Not just IBS – My SIBO Saga
The struggles with my digestion dates back more than 20 years to my high school days. I am not sure if there was a specific trigger – common ones include antibiotics, food poisoning, stress, food allergies – or maybe I was predisposed genetically? I will probably never know. But I recall in my high school years dealing with a lot of bloating, gas and fatigue. The brain fog and fatigue was so severe I thought I was narcoleptic, commonly sleeping through my classes, movies and even concerts! I have memories of sleeping on the lawn when I was at SDSU for college – and Tyler, who was my boyfriend at the time, pointing me out to his friends … “there’s my girlfriend, she sleeps anywhere.” Or in World Music class with Tyler I would fall asleep and start to lean on the classmate next to me.
Sometime in my early 20’s I pinpointed that I was lactose intolerant. Removing dairy from my diet provided some initial relief. I worked on fine-tuning my diet, focusing on a lot of vegetables, fruits and whole grains. Unfortunately throughout those years I had major flairs with gas and bloating – it was so painful I would often curl up into a ball until it passed. It would get worse when I was a little anxious (like before a holiday dinner or athletic competition) or if I wore clothing that was too tight.
The chronic abdominal distension crushed my body image. I was working out daily – cardio, weights, triathlon training – all the things. And instead of the tight mid-section, I sometimes looked six months pregnant. I don’t want to count the number of people that have asked me over the years when I was due. Each time, I thought maybe I was doing something wrong…that I needed to restrict more foods, exercise more.
In my late 20’s I started talking to my doctors more about it and they suggested IBS and that there wasn’t much they could do…and suggested to take some Tums. Tums did nothing. Other providers suggested an anti-depressant (which I declined). In my early 30’s after my first daughter was born, I started CrossFit and tried the Paleo diet which excluded dairy (which I had already removed from my diet) and gluten. After a few weeks off gluten, my body began to feel better. My brain fog lifted, my skin issues cleared up, I had less painful gas and no more bouts curling up into a ball in pain. However I doubled down into my exercise, and kept my high vegetable and moderate fruit intake. And I still had a good amount of bloating that usually grew throughout the day.
This was around the time gut health became more main-stream. I consulted with a functional medicine provider and after listing to my detailed history and how I flair up with even healthy foods like broccoli and grapes she suggested that maybe I have small intestine bacterial overgrowth (SIBO). I had never heard of SIBO, but after looking it up online it I was convinced it was what I had, and hopeful that maybe I could fix it.
I went on the low FODMAP diet that excludes or limits a lot of “healthy” foods like cruciferous vegetables, beans, onions, fruits, gluten and dairy because they are high in fermentable carbohydrates. I felt so much better! My provider suggested a SIBO breath test, and my results came back for Methane SIBO. There are two main types of intestinal overgrowth:
- Methane: this could be intestinal methane overgrowth (IMO) – in the small or large intestine and usually accompanied by constipation
- Hydrogen: this is usually accompanied by diarrhea
The research in SIBO was still early, and we decided to do four weeks of Rifaximin, which is a relatively safe antibiotic but not covered by my insurance (I purchased from a Canadian Pharmacy), followed by another four weeks of an herbal antimicrobial protocol. I remember the Rifaximin made me so severely bloated, but at the end of the herbal protocol my digestion was starting to feel better. I continued on my lower FODMAP protocol, started intermittent fasting and food spacing, and was about 50% better than before the treatment.
A few months later I was diagnosed with breast cancer, so my focus moved there. Unfortunately traditional cancer treatment (chemotherapy, antibiotics, steroids) aren’t very gut friendly. But I did my best to help maintain the quality of my intestinal track by staying away from trigger foods like gluten and dairy, and including healing foods like bone broth, aloe juice and ginger. Practicing water fasting and the Keto diet during treatment also helped, as I wasn’t eating many of the fermentable carbohydrate foods. During my cancer treatment, I was diving into so much research and information around how integral a healthy gut is to your immune system. Could all those years of chronic gut inflammation have contributed to my cancer risk? I dove further into testing my body, with stool tests to look at my microbiome, and other tests to look at my estrogen pathways and cortisol. I had abdominal ultrasounds to rule out blockages and an endoscopy and colonoscopy to rule out other diagnosis.
My stomach issues didn’t get much worse but they didn’t get much better either. I was still on my lower FODMAP diet, but I also wanted to ramp up my crucerfous vegetable intake because I love broccoli and Brussel sprouts, and they are very important cancer fighters. I also began to really pay attention to my motility and became more aware that over the years, I was constipated with a few bowel movements a week. Learning about how our body excretes toxins through our poop, I knew I had to do something to get things moving. I started doing weekly coffee enemas to ensure I was excreting all the bad stuff.
I also still dealt with bloating. It was uncomfortable and after a few people asking if I was pregnant, I knew it was time to do another SIBO test. I started working with my functional medicine doctor and did a breath test, which left me severely nauseous for four days. My numbers came back with very high methane (CH4 was 68ppm @60 minutes and 81ppm @ 120 minute mark – for reference positive methane is over 10pmm). She suggested a round of Rifaximin and Neomycin, followed by four weeks of an herbal protocol.
