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Why and When to do a SIBO Retest - Dominick Hussey

Why and When to do a SIBO Retest

Once you have treated SIBO it is essentially important to do a SIBO retest. This is probably the number one mistake practitioners make when dealing with SIBO.

Read on to learn about the reasons why it is vital to retest after treatment and the best time to do a SIBO restest.

Why a SIBO Retest is so important

Retesting is a crucial component in the successful treatment of SIBO.

If you do not do a SIBO retest will not know if the treatment was successful.

You need to remember that symptom improvement occurs before the breath test normalizes. If you stop the treatment when symptoms improve, there’s a very high likelihood of recurrence.

If you do not improve from treatment, it doesn’t mean the treatment didn’t work. It could mean it did work, but the symptoms you were experiencing, despite being symptoms consistent with SIBO, were not actually related to SIBO.

We know from research that 20 percent or more of controls that don’t have symptoms have SIBO. So it is possible that if you have SIBO, it may not actually be causing their symptoms.

So the key principle here is “test, don’t guess.” and this is what separates a good treatment from a poor treatment.

When to do a SIBO Retest

In general, I recommend retesting two weeks after the end of treatment.

During that period, you should not take any antimicrobials and probiotics.

Disclaimer

This article is not intended to provide medical advice, diagnosis or treatment.

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SIBO Relapse Causes and Management - Dominick Hussey

SIBO Relapse Causes and Management

SIBO relapse is a common occurrence. According to research SIBO relapse rate ranges from 44 to 50 percent.

Those high figures are probably due to using doses that are high enough or durations that are long enough.

One study found a SIBO relapse rate of 13 percent at three months post-treatment, 28 percent at six months, and 44 percent at nine months. The significant caveats of that study, though, were that the probability of recurrence was increased with older age, constipation, a history of appendectomy, and chronic PPI use.

That said SiBO relapse is a significant issue.

Read on to learn about the number one reason why SIBO relapse occurs and some strategies to manage and prevent reoccurrence.

SIBO is as much a symptom as it is a cause.

The authors of the above study wrote that without correcting underlying mechanisms that lead to bacterial colonisation of the small bowel, SIBO would recur.

So, this highlights the point that SIBO is as much a symptom as it is a cause.

The key takeaway here is that if SIBO continues to recur, it probably has to do with not correcting an underlying mechanism.

Not dealing with the underlying cause, in my opinion, is the #1 reason why SIBO relapse occurs.

Guidelines for managing a SIBO Relapse

If you have a relapse of your SIBO symptoms, it is essential you get a retest.

If this is your first follow-up test, then you should try a different treatment.  If you did a botanical protocol, you could try a  treatment with Xifaxan. If you took Xifaxan, you could try a herbal protocol.

You could also consider extending the duration of the treatment depending on the test results.

If the test results were relatively low, a shorter duration is fine, but if they were elevated, you might try a more extended period.

If trying a different treatment fails to produce a negative test result, you may consider an elemental diet.

If your test results repeatedly test positive, you need to start considering the potential underlying mechanism that may be causing the SIBO.

Possible causes of SIBO include gut dysbiosis, parasites, infections, heavy metal toxicity, mould, biotoxins, or other chronic infections like Lyme Disease as well as HPA axis dysregulation (aka Adrenal Fatigue) and past emotional trauma.

If you have ruled out all of the above or if the mechanism cannot be addressed, for example, you have a disease or a mechanical problem that impairs gut motility, and you may need periodic retreatment with botanical or Xifaxan protocols.

Additional steps to reduce the likelihood of recurrence

Prokinetics

The first is using a prokinetic, which is an agent that increases gut motility. One theory on why SIBO recurrence is common is that SIBO involves the dysfunction of the migrating motor complex or MMC.

The MMC has a cleansing function in the intestine. A dysfunctional MMC can lead to bacterial overgrowth. Prokinetics stimulate the MMC which would counteract this tendency.

There are three types of prokinetics, herbal, nutritional and Medications.

Iberogast is a herbal prokinetic which has a been shown in research to be clinically valid. It has also been used in Europe for many years.

MotilPro is a nutritional type prokinetic. Motil Pro contains 5-HTP which is a major neurotransmitter in the gut that affects motility.

Drug type prokinetics include a low dose of Naltrexone or a low dose of Erythromycin.

The recommended duration you should take prokinetics is between 3-6 months.

Diet

Limiting fermentable carbohydrates is not good during the treatment with antimicrobials, however, it may be a useful measure to prevent recurrence of SIBO.

Possible diet options here would be a low FODMAP diet, or a low fermentation potential diet, which is a diet introduced by Dr Norm Robillard.

One downside to using these diets is that studies show that long-term low FODMAP diets can lead to reduced diversity in gut flora in the colon.

A kind of middle ground approach might be better by doing a low-FODMAP diet and using a soluble fibre like partially hydrolysed guar gum to continue to feed the beneficial gut bacteria.
 

Disclaimer

This article is not intended to provide medical advice, diagnosis or treatment.

