SIBO: A doctor's guide to the root cause of Bloating and IBS

Summary

视频脚本由Dr. Raj Sharina Budripat主讲，深入探讨了小肠细菌过度生长（SIBO）这一病症。Dr. Budripat解释了SIBO的症状，如饭后腹胀和不适，以及它与肠易激综合症（IBS）的联系。视频介绍了SIBO的成因，诊断方法，以及包括特殊饮食、抗菌药物和促进肠道蠕动在内的治疗方法。此外，还讨论了SIBO治疗的益处，如减轻炎症和改善营养吸收，以及如何预防复发。

Takeaways

• 😀 小肠细菌过度生长（SIBO）是一种可能引起腹胀和不适的病症，常见于进食后。
• 🤔 SIBO的症状包括腹胀、腹痛、恶心、打嗝、反酸、便秘或腹泻等，还可能影响情绪和注意力。
• 🌐 SIBO与肠易激综合症（IBS）密切相关，约70%的IBS患者存在SIBO问题。
• 👩‍⚕️ Dr. Allison C Becker是SIBO治疗领域的世界领先权威之一。
• 📚 治疗SIBO需要综合方法，包括特殊饮食、使用抗菌药物以及促进肠道蠕动。
• 🍽️ SIBO饮食主要原则是排除喂养细菌的糖、碳水化合物和淀粉，类似于无FODMAP和低凝集素饮食。
• 💊 治疗SIBO可以使用抗生素或草药抗菌剂，后者具有抗炎和抗真菌活性。
• 🔄 促进肠道蠕动的方法包括合理安排饮食时间、间歇性禁食以及使用天然促动剂如生姜。
• 🧬 SIBO可能导致肠道炎症和“肠漏”，影响营养素吸收和食物耐受性。
• 🌱 某些植物防御机制如凝集素和麸质可能在IBS患者中难以消化，可能需要在治疗期间排除。
• 📉 SIBO治疗期间可能会出现“死亡反应”，但有方法可以缓解这些症状，如使用消化酶和益生菌。

Q & A

什么是小肠细菌过度生长（SIBO）？

小肠细菌过度生长（SIBO）是一种条件，其中小肠中的细菌数量异常增多，这可能导致大量气体和腹胀，以及可能的其他症状，如腹痛、恶心、疲劳等。

SIBO的症状有哪些？

SIBO的症状包括腹胀、腹痛、恶心、打嗝、胃食管反流、便秘或腹泻、疲劳、关节痛、脑雾、体重下降和多种食物不耐受。

SIBO如何影响情绪和注意力？

由于肠脑轴的存在，当肠道因细菌过度生长而不健康时，可能会出现焦虑、抑郁和脑雾等症状。

SIBO与肠易激综合症（IBS）有何关系？

SIBO是IBS的根源之一，据发现，70%的IBS患者的症状根源是SIBO。

SIBO的常见原因是什么？

SIBO的常见原因包括食物中毒、慢性便秘、自身免疫疾病、甲状腺功能减退、子宫内膜异位症、低胃酸、某些药物使用（如质子泵抑制剂）和压力。

SIBO如何导致炎症和肠漏？

SIBO中的细菌会破坏细胞间的紧密连接，导致异常的肠道通透性，允许食物抗原和毒素进入血液，这可能是关节痛和自身免疫疾病的原因。

SIBO如何影响小肠的消化？

SIBO中的细菌会损害小肠的糖萼层，这是小肠细胞上的微小指状突起，负责从食物中吸收营养，损害这些结构会导致碳水化合物和食物不耐受。

SIBO有哪些治疗方法？

SIBO的治疗包括使用特殊饮食饿死细菌、使用抗生素或草药抗菌剂杀死细菌，以及通过餐间间隔和促动剂促进肠道蠕动。

SIBO饮食的主要原则是什么？

SIBO饮食的主要原则是切断喂养SIBO细菌的糖、碳水化合物和淀粉，通常需要遵循一个月或更长时间，然后逐渐将食物重新添加到饮食中。

SIBO治疗期间可以使用哪些草药抗菌剂？

SIBO治疗期间可以使用的草药抗菌剂包括黄连素、牛至油和大蒜素，这些草药除了具有抗菌作用外，还具有抗炎和抗真菌活性。

SIBO治疗期间如何促进肠道蠕动？

SIBO治疗期间可以通过餐间间隔、间歇性禁食、确保每天有良好的排便、使用天然促动剂（如生姜）和其他补充剂（如低剂量纳曲酮）来促进肠道蠕动。

SIBO治疗后有哪些可能的副作用？

SIBO治疗后可能出现的副作用包括恶心、疲劳、类似流感的症状、肠道习惯变化或腹部不适，这些通常被称为“死亡反应”，是免疫系统对细菌死亡时释放的内毒素的反应。

SIBO治疗后的预后如何？

根据专家Allison C Becker的说法，三分之一的患者可以通过一轮治疗治愈，而三分之二的患者可能是慢性的，可能需要连续几轮治疗或每隔几个月治疗一次以控制症状。

