I’ve probably had small intestinal bacterial overgrowth since childhood, and I’m now in middle age. This is a difficult-to-treat condition where colonic bacteria drifts up, beyond the gateway between the colon and small intestine, known as the ileocecal valve. This happens because the valve is stuck in the “open” position, either due to neurological impairment or constipation, which backs up the entire GI tract and keeps the valve propped open with the fecal stream.
In the early stages people might notice they’re developing rosacea. Most western medical doctors claim there’s no known cause for this skin condition, but in recent years practitioners with a more holistic approach, like Chris Kresser, and others, identified a study from decades ago where common probiotics were proven to be an effective treatment for it. Look for more on this in future GHN blog articles.
Besides rosacea and acne, other early stage SIBO symptoms might include low-grade fatigue, mild mood disturbances and cognitive impairment, minor food intolerances, aches and pains, low-grade, intermittent tinnitus (usually after meals), urinary and sinus infections, ear aches, gingivitis, halitosis, trouble staying warm, mild insomnia, IBS, trouble gaining weight.
Unenlightened doctors were treating my SIBO symptoms, such as sinus infections and prostate problems, with more antibiotics, which was unfortunate considering these drugs (Cipro, for example) likely caused SIBO in the first place. Fluoroquinolones contain fluoride, which binds iodine receptors and (among other things) impairs thyroid function.
About six years ago I began to feel my whole gut, from the front around to my lower back, becoming burning hot. I could feel that same heat in my neck. Along with this came increasing brain fog and tinnitus. What’s happening with SIBO is simply upper gut fermentation – a low grade infection of the abdomen. With every single meal consumed, bacteria is fed first, then we get the scraps.
In healthy people the small intestine does have some protective bacteria in low concentrations, but in SIBO the ranks and type of flora resemble the lower gut populations, and these misplaced microbes can cause a lot of damage, by inflaming the small intestinal wall, and running amok systemically, with both toxic byproducts of fermentation and the bacteria themselves in the bloodstream.
This is made even worse when gram-negative bacteria are involved because they boost levels of lipopolysaccharide, a part of their cell membranes, and LPS is one of the most potent triggers of inflammation in our bodies.
Diet plays a role, with the distinct possibility that higher fat consumption fuels the growth of gram-negative bacteria. Paradoxically, this suggests those of us who switched to a higher-fat Paleo approach might be inadvertently increasing inflammation from gram-negative flora and LPS. It’s a controversial theory, with a lot of strong opinions on all sides, so count on reading more of this in future GHN articles, too.
As SIBO becomes more advanced, think of those 14 feet or so of narrow tubing, the small intestine, where scopes and medicines have trouble penetrating, and how hard it might be to remove these uninvited guests. Bacteria and yeasts, such as candida, build biofilms that act as hardened bunkers against the gut wall. Think of tartar on your teeth, which is also biofilm, and it becomes clear how impossible it might be to cure.
Sadly, SIBO can become “self-worsening” because toxins further impair nerve function, which means the “migrating motor complex“, or MMC – which are peristaltic cleansing waves that normally clear colonic bacteria from the upper gut – this safety mechanism gets even weaker, resulting in more accumulation of bacteria and yeasts, then further inflammation develops.
Another paradox is mounting mineral deficiencies, from malabsorption, yet being unable to take vitamin and mineral supplements without fueling the problem. I am finding magnesium is especially difficult to take when upper gut fermentation is happening.
Later stage SIBO symptoms include crushing fatigue (which I’ve had since my last dose of Levaquin in 2009) to the point where it’s tough to get out of bed. Most people also have wide-ranging food intolerances, loud and constant tinnitus, major brain fog, personality changes (depression/anxiety, cognitive decline), tremors, hormonal problems, cardiovascular issues (tachycardia, hypertension) severe weight loss, and chronic, widespread joint pain.
A link is being established now, in recent studies, between rising fasting glucose levels, which I have, systemic inflammation, and metabolic disorders. Is SIBO a common denominator? I wouldn’t be surprised, and indeed, this isn’t a trivial condition that should be left alone.
I did seek conventional medical treatment a few years ago for SIBO. My gastroenterologist wanted me to avoid a “breath test” (patients breathe into a tube and gases are analyzed) because the sugar solution taken prior to the test could have flared my ulcerative colitis. Her caution was sensible. Instead, we just treated for it.
