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

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 [Music] finally we have polysaccharides which means many sugar molecules link together [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] oregano is also very anti-inflammatory it can also help with sinus infections and preventing common colds and viruses [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] first of all you can have die-off symptoms we see this with both the antibiotics as well as the herbal antimicrobials [Music] die-off happens because your immune system is reacting to the lipopolysaccharides that are being released from bacteria as they die and break apart [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] 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 [Music] i tested her for sibo and she was positive for both hydrogen sibo as well as methane sibo [Music] 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 enjoyed the video please share it with your friends and family if you liked the video please subscribe to my youtube channel you can also follow me on instagram and facebook to get updates on a variety of health topics thank you again and i wish you all great [Music] health you

Channel: Rajsree Nambudripad, MD

Views: 653,675

Keywords: IBS, SIBO, Small Intestine Bacterial Overgrowth, bloating, heartburn, GERD, constipation, diarrhea, irritable bowel syndrome, functional medicine, integrative medicine, small intestinal bacterial overgrowth, sibo treatment, sibo cure, bacterial overgrowth, sibo root causes, sibo causes, sibo symptoms, what causes sibo, sibo treatment dr berg, gut health dr gundry, sibo treatment dr axe, sibo cure naturally, sibo permanent cure, methane sibo cured, ibs treatment

Id: 1WPv2FijZ5s

Length: 36min 17sec (2177 seconds)

Published: Sun Feb 28 2021