什么是小肠真菌过度生长（SIFO）？

小肠真菌过度生长（SIFO）是一种与SIBO类似但涉及小肠中真菌过度生长的情况，它具有与SIBO相同的症状和风险因素，并且可以使用类似的治疗方法。

SIBO治疗成功的例子有哪些？

视频中提供了几个成功的例子，包括一位年轻女性通过草药方案治疗后SIBO消失，腹胀消失，月经周期规律，精力显著改善；另一位年轻女性治疗后食物敏感性改善，头痛消失，体重减轻；还有一位严重便秘的女性治疗后每天排便，腹胀和脑雾消失，面部皮肤变得光彩照人。

Outlines

00:00

👩‍⚕️ 小肠细菌过度生长(SIBO)简介

Dr. Raj Sharina Budripat介绍了小肠细菌过度生长(SIBO)这一病症，解释了其症状，如饭后腹胀、不适，以及与肠易激综合症(Irritable Bowel Syndrome, IBS)的关联。她提到SIBO可能导致的多种症状，包括恶心、胃酸反流、便秘或腹泻等，并强调了SIBO与情绪和注意力问题之间的联系。Dr. Budripat还提到了SIBO的发现者Dr. Mark Pimentel和她自己完成的SIBO专业课程，表明了对这一病症深入研究的承诺。

05:03

🌡️ SIBO的成因与影响

本段讨论了导致SIBO的多种可能因素，包括食物中毒、慢性便秘、自身免疫疾病、甲状腺功能减退、子宫内膜异位症、低胃酸以及压力等。同时，解释了SIBO如何引起炎症和“漏肠综合症”，以及细菌如何破坏小肠的糖萼层，影响营养吸收并导致食物不耐受。此外，还提到了SIBO可能导致组胺不耐受和营养吸收不良，引起体重下降等问题。

10:04

🛡️ SIBO的天然防御机制

Dr. Budripat介绍了人体防御SIBO的三种天然机制：结构防御、化学防御和运动性防御。结构防御包括小肠的前后门（pyloric valve和ileocecal valve）防止细菌侵入；化学防御涉及胃酸和消化酶，以及胆汁帮助消化脂肪；运动性防御则是通过迁移运动复合体(MMC)每90分钟清除一次小肠内容物。她还提到了压力如何影响MMC，以及食物中毒可能导致MMC损伤。

15:05

🌬️ SIBO的三种类型及其诊断

本段讲述了三种SIBO类型：氢气型、甲烷型和硫化氢型，它们分别与不同的症状和排便习惯相关。介绍了通过乳果糖呼气试验来诊断SIBO，包括如何通过测量呼出的氢气和甲烷水平来确定SIBO的存在。还提到了新开发的测试可以检测硫化氢。

20:05

🍽️ SIBO的治疗：饮食、药物和促进肠道蠕动

Dr. Budripat详细介绍了SIBO的三步治疗法：首先是通过特殊饮食饿死细菌，其次是使用抗生素或草药抗菌剂杀死细菌，最后是通过饮食间隔和促动剂促进肠道蠕动。她分享了自己基于研究创建的SIBO饮食，并解释了FODMAP和凝集素的概念，以及如何通过排除这些成分来帮助治疗SIBO。

25:06

🌿 SIBO治疗中的草药抗菌剂

本段讨论了治疗SIBO时使用的草药抗菌剂，包括黄连素、牛至油和大蒜素。Dr. Budripat解释了这些草药的抗菌特性以及它们如何帮助减少炎症和促进肠道健康。她还提到了2014年约翰霍普金斯大学的研究，表明草药抗菌剂与抗生素在治疗SIBO方面同样有效。

30:06

🚶‍♀️ 促进肠道蠕动与SIBO治疗的其他建议

Dr. Budripat强调了促进肠道蠕动在SIBO治疗中的重要性，并提供了一些具体建议，如饮食间隔、间歇性禁食、使用天然促动剂如生姜和iberogast，以及低剂量纳曲酮(LDN)的使用。她还提到了消化酶和益生菌在SIBO治疗中的作用，以及如何处理治疗过程中可能出现的副作用。

35:09

🌱 SIBO治疗的益处与复发预防

本段讨论了SIBO治疗的益处，包括体重下降、炎症减少、精神敏锐度提高、睡眠质量改善和皮肤状况变好。Dr. Budripat还提到了治疗后如何维持肠道健康，预防SIBO复发，包括使用促动剂、消化酶和睡前服用镁。她还介绍了一种特殊情况——小肠真菌过度生长(SIFO)，以及其与SIBO的相似之处和治疗方法。

