SIBO Rx – End of Week 2

For 2 weeks I’ve been following an herbal antibiotic treatment protocol for Small Intestine Bacterial Overgrowth (SIBO).  The treatment is of my own design, using herbs recommended by Allison Siebecker.  I am not working with a doctor or practitioner on this, mostly because I don’t know of one.  In addition I’ve been telling myself I’m following the Specific Carbohydrate Diet (SCD) but in reality I cheat on it a little every day.  Most of what I’ve been eating is Ray Peat inspired and SCD friendly.  Eggs, cheese, meat, orange juice, fruit, cooked spinach, and broth.  My cheats are usually white sugar in small quantities, but I did have some stuffing and mashed potatoes on Thanksgiving.  Dr. Steven Sandberg-Lewis says that you can’t really starve out SIBO anyway…it’ll just start eating your intestinal mucosa if it gets hungry. The best thing to do is kill it and then prevent it from coming back.

Some of what I’m going to write here is TMI – so I apologize in advance.  It’s difficult to discuss the treatment of a digestive disorder without a little TMI.  I’ll try to keep it clinical and professional.

There’s no doubt in my mind that I have SIBO.  For years I’ve had bloating after eating starches, but recently it started to occur whenever I ate any dairy or white sugar as well.  The bloating had become out of control – like I would just give up and let people think I’m pregnant sometimes.  The bloating lasted a few hours, and then deflated again.  Sometimes there would be gas, but usually not.  My research over the last several days indicates that in some people the gas that’s produced can escape through your breath or in the form of belching.  And there’s definitely been a lot of that.  The piece that didn’t fit for me was that my stools have been pretty perfect for months and months.  In the past I’ve had constipation – off and on for about 10 years actually – but recently things have been really good.  I’m not sure if that’s unusual or not with SIBO – According to Dr. Siebecker, hydrogen producing bacteria in the small intestine typically produce diarrhea (D) and methane producing bacteria lead to constipation (C).  So how come I had neither one?  No doctor to test me, so I guessed and just started throwing herbs at it.

As I mentioned previously I’ve been taking Oregano Oil, Allicin, and Berberine.  I’ve been doing some research on these herbs, mostly through websites, youtube videos, and this book by Stephan Buhner. The Allicin is supposed to be most effective against “bad” bacteria, and is great for treating methane-producing SIBO.  Berberine is also effective against “bad” bacteria (while sparing the “good” bugs) and is supposed to be great for treating hydrogen-producing SIBO.  Oregano oil is more of an all-purpose killer, killing good, bad, and ugly – but this is necessary because typically the flora that has migrated to the small intestine would be considered “good”  – it’s just in the wrong place.

Again, here are the doses and schedule I’ve been using:

  • Allimed (pure allicin) – 8 drops 3x a day. 
  • Oregano oil – 3 drops 3x a day
  • Berberine – 5g a day, divided into 3 doses

So here’s what I’ve noticed after 2 weeks of this.

1.  My perfect stools are gone – hopefully temporarily – and things are trending much more in the direction of D., over the last 3 days.  I’m not sure why this happened, and can’t find resources to explain it to me, so what i’m thinking is this:  I think before I started my SIBO was probably balanced between hydrogen producing and methane producing bacteria, and the methane producers have been more effectively killed off first, leaving the hydrogen producers.  Dr. Siebecker says herbal antibiotics take a month to work fully, so I’m going to continue all three herbs for now, but I’m eliminating one of the doses of Allicin.  So for now, I’m changing to the following dosing schedule:

  • Allimed (pure allicin) – 8 drops 2x a day.
  • Oregano oil – 3 drops 3x a day
  • Berberine – 5g a day, divided into 3 doses

2. My bloating is much improved.  I could eat nothing with even a trace of sugar or starch in it 2 weeks ago without looking like I’ve hidden a basketball under my shirt.  Now bloating is about half gone.  Still there though.

3.  My stomach makes more noise now.  It doesn’t hurt or anything.  Just noticing it.

4.  My fasting blood sugar is dropping.  Before I started this my fasting sugar was averaging around 155 (and yes, I know that’s really high).  Tested it yesterday and it was in the 130s for the first time in at least a few months.

