Recurring SIBO:Tips For Taming The Beast! Part I
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A Beast Moving In and Out Of Hibernation
Recurring SIBO (Small Intestinal Bacterial Overgrowth) is a beast, indeed!
Last week's blog post, 5 Reasons Your Gut Is Not Healing & What to Do About It, received a very positive response. As a result, I've decided to keep the theme of gut health going this week in order to focus on another hot gut topic, recurring SIBO!
My personal experience with recurring SIBO caused me to envision it as an evil, fire-breathing dragon that moves in and out of hibernation.
As long as the beast is in hibernation, all is rather quiet in the surrounding villages. Everyone lives in a state of vigilance, though, afraid to do anything that may awaken the dragon from his slumber and spur yet another fire-breathing rampage.
On days or weeks that it is “quiet,” symptoms are minimal or sometimes non-existent, but the sufferer typically lives in a state of vigilance. Every diet or lifestyle choice they make brings fear that it might trigger a “fire-breathing” flare.
If you have experience with recurring SIBO, I presume you are familiar with some or all of the following life-altering symptoms associated with a flare or recurrence:
Varying degrees of gut pain and/or nausea that can often be worse in the morning.
Not being able to eat because of the symptoms that eating brings on but also feeling incredibly hungry because you are so nutrient deficient.
Bloating and/or belching or flatulence that seems to be triggered by anything you eat or drink, even water at times.
Constipation or diarrhea (or alternating between the two).
A build-up of gas-like pressure in the diaphragm area or entire abdomen but not being able to release it.
A feeling as if infectious microbes are partying and driving go-carts around in your intestinal tract. At least this is how I felt!
Wrenching flu-like malaise, fatigue, muscle aches, and brain fog.
Anxiety and/or depression.
Headaches.
Weird heart palpitations.
Increased histamine, allergic-like reactions, and mast-cell activation issues - and thus being “overly” reactive to a wide array of food and environmental triggers.
Sugar and carb cravings and blood sugar dysregulation that comes with not properly absorbing nutrients.
What Exactly Is SIBO?
SIBO is a condition of disrupted digestive motility that allows colonic microbes to migrate into the small bowel where they do not belong.
Disrupted motility inhibits digestion and prevents undigested food particles, incoming microbes on the food and water we ingest, and other compounds, from being swept through the digestive tract and properly removed from the body.
Microbes that don’t belong in the small bowel feast on specific kinds of ingested carbohydrates and then begin producing metabolic byproducts in the form of gases (hydrogen, methane, and/or hydrogen sulfide). They also excrete their own waste, which irritates the small intestine.
The lining of the small intestine, which is the seat of digestion and home to upwards of 70% of the immune system, gets inflamed and leaky. When this occurs, two major things happen:
Digestion becomes greatly impaired, preventing the foods we eat from being adequately broken down into useable nutrients for our cells; this leads to reduced cellular energy, cellular dysfunction, and ultimately widespread inflammation. These three factors are at the heart of virtually ALL dis-ease states.
Compounds that should remain inside the digestive tract are able to leach across the mucosal barrier (aka: the gut lining) and into the blood supply; which then triggers a cascade of inflammatory immune responses that can make a person feel very crappy and also lead to widespread, life-disrupting symptoms and hyper-sensitivity.
Another thing to keep in mind with recurring SIBO is that it does not always involve obvious, life-altering gut-related symptoms as mentioned earlier. Chronic SIBO can manifest as neurological issues, migraine headaches, anxiety, depression, fibromyalgia, and more!
SIBO is becoming increasingly prevalent, possibly because it is being diagnosed more often. In random testing, between 6 to 15% of healthy adults were found to have SIBO. (1) Furthermore, many cases of IBS are actually unidentified SIBO! (2)
It is a condition that often does not respond to many popular interventions that are efficacious for other gut disorders; which leaves both sufferer and clinician very frustrated!
Recurring SIBO is often an extremely disabling condition that can have serious consequences on the rest of the body but is often greatly minimized and not well-understood within much of the conventional medical community.
What Causes Recurring SIBO?
SIBO is often a result of several factors that come together in a “perfect storm.” Based on my personal and professional experiences, I feel some of the common factors include, but are not limited to, a history of:
Chronic Lyme and Company and/or Bio-toxin illness, leading to chronic inflammatory response syndrome.
Physical, physiological, or psychological trauma; particularly brain traumas and infections involving the central nervous system.
Chronic, psychological distress and acute or ongoing trauma is often a major underpinning as well as an obstacle to healing
Autonomic nervous system dysfunction, which can be triggered by the first three factors.
Excessive antibiotic use (and sometimes not excessive use!)
PPI (proton pump inhibitors) or acid reducing drugs.
Opioid use and other prescription drugs known to slow gut motility.
Food poisoning, C. Diff (clostridium difficile), stomach flu, or some other microbe known to cause intense digestive distress.
