This is where I began over a year ago, and let me save you the trouble – this protocol didn’t work. It wasn’t until I found a better doctor that things got better. Check out what worked for me on SIBO Update #4: Complete Protocol Change.
A note to the reader: this is a graphic description of small intestine bacterial overgrowth, my symptoms and my attempts to get well. I’m laying it all bare, here, so if would rather not read about urethras and poo, click away!
SIBO = Small Intestine Bacterial Overgrowth.
Otherwise known as bad bugs in the gut that keep you from digesting foods and absorbing critical nutrients while simultaneously screwing up the morning poo, distending the belly, causing weight gain or loss and disrupting hormone regulation.
Last year, after a round of anitbiotics for a urinary tract infection left me with a candida outbreak (read: systemic yeast infection), I worked with naturopaths to help get well. I took both prescription medications and herbs to help kill yeast, cut out all sugars and stopped drinking coffee and alcohol. While some of my symptoms diminished, like frequent urination, other started to get worse, namely, my digestion. Whereas before I had noticed mild discomfort, if any, during digestion, I was now experiencing very poor elimination (alternating constipation and diarrhea), painful gas and bloating. My signature sign of a bad day was a stomach so distended I looked six months pregnant.
I’m not talking about a food baby, or when women pooch out their stomachs in self-loathing to say, “I’m so fat….” with a sigh. No, this was different. I could wake up, looking like my normal 145 pound self, and by 2pm not fit into any clothing that had closures resembling a waist band. Yoga pants and mumu’s became my signature clothing (lucky for me, I teach yoga, so it wasn’t too strange), and I started storing all of my other pants. The scale only showed about 3-4 pounds of weight gain, about the amount I would experience before my menstrual cycle from water retention. What was wrong? My naturopath thought that maybe I just wasn’t following the candida protocol well enough, and said to hold the course. A body worker I saw said, “You might want to consider a SIBO test,” but my doctor wasn’t convinced.
For a few months, I figured it was just me. Maybe I was getting old, becoming lazy with my diet and exercise, and needed to charge through. I couldn’t find any Ayurvedic information that fit all of my symptoms that I wasn’t already trying, either. So I exercised more – I joined a kickboxing class, walked and ran, did yoga, circuit training and swam. At the same time, my stomach was such a bother that I was eating less. My boyfriend noted that I now ate about a third of what he did, rather than the usual half. I just couldn’t get more down. All this and I was still bloated, the scale creeping up and not down.
About a month ago, I finally decided to try another naturopath. As I explained my symptoms and she gathered information from my body, feeling my tender liver and noting my general fatigue, her eyebrows continued to raise. She ordered a fasting blood draw and a SIBO test. “I’m seeing an incredible number of people presenting with both SIBO and candida overlapping each other. I hope that’s not you, so let’s do some tests to rule things out.”
To make a long story short, it was me. Or rather, is me. The SIBO test came back positive, and the blood panel showed nothing too irregular – taxed thyroid and adrenals (apparently running a business is stressing me out more than I realized), deficient vitamin D (hello, Seattle), low iron stores and extra EOS – the part of my blood that seeks out allergens and parasites.
While that all may sound a bit overwhelming, to me it was empowering. Finally, some conclusions as to why my stomach bloats this way (it was becoming so regular that I started to think it had always been this way) and why I fatigue more easily. When I asked about the weight gain in terms of this diagnostic picture and if I was just eating too much, my doctor said, “No. You have bugs inside you that aren’t letting you process foods and they’re sitting undigested in your gut.”
So what exactly is SIBO, and does it do to you? SIBO stands for small intestine bacterial overgrowth. SIBO is a chronic bacterial infection of the small intestine. While some bacteria normally inhabit parts of the gastrointestinal tract, this infection occurs when these types of bacteria overgrow abnormally in areas where so many bacteria aren’t supposed to occur. Not only do these bacteria interfere with the digestion and absorption of food, they also damage the lining of the small intestine. This leads to several problems (taken from siboinfo.com):
- The bacteria consume food meant for the body, depriving the body of nutrients, vitamins and minerals and leading to conditions such as anemia (low iron)
- The bacteria consume the food that is unable to be absorbed by the small intestine due to intestinal wall damage, which creates more bacterial overgrowth and resulting damage (a pretty vicious cycle)
- The bacteria produce certain gases as a bi-product of eating our food, which leads to abdominal pain and bloating, constipation and/or diarrhea
- The bacteria decrease proper fat absorption, leading to deficiency of fat soluble vitamins A and D and creating fatty stools
- Through the damaged lining, undigested food particles can enter the blood stream (leaky gut syndrome) where the immune system attacks it, leading to food sensitivities/allergies
- The bacteria can also enter the blood stream, where the immune system reacts to them, causing fatigue and liver congestion
- The bacteria excrete acids which, in high amounts, can cause neurological and cognitive symptoms
SIBO is now thought to be the underlying cause for up to 84% of people diagnosed with Irritable Bowel Syndrome. Studies have shown links from SIBO to a variety of other diseases, including autism, chronic fatigue syndrome, Parkinson’s disease and diabetes. There is a lot of great information about SIBO, symptoms and treatment at siboinfo.com.