📈 SIBO治疗案例与总结

Dr. Budripat分享了三个治疗SIBO的案例，展示了治疗前后的显著改善。她强调了SIBO是IBS的根本原因，并且是一种可以治疗的病症。她鼓励寻求合格的SIBO治疗提供者的帮助，并提供了自己的实践网站，以便观众了解更多信息。

Keywords

💡小肠细菌过度生长（SIBO）

小肠细菌过度生长，简称SIBO，是指小肠内细菌数量异常增多的状况。这种情况会导致气体和膨胀，影响食物的消化和营养吸收。在视频中，SIBO被描述为IBS（肠易激综合症）的一个根本原因，并且与多种症状相关，如饭后腹胀、恶心、疲劳等。

💡肠易激综合症（IBS）

肠易激综合症是一种常见的肠道功能性疾病，特征是腹部不适或疼痛，伴有排便习惯的改变。视频中提到，全球有四分之一的人口受IBS影响，而70%的IBS患者有SIBO作为症状的根本原因。

💡气体和膨胀

气体和膨胀是SIBO的典型症状，由小肠内细菌过度繁殖导致食物发酵产生气体。视频中提到，患者可能会感到饭后腹部膨胀，甚至在晚上看起来像怀孕六个月。

💡胃肠轴

胃肠轴是指肠道和大脑之间的相互作用和联系。视频中提到，由于SIBO导致的肠道不健康可能会引起焦虑、抑郁和脑雾等症状，这是因为肠道健康与情绪和认知功能紧密相关。

💡食物不耐受

食物不耐受是指身体对某些食物成分的不良反应，这在SIBO患者中很常见。视频中解释说，SIBO细菌会损害小肠的刷状缘酶，导致碳水化合物和食物不耐受，影响营养吸收。

💡肠道微生物群

肠道微生物群是指生活在肠道中的微生物群体，它们对消化和健康有重要影响。视频中提到，慢性便秘、自身免疫疾病、低胃酸等都可能破坏肠道微生物群，导致SIBO。

💡肠道通透性

肠道通透性是指肠道内壁细胞之间的紧密连接，正常情况下不允许大分子物质通过。视频中提到，SIBO细菌会破坏这种紧密连接，导致异常的肠道通透性，可能引发全身性炎症和自身免疫疾病。

💡氢气和甲烷

氢气和甲烷是SIBO检测中测量的两种气体。视频中解释说，通过呼气测试可以检测这些气体的水平，以诊断SIBO。氢气和甲烷的产生与不同类型的SIBO细菌有关。

💡SIBO饮食

SIBO饮食是一种特殊的饮食计划，旨在减少喂养SIBO细菌的食物，从而帮助治疗SIBO。视频中提到，这种饮食通常包括低FODMAP和低凝集素的食物，如白巴斯马蒂大米，但不包括水果、大蒜或洋葱。

💡抗菌治疗

抗菌治疗是SIBO治疗的一部分，旨在杀死过度繁殖的细菌。视频中提到，可以选择使用传统抗生素或草药抗菌剂，如黄连素、牛至油和大蒜素，这些都有抗炎和抗真菌的特性。

💡促进肠道蠕动

促进肠道蠕动是SIBO治疗的另一个重要方面，有助于清除小肠中的食物残渣和细菌。视频中提到，通过合理安排餐间间隔、间歇性禁食、使用天然促动剂如生姜等方法来促进肠道蠕动。

Highlights

小肠细菌过度生长（SIBO）是一种可能导致腹胀和不适的病症。

SIBO的症状包括饭后腹胀、腹痛、恶心、打嗝，可能影响情绪和专注力。

SIBO是肠易激综合症（IBS）的主要原因，全球约有四分之一的人口受IBS影响。

SIBO由胃肠病学家Dr. Mark Pimentel在2006年首次发现，并持续进行相关研究。

Dr. Allison C Becker是世界领先的SIBO治疗权威之一。

SIBO的治疗包括特殊饮食、使用抗菌药物以及促进肠道蠕动。

SIBO饮食主要原则是排除喂养细菌的糖、碳水化合物和淀粉。

FODMAP饮食有助于减少SIBO症状，它衡量食物发酵产生气体的可能性。

SIBO治疗中可以使用草药抗菌剂，如牛至油和大蒜素，它们具有抗炎和抗真菌特性。

促进肠道蠕动的方法包括正确间隔餐食时间和使用天然促动剂。

SIBO治疗期间可能出现的副作用包括恶心、疲劳和类似流感的症状。

SIBO治疗后，患者通常能体验到体重减轻、炎症减少和整体健康改善。

治疗SIBO的预后通常是积极的，但一些患者可能需要多轮治疗或定期治疗。

SIBO的诊断通过呼气测试进行，可以检测氢气和甲烷。

SIBO的根源可能包括食物中毒、慢性便秘、自身免疫疾病和低胃酸等。

SIBO可以导致肠道炎症和“漏肠”症状，影响营养物质吸收。

SIBO患者可能发展出对某些食物的不耐受，影响生活质量。

SIBO的治疗还包括使用消化酶和益生菌来改善肠道微生物平衡。

SIBO的预防复发措施包括使用促动剂、消化酶和避免过度零食。

Transcripts

hi i'm dr raj sharina budripat

i'm board certified in internal medicine

and today i'm going to talk about a

condition called sibo

which stands for small intestine

bacterial overgrowth

do you feel bloated or uncomfortable

after eating

have you been told you have ibs or

irritable bowel syndrome

[Music]

