Classify these thoughts as speculative—based on logic and experience, but not on hard data, and therefore speculative.
We’ve lately been considering many of the unique issues surrounding small intestinal bacterial overgrowth, or SIBO, in which bowel flora have ascended up from the colon and infect the small intestine, duodenum, and stomach. The unhealthy species that proliferate in this condition are responsible for causing or worsening an impressive number of health conditions, a list that includes fibromyalgia, irritable bowel syndrome (IBS), type 2 diabetes, colorectal cancer, autoimmune diseases, psoriasis, restless leg syndrome and many others. We’ve discussed the “tell-tale signs” of SIBO including what I call the Prebiotic Fiber Test. We’ve also discussed how more and more people participating in our discussions in the Undoctored Inner Circle are managing and treating their own SIBO with success using various herbal antibiotic regimens coupled with low-dose prebiotic fibers (presumably to prevent sporulation and/or prevent mucous lining sequestration that makes microorganisms impervious).
But, whether you engage in conventional diagnosis and treatment of SIBO (tough, as the majority of doctors have never heard of this condition, let alone how to diagnose and treat it) or the Undoctored path, there is not 100% success (often 50% or lower response with conventional antibiotics) and substantial likelihood of recurrence over time. After treatment, for instance, that results in complete relief from the pain of fibromyalgia, or the itching and redness of eczema, or the intermittent abdominal discomfort and diarrhea of IBS, previous symptoms can recur weeks or months later, necessitating another round of treatment. Three, four, or five rounds of treatment are not uncommon.
Imagine that SIBO is like a forest fire. Trees, bushes, and grasses ablaze, animals dead, everything in sight scorched, down to the roots, now smouldering after firefighters put out the flame. Is the forest now back to normal? Of course not–the phases of recovery are set in motion, years of recovery now necessary.
Perhaps it’s that way with SIBO: The offending microbes may be eliminated or reduced by antibiotics, but the “fiery” inflammation of SIBO that inflamed the intestinal lining, altered the mucous lining, caused abnormal intestinal permeability, all need to recover, a process that may require days to months.
Here’s my question: Because many strains of desirable microbes, such as Lactobacillus reuteri and Bacillus coagulans, can help heal the intestinal lining, suppress abnormal inflammation, and suppress regrowth of undesirable bacteria (e.g., via production of bacteriocins such as reuterin that kill or weaken other species), should we flood the intestinal tract with probiotic microorganisms in the wake of antiobiotic therapy? Should we fill our day with kombucha, kefir, kimchi, takuan, yogurt, fermented veggies, etc. several times per day, every day, in order to recover from SIBO—or prevent it?
Does consuming a virtual onslaught of microbes from food fermentation make sense? I believe it does, but we are unaccustomed to this idea. Think of it: During the late 19th century, cold storage of food was cumbersome and short-lived, reliant on access to imported or commercially manufactured ice. Inexpensive consumer electric refrigerators appeared in the 1930s, leading to the ubiquitous modern home refrigerators we now have. But these are recent innovations.
How did humans store food—vegetables and fruits that were gathered or harvested, organs and meats from animals, birds, or fish caught days or weeks prior, the milk yield from ruminant mammary glands, etc.—when no ice or refrigeration were available? They dried and air-cured, salted and pickled, canned, and fermented.
Fermentation therefore played a central role in food preservation, especially once human civilizations abandoned the nomadic hunter-gatherer lifestyle.
Fermentation was also a practice that enhanced both the flavors and nutritional value of food, while also providing a source for a variety of probiotic microorganisms. It would not be uncommon to consume several forms of fermented foods every day: yogurt, kefir, sauerkraut, beers, root vegetables, many other fermented vegetables and fruits. (Such fermented foods are consumed enthusiastically even today in Korea, parts of China, and Japan.) A vigorous flow of probiotic microorganisms was therefore common and widespread.
What were the sources of probiotic microorganisms in nomadic hunter-gatherers who did not remain in one location long enough to continually ferment foods? This is not entirely understood, as different populations in different parts of the world varied in their habits. But several practices are clear: Humans were not as meticulous about “cleanliness” as we are: no antibacterial soaps, shampoos, laundry detergents, bleach, disinfectants, etc. Many populations ate their organs and meats raw, often contaminated by microbes, especially if the intestines were eaten (raw or cooked; cooking may kill most microorganisms, but many beneficial factors from microbes still provide benefit in the absence of live cells). Delivery was vaginal, the first two to four years of infant/toddler nutrition breast milk. Roots and tubers were often consumed without washing off the dirt, just a brush or two by hand. Food was likely largely eaten by hand, no forks or knives within reach. Drop some of your hard-fought wild boar’s pancreas or heart on the ground? Pick it up and eat it.
I am therefore proposing that our management of SIBO (or prevention of SIBO/dysbiosis and numerous other health conditions) not end at antibiotics, but include a flood of probiotic organisms from fermented foods, especially at the conclusion of your antibiotic course, providing trillions of microorganisms that participate in the healing process, along with the billions from a high-potency, multi-species probiotic supplement. Even consider consuming fermented foods, such as some kefir or kombucha, say, a couple of hours following every dose of antibiotic so that the microorganisms can begin to exert their healing properties before the next dose. I have suggested this strategy to a couple of people recovering from SIBO and, so far, have been encouraged by the response—or, of course, you could eat raw intestines and stop showering.