I am no SIBO expert. I can only speak from the experience I have with my own body. Interestingly enough, I can’t find any Ayurvedic articles on SIBO or the treatment of SIBO, so I’ll probably be writing one soon. In the mean time, I’ll continue to write about my treatment experience in the hopes that it might help or be of inspiration to someone out there.
What Causes SIBO? My Best Guestimate.
There is no smoking gun on what causes SIBO. Research points to an underlying food allergy like celiacs disease or lactose intolerance, overuse of antibiotics, and a diet high in sugars. I was never diagnosed as a child with a food allergy, and my parents fed me healthy foods in comparison to what other kids my age seemed to eat. As a teenager, I often brought sack lunch to school to avoid the greasy lunchroom. In my early 20’s, I was a vegetarian and ate a diet rich in grains and home-baked breads, but rarely indulged in sugar save for a few squares of chocolate. Compared to the general population, I don’t think my diet was at all high in sugars or carbs. But “too much” is always relative, and taking into consideration my highly sensitive body, perhaps it was too much for me.
For someone as sensitive as me, this SIBO infection is probably a combination of a sensitive body and gut and too many antibiotics for my sensitive system. Looking back on my digestive history, I remember now that I had elimination problems such as mixed constipation and diarrhea as early as high school, when blood in my stool lead to a flexible sigmoidoscopy, which showed hemorrhoids. In college, I started having chronic diarrhea and a doctor told me to stop drinking milk for a while, which eliminated my symptoms after a few weeks. In graduate school, the diarrhea returned, along with a sometimes-there debilitating pain in the rectum which doubled me over the toilet for about ten minutes. A doctor then had me start a gluten-free diet, which cleared up my symptoms and healed me enough that, a year later, I was able to resume eating gluten.
After graduate school, I had symptoms off and on, but none were as debilitating as before. When I studied Ayurveda, I really normalized my digestion and elimination through a dosha-specific diet and specific lifestyle routines. I learned through Ayurveda that some of the small symptoms that I considered part of normal living were, in fact, not – rather, these simple digestive maladies were the first signals of a body imbalance. I did my best to work through imbalance and had things fairly under control through my Ayurvedic practices.
In the summer of 2010, I was guiding a yoga-adventure retreat in Sequoia National Park and wasn’t feeling well. I had what felt like a fever, my mucus membranes were dry and I was fatigued. I thought maybe it was the altitude or the fact that I was menstruating. One evening, I developed symptoms of a urinary tract infection. Over the next hour, while I cooked dinner for the participants, the symptoms progressed rapidly and I was forced to seek medical attention – driving myself to a hospital 90 minutes down a one-lane, windy road to a small, beat-up town and greeted by a metal-detecting security system at the emergency room. It was the middle of the night, and the ER staff thought I was trying to get hooked up with pain medications. Treated like a drug addict, they said they’d offer me Vicodin if I could just get someone to drive me home. When I finally convinced them to take a sample of my urine (I think they woke up to my real condition when I demanded a catheter), they realized I had a severe urinary tract infection that was very likely on its way to my kidneys, and immediately administered IV antibiotics and fluids. Once released, I continued with oral antibiotics for another week or two.
Weeks later as my system recovered from the infection and from the antibiotics, I started noticing systemic symptoms – frequent urination not associated with an infection, vaginal yeast infections, alternating diarrhea and constipation, increased mood-swings and increased cravings for sweet foods. It was as if all the work I’d done to regulate my sensitive body had been undone.
I continued to seek balance through Ayurvedic and other natural treatments, and did well for a while. Early in 2013, I again contracted a urinary tract infection, and things went down hill again. After my urinary system had been so badly infected from the time before, I had had only limited success in stopping one naturally (I had done so a few times, with herbs), and this one progressed quickly and severely so, frightened, I went to the doctor. This time, it took two different antibiotics to clear it.
As an Ayurvedic practitioner, I don’t think of myself as someone who rushes to the doctor for antibiotics. I am aware of their dangers and try to avoid them when possible. As a child, I had several ear infections for which I was given antibiotics, and during college seemed to have a propensity for contracting bacterial infections such as sinus infections and bacterial throat infections rather than viruses. As I’ve grown into adulthood, the only times I’ve been given antibiotics is for the aforementioned urinary tract infections.
