OT: SIBO diagnoses

[JAllen]

So I'm not sure if anyone knows anything about SIBO or small intestinal bacterial overgrowth, but my wife was just recently diagnosed with it. We are about to start her on an antibiotics round and a temporary dietary change that eliminates agitating foods. I was curious if anyone had any experience or knowledge regarding it? Could really use some advice on the dietary aspect.

[stephenmarklay]

My wife has not yet been diagnosed but I think she may have the same issue. Foods that never bothered her give her gas a bloating.

I am not a fan of antibiotics (unless you have to have them and then I am a super fan) and she is trying a more natural method. There is a lot of stuff written up on the web about it.

[rugbysecondrow]

I wonder if probiotics (found in Kefir, Kombucha or elsewhere) would help?

Best of luck

[benb]

I was diagnosed with it in 2009.. I probably had it starting around 2005 or so with it getting progressively worse.

I was mis-diagnosed with lactose intolerance before I finally got to a gastroenterologist. They put me through a massive ringer of tests before giving me the bacterial overgrowth test as at least where I went they wanted to rule out all the more dangerous things first as a lot of different things cause the same symptoms. There was some miserable stages.. at one point they put me on Paxil which is apparently used sometimes when they think anxiety might be part of the cause. The Paxil dose for this is low, so it didn't have any noticeable mental effect on me, but it actually made my symptoms worse so I didn't take it very long. They also tried a few weird natural products (aloe juice) that also made me really, really sick.

For natural stuff when it was bad peppermint tea was the best thing.

When they finally ran the right test (I was tested for cancer, celiac, giardia & other parasites, lactose intolerance, etc, etc.. ) they gave me the antibiotic. The antibiotic followed by probiotics did the trick, but I had to be careful for several years before I could eat most of what I wanted.

Caffeine seemed to be a big part of it.. I came down with this when I was cycling a lot, eating tons of carbohydrates, and drinking tons of coffee and working a lot too.

I work pretty hard at keeping my caffeine intake down and I still take probiotics and have yogurt most days. Take the probiotics the gastroenterologist tells you to.. at the time I was going they were saying only Align and Culturelle had solid evidence of efficacy, lots of the other stuff is supplement quackery. I'm doing fine these days. It really messed up my cycling for a few years there... it made it easy to lose weight but if you were trying to do a race and got sick the night before.. forget being competitive.

I also eat a reduced gluten diet, the doctor had said I could be one of the weirdos who was "gluten sensitive" but didn't have celiac. Really the only reason I eat reduced amounts of gluten is both my wife and son DO have celiac.. so there is less of it in the house. But it is possible that is helping me not have another round of overgrowth. I am supposed to actually try going totally gluten free but I never have. I avoid fructose too.. I wish I had been tested for fructose intolerance but I never was because I came back positive on the bacterial overgrowth test. I basically never have anything with HFCS, I never have any fruit juice except cranberry juice (your dentist will love you for this too), and I even avoid some of the fruits that are known to be > 50% fructose. Grapes & Wine are pretty bad.. some wines are fine but it's not worth the effort for me to figure out so no wine. Apples can be pretty bad too.. wikipedia has a big article on this, but in general there is a super unnatural amount of fructose and sugar in general the american diet.. you combine that with caffeine speeding up your GI tract and you can't absorb all the sugars in your small intestine.. some of the sugar makes it to your large intestine and the bacteria can have a feast.

I actually don't really think this is that Off topic.. in my case I definitely think cycling a lot was part of the issue. Cycling hard messes with your GI tract, a lot of the upset stomach issues people get when riding long & hard are related to bacteria and I think it's possible cycling without being careful about your diet can be part of the cause of this. Cycling seems pretty into the whole caffeine culture and you sit there and ride hard and put stress on your GI system while sucking down high carbohydrate beverages, gels, and foods.. seems like it could be a recipe to bring this on if you're susceptible.

[John H.]

I was diagnosed with this in 2011.
I opted for antibiotics- total mistake. Two round of Xifaxin left me depleted, weak and even worse off.
I found relief by dialing in my diet and getting very minimalist.
I cut out wheat/gluten, caffeine, pretty much all processed foods, dairy, all fruit, most sugars, and vegetable that tend towards acidity.
That does not leave much to eat.
Rice, quinoa and other wholegrains, some fresh vegetables, and organic free range chicken.
It took at least six months but I am convinced that it is the way to go. It is slow medicine.
Docs don't even really know what they are shooting at when they prescribe antibiotics for this. They just have some anecdotal evidence that antibiotics cured some gastric issues in the short run.
Also, Xifaxin is stupid expensive and most health insurances do not pay for it.

Oh yeah, I second the high end probiotics along with this.
Good news is that my digestive system healed- Now I can eat pretty much anything I want (though my diet does tend towards minimalist).
Only thing that bothers my gut is junky dairy like frozen yogurt.

One more thought. I agree that cycling does make this problem worse. Eating a bunch of simple sugars during and after exercise while putting out an effort. I discovered that I needed products that were free of maltodextrin and also fructose. Fructose is very acidic.
Giving up maltodextrin and fructose based drinks, gels and bars helped me too.
Recovery food too- I used to have a smoothie after riding with more maltodextrin, fruit and some protein- the fruit and maltodextrin part was a very bad choice.