Alcoholism and/or recreational drug abuse.
Poor lifestyle habits and a SAD Diet (Standard American Diet)
Infection: H Pylori, parasites, or other gut ecology disrupting microbes!
Known or undiagnosed Celiac Disease.
I experienced a case of recurring, autoimmune type SIBO as a result of 3 major gut insults: salmonella food poisoning, which resulted in the production of anti-vinculin antibodies, giardia, and C. Diff.
These three insults were precipitated by years of intense mental and emotional distress, tons of antibiotics over many years for Chronic Lyme and Company, toxic mold exposure, and liver resection surgery to remove a massive, infectious cyst that required gallbladder removal and a 16-inch incision up and down my midline.
I also have Celiac; which was not identified until very late in my life. While most cases of Celiac are present at birth or discovered in the first decade of life, I believe my case was most likely triggered later in life by all of the above.
How Can I Heal from This Condition? Where Do I Begin?
Please know that I absolutely believe it's possible to heal from recurring SIBO. The road is often long and winding, though, requiring a multi-factorial approach, tons of patience, perseverance, and a willingness to step out of the box of conventional thinking. Since the cause of SIBO is often multi-factorial, healing from it often requires a multi-modality approach. This was my personal experience and also what I have observed with my clients.
There are interventions that can help pave the way for healing for everyone. However, each case of SIBO and each individual is unique, and therefore protocols must be tweaked based on bio-individual needs.
Since the causes of SIBO are most often multi-factorial, a simple microbe-killing focus is one reason people find it difficult to recover from SIBO. Additionally, autonomic nervous system dysfunction causes disrupted motility, and, therefore, healing cannot take place unless motility is simultaneously addressed by restoring ANS balance and function.
I will share many strategies for healing recurring SIBO, but for the sake of avoiding overwhelm and keeping this article a reasonable length, I will focus on what I believe to the be the starting point and a primary pillar of health -- DIET!
So when it comes to diet and healing from SIBO, where does one begin?
Eat to Reduce Inflammation!
In order to pave the path for healing and bring the immune system back into balance, it is crucial to eat to reduce inflammation. I believe these to be the most important dietary considerations to keep in mind:
Remove All Known Heavy Hitting Gut Irritants!
When it comes to healing the gut, if you have not already done so, the starting point is to stick with a whole food diet and remove the most commonly known gut irritants and inflammation triggers: sugar, gluten, corn, soy, dairy, artificial sweeteners, vegetable oils, caffeine, legumes, all processed foods, and also preferably eggs, and all grains -- even non-gluten grains.
If feasible, I also feel it is wise to stick with organic produce as well as grass-fed and free-range animal protein as often as possible. When it comes to healing from chronic health challenges, reducing toxic burden is essential. The hormones, antibiotics, and levels of pesticides within non-organic produce and non grass-fed animal protein are proven health-blocking factors and can absolutely burden an already over-burdened system.
Bio-Individuality Is KEY
There are many SIBO diets available, but I don’t buy into any one philosophy. The BEST and most effective SIBO healing diet is the one that works to reduce inflammation for YOU and the one that allows for as much variety as possible while also supporting the integrity of the gut microbiome.
For instance, one person may be able to tolerate Brussels sprouts, which are typically considered very SIBO “unfriendly”, without a problem while they trigger major symptoms in another person. Another factor to consider is quantity. You may be able to tolerate ¼ cup serving of something but when you go over that amount, your gut gets super cranky.
Long Term Low FODMAP Diets Often Create More Issues!
I am not a proponent of a long-term low FODMAP diet. While this approach may be effective at keeping symptoms at bay for many, it can often have detrimental effects on the health and integrity of beneficial gut microbes that need FODMAP foods to flourish for optimal health.
One of the main reasons why the gut does not heal despite huge effort is low bio-diversity and richness of beneficial microbes, which you can read more about HERE.
Consider Damage to the Disaccharides Enzymatic Pathway
Based on my experiences, observations, and research, I believe that most cases of SIBO, especially where Celiac is a factor, involve damage to the disaccharides enzymatic pathway. Optimal functioning of this pathway is required for proper digestion and assimilation of specific complex carbohydrates. If this pathway is damaged then consuming carbs of this nature can put undue stress on the gut lining and enterocytes (intestinal cells), creating a barrier to healing.
Examples of complex carbohydrates are sweet potatoes, plantains, cassava, and whole grains. Examples of simpler, short-chain carbohydrates that don’t put undue stress on this pathway are ripe bananas, other fruits in moderation, and low starch vegetables. When it comes to fruit, however, one must also be aware of the possibility of fructose malabsorption, which can also be a health-blocking factor if gone unchecked.