My Treatment Protocol
Below is my protocol, but I want to share everyone is different and I suggest working with an integrative / functional medicine doctor to find the best option for you.
Day 1 – 14: Rifaximin and Neomycin + Sunfiber
I was severely bloated and in pain for the first week, and then it got better. Sometime during the second week my motility was becoming more regular, which I was really excited about. During the antibiotics I didn’t eat low FODMAP so the bacteria were more abundant and could be killed.
- Rifaximin 550 mg every 8 hours
- Neomycin 500mg every 8 hours
- Probiotic at lunch (Biospora from Klaire)
- Partially hydrolyzed Guar Gum (Sunfiber)
Rifaximin and Neomycin are both antibiotics (however broad spectrum and minimal effect on the intestinal microbiome) and it’s a little controversial if it’s best to use these or just the herbal protocol. However because I have had my issues for so long and my numbers were pretty high, we decided to to use them to see how effective it would be to wipe out the bacterial overgrowth. Many people find a few rounds of the herbal protocol to be effective.
Day 14 – 28: Herbal Protocol
Less bloated, more regular motility. I felt pretty good! Low FODMAP.
- CandiBactin (Berberin + Other herbs): 2 capsules / twice daily
- Uva Ursi: 2 Capsules Daily
- MicroDefense with Oregano: (Olive, wormwood, clove) 2/day
- Biospora from Klaire: (1xday)
- Glutamine powder: (1tsp in smoothie)
Day 28: Retested – results showed significant improvement in Methane
My breath retest showed significant improvements to my methane (CH4 was 4ppm at 60 minutes and 15ppm at 120 minutes). Slowly started to reintroduce FODMAP foods.
Month 2: Relapsed?
I became really discouraged because my motility slowed down again. I met with my doctor, they suggested another round of herbals. I did the GI Effects stool test to see if there were any other gut issues – and the test showed methane in the large intestine. I am not surprised of the timing of this “relapse” as it was around the same time I was going through some life stressors (breast biospy) and stress is one if the risk factors for SIBO. When you are stressed, the ileocaecal valve that is situated between your small intestine and colon/large intestine stays open when it should close and food particles and bacteria flow where they shouldn’t.
Month 3: Herbal Protocol Round 2, targeted acupuncture, motility agent
Went back to lower FODMAP. My provider suggested a different herbal formula to help trick my body and target the bacteria differently. No significant bloating, gas or pain. Eventually motility started to become more regular.
Where am I now?
Well the most important thing to me right now is to ensure I am getting rid of the waste in my system, and I am happy to say I have almost-daily regular bowel movements – although there is room for improvement (my goal is 2/day)! I was able to introduce a few FODMAP foods like avocado, some broccoli and sweet potatoes but have still been mindful of my overall intake of FODMAPS and completely avoid gluten and dairy.
My next step is to try to rebuild beneficial gut bacteria because all the treatments and herbs probably wiped them out and that’s the best way, in addition to keeping up my motility, to prevent SIBO relapse.
HCL / stomach acid: my GI tests shoed low pancreatic enzymes and I failed the stomach acid baking soda challenge so I take digestive enzymes with HCL before meals, and also sometimes bitters and apple cider vinegar. I also need to up my zinc as it supports stomach acid.
Prebiotic fibers: prebiotic fibers will help feed the good gut bacteria and prevent the bad ones from creeping up again. I have a vegetable-focused diet, but I need to gradually add back in fermented foods.
Purposeful eating habits: Over the last year I have really being more mindful of how I eat. No more eating while working. I try to eat outside undistracted if I can. I have been more mindful about chewing. All these will help my body digest and not ferment the foods I eat.
Motility Support: I continue to use MotilPro to help encourage bowel eliminations and a weekly coffee enema.
Other: I am experimenting with colostrum, which has been found to help with leaky gut. And continuing to use gut rebuilding protocol including aloe juice, L-glutamine, Saccharomyces boulardi, Licorice root and other herbs that help soothe the intestinal linings.
I am not sure if there is a “cure” to SIBO, but I am excited that research is focused on new ways to identify and manage it. And my goal is to create a healthy microbiome to help prevent those nasty little bacteria or archaea from taking over in my intestines.
What are FODMAPS
What are FODMAPS
FODMAPs are types of carbohydrates (sugars) that are fermentable. In certain people, these foods can trigger gas and bloating, and exacerbate IBS. The types of carbohydrates include Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPS), and the specific types of sugars include fructose, lactose, polyols (sorbitol and mannitol), fructans, and galacto-oligosaccharides (GOS). If these carbohydrates are poorly absorbed and fermented by bacteria in the small intestine, as is often the case for people with IBS and or SIBO, the result can be gas, abdominal pain and distension.
In recent years there has been more research and attention towards understanding bacterial overgrowth, SIBO, intestinal methane overgrowth and IBS. Here are some resources I have found helpful:
- SIBO Made Simple book with an overview of SIBO and low FODMAP recipes.
- Dr. Allison Siebecker
- Mark Pimentel: one of the top researchers on SIBO
I do suggest working with a functional medicine doctor who can help diagnose SIBO, and also identify root cause issues and different treatment approaches.