Over 75% of Irritable Bowel Syndrome cases are misdiagnosed. Upon further investigation, most IBS cases are actually Small Intetinal Bacterial Overgrowth. This is a scenario where the Migrating Motor Complex (MMC) is malfunctioning; this mechanism is in place to eliminate waste. This condition is becoming an epidemic……why?
I will begin with a Functional Medicine approach in addressing SIBO (paramount) followed by a Chinese Medicine perspective (to further support treatment).
Most Common Causes of SIBO (opportunistic bacterial infection):
- G.I. Flu or Food Poisoning- this is the most common. Even after urgent symptoms have disappeared, the dysbiosis has not been resolved completely. Often patients with SIBO do not even associate an episode such as this on the timeline of when their digestion slowly began to decline. The pathogenic microbes that caused the flu or food poisoning slowly over time begin to disrupt the microbiome until eventually symptoms become unmanageable and extremely uncomfortable. This could be years after the episode
- Long-term use of ant-acids- By reducing stomach acid, antacids drastically decrease the very essential ingredient that normally rids the small intestine of microbes. Stomach acid is needed to maintain a healthy biome. Most people now reach for ant-acids every time they get symptomatic from poor eating; this is absolutely the wrong way to address ‘heartburn’ or GERD. Ant-acids (just like probiotics) should be regarded as a drug, not a staple.
- Diet- The SAD diet (Standard American diet) of processed foods, insane amounts of protein, sugar, caffeine, gluten, or high carb create the perfect breeding ground in the SI for infection.
- Narcotics: There is an opioid epidemic in America. If you take this class of drugs for more than 2 weeks, there is almost a guarantee of SIBO. Narcotics profoundly slow down digestion and motility; bacteria will thrive in these cases.
- Kinks in the Small Intestine from surgery: SIBO very often follows any type of surgery pertaining to the SI, such as tubal ligation, Gallbladder removal, strictures, ileocecal valve issues, or tumor removal. Structural issues allow for overgrowth, and surgeries almost always create scar tissue which in turn leads to a deformed “pipe.” As motility slows down, the now “bent hose” easily create perfect little pockets for infection. These situations cannot be detected by a breath test and require imaging studies such as x-rays or MRI’s.
* Also, ingestion of Sorbitol has now been linked to SIBO. Sorbitol can be found in many ‘natural’ products
The Migrating Motor function is also very much influenced by constant grazing (doesn’t allow for the “sweep” to take place), constipation, H. Pylori infection, lack of exercise, stress and anxiety, low thyroid and adrenal fatigue. Maintaining and re-establishing MMC function is essential in recovering from SIBO. Things like acupuncture, abdominal massage, neurological chiropractic work can support this process. Of course prokinetic drugs are an option.
SIBO testing is NOT always accurate. If you are suffering from pervasive gas, bloating and stomach irritation it is highly likely you have SIBO even f your test came back negative. There is much debate over which test is superior: the glucose or lactulose hydrogen/methane breath test. Both can give false negatives. It is best to rely on your symptoms, and how you feel. If you test negative, it could be because a) All 17 feet of your SI has not been tested when you drank the glucose b) not all bacteria ferment lactulose and/or c) not all bacterial infections produce hydrogen. Or, if you test negative and symptoms persist, you might have a fungal infection rather than SIBO
Also, there is a lack of consistency as of yet among doctors when interpreting SIBO test results. This is relatively new testing, which in and of itself lends to misdiagnosis.
You will need to follow a Paleo or low FODMAP diet or you will most likely not get the results you are seeking. Check out my diet section here.
I believe in following a Functional Medicine approach (the 4 R’s) which offers a framework around addressing gut infection: Remove, Replace, Reinoculate, Repair. Below is the 4 R Protocol, followed by a Chinese Medical interpretation. . In my experience, combining both Western and Eastern schools of thought will offer you the greatest potential in healing.
Reading my ‘Root Cause’ article (that you will receive for free by subscribing to my site from home page) is a crucial addition in understanding my approach to reversing gut disease symptoms. It is very educational and gives a very comprehensive look at my 4-step approach.
Step #1: REMOVE
To eradicate infection, you will need antimicrobials AS WELL AS bio-film busters. Infectious bacteria create colonies, forming a glue-like ‘shield’ around them for protection. You have to penetrate through the biofilms to even get access to killing the pathogens. Often when results are elusive, it is because the compound being used is not able to get through the biofilm.
Take One Anti-microbial for 3 weeks, then choose another and take for 3 weeks, then another for additional 3 weeks (Bacteria often become resistant to a compound at the 3 week marker) This may sound excessive, but clinically I just do not see SIBO success stories from taking one antimicrobial for 2-3 weeks; I consistently see results from a minimum of 9-12 weeks of antimicrobial rotation. If infection is severe and persistent, you might need to take 2-3 antimicrobials at a time and/or pharmaceuticals.
- Argentyn 23- Hydrosol Silver. This is my top choice. See SIBO dosing schedule with silver here and general safety info here.
- Biocidin LSF- BioBotanical Research
- GI Microb-X - Designs for Health
- Allicin – Designs for Health
- CandiBactrin- AR – Metagenics
- Wild Oil of Oregano- American Herb and Spice: One of only 2 companies making the real deal, the rest is some synthetic version lacking real carvacrol. You will get inferior to no results with other brands.