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7 Little Known Warning Signs That You Have SIBO

7 Little Known Warning Signs That You May Have SIBO

SIBO or Small Intestinal Bacterial Overgrowth is characterised, as the name implies, by excessive bacteria in the small intestine.

Typical symptoms of SIBO include bloating, gas and constipation and or diarrhoea.

If you thought that not having any of these symptoms meant you do not have SIBO, think again.

There is a growing amount of evidence to show that SIBO can manifest with symptoms both inside and outside of the gut. Read on to find out more about some of the little-known signs and symptoms of SIBO that I observe every day in my practice.

Do you Burp after meals?

The majority of your friendly bacteria or microbiota should reside in your large intestine. Your small intestine should be virtually sterile.

One of the main occupations of the microbiota is to breakdown fermentable carbohydrates and produce valuable nutrients for your body as well as gases.

When SIBO occurs your microbiota overgrows from your large intestine to your small intestine. The microbiota that now lives in your small intestine continues to feed on these carbohydrates and produce gases.

These gases become partially trapped in the small intestine leading to the typical bloating and gas.  These gases are expelled upwards causing burping.

So, if you find yourself burping a lot especially after eating, this could be a symptom of SIBO.

Do you experience Fibromyalgia symptoms?

Fibromyalgia symptoms include chronic muscle pain and stiffness, especially across the upper back, neck and shoulders. There has been growing evidence of a link between Fibromyalgia and SIBO two studies published in the Annals of Rheumatic Disease, researchers from the Cedars-Sinai Medical Center found a direct association between subjects with fibromyalgia and SIBO. (1) (2)

Do you get Interstitial cystitis?

Interstitial cystitis (IC) is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. A large number of people who suffer from IC have SIBO. In a study published in Digestive Diseases and Sciences, researchers found 81% of 21 subjects with IC tested positive for SIBO. (3)

Are You Lactose Intolerance?

People with lactose intolerance are unable to completely digest lactose. Lactose is a sugar found in milk. A small but significant amount of people with a lactose intolerance also has SIBO. In a study published in the Saudia Arabia Journal of Gastroenterology, researchers found that 18% of subjects with IBS were also lactose intolerant. (4)

Do you have chronic low Iron and or B12?

You may have SIBO if you suffer from chronic low B12 or iron that does not increase with supplementation. It is thought that the bacteria that have overgrown into the small intestine take up nutrients such as B12 and iron before they can be absorbed. (5)

Do you suffer from Restless Legs?

Restless legs syndrome (RLS) is a condition in which you have an uncontrollable urge to move your legs. It typically occurs in the evenings while you’re sitting or when you first lie down to go to bed. Recent research has found a strong association between IBS and RLS. In a study published in 2012, researchers found that 25% of people with RLS suffered from SIBO compared to 6.5% of controls. (6)

Do you have Diabetes?

If you have been diagnosed diabetes and suffer from digestive symptoms then you may have SIBO. A recent study observed that SIBO was present in 43% of diabetic patients with chronic diarrhea, and 75% had a positive change in their symptoms after being treated with antibiotics. (7)

Conclusion

If you suffer from any of the above conditions with or without other digestive symptoms then I suggest that it worth looking into the possibility you have SIBO.

SIBO is diagnosed using a Lactulose breath test.

Disclaimer

This article in not intended to provide medical advice, diagnosis or treatment.

Now I’d like to hear from you. Do you suffer from any of the above conditions? Have you heard of SIBO? Let us know in the comments below.

 

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What diet is best for IBS

How to choose the best diet for IBS?

Is there a best diet for IBS? The answer is: it depends.

The actual cause of IBS, short for irritable bowel syndrome,  is unknown although there have been numerous factors associated with it including food sensitivities, epigenetics, nutritional deficiencies, genetics and psychological stress. (1)

In my clinical experience, there is never one single cause for a condition it always a blend of factors.

The food we eat can often be a common constituent of this blend but deciding which foods are triggering your IBS symptoms can be confusing.

Read on to learn about the most clinically and scientifically valid diets for IBS and how to work out the best diet for you.

Diets for IBS

There are various of diets that have been shown either clinically or through scientific research to help with symptoms of IBS. In this next section, I will briefly outline each of these diets, beginning with the simplest.

A Gluten Free Diet

Gluten is a protein found in the protective casing around all grains. The most well known and most toxic glutens include:

  • Wheat gluten.
  • Barley gluten.
  • Rye gluten.
Other less well known but potentially harmful glutens are found in Spelt, Kamut, farro and durum.
If you suspect that gluten may be triggering your IBS symptoms, it is crucial that when following a gluten free diet you exclude all the above grains.

It is a well known scientific fact that gluten is associated with IBS. (2) A gluten-free diet has also been shown to help with IBS symptoms. (3)

A Low FODMAP Diet

FODMAP is an acronym, for a group of carbohydrates, which stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These carbohydrates are found in various foods and alcohols including:

  • Oligosaccharides –Fructans and Galacto-oligosaccharides found in wheat, rye, barley, onions, leek, shallots, garlic, legumes, lentils, artichokes, and chicory.
  • Disaccharides – Lactose found in dairy products.
  • Monosaccharides – Fructose found in honey, mango, watermelon, apples, pears, and high fructose corn syrup.
  • Polyols – Alcohols found in Apples, pears, apricots, nectarines, plums, cauliflower, products (e.g., gums & confectionery) sweetened with artificial sweeteners such as sorbitol known as polyols.

