Anyone with any of the common tell-tale signs of small intestinal bacterial overgrowth, SIBO, should definitely embark on an effort to reverse this situation. It may involve H2-breath testing, using the new Aire device (that I shall be discussing in future) to detect breath hydrogen, or empirically treating because of signs such as intolerance to prebiotic fibers.
But what if you have none of the tell-tale signs such as intolerance to prebiotics, fat droplets in the toilet, or irritable bowel syndrome-like symptoms? Should you still be suspicious that you might have SIBO?
I believe that you should. SIBO is so incredibly common with considerable potential for health complications down the road that it is worth looking for, then managing. Many studies have compared people with a disease such as diverticular disease vs. people without diverticular disease. Time and again, the presumed “normal healthy control” groups chosen for comparison also have high levels of positive testing for SIBO, as high as 40%. This and other signs therefore suggest that we are witnessing an epidemic of unprecedented proportions, some of it outwardly evident, some of it silent.
What are the long-term consequences of uncorrected SIBO? SIBO has been associated with:
- Diverticular disease
- Colon cancer
- Fibromyalgia
- Restless leg syndrome
- Type 1 diabetes, type 2 diabetes
- Autoimmune conditions such as Hashimoto’s thyroiditis
- Fatty liver
- Ulcerative colitis, Crohn’s
- Irritable bowel syndrome, IBS
- Increased visceral fat, obesity
- Coronary artery disease
It is not always clear if SIBO is a cause and when it is a consequence. But given the positive response of, say, fibromyalgia or IBS that can virtually disappear with management of SIBO, in most instances it is looking like SIBO is indeed a cause. SIBO can also complicate various conditions, worsening signs and symptoms. The list of such conditions is growing rapidly and includes dementia, cirrhosis and liver failure, Parkinson’s disease, scleroderma, multiple sclerosis, and celiac disease.
Sadly, because the science documenting SIBO has emerged mostly within the last few years, most physicians pooh-pooh questions about SIBO, denying that it is a real condition or telling you that you have nothing to worry about. Or worse, a primary care doctor refers you to a gastroenterologist who recommends upper endoscopy and colonoscopy (ka-ching!), who declares “Good news: You don’t have an ulcer nor colon cancer. Bye.” You ask “But what about my question about SIBO?” The answer 9 times out of 10: “Go back to your primary care doctor” or “You’re fine, don’t worry about it.” Occasionally, a better-informed gastroenterologist will write a prescription for rifaximin, the conventional antibiotic for SIBO, but make no mention of alternative treatments, how to prevent recurrences (which are the rule), fail to discuss the role of probiotics, fermented foods, or prebiotic fibers, or discuss any of the many other important issues surrounding SIBO.
Because of the widespread ignorance of doctors on SIBO, we’ve been having frequent discussions on self-managing SIBO in our Undoctored Inner Circle that starts with an Undoctored Protocol for SIBO, followed by two-way video discussions of all the finer points.
I definitely think I have SIBO. I am constipated for days and then when I eliminate, it comes out in small, hard balls. Once that’s all out, then what was behind it comes rushing out in almost uncontrollable spurts. And then, I’m constipated again! I hate living this way.
I have a terrible time with prebiotic fibers. Everything I’ve tried gives me excruciating gas pains that work clear up into my right shoulder. I was so excited about the yogurt, and I made it about 5 times, but I just couldn’t take the discomfort and pain! I love yogurt, and that was the very best I’ve ever had!
I’ve been living the Wheat Belly lifestyle for 7 years and 4 months. I was one of the first group that followed Dr. Davis on the Wheat Belly Facebook page. My only real disappointment and failure is the constipation and the inability to ingest prebiotic fibers. Any suggestions? Could I make the yogurt for awhile without the inulin?
Janie wrote: «I definitely think I have SIBO. … I have a terrible time with prebiotic fibers.»
Is this reaction prompt?
re: «I was so excited about the yogurt, and I made it about 5 times, but I just couldn’t take the discomfort and pain!»
How do you react to commercial full-fat, live-culture, no-sugar-added yogurts? The answer might point to or rule out some possible explanations.
re: « Any suggestions?»
The subscription site has a Protocol for SIBO (which arose after the most recent book, so isn’t in any of them, and may evolve more before it turns up in one). If the problem is fungal, that just got an Advanced Topic, and is not yet a protocol.
You can get a sense of the approach from the various articles on both blogs over the last year. Here are search results for the Undoctored Blog, and Wheat Belly Blog.
There may be an update for both SIBO shortly, as several members are experimenting with using a new home testing device, off-label, to assess their status more frequently (and more cheaply) than with other methods used to date. If there’s a break-through, I’d expect to see at least an announcement on one or both blogs.
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I have a question regarding inulin in the yogurt recipe. I followed the instructions on my first batch and included potato starch. In subsequent batches I have used a 1/2 cup of yogurt and 2 of the probiotic tablets, but have not been adding inulin or potatoe starch as it is not in the recipe. Was this an omission and should I be including it in subsequent batches? The yogurt comes out great without.
Rick wrote: «I followed the instructions on my first batch and included potato starch.»
I’ve stopped doing that, and just use inulin.
re: «In subsequent batches I have used a 1/2 cup of yogurt and 2 of the probiotic tablets…»
In general adding more tablets is a needless expense. ½ cup (8 tbsp) of saved yogurt seems excessive as well.
I presently use ~2 tbsp starter per quart, which is either from a dedicated starter batch, or separated whey.
re: «…but have not been adding inulin or potatoe starch…»
I do use inulin, at 2 tbsp per quart, although 1/qt might suffice. Apart from any other advantages it provides, I see it as providing a delayed substrate for the L.reuteri to feed on when they exhaust the lactose in the dairy.
re: «The yogurt comes out great without.»
I’m tempted to say: don’t mess with success. But you asked.☺
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