Part two of my SIBO overview.

Links

1. Risk factors for SIBO - https://www.goodnessme-nutrition.com/sibo/four-risk-factors-for-sibo/
2. What is the Migrating Motor Complex - https://www.goodnessme-nutrition.com/sibo/what-is-the-migrating-motor-complex-how-to-fix-it/
3. How to use prokinetics in SIBO - https://www.goodnessme-nutrition.com/sibo/using-a-prokinetic-in-sibo/

If you have a question about SIBO, or want to work with me email - info@goodnessme-nutrition.com

Welcome to the Inside Knowledge for people with IBS.

This is part two of a two part episode about small intestine bacteria overgrowth.

In this session, I'm going to focus more on some of the key risk factors for SIBO

as well as focusing on the treatment.

Part one covered a little bit about an overview of SIBO and also we looked

at testing and how you can get tested.

Now we're going to move into what you can actually do about it as well as

some of the preventative things that you could do in order to lower your

risk of getting SIBO in the first place.

Let's get going.

So welcome to episode 12 of the Inside Knowledge for people with IBS.

I'm Anna Matson.

Today, I'm going to focus more on the causes, the risk factors for

getting SIBO and also the potential treatment options that are open to

you if you have a positive test.

Remember the types of Causes for SIBO would be down to impaired

mobility, so you're getting less cleaning of the small Intestine

through the migrating motor complex.

Maybe you're getting impaired digestion And that can be down to stress and diet

or you're getting some sort of impaired flow of food through your digestive

system I'm going to talk to you a little bit about how each of those work.

So the changes in small bowel motility, which is where you're getting changes

in your migrating motor complex.

You're just not getting the cleaning working enough.

This can be caused by a number of things.

It might be as random as having a traumatic brain injury a long time ago.

That has actually been shown to affect the nervous system of the gut if your

vagus nerve is affected by the nerves depending on where your brain injury was.

And that can actually lead to an impaired migrating motor complex.

The same kind of thing with a hypothyroid, so your low functioning thyroid.

That means that a lot of processes in your body are on a go slow mode.

And people who have low functioning thyroid might also, you know, feel

the cold quite a lot, might, um, experience dry skin like dull and

brittle hair and nails, difficult to lose weight, and these can be

signs of low functioning thyroid as well as slow motility in the gut in

terms of the migrating motor complex.

You might also find that people who have blood sugar issues like

diabetes may, it may affect.

So, um, I'm going to the post infectious IBS scenario, where you're getting

damaged to the migrating motor complex from an episode of food poisoning,

and we covered that in episode 10.

that give you an increased risk of SIBO, not necessarily causative,

but an increased risk, would be changes to your digestion.

What I mean by that is that maybe you've got poor bile flow, issues with

your gallbladder, maybe you've had your gallbladder removed, maybe your,

gallbladder, is not functioning as well as it should and it's just not

releasing as much bile as possible.

This is an antimicrobial substance in the small intestine that

actually helps us digest our fats.

But also, It helps to regulate the microbes within the guts.

If you don't have enough bile acid, or you have too much, that can also

affect your likelihood of getting SIBO.

If you've got reduced stomach acid, that may bring in additional

bacteria, as in the stomach acid is one of our first lines of defense.

And if you don't have that barrier, things are not getting killed off in the stomach.

They may be entering the small intestine and hanging out there and overgrowing.

Um, other things that really affect this are your stress levels, your

eating pattern, so how often you're eating, and like how you're eating,

are you chewing your food, are you eating in a relaxed state.

These things seem really basic, but they can actually make a difference.

And you might actually get a slower digestion due to structural changes in

your small intestine or within your...

So, you might have, an obstruction within the small intestine.

Could be a lump or something that is growing there.

Could be adhesions slowing down the transit of food through the gut.

This also might happen after you've had surgery and you have surgery.

scar tissue.

So people who've had, appendicitis and have their appendix removed, anybody

who's had like multiple abdominal surgeries, for example, endometriosis

is a clear area here where you also get scarring and you might have,

adhesions and that sort of thing.

Another condition where you definitely get slowed down digestion is Ehlers

Danlos Syndrome, which is where you get very relaxed muscles, like

smooth muscles are extremely relaxed.

People will have excessive hypermobility of their joints, may be extremely

flexible, and could have slow transit time because a lot of the other smooth

muscles that are not under our conscious control tend to be slower with EDS.

There are some specific medications which also raise your risk of getting

an overgrowth of microbes in the small intestine, and that can include

anything that's known to slow down the gut, so we know that taking any opiate

medication, like significant painkillers based around morphine, We'll slow down

the gut, give people constipation, but also slow down the small intestine

taking any proton pump inhibitors.