To download a more comprehensive list of FODMAP foods, please click here.

The low FODMAP diet has been shown to help IBS symptoms in several high-level clinical trials significantly. (4, 5)

FODMAPs are broken down by our friendly bacteria that normally reside in our large bowel.

In a significant percentage of people with IBS, these bacteria overgrow into the small intestine, known as small intestinal bacterial overgrowth or SIBO.

When the bacteria break down FODMAPs in the small intestine, they produce an excess of gases. These gases cause the symptoms of bloating and altered bowel function.

The diet is thought to help symptoms by starving the bacteria of FODMAPs.

It is important to see this diet as a short term measure to get symptoms under control since there concerns about the future health of the bacteria in the large bowel.

A Low Histamine Diet

Histamine is a compound produced by your immune system when it encounters an allergen.

Histamine Intolerance occurs where there is an excess production of histamine. Histamine intolerance has been associated with the development and severity of IBS. (6)

Histamine is found naturally in various foods and food additives.

In my clinical experience, I have observed IBS symptoms improve when clients have followed a diet low in histamine foods. A present there have no clinical trials to show that a low histamine diet helps with IBS.

A brief list of high histamine foods includes:

  • Leftover meats and fish
  • Processed or smoked meats
  • Fermented foods such as sauerkraut and kefir
  • Aged Cheeses and meats
  • Tomatoes and Avocados

To download a more comprehensive list of high histamine foods, please click here.

How to choose the best diet for IBS

If you suffer from IBS and are confused by which of the above diets to follow I suggest taking a simple step by step approach.

Begin by putting yourself on a gluten-free diet for at least two weeks. If your symptoms totally disappear, then you have your answer.

If your symptoms only partially improve, I suggest starting the low FODMAP and following that for another two weeks.

If your symptoms significantly improve, then this would strongly suggest that you may have SIBO. In such case, I recommend that you seek out a health professional, such as a Functional Medicine Practitioner or Naturopathic Doctor, that has experience in diagnosing and treating SIBO.

If your symptoms only partially improve, I suggest moving to a low histamine low FODMAP diet for another two weeks. If your symptoms significantly improve, then this is also a strong indication of SIBO.

To download a more comprehensive list of Low FODMAP Histamine Diet, please click here.

If your symptoms do not improve on the Low FODMAP Histamine diet, I strongly recommend you go to your doctor and ask to be referred to a GI specialist for further investigation including a colonoscopy.

Disclaimer

This article in not intended to provide medical advice, diagnosis or treatment.

Now I’d like to hear from you. Do you suffer from IBS? Have you been confused about what diet to try? Do you have any other suggestions that have worked well for you? Let us know in the comments below.

 

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signs of sibo

SIBO: Everything you need to know

Have you ever consumed some food or drink and within a few hours seen that your belly is so bloated that you can’t fasten your pants? It’s not unusual for my clients to inform me that they get up with a flat tummy and by the close of the day they look seven months pregnant. Even if you haven’t endured abdominal swelling to such an extreme, any amount of bloating is not healthy, and it is a mark of intestinal inflammation. If you’re producing gas and bloating frequently, you could have food sensitivities and a gut infection, such as SIBO.

What is SIBO?

SIBO or Small Intestinal Bacterial Overgrowth happens when the bacteria in our gut get out of balance and overgrow. Most of your friendly bacteria should reside in your large intestine. When you have SIBO, these bacteria overgrow into your small intestine. This overgrowth occurs when you have a slowing down peristalsis through the digestive tract.

What causes weak peristalsis?

  1. Intestinal wall nerve damage, For example, diabetes mellitus and scleroderma can both affect the muscles in the gut.
  2. Scarring from surgeries or Crohn’s disease.
  3. Diverticulitis, which are tiny pouches that can form in the wall of the small intestine.
  4. Medications such as antibiotics, acid-blocking drugs, and steroids.
  5. A diet high in sugar processed carbohydrates and alcohol.

17 Signs Of Small Intestinal Bacterial Overgrowth (SIBO)

  1. Abdominal bloating
  2. Belching,
  3. Flatulence
  4. Abdominal pain or cramps
  5. Constipation and or Diarrhea.
  6. Heartburn
  7. Nausea
  8. Food Sensitivities
  9. Headaches
  10. Joint Pain
  11. Fatigue
  12. Eczema or rashes
  13. Asthma
  14. Depression
  15. Fatty stools – stools that float
  16. Iron Deficiency Anaemia or B12 deficiency that does not resolve with supplementation
  17. Weight Loss

How to test for SIBO

The gold standard test for testing SIBO is a lactulose breath test. This test is not readily available in Canada but can be obtained from labs in the US such as Genova Diagnostics.

If you have any questions about this article either post them in the comments section below or email using the form on my contact page.

Disclaimer

This article in not intended to provide medical advice, diagnosis or treatment.