are you most bloated by bedtime for

example i have patients who tell me they

look

six months pregnant after a meal

if you're suffering from these symptoms

you may have a condition called sibo or

small intestine bacterial overgrowth

so normally your small intestine does

not have a lot of bacteria

most of the bacteria are located in the

colon or large intestine

the job of the small intestine is

primarily to absorb nutrients from your

food

when the bacteria populate your small

intestine

this is a condition called sibo and can

cause tremendous gas and bloating

every time you eat what are some of the

symptoms of sibo

placebo can cause bloating and abdominal

pain

it can cause nausea burping

the gas pressure from under the

diaphragm can trigger acid reflux

or heartburn it can also alter your

bowel habits

leading to constipation or diarrhea

sibo can also cause systemic symptoms

such as fatigue

joint pain brain fog weight loss

and numerous food intolerances

[Music]

sibo can also affect your mood and your

focus

because remember the gut is the second

brain and because of the gut brain axis

when your gut is unhealthy due to this

bacterial overgrowth

you can develop symptoms such as anxiety

depression

and brain fog the big deal is that sibo

is the root cause of irritable bowel

syndrome or ibs

did you know that a quarter of the

world's population suffers from ibs

and it turns out 70 percent of ibs

patients

have sibo as a root cause of their

symptoms

sibo was first discovered by dr mark

pimentel a gastroenterologist at cedar

sinai

in 2006 and he continues to do a lot of

the leading research on this condition

dr allison c becker is respected as one

of the world's leading authorities on

sibo treatment

i'm happy to announce that i recently

completed her sibo pro course

the most comprehensive educational

program on sivo for healthcare providers

the course really offered me a wealth of

information and it also inspired me to

create this video for you all

to make it easier to understand sibo

now in case you were just thinking

what's the big deal

it's just a gas problem why not just

take a gas x

[Music]

well let me delve into that and just in

case you're wondering gas

x is cymethicone which just breaks up

bubbles it doesn't actually

reduce gas

[Music]

the issue is that gas trapped in the

small intestine

is very different from gas in the colon

gas in the colon has a much easier way

out

normally fermentation of undigested

carbohydrates in your diet

happens in the large intestine so the

large intestine has a tremendous

bacterial load and gas production in

that area is normal

a healthy small intestine has very

little bacteria

but in sibo there's an overgrowth of

bacteria in the small intestine

so this creates gas in fermentation of

carbohydrates in the small intestine

which is abnormal

the gas that's trapped in the small

intestine causes a lot of problems in

sibo

the gas really doesn't have an easy exit

pathway so it stays in there

and it stretches the wall of the small

intestine

the wall of the small intestine is made

out of smooth muscle

and anytime smooth muscle is irritated

or stretched

it can cause a tremendous amount of pain

in addition to the gas the bacteria are

also responsible for inflammation in the

small intestine

and this can lead to a condition called

leaky gut or

abnormal intestinal permeability

the bacteria also cause damage of the

brush border enzymes which i'm going to

explain in more detail

but this leads to significant

carbohydrate and food intolerances

what are some of the root causes of sibo

food poisoning is actually one of the

main causes of sibo

and i'll go into this in more detail

chronic constipation can lead to sibo

because you're not clearing out your

bowels

and this can lead to a backup of

bacteria into the small intestine

disrupt the gut microbiome and can lead

to dysbiosis

as well as sibo autoimmune diseases such

as hashimoto's thyroid disease

lupus rheumatoid arthritis scleroderma

or crohn's disease could all be a risk

factor for developing

sibo hypothyroidism and endometriosis

are also associated with sibo low

stomach acid

or hypochlorhydria is another risk

factor for sibo

another cause of low stomach acid is

being on a proton pump inhibitor type

medication

such as prilosec diabetes is another

potential root cause of sibo

finally stress could be a root cause of

sibo and i will go into more detail on

how stress

affects the motility of your gut now

let's talk about how sibo causes

inflammation

and leaky gut the bacteria

cause disruption in the tight junctions

between the cells

and this can lead to abnormal intestinal

permeability

allowing food antigens and toxins to

enter the bloodstream

this inflammation can be a root cause of

joint pain

and autoimmune disease in the body

patients with leaky gut will have an

elevated zonulin level in their stool

they also have elevated fecal secretory

iga

which is an inflammation marker so now

we want to talk about how the sibo

bacteria can damage

something special in your small

intestine called the glycocalyx

these tiny finger-like projections are

microvilli

on a cell in your small intestine their

job is to absorb nutrients from your

food

the glycocalyx is the protective

glycoprotein layer

which has enzymes for carbohydrate

digestion

carbohydrate digestion becomes a problem

in sibo

to better understand this let's talk

about the three types of carbohydrates

monosaccharides are single sugar

molecules like glucose or fructose

disaccharides are two sugar molecules

linked together

for example table sugar is sucrose which

is made out of glucose and fructose

and lactose which is the sugar in dairy

products is made out of glucose and

galactose

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finally we have polysaccharides which

