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?
This is great! Good for you for getting a recap up so quickly 🙂 And thanks for the shout out! Looking forward to talking more about these hormonal connections.
Thanks so much for sharing this info with folks who were unable to attend. Please post more about the conference if possible.
Thanks for sharing your insights. I was unable to attend but I was tested and diagnosed 3 years ago at the Portland clinic. I have done Dr. Pimentel’s protocol and Dr. Siebecker’s herbal/botanical regime, with diet restrictions. Any success with each approach lasted about 2-3 months and then it returned. I’d love to know more about new treatments and/or recommendations(diet, supplements, etc), they presented. I will definitely follow your blog and share it with others!
Hi Jan,
Relapse definitely seemed to be a theme at the symposium. Have you ever had a negative breath test? They did not seem to have many new treatments- other than perhaps no probiotics during treatment. The information on Dr. Siebecker’s site still applies in terms of the various ways to treat.
I’ve been suffering from SIBO for over a year, and I battled IBS-D in my 20s. #4 had me yelling YES!!! I think my stomach problems all began (and came back) with birth control. I was put on bc when I was 17, by my mid twenties I was seeing specialist after specialist for my daily diarrhea and other stomach issues. Finally got the IBS diagnosis and managed to control it through guided meditation and diet. Went off bc at age 27 to get pregnant. While off, and during the years of my pregnancy/nursing and the few years after, my stomach problems got much better. When my daughter was 4 I went back on bc and boom…everything came back with a vengeance and that’s when I got the SIBO diagnose.
Very interesting! It certainly seems to be a potential trigger for some people. However, so many people take it that it could be difficult to study.
Great notes! My husband and I went to the Symposium because our daughter was told she had it by a team of FMP’s and 2 ND’s. She has typical methane-C symptoms. She took 10 days Rifaximin/Neomycin (ND wouldn’t do more) and she started feeling better on the 7th day. She then did 10 days of Siebecker’s herbal protocol, which basically put her to bed with the symptoms. Finally, after changing physicians again because no one would administer the breath test, we drove to Portland to have the breath test done in-clinic 2 days ago. Much to our surprise, the test for Hydrogen and methane came back NEGATIVE! Yet, our daughter is still bed ridden and has still has all of the symptoms, plus some. Someone on the SIBO FB group gave me a link to your blog because of the Sulfide gas. It’s something neither my husband or I made notes of at the conference because we were convinced our dd has methane. Do you have anything on podcast or written that I can take to her new ND? We will be doing more testing for lyme, H. Pylori, etc, but not convinced she doesn’t have SIBO yet. Thanks for a great blog!
Hi Stacey, I am not familiar with any podcasts on the subject, but here is an in-depth article about hydrogen-sulfide SIBO. I am not sure why it is called a “patent”, but it contains a lot of fascinating information: http://www.google.com/patents/WO2006102536A2?cl=en
Hi there! Thanks so much for this article and your blog. I’m debating whether to spend the $400 to get to 2015 symposium recordings, but since you said the presenters didn’t present much new information in terms of treatment, I’m hesitant. Do you think it’s worth buying if one is already pretty well versed in the current information readily available on the internet?
Hi Jasmine,
That’s a tough question. It is really difficult for me to know whether it would be beneficial for you. I would say that if you are a practitioner, then yes, you need to hear the information to be up to date. But if you are a patient, I would need to know your entire SIBO story, your financial situation, and what you already know in order to give a guess as to whether it would be worth the cost. Sorry I cannot be more helpful.
Riley
Really great stuff Sibowithhope. Thanks for posting. Did they discuss anything regarding which treatments (RX or herbal) have a better track record of success for IBS-D
They did not mention anything specifically about which were better for IBS-D, likely because it will always be individual. However, I do remember hearing that people tend to experience less die-off with antibiotics. Some possible things to consider are cost of each and whether yeast is part of the picture (in which case antibiotics may exacerbate, but antimicrobials might be helpful).
Good to know. Thanks again!
Thank you for sharing. I suspect the gallstones are a common symptom that leads to autoimmune issues and other diseases. I also wouldn’t be surprised if birth control and/or SIBO contributes to their formation. I found out after I was diagnosed with IC a mast cell disorder that I also had gallstones. I had an 18mm gallstone which I tried to dissolve with acupuncture and Chinese herbs. I’m not sure if it has fully dissolved and am very curious about D-Limonene. If you know more will you please share?
There is definitely research indicating that birth control pills are a risk factor for developing gallstones. Also, here is a study about the correlation between IBS & Gallstones- inconclusive results: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335764/. 18 mm?! That seems very large! Did you have any pain in your upper right abdomen or was it an asymptomatic gallstone? For more information on D-Limonene, check out this review article: http://www.ncbi.nlm.nih.gov/pubmed/18072821. Page 4 of the PDF has information on gallstone dissolution.