, so I may have another problem.

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Thanks jza. My doctor has me taking over the counter laxatives for now, pretty regularly, and it least it provides some relief for a few hours of the day before the bloating builds up again.

MKW, my doctor and naturopath both suspect this has been an issue for me since my teens when I had an eating disorder – this likely started things off, slowed my motility and just flat out messed up my system. My symptoms however got out of control last year, and they think it is because I was taking morphine regularly and not eating much – my motlility did not recover from that (and at one point I didnt have a bm for two weeks and had to go to emergency – not a fun experience. Long story short they cleared me out with a bowel prep but I had just had rectal surgery for a pelvic floor injury and the pain of eliminating so much in such a short period of time was unimaginable. ..like incredibly painful. Those dang meds are a catch 22).

Could it be that the c diff itself was the cause? Just wiped out the good bacteria and allowed bad stuff to take hold and migrate? It seems as though it wouldnt be the case because c diff = diarrhea but I know many people have long term bowel issues following c diff (most often labelled ibs – but who knows whats what).

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