So that's things like Omeprazole, which stop your stomach acid, um, as

well as some tricyclic antidepressants have also been shown to slow down the

gut in some cases, not for everyone.

Potentially people who take levothyroxine, so that's the um, thyroid medication

for low functioning thyroid.

The reason I'm going into all of these, you might think, oh well, how is this

relevant to me, but often people find when they get SIBO they want to know why

it happened, how did this occur, and just understanding some of the risk factors

might help you to put your own picture together wherever you are in the world.

If you're working with somebody who has Good knowledge of SIBO.

These sort of things should be explained to you anyway, and part of

your health history, when you work with a nutritionist or doctor who

understands SIBO, they should have investigated all this stuff with you.

If you know that you've got SIBO, you've got a positive test, there

are different ways you can...

treat it, depending on your symptoms, your capacity to make change, your

health conditions, and the type of health care that you've got access

to wherever you are in the world.

We either want to look at killing the microbes, so whether that's using

antibiotics or antimicrobial herbs.

We want to look at your diet and also lifestyle changes.

Again, these very much depend on what you think your root cause was that you got the

SIBO from, and what you want to do about it, like how much you're up for changing.

When we look at tackling the SIBO through killing the microbes, There

are various approaches and it depends on whether you're working with a

doctor or whether you're just working with a non prescribing nutritionist.

The main antibiotic that is used for SIBO is called Rifaximin.

It's a very good sort of antibiotic because it's not systemic.

It doesn't go and kill all the bugs.

It just works in the small intestine without wiping out

your large intestine bacteria.

It's been shown that when people take rifaximin it doesn't cause as much

of the yeast overgrowth like candida overgrowth that might be an issue

after taking more systemic antibiotics.

And actually it has been shown in some cases to increase the beneficial large

gut microbes like Bifidobacterium and Lactobacillus species.

Depending on the type of SIBO that you've got, you might also be given another

antibiotic treatment alongside it.

This depends very much on your doctor who is prescribing the

antibiotics and whether they think you need two types of treatment.

Now in the UK, you probably will struggle to get hold of Rifaximin.

It's not actually licensed to be used widely for gastro issues and so some

Gastroenterologist consultants will prescribe it, and you can get it on the

NHS, but it very much depends on where you are in the country and who you're seeing.

So it's not a given, it's not a standard practice to access

these drugs, unfortunately.

And you do need to be working with a doctor to get them.

as a nutritionist, I'm not, able to prescribe antibiotics.

The things that I have access to are antimicrobial herbal treatments, and these

include a range of different herbs like berberine, oregano oil, garlic, and neem.

If you have hydrogen predominant SIBO, the main herbs that people would use, is

berberine, neem, and potentially oregano.

In some kind of combination, there's no set protocol.

If you've got more methane predominant symptoms, then

tend to go for, garlic extract.

It's not a high FODMAP garlic.

So it won't cause a lot of bloating, although some people I work with say

they get a garlicky after burp later in the day, which is obviously not

that pleasant, but it's not the bit of garlic that is going to cause bloating.

So that is sometimes what people worry about because obviously garlic can be

a trigger for bloating and symptoms.

And then sometimes organo again with a methane based, Sibo.

So the antibiotics you normally take for two weeks, sometimes it's 10 days, but

often 14 days, two to three times a day.

Again, depending on what your doctor will prescribe you.

The herbal antimicrobial treatments do take a little longer.

So I would normally have people take them for six to eight weeks and then

have a gap and sometimes then change to another type of antimicrobial treatment.

What we want to do is try and rotate the treatment, sometimes it's a little bit

more gentle when you're taking the herbal route and, can take a little bit longer.

So it's obviously more effective short term to take the antibiotics

if those are on offer to you, but then not everyone wants to do that.

When you're taking these antimicrobial treatments or antibiotics, sometimes

people can get a bit of a die off experience where this is where the

microbes in your gut are kicking off and breaking down, and small fragments of

the microbes can get into your blood.

So, like, your immune system recognises this and reacts, and it's almost like

you get a flu y sort of reaction.

in that case, sometimes it's good to decrease your dose until your reaction

calms down, and just support your immune system through things like vitamin C and

fish oil, if that's relevant for you.

But just lots of rest and like looking after your body

as you would if you had flu.

Sometimes it's called a Herxheimer reaction typically will be within the

first week of starting your treatment.

The other treatment for SIBO is something called an elemental diet.

Again, as a nutritionist, I'm not authorised to recommend this to anybody.

Some doctors will prescribe it for you and help you to decide

whether this is right for you.

