What a wonderful, informative, thought-provoking weekend! I spent this past weekend at the 2nd Annual NCNM SIBO Symposium learning a myriad of information about digestive conditions- specifically IBS & SIBO. While listening to the presentations, I kept a keen ear out for information that relates to individuals with chronic relapse, to those with sulfur/thiol intolerance, and additional testing to help reveal underlying causes for SIBO patients.
I have scoured through my notes to present to you some of my key takeaways from the presentations:
1) Stress is NOT the trigger/cause of SIBO, but it often plays a role in the manifestation of the condition.
Dr. Pimentel shared that a study has been conducted on soldiers sent overseas to regions such as Afghanistan & Iraq. The study showed that stressful circumstances such as shooting a gun or experiencing a major injury did not correlate with the subsequent development of IBS. However, patients often indicate that stress exacerbates their IBS/SIBO symptoms and practitioners find that patients who are able to integrate strategies such as yoga, meditation, massage, etc. into their healing journey experience greater improvement than those who do not. Therefore, it seems that stress does not trigger IBS/SIBO in the first place, but it may worsen symptoms.
2) Finding the right prokinetic often requires experimentation, but here are some tips to lead you in the right direction:
Pharmaceuticals: often required due to greater efficacy than natural options
- Resolor (prucalopride)– highly effective for individuals with constipation, but contraindicated for those with diarrhea due to invoking slight motility of the large intestine rather than just the migrating motor complex (MMC)
- Low Dose Erythromycin– frequently used for both IBS-C and IBS-D due to affordability and availability. Currently, there are no studies on potential impacts on the large intestine commensal flora.
- Low Dose Naltrexone– potentially beneficial for those with autoimmune conditions, however, many of the physicians did not find it to be a strong enough prokinetic unless combined with other options
Herbals: sometimes used in conjunction with pharmaceuticals
- Ginger– a remedy traditionally recommended for nausea, ginger is effective at stimulating gastric motility i.e stomach emptying (Ming-Luen, Hu et al 2011) so it may be helpful for individuals with gastroparesis.
- Iberogast– a combination of herbs that appears to be highly effective for nausea. This formula has been used for decades in Europe as a remedy for a myriad of digestive complaints ranging from nausea to acid reflux, bloating, constipation, diarrhea, and more. It was indicated as a safe option during pregnancy.
- D-limonene– one of the presenters shared this as a prokinetic option, but it did not seem to be widely used among practitioners. It has been used clinically to dissolve gallstones, provide relief from GERD, and induce phase 1 and 2 liver enzymes which could help protect against cancer (Sun, J. 2007).
3) Biofilm disruptor may be unnecessary in SIBO treatment
Many SIBO experts have not seen an increased benefit when adding a biofilm disrupting agent to their SIBO treatment protocols. It was expressed, however, that biofilm disruptors may be more beneficial in the treatment of SIFO (small intestine fungal overgrowth) such as with candida albicans. It was discussed that stool testing may not be reliable for ruling out candida. One suggestion was that if a stool test is negative for candida, but an antibody test is positive, it could indicate the presence of SIFO specifically in the small intestine.
4) Hormone imbalances and birth control pills may be at play in some SIBO cases
I find it very fascinating that the number of women afflicted with IBS/SIBO far outnumbers the number of men with this condition. I have suspected that oral contraceptive pills may have played a role in the development/worsening of my GI symptoms. My friend, Emily, who shares similar skepticism about the connection was brave enough to submit a question to the panel of SIBO experts regarding this issue. The experts shared that they clinically see hormonal issues and SIBO go hand and hand and that it is certainly possible that oral contraceptive pills could be a factor in SIBO. I was curious about this issue and stumbled upon a couple of fascinating studies on this issue. An article titled “Sex Hormones in the Modulation of Irritable Bowel Syndrome” indicates:
“Sex hormones may influence peripheral and central regulatory mechanisms of the brain-gut axis involved in the pathophysiology of IBS contributing to the alterations in visceral sensitivity, motility, intestinal barrier function, and immune activation of intestinal mucosa” (Agata, Mulak et al 2014)
5) Heavy metals as a potential underlying cause of SIBO
I have suspected for a while now that heavy metals (specifically, mercury- due to my high thiol sensitivity & high levels of mercury on my hair test) could be one of my underlying causes, but I never had a scientific explanation until now. Heavy metal toxicity causes oxidative stress (which my Organix test showed that I have) which can lead to delayed gastrointestinal motility- i.e. constipation (Rana S.V. et al 2014). One of the biggest controversies with heavy metal testing is how to test the body burden accurately. At the SIBO symposium, I was able to speak with a Cyrex representative about the Array 11. It appears that it tests for immune reactions to mercury toxicity (among other toxins) rather than just the presence of the toxin.
6) The infamous hydrogen sulfide- more to come later this year!
Dr. Pimentel shared a very exciting notice regarding the third type of gas produced in SIBO- hydrogen sulfide. He promised that there would be more information on sulfate-reducing bacteria sometime this year- perhaps it could be testing?!? As some of my followers may be aware, the connection between sulfur intolerance and SIBO is one of the areas that I focus much of the content of my blog. Plan to hear more in the future!
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Thanks for reading! =)
Article titles & links to the sources listed above:
Effect of ginger on gastric motility and symptoms of functional dyspepsia
D-Limonene: safety and clinical applications
Relationship of cytokines, oxidative stress, and GI motility with bacterial overgrowth in ulcerative colitis patients
Sex differences in irritable bowel syndrome: do gonadal hormones play a role?