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GUT HEALTH
Irritable bowel syndrome (IBS)
Small intestinal bacterial overgrowth (SIBO)
Small Intestinal Fungal Overgrowth (SIFO)

GUT HEALTH

In general, gut issues can be due to a multitude of factors and can result in mental health changes and allergies. Whether this is due to an infection (parasitic, bacterial, yeast etc.), inflammatory issue that is affecting the lining of your gut or possibly an autoimmune disease. A functional medicine approach can help you decipher a unique Gut Reset protocol just for you. 

 Conditions Treated:

  • Irritable Bowel Syndrome (IBS)

  • Small Intestinal Bowel Overgrowth (SIBO)

  • Irritable Bowel Diseases (IBD) (Diverticulitis and Ulcerative Colitis) 

  • Parasitic or helminthic infections

  • Bacterial infections

  • Yeast

  • Diarrhea and constipation

Analysis:

  • Full history and physical exam.

  • Possible laboratory evaluations. 

 

Treatment Approaches:

  • Dietary protocol.

  • Nutraceuticals where appropriate.

  • Medications where appropriate.

"60-80% of all Irritable Bowel Syndrome (IBS) is actually SIBO."

What is IBS?

IBS aka Irritable Bowel Syndrome

About IBS:

  • IBS is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.

  • IBS affects about 10-15% of the population in North America

  • IBS is a diagnosis of exclusion which is why it roughly accounts for $30 billion in health care costs each year.

  • IBS is a syndrome, not a disease.

SIBO & SIFO

What is SIBO?
 

Small intestine bacterial overgrowth is a condition where bacteria which are normally found lower in the large intestine have overgrown in the small intestine instead, causing bloating and discomfort. 

What is SIFO?
 

Small intestinal fungal overgrowth is a condition where candida or yeast have taken over the intestines, often as a result of inadequate good bacteria. This state may be a result of poor dietary choices leading to poor good bacteria and immune compromise. 

What is wrong with having these "bad" bugs in our gut?
 

  • They damage the microvilli 

  • Create inflammation 

  • Create "leaky gut"

  • Cause malabsorption of nutrients

  • Cause undesirable symptoms such as: sugar cravings, bloating, gas, burping, diarrhea and or constipation.

 

Causes of SIBO and or SIFO:​

 

Conditions that may predispose someone to SIBO:

  • Chronic pancreatitis (SIBO in up to 40%)

  • Immunodeficiency (IgA deficiency, AIDS)

  • Autoimmune conditions (damage the nerves in the gut, reducing motility, causing bacterial overgrowth).

  • Low stomach acid (SIBO increased w/ long term PPI use)

  • Liver cirrhosis

  • Scleroderma

  • Diabetes Melitus

  • Motility Disorders/ Slow bowels

  • Stress reduces the migrating motor complex, reducing motility.

  • Joint hypermobiliy syndromes (Ehlers Danlos, Marfans)

  • Medication use such as: Opioids, Chronic antibiotic use, Acid blocking medications, Long term corticosteroid use, Anti-diarrheals.

  • Food poisoning (from bacterial pathogens such as Campylobacter jejuni, Shigella, E.coli, and Salmonella)

  • Anatomical/Structural abnormalities (obstructions, diverticula, fistulae, removal of galbladder (cholecystectomy), gastric bypass, removal of ileocecal valve or Ileocecal valve dysfunction, intrabdominal adhesions, blind loops).

  • Elderly (present in up to 90% of 70-94 yo)


Conditions associated with SIBO

  • Diabetes (gastroparesis)

  • Parkinson's Disease (54% have SIBO15)

  • Osteoporosis

  • Anemia

  • Celiac disease

  • Irritable Bowel Disease: (Crohn’s disease and Ulcerative Colitis)

  • Chronic Liver disease

  • Fibromyalgia

  • Rosacea

  • Cystic fibrosis

 

Conditions that may predispose someone to SIFO:

  • Diabetes Mellitus

  • Compromised immune systems
     

Conditions associated with SIFO: 

  • Diabetes Mellitus

Signs and Symptoms of SIBO and or SIFO

  1. Any disease state arising from nutrient deficiencies.

    • Neuropathy from B-12 deficiency.

    • Anemia from B-12, folate or iron deficiency.