It's basically a liquid diet, just based on shakes that you get

out of a packet for two weeks.

And it strips out...

all the carbohydrates.

So effectively you're starving out your gut bacteria by doing this.

Um, it's challenging mentally because you don't eat anything

except these shakes for two weeks.

So no food, no snacks.

And this can be really challenging because, you know,

eating is not just for fuel.

It's kind of what we do socially and, you know, in a family and it can

be very challenging to change this aspect of your approach to eating.

We move on to diet a little bit.

Some people feel better on a low carb diet.

This doesn't necessarily kill all the microbes, but it may

help you manage your symptoms.

So if you've been given a SIBO diagnosis, Going on a SIBO diet or a low FODMAP diet

may help to some extent, but it's really about helping you manage your symptoms.

When you've reduced your bloating, reduce your diarrhea, that kind of thing, you

probably feel more energy and more impetus to actually make some other changes.

So sometimes that is the first thing that we'll do in order to help you

get better control of your symptoms.

In the longer term though, once you have got control of the symptoms a

little bit, you do need to build up the good microbes, you really need

good large intestine microbes and that does rely on you eating fibre.

So essentially, you can't stay on that low SIBO diet for a long time.

I've seen people who've been on it for years and years.

And so the main thing is trying to get you back to eating a better diet.

Simple things like moving your body every day, getting some sleep,

trying to find ways to relax and do things that make you feel happy.

These are important parts of managing SIBO, rather than

letting SIBO run your life.

I know it's easier said than done, but these sort of things are as much of

the prescription as taking the pills and eliminating foods from your diet.

Making sure that you are...

So if you are actually doing things to support better sleep, these are really

key, not just taking more supplements.

Finally, I want to talk about Prokinetics.

So these are things that encourage the migrating motor complex to move.

They can include herbs and supplements, so things that include ginger, artichoke,

5 HTP, and other kind of herbs.

Or you can actually get from your doctor low dose antibiotics and

there's a couple of them, low dose naltrexone, low dose erythromycin.

These can also be prescribed to help kickstart your migrating

motor complex if none of these things you're doing have worked.

And again, go back and talk to your doctor about this if you think that

that might be a good help for you.

Often people get pretty disheartened when they've done all of this stuff.

They then retest the SIBO and the levels haven't dropped that much

and they feel very disheartened and I can completely understand why.

Now In an ideal world, we would suggest testing again after each round of

treatment because you might not actually see improvements in your symptoms.

They might come in around after the second round of treatment.

But if you see a reduction in your numbers on the test, it could

give you a bit of encouragement.

So for example, each I would expect to see a drop of about 30 parts per million

per round of treatment and that is pretty much the same whether you go down

the rifaximin route or antibiotics or whether you do the antimicrobial herbs.

It's pretty similar.

The only thing that I would say is after.

each antibiotic or each treatment round that you need to engage that pro kinetic.

You need to start working to keep the gains that you've got and you can't

just rely on, sustaining the same place.

It may slide backwards and the microbes may overgrow.

The things I mentioned around diet and lifestyle are, are important but

it depends a little bit on the cause you think of your original Like, what

gave you the SIBO in the first place?

So, for example, if it's a structural adhesion, then changing your diet and

taking some supplements, it might help for a while, but unless you get to

the bottom of that structural issue, possible it's going to come back again.

So, it is important to think about it holistically, think about where your

root cause of SIBO might have been.

As I said at the beginning, it is a really challenging condition, and I...

Always hope that people are negative for the test when we do it, but at least you

know, then what your Potential treatment plan would be and I've just outlined it

here in very general terms It's difficult to negotiate all this stuff on your own

And if you want me to help guide you and work with you to implement it in your life

and with your Set of unique circumstances and symptoms then please get in touch.

I'm Working with people one to one over three months and SIBO and IBS are like

my daily core topics of conversation.

So, this is what I do day in, day out.

If you've got any questions particularly about this, you can email me.

And, um, if you want to know more about working with me,

you can set up a free call.

And we can talk about where to go, talk about what you're experiencing,

what you've already tried.

And whether you think I'm the right person for you.

And then I'll see whether I think I can help you and whether, you

know, I think it's going to be a good fit for us to work together.

So I hope this has been a good two part intro to SIBO.

I'll put a link in the show notes to a couple of blog posts that I've written.

One is about the risk factors, if you prefer to read some of that stuff.

There's another.

blog post about Prokinetics, another one about Ginger and

how that's good for your IBS.

So give all that a go, have a look through the website blogs that I posted below

and then, um, see where we go from there.

All right, that's it for this week.

I will be back next week.