means many sugar molecules link together

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this includes starch and cellulose which

is seen in vegetables

fruits whole grains as well as beans and

legumes

this diagram shows how carbohydrates are

broken down

larger polysaccharides like starches are

broken down to disaccharides in the

lumen of the intestine

by enzymes disaccharides are broken down

to monosaccharides by

enzymes that are present on the

glycocalyx

the problem is in sibo the membranous

phase of digestion

is disrupted due to the damage of the

glycocalyx by the sibo bacteria

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this is why sibo causes carbohydrate

intolerances

look at this poor lady she's so afraid

to eat this burger because she knows the

bread is gonna cause her tremendous

bloating

this is the problem we see in sibo

people become

afraid to eat certain foods because they

know how much discomfort they're gonna

experience

sibo can have other consequences on your

health

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it can cause histamine intolerances so

histamines are found in certain

fermented or

aged foods such as vinegars bone broth

or sauerkraut the reason this

happens is the sibo bacteria interfere

with the dao

enzyme which stands for diamine oxidase

on the intestinal lining which normally

breaks down histamines

histamines trigger allergic reactions in

the body such as rashes

hives nasal allergy symptoms and

headaches

one of the biggest problems in sibo is

food sensitivities

normally food is a source of nourishment

and pleasure but in sibo it becomes a

source of pain

and suffering the sibo bacteria also

interfere with nutrient absorption

so this can lead to low vitamin levels

such as low ferritin which is iron

stores

low vitamin d low b12

instead of the person getting all the

nutrients from their food

some of the nutrients are actually used

by the sibo bacteria

and this can lead to malabsorption and

weight loss

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there's also a kind of sibo that slows