5.  My energy and mood are consistently good now.  Fatigue is 90% gone,

6. My appetite is dropping.  I used to snack all day long.  I don’t feel the urge to do that anymore.  The scale is down a couple pounds, but still within a range that’s typical for me these days.  I think what’s going on is my blood sugar is more stable so the need to snack is lower.  Berberine is supposed to have an effect on lowering blood sugar, so maybe that’s what’s going on.

So, aside from the change in bowel production and my stomach making more noise everything is better.  I’ve started taking 1 capsule of Betaine HCL with high-protein meals.  That may account for the noisy stomach thing.  Not sure.

Will continue to update with further progress.

Edited to add…

I forgot to mention I ordered a really fancy (read: expensive) probiotic – GutPro – which contains the 3 strains of bacteria that Dr. Siebecker says are good for treating SIBO. This is the only brand I could find that contained all of them.  Plus, this probiotic formula contains no prebiotic.  It’s important for those with SIBO to know that prebiotics are often packaged into the probiotics, which is fine for most people, but if you have SIBO it can feed the bugs living in the small intestine.  This is what happened to me when I tried consuming potato starch, inulin, FOS, and other probiotics containing these.  GutPro contains the following strains (the ones recommended by Dr. S are in bold):

  • Lactobacillus plantarum
  • Lactobacillus gasseri
  • Lactobacillus salivarius
  • Bifidobacterium bifidum
  • Bifidobacterium infantis
  • Bifidobacterium longum
  • Bifidobacterium breve
  • Bifidobacterium lactis

Ok, done now.

SIBO

Since watching the ongoing Digestive Sessions videos over the past week (which actually continue for the next couple of days) my difficulties have come into greater focus.  I clearly have a case of Small Intestine Bacterial Overgrowth (SIBO), complete with a ton of bloating, fatigue, abdominal pain, and other assorted pleasantries such as periodic depression, acne, and heartburn.

Here’s what I’ve learned, mostly from Allison Siebecker.  Dr. Siebecker specializes in treating SIBO.  She says a breath test can be used to diagnose this condition, and it’s treated one of several ways depending on whether the test indicates the gas present in the breath is mostly hydrogen or mostly methane.  If your breath test is high in hydrogen, the best treatment is an antibiotic called Rifaximin (Xifaxin).  If it’s high in methane, you need 2 antibiotics – Rifaximin plus Neomycin or Flagyl.  Quick and dirty diagnosis – SIBO that produces hydrogen tends to cause diarrhea, while SIBO that produces methane tends to cause constipation.  If for some reason you don’t want to take antibiotics, there are herbal options (more on this in a bit).

Interestingly, SIBO is not typically caused by pathgenic bacteria.  Dr. S says that if you’ve got pathogenic bacteria in your small intestine you’re going to feel (and be) pretty sick.  Instead it’s normal – beneficial, even – bacteria that has just relocated from the colon to the small intestine where it doesn’t belong.  So once it’s there, if you’re eating carbohydrates that are disaccharides (such as sucrose or lactose) or polysaccharides (starch), you’re going to be feeding the SIBO bacteria, and experiencing exactly what I’m currently experiencing.  A ton of bloating, as the bacteria ferment the carbohydrates and produce gas.  Monosaccharides (honey, fruit sugar) do not require much digestion – they’re already in an absorbable form – so they don’t stay in the small intestine long enough to feed the bacteria.  They’re absorbed into the bloodstream high up in the digestive process.  Hence, the Specific Carbohydrate Diet, which limits carb intake to only monosaccharides and tries to starve out the bacteria that doesn’t belong in there.  The low FODMAP diet also attempts to limit carbohydrates that ferment in the gut.  Dr. Siebecker uses her own version of a combination of these diets that she recommends for her patients.

Remember my Great Garlic Experiment? The antibiotic ingredient in garlic is called allicin.  Siebecker recommends allicin highly for the treatment of SIBO but she says that allicin does not kill all bacteria – only certain kinds, most of which we would consider pathogenic or “bad” bacteria.  It doesn’t do much to the good bugs.  That’s probably why the Great Garlic Experiment worked so well for me at the time – it killed off the dudes putting out all the endotoxin and making me depressed and tired.  However, it did not kill off all of the “good” bacteria that was also inappropriately located in my small intestine, and IN FACT the inulin in the garlic FED those guys.  That’s why I’ve now got a raging case of abdominal distention and food intolerance.  And over the last few months, these “good guys” who have taken up residence in the small intestine are friggen thriving on all the sucrose and lactose I’ve been feeding them.  The last straw was the day I tried to live on milk all day long. Not a good day.  It was then that I realized I have something seriously wrong with my gut.