  2. Gas, flatulence, bloating, belching, indigestions, heartburn, central abdominal pain, loose and frequent bowel movements. Less commonly, constipation.

    • Symptoms are worse with: garlic, dairy, apples, raw veggies, onion, mushrooms.​

Testing

  • Anti Vinculin and Anti CDT B Antibody Test (IBS Blood Test)

    • The IBS Blood test measures antibodies against the bacterial toxin Cytolethal Distending Toxin B (CdtB) and the small intestine nerve protein Vinculin.  If the test is positive, it means that there is a motility issue originating in the nervous system of the intestines and rules out inflammatory bowel disease with 98% probability. Whether test is negative or positive, a breath test is warranted. The breath test diagnoses SIBO from all causes, whereas the IBS blood test only detects SIBO from food poisoning etiology, and doing the breath test in this instance helps us determine best treatment strategy.

  • Fecal Calprotectin

    • Differentiates IBS from IBD

  • Tissue Transglutaminase

    • Presence of Celiac's disease

  • H pylori breath test

    • A great adjunct test to SIBO to rule out H pylori related causes​.

    • Typically people who would be ideal candidates for this test will have reflux and stomach pain, possibly associated with an ulcer

  • SIBO Breath test for Hydrogen and Methane Gas

    • Breath testing measures the hydrogen (H) & methane (M) gas produced by bacteria in the SI that has diffused into the blood, then lungs, for expiration.  H & M are gases produced by bacteria, not by humans.  The gas is graphed over 2 or 3 hours & compared to baseline.  Patients drink a sugar solution of glucose or lactulose after a 1 or 2 day preparatory diet.  The prep diet removes much of the food that would feed the bacteria, allowing for a clear reaction to the sugar drink. 

    • Two types of tests may be used: Lactulose or Glucose. A 3 hour Lactulose is a superior test.

    • In the first 3 feet of small bowel, with glucose you can definitely tell if there is bacterial overgrowth. With lactulose which doesn’t get absorbed, it may get to the colon too fast.  Use correct dose of lactulose 10g

  • Stool Yeast Testing

SIBO BREATH TEST

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What is the Value of the SIBO Breath Test?

To determine whether you need antibiotic therapy or not. To optimize chances of success with treatment. 

How Can We Improve SIBO/ SIFO​?

The 4R Protocol!

  1. REMOVE pathogens and inflammatory triggers that are associated with increased intestinal permeability. This can range from worms, parasites, yeast and bacteria.

  2. REPLACE nutrients in the diet that will help reduce inflammation and optimize digestive health.

  3. RE-INOCULATE (reintroduce) favourable microbiota to the intestines.

  4. REPAIR the integrity of the intestinal lining with specific nutrients and medicinal herbs known to decrease intestinal permeability and inflammation.

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For many patients, it is not as simple as omitting or adding. Treating IBS and SIBO is more of an art than a science as there are many overlapping conditions that may be in play concurrently. The sheer number of bacterial varieties alone in each unique individual can create variabilities in treatment outcome.

 

Antibiotic versus Herbal Protocols
 

Antibiotics and herbal protocols were both equally effective but both have about a 50% efficacy. Their relapse rates are also equal. However, antibiotic therapy can cost between $500 - $1000 depending on the country you live in. I have seen some extended insurance plans cover the majority if not entirety of this cost. This is why we start with the herbal protocol in conjunction with the low FODMAP Diet. A cost of about $200-$300 for supplements. Clinically the relapse rate is lower and patients typically do very well.

Why the Low FODMAP Diet is not enough as a stand alone treatment

The low FODMAP diet is a great way to starve the bacteria that are producing the unwanted gase(s). It can even relieve discomfort, but as soon as you start to challenge the diet and eat soluble fibers, you will experience symptoms all over again. The antimicrobials help keep the bad bacteria at bay while you train and select the good bacteria to stay and crowd out the bad bacteria by reintroducing fiber slowly. 

It is also not a sustainable diet and can only be done for a short period of time as it is restrictive and can result in weight loss, and most patients with SIBO are having trouble gaining weight already. 

Many doctors (MD's) will recommend this diet to their IBs patients. But without support from a nutritionist and herbal or antibiotic therapy, success rates are low.

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