I took a 10 day course of Rifaximin antibiotic, which stays in the gut rather than acting systemically. It worked for the first two days, which my doctor thought was confirmation enough of SIBO. I had a big surge of energy, clarity. It was fantastic. Then on day three the drug had no effect. This is not uncommon, and makes sense considering I’ve got a gut full of antibiotic resistant bacteria. Historically, herbals and fermented foods plus diet and fasting have been more beneficial.
SIBO is insidious – if you didn’t know what was wrong, you might think you were just aging badly, since most people tend to do better when younger. As time goes by, you lose the ability to fight it because your mind is too scattered to do focused self-treatment. Even cooking meals becomes difficult, especially because SIBO can lead to a loss of appetite. Starving it becomes the easy way out – symptoms are reduced when fasting – but any further loss of nutrition compromises an already weak immune system.
So despite my years of struggle with SIBO, including most all the symptoms listed above, I was confused when it flared the last time. This is because it came on strong with pain in my joints. I would wake in the late morning, feeling as if I’d never slept, and my whole body was throbbing. I figured this couldn’t be SIBO, it must have been something entirely different like arthritis. Instead, it was just the worst flare I’d ever experienced.
I started doing a lot of the old fixes, which are quite good: intermittent fasting (I cut out all food after 4pm) to starve the bacteria daily. I took peppermint oil with meals – a surprisingly good antifungal and antibacterial. I boosted my water consumption to about a gallon of distilled water daily, with trace minerals added. I went to 1 cup of coffee in the AM, cut out fibrous vegetables, I added Interfase Plus, to dissolve biofilms.
The whole time I kept reading, and came across references to bovine-sourced lactoferrin, which is a substitute for the human lactoferrin babies get in breast milk. We adults also have it in our tears, and it can be found throughout the body. Lactoferrin is a bone-builder, a binder of iron (which pulls that fuel away from pathogenic bacteria), it’s also antiviral, used by some people to treat hepatitis C, and a potent antifungal. Throughout the literature, I read of its ability to harm pathogens while protecting, or even nurturing, healthy flora.
This makes lactoferrin a perfect choice for me, because as effective as peppermint oil, olive leaf, or berberine might be, these herbals also kill a lot of good bacteria. I am an avid sauerkraut and kefir-consumer, so I’m putting some flora back, but I don’t want to lose important lower gut microbes that fermented foods cannot replace.
Here’s perhaps the most exciting thing of all: lactoferrin’s interaction with lipopolysaccharide. Very encouraging, to say the least.
My results: it’s been a very exciting few days. The fatigue is still pretty bad, but it’s getting better. I’m finding my mind is clearer, my mood is brighter, and I can at least go for a walk and feel a bit stronger. A few days ago if I ventured out at all, I could hardly get down the block and back.
This makes me wonder how many of us with CFS/ME actually just have advanced SIBO. New science is beginning to understand the “gut-brain axis”, how the brain is linked to a “gut-brain”, our enteric nervous system, and CFS is a condition where that connection is obvious. In this thread “Lisa” did incredibly well with lactoferrin, for a time. For her, it seemed to provide energy as well as clearing the fog.
So far, I’ve had some toxic die-off symptoms (LPS!), but not as much as in the past when using antibiotics (such as the Rifaximin) for SIBO. My joint pain is not entirely gone, but it’s a lot better, same with my sleep patterns.
One very notable fact is I tend to feel more energetic while in motion than I do when I am laying down or sitting. I’ve heard this is a classic hypothyroid symptom, although not often documented, and back to the subject of LPS, I may have found a source of thyroid inflammation. Look for a lot more on this topic in future articles.
My plan from here forward is to reduce the broad spectrum herbal antimicrobials, be more strict about intermittent fasting, eat a lower fat diet with a few more simple carbs to reduce LPS (this is complex – kudos to Paul Jaminet), and continue on taking the lactoferrin. The brands I’m trying are Life Extension and Jarrow. The dose has varied. I started slowly, just two pills a day of Jarrow, but have since gone to 4 of each kind as of today.
I am also still a believer in supplemental iodine, but my dose is lower now, about 2.5mg a day, which is one drop of Lugol’s 2%, and I always take 200mcg a day of selenium to protect my thyroid. I have reduced iodine because if LPS is a factor in my hypothyroidism, I want to heal my SIBO first.
Lactoferrin to the rescue. Let’s see how this goes.
To be continued.