I just started a new job.  I don’t have decent insurance yet (but will in February) and I don’t have time off yet (will in January), so doctor shopping for someone to follow Dr. Siebecker’s SIBO approach with me wasn’t likely to happen right now.  So I’ve got no Big Pharma antibiotics.  Instead I’m following Dr. Siebecker’s recommendations for herbal treatment for SIBO.  I’m assuming (perhaps incorrectly) that a lot of my issue is with methane-producing bacteria since historically I tend more toward constipation (though I don’t have that now), and because the garlic was so helpful for me at first (she recommends allicin for methane-producing SIBO).  She recommends an array of herbal treatments, and of these I’ve selected and am currently taking the following:

  • Allimed (pure allicin) – 8 drops 3x a day.  This is ridiculously expensive, but less expensive than doctor shopping.  It tastes like Italian dinner…kind of yummy in a very strong garlic-ish way.
  • Oregano oil – 3 drops 3x a day
  • Berberine – 5g a day, divided into 3 doses

I haven’t been watching my diet very closely, mostly eating what I want including some starchy foods.  This is mostly because 3 weeks into my new job I’m still struggling to manage my time and also be a mom, and I’m disorganized.  Dr. S recommends the SCD diet or her own version of it (above), for the prevention and treatment of SIBO.  A week in I’m feeling much better – less bloating, less abdominal (gas) pain.  She says for herbal antibiotics you must treat for 1 month.  Pharmaceutical antibiotics require treatment of 2 weeks. There’s still some bloating after eating the wrong types of carbohydrates, but with my diet all over the place right now I’m happy with how it’s going.

Dr. S says to prevent relapse after treatment you should use a prokinetic – a drug or herb to enhance GI motility.  She lists a number of them here.  Herbal prokinetics include ginger, Iberogast, and Motilpro.  She favors the Iberogast, recommending 20 drops before bed, and comments that a study found it to be even more effective than two different Big Pharma prokinetics.  I haven’t ordered one of these yet, but will probably go with the Iberogast as I get closer to 1 month of treatment with the herbs.

Yes, I should have gotten tested first with the hydrogen methane breath test.  That would have been smart.  But I needed to do something fast.  Desperation caused me to spend $130 on friggen garlic juice.  I don’t regret it for a minute though.  All the power of garlic with no inulin to feed the SIBO.

So where do I stand right now with diet?  I’m not really happy with my Peat-inspired diet.  Milk and sugar got me in to this mess.  Late last winter I was feeling so awesome, having flashes of euphoria that lasted hours sometimes….At the time I attributed that to eating sugary food, but actually I think it was because I had taken antibiotics last December for strep throat, and then I stuck to a starch-free diet for a long time.  I bet I’ve had obnoxious gut bacteria causing me problems for years.  I’m probably going to have to stick with a diet that restricts polysaccharides for sure, and disaccharides maybe…so some form of a lower carb diet.  I’m not sure that’s a bad thing.

I’m feeling so bad lately that I don’t know who to trust anymore.  Maybe a lower carb diet – carbs including only whole fruit, and only when I feel like it – with a lot of attention to nutrient density is the way for me to go.  Maybe a low-PUFA Paleo diet.  Don’t know…still trying to get through the current health crisis.  Will update as I have time.

Hopeful

…and after seeing today’s Digestive Sessions videos, I have hope.

I’m pretty sure at this point that my problem is Small Intestine Bacterial Overgrowth (SIBO).  This amazing person, Dr. Allison Siebecker really knows about this stuff.  I’m excited to find someone to give me a hydrogen and methane breath test, which she says is the gold standard test for SIBO.

She explains why my problem seems to have “grown back” after my success with the Great Garlic Experiment. It’s detailed so I won’t get into it, but suffice it to say I think I need a practitioner to work with who is very familiar with this condition.

Hope is good.

Tired

Newsflash – I’m not doing great.  I think I’m becoming intolerant of dairy, which sucks because it’s currently a large part of my diet.

I’m wondering if I have H. Pylori.

I’m wanting to give up, but don’t really have any plan for what happens after I give up.

So I continue.