Most IBS is actually SIBO. Small Intestine Bacterial Overgrowth. You see, the small intestine is where digestion and absorption takes place…but it should be relatively sterile and free of bacteria. So when bacteria – for whatever reason – migrate up from the large intestine, they disrupt normal function and people are symptomatic.
Just like you can have IBS-Diarrhea or IBS-Constipation (or a little of both), there are 2 forms of SIBO. It just depends on what kind of bacteria or organisms have migrated up into the small intestine.
But to be clear, IBS/SIBO is now clearly not a “psychological” issue. We can adequately test and treat the condition. Goodbye to laxatives and anti-diarrhea medications!
Symptoms are the same and still include gas, pain, bloating, distention, fatigue, brain fog…and because of malabsorption of nutrients in the small intestine, patients may also experience weight loss, night blindness, softening of bones (osteomalacia), and any other broad nutrient deficiency symptoms (skin conditions, fragile thinning hair, etc). Of interest, some IBS/SIBO patients also find they can not lose weight! I’ll explain that in a future article and I cover it in the SIBO Series as well.
The research on SIBO keeps coming and this year, at the SIBO SYMPOSIUM 2015, was no different.
Here are (5) new things you might be interested in.
1. Insurance now covers the use of Xifaxan for IBS-D (or SIBO-Hydrogen). This is HUGE since a 14-day regiment of Xifaxan runs about $1250 and was 100% out of pocket. Yes, there are generics from Canada and India but they may be as much as 50% less effective.
2. Dr. Pimentel has launched an antibody test in regards to SIBO. As you may know, ~ 25% of SIBO is post-infectious meaning it starts after a round of food poisoning. While our immune system attacks the CdtB toxin responsible for food poisoning, it ALSO attacks the vinculin on the ICC nerve cells which damages our inherent mechanism for motility. This makes SIBO an auto immune disease. So now, in a simple blood test ordered by your doctor through www.ibschek.com, you can see if you have antibodies to CdtB and/or vinculin. It is important because if we know you have antibodies, it means your ICC nerves will not function as well and you’ll need a prokinetic for years, not months!
3. While I realize that antibiotics are over-prescribed and often cause SIBO, not all antibiotics are created equal. Xifaxan, the antibiotic used for SIBO, has 3 special qualities to it’s name. a) It only acts in the GI tract. It is dependent on bile to activate it and once it hits the large intestine, it crystallizes and dissipates. b) As such, it does not wreak havoc on your microbiome (large intestine bacteria) the way other antibiotics do. Dr. Pimental did “deep sequencing” of the large intestine flora and found that Xifaxan did not significantly affect the flora. To be specific, there was only a 2% change. That is remarkable! c) Xifaxan keeps other antibiotics from developing resistance. For example, Neomycin alone can be used one time in SIBO but then it forms resistance when used again. Same with Cipro. But Xifaxan + neomycin inhibits that resistance. So, given this latest news on Xifaxan, I do sometimes advocate for the use of antibiotics in SIBO. Especially safe ones such as Xifaxan.
4. Being a nutritionist, I love that data presented at this years SIBO SYMPOSIUM documented that an elemental diet is a viable option to treat SIBO when the patient doesn’t want or tolerate either herbs or antibiotics. I’ve had many patients who really want to do an herbal approach to treating their SIBO, but they just seem intolerant to any of the herbs we need to use. And some patients don’t mind using antibiotics but it may make them sick for the 14 day trial. An elemental diet is a formula of amino acids, fats, and legal carbohydrates and it essentially starves the SIBO bugs. Since you not eating ANY food while doing this, it’s important that this is done with medical supervision so that its safe and doesn’t cause more issues!
5. I was thrilled to learn about new technology called a Smart Pill. It literally is a pill that you swallow and then you wear a little monitor which captures your pH, transit time, valve pressure, and temperature. A poor test is predictive of who will get SIBO or easily relapse. Not enough hydrochloric acid and you are at risk because acid is anti-microbial. Slow transit time and you have a pond fermenting instead of a nice moving creek. Poor (ileocecal) valve pressure and you allow bacteria through the trap door between the small and large intestine. Information is good and this is easy to do and being covered now by Medicare as well as several insurance companies including BCBS.
SIBO is my passion. I’ve been there myself and I see it weekly in my private practice. I”m currently doing a SIBO Series and it starts with a free “What is SIBO” call so you can see if the shoe fits for you or a loved one. More info here: bit.ly/freesibo
And if you’ve had SIBO and either haven’t been adequately educated, or continue to relapse, you absolutely should enroll in my SIBO Series this August 2015. Even if your doctor is tuned up on SIBO – or you’ve been my patient – we probably have not spend 6 hours just talking about all the details of SIBO. Who has that much time per patient?! The SIBO Series is (4) 90 minute classes and will provide you all the information you need, including the absolute latest research on SIBO from this years symposium.