In the case of recurring SIBO, I feel it is necessary to stick to simpler carbohydrates that are digested and assimilated higher up in the digestive tract. This means eating ripe bananas, other fruits in moderation as mentioned above (if able), and low starch vegetables such as but not limited to, summer squash, greens, carrots, and more!
I will also mention that until a certain level of healing has occurred, raw fruits and vegetables of any kind are often way too much for a a gut struggling with SIBO to handle. For this reason I highly recommend only consuming cooked vegetables and stewed fruits until inflammation and flares are greatly reduced. It is almost as if one needs to approach their digestive tract as they would an infant and stick with soft, easily digested foods. When I was at my absolute worst the only way I could tolerate any fruits and vegetables was to stew, mash, or puree them.
To learn more about this approach for gut healing and for a full list of the specific carbohydrate foods to include and avoid, I highly recommend you read the book Breaking the Viscous Cycle: Intestinal Health Through Diet by Elaine Gottschall. (3)
How Do I Find the Best Inflammation-Reducing Diet for ME!?
It is widely held that the best way to find the right diet is to run food sensitivity panels. I thought so, too, at one point. However, I have changed my tune on this issue because I have observed a wide array of issues with these panels and not enough healing benefits to continue recommending them.
First off, I have seen too many conflicting results from lab to lab. I feel the reason for this is because different food sensitivity panels assess different aspects of the immune system.
Second, I am not aware of any lab that is able to assess all aspects of food sensitivity testing. There are far too many immune mediator responses -- IgE, IgD, IgA, IgE, and IgM -- and no lab includes all of the necessary markers. Furthermore, I don’t know of any commercial lab that assesses IgA and IgD antibodies. While lab testing may offer some guiding benefits; especially to those that prefer to have data, I am now of the belief that a good old-fashioned elimination diet is the gold standard, if we make the process a top priority.
Thirdly, the gut microbiome is heavily influenced by stress levels, mood, and environment, and it therefore shifts frequently. You may be sensitive to something this week or today, but you may not have an issue with it on another day or week.
And lastly, I have seen food sensitivity panels trigger a significant amount of food fear in many people, myself included. Food fear creates an immense amount of stress around eating and feeds into creating a limbic system trauma loop in the fight or flight center of the brain. This is a very real phenomenon amidst chronic illness but it is also a topic to be explored in greater detail in another article or my future podcast!
Back To The Basics!
A more beneficial and cost-effective approach is to implement what I refer to as a “back to the basics diet” for a period of time, until inflammation is greatly dialed back. You then will re-introduce foods one at a time no sooner than 2-3 days apart and keep a food journal to notate any and all responses.
When I was at my worst with battling the SIBO beast, I stuck with the Intro Specific Carbohydrate Diet (3) minus eggs and the allowed dairy until symptoms were greatly reduced. For 2-3 weeks I ate only homemade chicken soup made with chicken, soft cooked carrots, and salt and pepper, ripe banana, and short-cooked meat stock broth with MCT oil for added fat.
Once symptoms were greatly under control, I then began introducing one food at a time every 2-3 days, within the confines of what is permitted in both the Autoimmune Paleo and Specific Carbohydrate diets. I also had to avoid super high histamine foods while keeping more moderate level ones to a minimum. I kept a daily food symptom journal to find what worked best for me.
This process definitely took some time, dedication, and patience, but it was invaluable in helping me lower inflammation quickly. I also became much more in tune with my body’s needs versus overly relying on lab tests that are often only snapshots in time to tell me what my body needed the most. I finally arrived at a diet that was a combination of the Specific Carbohydrate Diet and Low Starch Autoimmune Paleo. I found The Autoimmune Solution By Dr. Amy Myers helpful as I went through this process. (4)
This approach has been integral to my healing from this insidious condition. A mistake that I made that I must make you aware of, however, is veering from this way of eating too soon. On several occasions now, while feeling really good and having no gut symptoms whatsoever, I attempted to expand my diet by moving into the Wahl’s Autoimmune Protocol.
This approach allows for a bit more variation by allowing nightshade vegetables, more spices, nuts, and seeds. Within 1-2 weeks of each attempt my gut and the rest of my body quickly reminded me that I was not ready for these re-introductions. When my body speaks, I listen! I did not always have this level of reverence for my body’s wisdom. Live and learn!
While I do not intend to eat this way forever, I will continue to do so for as long as it takes to heal my gut lining and nerve damage once and for all. That's a wrap for the first article of this series! I hope you found it validating, supportive, and insightful. Stay tuned for Part II where I will be discussing more tips, strategies, and healing interventions for the recurring SIBO BEAST!
References:
3. Gottschall, Elaine Gloria. Breaking the Vicious Cycle: Intestinal Health through Diet. The Kirkton Press, 2018.
4. Myers, Amy. The Autoimmune Solution: Prevent and Reverse the Full Spectrum of Inflammatory Symptoms and Diseases. HarperOne, 2017.