Understanding why I developed this condition is somewhat of a mystery, but I can draw some general connections to my past. I know that I have a highly sensitive body and am easily affected by all the things my sense organs take in. I know I have a sensitive gut as indicated by the teenage and early adult elimination problems. My predominant diet in my early 20’s was healthy but carbohydrate-centered, and what I now know about the condition of my gut was that I probably couldn’t handle those “healthy” types of foods. I took as few antibiotics as I could, but it seems that even those amounts were too much for my sensitive system. Now, all I can do is move forward with the information I have.
Treatment Plan: Diet
The goal for ridding the body of SIBO is to first kill the excessive amounts of bacteria, then heal the gut lining and then maintain health. The treatment for SIBO is an oral antibiotic and a strict diet that limits carbohydrates. While there are many specific diets to choose from, my naturopath prescribed the Specific Carbohydrate Diet (SCD) combined with the Low-FODMAP diet.
The SCD diet limits any carbohydrate chains beyond a monosaccharide; namely, disaccharides and polysaccharids. Monosaccharides are single chain carbohydrates (just one glucose) and include foods like honey and some ripe fruits. These carbs require very little digestion because they are already in the form of glucose, which the body can easily absorb. Disaccharides (foods like table sugar) have two glucose molecules and require further digestion in the small intestine. Polysaccharides (starches and grains) have several glucose molecules, which need further digestion in the small intestine.
Disaccharides and polysaccharids must be limited because when the lining of the small intestine is damaged, as in the case of SIBO and other bowel diseases, what that means on a cellular level is that the digestive cells that capture complex carbohydrates and digest them have been damaged. Instead of a healthy cell with micovilli designed to digest carbs, the damaged cells have been flattened and their micovilli damaged. Effectually, this means that the cells designed to digest these types of complex carbohydrates don’t exist in a damaged gut.
The low-FODMAP diet (which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) is a diet that limits foods that are known to ferment in the gut. It is a similar idea to that of the SCD diet with some additional restrictions. These two diets combined are the strictest in the treatment of SIBO, but there are other options for those who have less severe symptoms.
Here is the list I taped in my kitchen to help me stay clear on what I’m eating and what I’m not. Basically, NO grains or starches, lots of green vegetables, homemade 24-hour fermented yogurt (which naturally becomes lactose-free), no lactose (most dairy), no sugar, some honey and fruit and lots of healthy meats and fats. I basically created a chart from these lists.
Treatment: Antibiotics (irony, anyone?)
There is one prescription antibiotic, Rifaximin (commercially sold as Xifaxan), that has shown to help with SIBO eradication. A 30-day dose of this medication costs $800 and was not covered by my high deductible health insurance plan. However, new studies have shown that herbal antibiotics are just as effective, if not more effective, than conventional antibiotics. I opted for the herbal route.
The two main herbal antibiotics I’m taking are Mentahril (Peppermint Oil) and Hydrastis (goldenseal). In two weeks, I’ll also start a treatment to kill the biofilm left behind by bacteria and yeast (think of it like the exoskeleton of an insect. I know, it’s gross) called Interfase. It’s important to take these away from food for effectiveness, and to wait at least 4-5 hours between meals so that the gut empties completely. I’m also taking Motilpro to help with gut motility (another problem with SIBO is that it severely limits gut motility, or the ability for the gut to push food through). I’m also receiving monthly treatments of visceral manipulation to help with gut motility.
In addition, I’m drinking a liver detox tea and applying a castor oil pack to my abdomen each evening, and taking activated charcoal to help with any die-off effects (when bacteria inside you die, they can make your body kind of cranky and give you headaches, body aches or mood swings). I’ve also got some adrenal support and vitamin D to aid the whole process. The whole medicine cabinet looks something like this, and I had to pull out the label-maker last night to keep it all straight:
I’ve been easing my way into the diet, and I think I have it down now. I’ve got my yogurt maker working overtime to produce the required 24-hour fermented yogurt and then to make yogurt cheese, and I experimented with an almond and coconut flour cookie that, after trying, realized I didn’t digest well. I’ll be keeping a food journal, too.
I just started the herbal regimen today, so I’ll keep you posted on what I notice — die off, energy levels, and the trials and tribulations of the diet. This initial phase of killing the bacteria is a four to eight week journey, then I’ll repair my gut lining and then maintain. From what I’ve read on the various SIBO blogs and forums, it’s a condition that often requires long-term management.
Like anything that happens in the body, I’m also looking at the subtle-body connections, including the energy, emotions and belief systems linked to SIBO. I’ll be writing about that soon. As always, I realize that this is just another human experience for me to have as a spirit. This is another opportunity for me to learn, to grow, and to understand. It might suck sometimes and I won’t diminish that, but it’s also a great opportunity for reflection and growth, to get to destroy old ways of being in order to make room for the creatively new and inspired. As my astrologer would say to me, “How Scorpio of you.”