the motility in the gut

called methane sibo which i'll talk

about more later but this actually

causes recycling of toxins from the gut

which can lead to stubborn weight

the sad thing is sibo leads to secondary

fructose intolerance

don't we all love fruit it's sweet and

juicy

and delicious but sadly in sibo the

inability to digest the fructose

leads to bloating and discomfort

sibo also causes secondary lactose

intolerance

so this means a person's ability to

digest dairy products goes down

so don't even think about ice cream our

body has three natural defense

mechanisms to prevent sibo

we have the structural defense the

chemical defense

and motility defense which i'll explain

let's go over the structural defense

that we have against sibo

the small intestine has a front door and

a back door

which are valves the front door is the

pyloric valve

which separates the stomach from the

duodenum which is the beginning of the

small intestine

the back door is the ileocecal valve

this separates the ilium which is the

end of the small intestine

from the secum which is the beginning of

the colon or large intestine

this valve is extremely important

because it prevents bacteria in the

colon from getting into the small

intestine

next we have a chemical defense

mechanism against sibo

so our stomach makes hydrochloric acid

and this is really important for protein

digestion

it also helps break down any bacteria

that may be present

in our food next we have digestive

enzymes

so this starts with the enzymes that are

present in our saliva

as we chew our food the pancreas is

responsible for making the majority of

the digestive enzymes

which help us to properly break down our

food and prevent the overgrowth of

bacteria in the small intestine

finally we have bile from the

gallbladder which helps us to

digest fats in the diet

now let's talk about the motility

defense we have against sibo

so we have something called a migrating

motor complex

and this is a wave of motility that

occurs through the small intestine

every 90 minutes so we have about 22

feet of small intestine

and every 90 minutes there's this wave

of peristalsis

and this helps to clear out food and

bacteria from the small intestine

what can mess up your migrating motor

complex

well stress because stress activates

your sympathetic nervous system

which is your fight or flight response

and this will slow down motility in your

small intestine

in contrast if you're nice and relaxed

after eating

this promotes your parasympathetic

nervous system which helps you rest and

digest

promoting motility in the small

intestine

food poisoning is a big root cause of

sibo

because in certain individuals it can

cause permanent damage to the migrating

motor complex

let me explain how this happens so the

bacteria release

cdtb toxins into your body and this

triggers your immune system

to create anti-cdtb antibodies as well

as antivinculin antibodies

the antivinculin antibodies can trigger

an autoimmune

reaction damaging the interstitial cells

of kegel which are the nerve cells that

control the migrating motor complex

the good news is there's a blood test

now that tells us if you have these

antibodies it's called the ibs smart

test and it's a blood test we can draw

in our office

if these antibodies are positive it

indicates that at some point in your

life you did have an episode of food

poisoning

and it may have potentially affected the

motility of your small intestine

the good news is then we can put more

emphasis on promoting motility

as part of your treatment strategy

now let's talk about the three different

types of sibo

the hydrogen sibo is associated with

looser stools

or irritable bowel syndrome with

diarrhea

the methane sibo is associated with

constipation

or irritable bowel syndrome with

constipation

finally there's a third type of sibo

called hydrogen sulfide sibo

which has recently gained more awareness

and this type of sibo is usually

associated with diarrhea

but occasionally also with constipation

what's fascinating is that the hydrogen

gas can be converted to methane

or hydrogen sulfide by the sibo bacteria

hydrogen gas is converted to methane by

archaea which are ancient prokaryotic

organisms

the species methanobrevibacter smithii

is responsible for converting four

hydrogen molecules

into one methane in patients who have

the methane sibo

similarly five hydrogen molecules can be

converted to one hydrogen sulfide

molecule

if there are sulfate reducing bacteria

present

methane and hydrogen sulfide are also

interchangeable

and that is why we sometimes see

constipation in patients who have

hydrogen sulfide sibo

this is why it's so important to get a

formal diagnosis of sibo

so that we know what type of gas you

have and the severity

we diagnose sibo through a lactulose

breath test

so in this test you first gather your

baseline breath

then you drink a solution of lactulose

which is a non-absorbable sugar that

your body can't absorb

if you have bacteria in your small

intestine they will ferment the

lactulose into gas

a rise in hydrogen of over 20 parts per

million in the first two hours

is considered a positive test for

hydrogen and any methane over 10 parts

per million at any time during the test

is considered positive for methane

so as you can see this is a positive

test for both hydrogen

and methane sibo a new test has recently

been developed that can also detect the

third gas or hydrogen sulfide

the great news is sibo is a treatable

condition

there's three parts to treating sibo the

first is starving the bacteria

using a special diet

the second part is killing the bacteria

using antimicrobials

we can use either antibiotics or herbal

antimicrobials

depending on the patient's preference

the third part of treatment is promoting

motility we do this through meal spacing

and prokinetics which i'll explain in

more detail

the sibo diet is one of the most

effective and important parts of the

sibo treatment

what i've learned from dr seabecker's

course is that every expert in the field

of sibo has their own opinion on the

diet

so there is no universal consensus on

the sibo diet

so i created my own sibo diet based on

my extensive research and it has proven

to be very effective for my patients

with sibo

the main principle of this diet is we're

cutting out the sugars

carbs and starches that feed the sibo

bacteria

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i like to overlap a low fodmap diet with

a low lectin diet

and i'll go over this in more detail an

easy way to think of the diet is it's a

paleo diet

with no fruit garlic or onions and the

good news is that white basmati rice is

okay

the big thing to remember is this is a

temporary diet

patients usually need to follow it for a

month or a little longer

and then they're able to add foods back

into their diet

so what's a fodmap fodmap stands for

fermentable olego disaccharides

monosaccharides and polyols

basically it's a measure of how likely a

food is to ferment the sibo bacteria and

cause

gas

some of this is obvious like beans and

dairy products

but other ones are not obvious for

example asparagus

artichoke garlic and onions are also

high fodmap

the good news is it's fine to use garlic

infused

olive oil to get the flavor of garlic

without actually eating garlic

i provide my patients with a sibo

handout that provides guidance on the

sibo diet

but i also encourage them to download an

app so that they can look up

any specific vegetable and find out if

it's okay during the treatment

you can download a free sibo app called

sibo which is designed by dr c backer

and another nice one is the monarch

university fodmap app

this one goes into a little more detail

for example here it shows that asparagus

is high fodmap because it contains

fructose as well as fructans

now let's talk about lectins what are

lectins

lectins are the defense mechanism of

plants

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they're present in the outer coating of

legumes whole grains

and seeded vegetables patients with

irritable bowel syndrome often have a

hard time digesting lectins

and they can be a cause of their

symptoms so that's why i like to

eliminate lectins during the course of

sibo treatment

gluten is considered a super lectin

other things with lectins include

tomatoes cucumbers

bell peppers eggplant beans and whole

grains

white basmati rice is unique in that it

has no lectins in it

and it's really easy to digest for

patients with irritable bowel syndrome

it also breaks down really quickly so

there's nothing left in the small

intestine

for the sibo bacteria to feed on

i really want to emphasize that the sibo

diet is tremendously helpful

it starves the sibo bacteria reduces the

gas load

and significantly reduces symptoms

but to really get rid of sibo we need to

kill the bacteria

and that's why we need antimicrobials

the great news is you have a choice when

it comes to antimicrobials

you can go with traditional antibiotics

or you can choose herbal antimicrobials

there was even a study in 2014 published

from johns hopkins university that

showed that the herbal antimicrobials

were as effective as antibiotics in

treating sibo

a lot of my patients choose the herbal

route and i'm happy to report i've seen

extremely good results with the herbal

antimicrobials

the herbals have the added benefit of

being anti-inflammatory

they also have anti-fungal activity as

well as anti-biofilm activity

the antibiotics most commonly used for

sibo are rifaximin

and neomycin

the herbal antimicrobials are berberine

oregano and allicin

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there are different protocols on the