[John H.]

Ever get your vitamin D levels checked?
Many people north of say SF Bay area have vitamin D deficiency in the winter months.
It can cause many of the same symptoms that you speak of.

[benb]

I was diagnosed with this in 2011.
Two round of Xifaxin left me depleted, weak and even worse off.


I'm not sure why the doctor didn't tell you to expect this. That's the whole point, it wipes out the good and the bad bacteria and lets you do a reset. I was told to expect this, and the idea was that dietary changes worked better after wiping out bacteria.


I found relief by dialing in my diet and getting very minimalist.
I cut out wheat/gluten, caffeine, pretty much all processed foods, dairy, all fruit, most sugars, and vegetable that tend towards acidity.
That does not leave much to eat.
Rice, quinoa and other wholegrains, some fresh vegetables, and organic free range chicken.
It took at least six months but I am convinced that it is the way to go. It is slow medicine.
Docs don't even really know what they are shooting at when they prescribe antibiotics for this. They just have some anecdotal evidence that antibiotics cured some gastric issues in the short run.


Again I'm not sure why the doctor didn't tell you this was a mandatory second step. You are making the mistake of thinking the 2nd step would have been just as effective without the first step. The whole thing with this is you end up with bacteria in your small intestine which aren't supposed to be there. With the correct diet they don't come back, but the diet alone can't necessarily make them go away, once the bacteria is in your small intestine they have access to the carbohydrates you're eating.


Also, Xifaxin is stupid expensive and most health insurances do not pay for it.


Mine did.. but I remember it was crazy expensive.


Oh yeah, I second the high end probiotics along with this.


Did your doctor tell you to do this? I am just curious since you basically had the same treatment as I did but you came out of it thinking the doctor was bad whereas I came out thinking the doctor did the right thing and got me on the path to healing. My doctor absolutely told me to start taking the probiotics because she had prescribed the antibiotics.


One more thought. I agree that cycling does make this problem worse. Eating a bunch of simple sugars during and after exercise while putting out an effort. I discovered that I needed products that were free of maltodextrin and also fructose. Fructose is very acidic.
Giving up maltodextrin and fructose based drinks, gels and bars helped me too.
Recovery food too- I used to have a smoothie after riding with more maltodextrin, fruit and some protein- the fruit and maltodextrin part was a very bad choice.

Yah I'm much more careful.. I mostly drink water and 0-calorie/low calorie electrolyte drinks now, and eat real food along with it on longer rides.

Two products I really think messed me up were endurox (lots of fructose + maltodextrin IIRC) and Accelerade with "Herbal Lift". The "Herbal Lift" was caffeine..

[John H.]

Xifaxin messed me up- It was not the 1st step.
My bacteria was just as bad after 2 rounds of Xifaxin.
I would never recommend this treatment to anyone.

[JAllen]

It might be a waste to do this during the antibiotic cycle, as it's going to kill everything. After the fact, is when we'll probably ramp up on these highly cultured foods. Although the fear with some of them is that a lot of the bacterias feed off the sugars and that's part of the thing to avoid. This diet is like threading a damn needle!

I wonder if probiotics (found in Kefir, Kombucha or elsewhere) would help?

Best of luck

I think her vit. D levels are ok. It hasn't been as cloudy this winter (if you can even call it that), we tend to eat a fair amount of healthy foods with some supplements (such as vit. D) to help combat that.... as well as everything else! :)
Ever get your vitamin D levels checked?
Many people north of say SF Bay area have vitamin D deficiency in the winter months.
It can cause many of the same symptoms that you speak of.

[JAllen]

My wife has pretty killer insurance through her step-mother. It was covered and we paid next to nothing for it ($10 for a ten day supply). Granted, we can only get it at the one and only CVS in town (opposite side of town we live on to boot).

[John H.]

What antibiotic is it? Usually Xifaxin is a longer course.

I would still consider supplementing vitamin D- you live far enough north.
Look up symptoms of vitamin D deficiency.


My wife has pretty killer insurance through her step-mother. It was covered and we paid next to nothing for it ($10 for a ten day supply). Granted, we can only get it at the one and only CVS in town (opposite side of town we live on to boot).

[JAllen]

What antibiotic is it? Usually Xifaxin is a longer course.

I would still consider supplementing vitamin D- you live far enough north.
Look up symptoms of vitamin D deficiency.
I'll read up more on the vit. D. It's Xifaxan. The 10 day course was the longer of the two options.

[sworcester]

if it is gut related, maybe fecal transplant? (I think that is what it is called) although only used currently for extreme cases of IBS and such (don't have all the facts straight) but the research looks pretty interesting

[Louis]

if it is gut related, maybe fecal transplant? (I think that is what it is called) although only used currently for extreme cases of IBS and such (don't have all the facts straight) but the research looks pretty interesting

There was a story about this a while back in the NYT. Not the most pleasant of things to read about, but it worked wonders for some folks.