antibiotics or the herbals depending on

the type of sibo

whether it's hydrogen methane hydrogen

sulfide or a combination of two of these

let me introduce you to the three main

herbals that we use to treat sibo

so the first is berberine which comes

from these bright red berries

the capsules made from berberine are

bright yellow in color

it reminds me of the powerful

anti-inflammatory benefits of berberine

berberine is also well known for

activating insulin receptors

so it's really helpful in patients with

pre-diabetes or diabetes

the good news is in patients without

blood sugar problems berberine does not

seem to cause low blood sugar

but for those who need it it can really

activate the metabolism

which is an added bonus

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oregano is one of my favorite italian

herbs

so we use capsules of oregano oil that

are released in the small intestine

where it has antimicrobial benefits

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oregano is also very anti-inflammatory

it can also help with sinus infections

and preventing common colds and viruses

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allicin comes from garlic and has potent

antimicrobial properties

you may be wondering why garlic i

thought garlic was not okay during sibo

treatment

great question so although you can't eat

garlic during sibo treatment we can

still use

allicin which is the antimicrobial part

of garlic

to kill the sibo bacteria

the next part of sibo treatment is

promoting motility

one of the ways we do this is meal

spacing

so we recommend four to five hours

between meals and 10 to 12 hours between

dinner and breakfast

this gives your migrating motor complex

time to do its job and sweep out the

small intestine

of food and bacteria

intermittent fasting which is 14 to 18

hours of not eating

is optional but also helps because it

gives your migrating motor complex an

even longer time to fully clean out the

small intestine

so the main thing to remember is no

snacking between

meals another big part of promoting

motility

is making sure you have a good bowel

movement every day

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sometimes we see a vicious cycle in

patients who have methane sibo

because methane is associated with

constipation and if you're suffering

from chronic constipation it can be hard

to clear this evil

this is why it's so important that we

promote motility

and get your bowels to move every day

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my favorite thing for constipation is

magnesium

either chelated magnesium or magnesium

citrate at bedtime

you can gradually titrate up the dose

until your bowels are regular

every day the great news is magnesium

has so many other beneficial effects on

the body

it helps with deep sleep it's good for

muscle recovery

it relieves anxiety it's good for blood

pressure

and it also helps to reduce menstrual

cramps

for those with severe constipation where

magnesium alone is not sufficient

i like to use aloe vera leaf capsules

this is another great way to get your

bowels moving and cleared out every day

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to promote motility in the small

intestine i like to use natural

prokinetic agents

as you may know ginger is amazing for

digestion

and supplements made from ginger can be

taken at bedtime to promote small

intestine motility

the good news is there are newer

formulations of ginger supplements now

that are better tolerated and don't

cause any ginger burn

iberogast or sdw5 is a tincture of nine

different herbs that originated in

germany

it can be taken with each meal and at

bedtime

there are actually now over 47 studies

on iberocast

showing its efficacy

ldn is low-dose naltrexone it's

considered a novel anti-inflammatory

treatment for chronic pain conditions as

well as autoimmune diseases

it's considered a glial cell modulator

and has a neuroprotective effect

so it can help with the nerves in the

small intestine that are promoting

motility

there are several other tips that can be

very helpful in treating sibo and

preventing sibo recurrence

digestive enzymes can make a world of

difference for patients with irritable

bowel syndrome

and they're really helpful in sibo

because the sibo bacteria love to feed

off of food that's not properly broken

down

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most patients with sibo suffer from

dysbiosis which means they have an

imbalance in their microbiome

that's why i find probiotics to be

helpful but they need to be

without prebiotics because prebiotics

are a type of fiber that would feed the

sibo bacteria

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sibo patients seem to do well with spore

based bacillus probiotics

in fact a prospective randomized control

study published in 2019

found that ibs patients had clinical

symptom improvement when given a spore

based

probiotic spores are dormant

soil organisms that germinate in the

intestines

spores can survive hostile environments

like stomach acid and have a longer life

of activity in the intestines

what are some of the side effects of

sibo treatment

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first of all you can have die-off

symptoms we see this with both the

antibiotics as well as the herbal

antimicrobials

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die-off happens because your immune

system is reacting to the

lipopolysaccharides that are being

released from bacteria as they die

and break apart

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this releases cytokines in your body

that can trigger a systemic inflammatory

reaction

so sometimes you actually feel worse

before you feel better

every patient with sibo is unique so

some patients don't experience much die

off while others get more significant

symptoms

some of the symptoms we see are nausea

fatigue

flu-like symptoms changes in bowel

habits or abdominal discomfort

the good news is i can offer some tips

to help with the die-off symptoms

for nausea i recommend putting two drops

of essential peppermint oil in a glass

of water

and sipping that slowly

igg antibodies or immunoglobulins help

to bind bacterial toxins as they're

released

and they help to reduce inflammation in

the small intestine

methyl b complex can be extremely

helpful in boosting your energy

and mood during the sibo treatment

we also offer b12 injections which can

be extremely helpful

because the b12 bypasses your gut and

goes straight into your body

boosting your energy and your mood

for body aches and flu-like symptoms we

find epsom salt baths to be helpful

because they're rich in magnesium which

help to promote your detox pathways

for abdominal discomfort or bloating i

recommend massaging the abdomen with a

digestive blend of essential oils

for example i like digest zen by doterra

so you mix it with a carrier oil and

then massage your abdomen clockwise for

about one minute

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the ingredients in digestzen such as

peppermint

ginger cardamom fennel help to alleviate

intestinal spasms and promote motility

in the intestines

ultimately these are the goals of

treatment we want to see

improvement in symptoms more consistent

bowel habits

and increased food toleration

the great news is that sibo treatment

offers other benefits as well

those looking to lose weight often lose

5-10 pounds during the month of

treatment

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we see reduction in inflammation in the

body and patients often report

improved mental sharpness less joint

pain they tell me they're sleeping

better

and that their skin and complexion have

improved

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once we clear the sibo patients are able

to better assimilate nutrients from

their diet

so their energy improves and their

vitamin levels improve as well

so what's the prognosis of treatment

according to dr allison c becker

a third of patients are cured with one

round of treatment

two-thirds of patients are chronic and

may need successive rounds of treatment

or they may need to be treated every few

months to keep their symptoms under

control

in order to prevent a relapse we often

use a prokinetic agent

like the ginger capsules i talked about

earlier

we also recommend continuing digestive

enzymes if the patient finds them

helpful

and continuing magnesium at bedtime so

that they're having good bowel movements

every day

it's also best not to snack excessively

between meals

sometimes we see stubborn cases of sibo

that don't respond well to antibiotics

or herbal antimicrobials

this is when we can use something called

the elemental diet

the elemental diet is a liquid medical

food diet that the patient follows for

two weeks

so the elemental diet starves the sibo

bacteria

but nourishes the patient with all the

proteins fats

carbohydrates and vitamins needed

the elemental diet can be challenging

but it's also extremely effective

it has an 80 to 85 success rate at sibo

eradication

i also want to introduce a condition

called sifo

which stands for small intestine fungal

overgrowth

it's very similar to sibo except instead

of bacteria

it's an overgrowth of fungal organisms

in the small intestine

it has the same symptoms as sibo the

same risk factors as sibo

and can actually co-exist with sibo

some of the leading research on sifo is

being done by dr satish rao

who's a professor and gastroenterologist

at augusta university in georgia

the great news is the herbal

antimicrobials like berberine and

oregano

they also work for sifo

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now i want to share with you a few quick

case examples

so here we have case example number one

so i had a young lady come to me

with bloating irregular periods and

fatigue

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i tested her for sibo and she was

positive for both hydrogen sibo as well

as methane sibo

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i treated her with an herbal protocol

for four weeks

and an additional two weeks and then she

repeated her breath test

and what's amazing is you can see the

sibo is gone

also she had no more bloating her

periods were now regular

and she had a significant improvement in

her energy level

so she was really happy

moving on to case example number two so

here i have another young lady

who was suffering from bloating frequent

migraine headaches

and a lot of food intolerances which was

really inconvenient because she

considered herself a foodie

she loved food so i tested her for sibo

and she had a pretty significant case of

methane sibo

so she also opted for the herbal

protocol

we did four weeks of treatment and then

two additional weeks

and then she repeated her breath test

and look at what a remarkable result her

sibo is gone

symptom-wise she was also thrilled her

food sensitivities improved so she was

able to eat more foods like onions and

garlic

she had no more migraines and she lost

five pounds

now we have case example number three so

here we have a lady who was having

severe constipation

in fact she told me she was only having

a bowel movement twice a month

she was also bloated she had brain fog

and she had a lot of redness on her face

as you can see from her sibo test she

had a very significant case of both

hydrogen and methane sibo

i treated her with an herbal protocol

for four weeks

and look at her repeat test isn't this

remarkable i was quite amazed when i saw

it

what's more amazing is she went from

having two bowel movements a month

to having a bowel movement every day

her abdominal discomfort and bloating

were gone her brain fog was gone

and her face looked radiant and

beautiful

in summary sibo is a root cause of ibs

sibo is a treatable condition

it's best to seek the attention of a

qualified sibo provider

to learn more about my practice please

visit oc

integrative medicine.com

thanks so much for watching hope you

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thank you again and i wish you all great

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health

you