[John H.]

I recall my courses being double that.

I'll read up more on the vit. D. It's Xifaxan. The 10 day
course was the longer of the two options.

[gasman]

if it is gut related, maybe fecal transplant? (I think that is what it is called) although only used currently for extreme cases of IBS and such (don't have all the facts straight) but the research looks pretty interesting

Fecal transplant has been used for Clostridium difficile colitis which can be life threatening.Usually the colitis is treated with oral Vancomycin. Fecal transplant hasn't been used for IBS that I've heard of.

They are working on a pill to be used for fecal transplant. Right now you have to undergo colonoscopy for the transplant but it can be life saving.

Oral probiotics serve in a similar way I imagine.

[benb]

Just 2 more things...

I had Xifaxin/Rifamaxin/whatever as well, my course was 10 days or less.

And I started supplementing with Vitamin D around the time I started taking the probiotics, etc.. as well. I seem to recall the doctor telling me to start.

I really had basically no side effects from the antibiotics.. I was so bad off when I started there is not much it could have done to my gut that would have been worse.. I had this weird cramp in my side for a while afterwards when I ate certain things.. that went away over months from probiotics or whatever.. that little cramp was a HUGE improvement over what was going on before. It's all TMI but my primary symptoms went away from the antibiotics.. so it was a big improvement.

[JAllen]

Digestive Health With Real Food. It's a pretty comprehensive book my wife found. It speaks a lot to SIBO along with IBS and the like. Might be with looking into folks!

[JAllen]

Just 2 more things...

I had Xifaxin/Rifamaxin/whatever as well, my course was 10 days or less.

And I started supplementing with Vitamin D around the time I started taking the probiotics, etc.. as well. I seem to recall the doctor telling me to start.

I really had basically no side effects from the antibiotics.. I was so bad off when I started there is not much it could have done to my gut that would have been worse.. I had this weird cramp in my side for a while afterwards when I ate certain things.. that went away over months from probiotics or whatever.. that little cramp was a HUGE improvement over what was going on before. It's all TMI but my primary symptoms went away from the antibiotics.. so it was a big improvement.
Not at all TMI! Dude, I love that you've shared your experience (others too). It is truly helpful. Thank you.

[John H.]

There are a few books out there about balancing your Ph.
A lot of the dietary advice is similar to what you would want to do to heal your gut.
PH Miracle is one title (though it touts some products that the author sells).
Staying away from acidic foods like fruit, red meat, processed flour products, sugar, etc.
Big on avacados from what I remember.


Digestive Health With Real Food. It's a pretty comprehensive book my wife found. It speaks a lot to SIBO along with IBS and the like. Might be with looking into folks!

[gasman]

There are a few books out there about balancing your Ph.
A lot of the dietary advice is similar to what you would want to do to heal your gut.
PH Miracle is one title (though it touts some products that the author sells).
Staying away from acidic foods like fruit, red meat, processed flour products, sugar, etc.
Big on avacados from what I remember.

Don't get sucked into the pH hype. There's nothing you can eat that will change your pH from a very narrow range around 7.4. The body has many mechanisms to keep it constant- bicarbonate buffer system, renal excretion of excess acid of base, buffering by proteins in your blood and intercellular. It's good to stay away from sugar, processed foods , red meat etc but not because it changes your bodies pH. Heck tomatoes are pretty acidic but have clearly been shown to decrease prostate cancers.

[John H.]

I am not suggesting that there is a benefit from attempting to change ph, or that it is really possible.
What I am suggesting is that eliminating the same foods that the book suggests tends to be good for healing an ailing gut.

Don't get sucked into the pH hype. There's nothing you can eat that will change your pH from a very narrow range around 7.4. The body has many mechanisms to keep it constant- bicarbonate buffer system, renal excretion of excess acid of base, buffering by proteins in your blood and intercellular. It's good to stay away from sugar, processed foods , red meat etc but not because it changes your bodies pH. Heck tomatoes are pretty acidic but have clearly been shown to decrease prostate cancers.

[gasman]

I am not suggesting that there is a benefit from attempting to change ph, or that it is really possible.
What I am suggesting is that eliminating the same foods that the book suggests tends to be good for healing an ailing gut.

I haven't seen the book so I don't know. But it is good to stay away from simple sugars, red meat and processed food. Avacados are great food.

[Louis]

Avacados are great food.

Don't eat too much - they're loaded with fat, lots of it saturated.

[JAllen]

Don't eat too much - they're loaded with fat, lots of it saturated.
Fats have gotten a bad rap for the last 40+ years, but it's just not true. Sure, some fats are bad for you (especially in excess) but avocados are not one of them. Avocados are one of healthiest fats you can have. Excess of anything isn't good for you, but that's the very definition of excess.

[Louis]

I'm not saying they're horrible for you, just that because they're a fruit some folks don't realize the fat and calorie content,

It's like nearly everything else - don't overdo it.

I grew up eating them, right off one of the several avocado trees we had in the yard, and used to love having them with a specific type of bread - they were awesome. And just the right degree of ripeness, not like what you get in most stores.

Enjoy.