*Dosing is key. Dosing is Misguided dosing schedules are the biggest reason I see people fail to get results with botanicals. For the first 2 weeks you must take the antimicrobials every 2-3 hours. Bacteria can double every 20 minutes (if it wants to). You must be committed to a very strict regime if you want results. After the second week, you can begin to taper down. So if you are getting 5-6 doses in for the first 2-3 weeks, try tapering down to 4-5 doses, then 3 and so on.
*Take soil based probiotics at bed time, 3 hours from last dose of antimicrobial. In theory, if a potent antimicrobial such as the ones listed are taken too close to a probiotic, the antimicrobial could weaken or altogether eliminate the effectiveness of the probiotic.
Best Biofilm Buster Combo:
- Liposomal EDTA - Quicksilver Scientific
- NAC- Thorne: N-Acetycysteine *very important. It pulls the iron out of the biofilm, is the precursor to glutathione and also a powerful antioxidant. Do not exceed 1,000 mg daily
*I do not find enzymes (i.e. the popular product Interphase Plus by Klaire Labs) to be a strong enough biofilm reducer. Clinically I failed to see results with this product.
Die-off (herxheimer effect) of bacteria is a huge issue for a lot of people. As these infectious pathogens die, they release toxins into the blood stream causing symptoms such as fatigue, headache, bodyache, joint pain, nausea, diarrhea etc. To greatly reduce such occurrences, one needs binders. In my practice, I will not prescribe anti-microbial supplements without binders. They literally soak up the toxins that are released when the bacteria is dying….this is essential, and very important to prevent recirculation of toxins. While of course binders will not rid every single toxin out of your body, they significantly lighten the load. If toxins are just sitting in your body, they pose risk for damaging cells. * Binders are very safe with little to no side effects except constipation- see below.
To have a more in depth look at binders visit my blog “The Importance of Binders.”
I personally and clinically prefer binding “formulas,” meaning combinations of multiple binders. As different binders have varying affinities for certain substances, formulas are the best option because you are covering all bases. Choose a binder:
- G.I. Detox- Bio-Botanical
- G.I. Detox 2 - Byron White Formulas
- Vitality Detox Drops: Zeolite. This is by far the most superior zeolite on the market; excellent for mycotoxins and mold which I find is an issue for many people struggling with digestive issues. Combining one of the above GI detox formulas with vitality drops ensures complete detoxification and is my favorite combo of choice.
- Charcoal- If you are going to take charcoal solo, I suggest activated charcoal or carbonized bamboo charcoal as it has been found to have a greater surface area for binding. Charcoal is excellent for binding bacterial endotoxins. * Both GI detox formulas contain activated charcoal.
- Green Calcium Bentonite Clay by BioPure- Clay is another fantastic binder of mycotoxins and endotoxins. Usually those suffering from GI distress (especially SIBO) do not tolerate clay at higher doses by itself because it slows down utility even more, which is the opposite of the goal with SIBO; clay is very dense in nature. The GI detox formulas contain small amounts of clay which is ideal, as clay in very small amounts is tolerable and very effective.
While taking binders it is VERY IMPORTANT to increase water intake. Binders slow down digestion and can cause constipation. It is almost guaranteed that if you’re on binders you will need to take higher doses of Magnesium Citrate. This form of Magnesium can be used as a mild, gentle laxative. It is absolutely necessary to keep the bowels moving to prevent toxin recirculation.
- Colon Rx – Designs for Health: Very safe and effective formula for constipation or sluggish bowels while taking binders. Contains Triphala (gentle Ayurvedic herb) for constipation as well as Magnesium hydroxide
Other ideas to support detoxification:
- Sweating- anything and everything you can do to sweat, including saunas, hot yoga, fast walking, bike riding.
- LV-GB Complex- Designs for Health: support bile flow for processing of toxins
- Epson Salt Baths- support the elimination of toxins
- Burbur Pinella by NutraMedix- best choice for brain fog and body pain from endotoxin release
Step #2: REPLACE
If you have SIBO it is highly likely that you have a stomach acid deficiency. Experiment with hydrochloric acid supplementation and see if symptoms improve:
- HCL- Designs for Health
Also with a SIBO diagnosis, digestive enzymes can be lacking. Digestive enzymes can really aid in the breakdown of food- form carbohydrates, to protein, lipids, and vegetable fibers. Sometimes digestive enzymes taken with meals can help reduce symptoms such as gas and bloating:
- REWARD Digestive Enzymes 120 Count (my company private labeled by Xymogen)
- Digsetzymes- 60,90, or 120 count- Designs for Health: contains small amount of HCL
Also, fiber is a really good idea with SIBO and can help reduce symptoms. .
PaleoFiber – Designs for Health: Contains 12 different types of soluble and insoluble fiber. * Contains very small amount of psyllium husk
PaleoFiber Berry – Designs for Health: same as above, just berry flavored.
FiberMend -- Thorne: Soluble fiber blend. *Does not contain any psyllium husk for those that might not tolerate it well.
Step #3: REINOCULATE
Reinoculating with beneficial bacteria can be beneficial with SIBO, but one must be very selective in the strains used.
If you are taking traditional probiotics (with or without d-lacate, doesn’t matter) you are likely feeding your SIBO infection. This is huge. If you have SIBO you should stick to soil based probiotics such as MegaSoprebiotic. *Read my blog on soil based spores here
- Megasporebiotic – Microbiomelabs
- Total Gut Restoration Kit – Microbiomelabs: This kit is phenomenal is addressing gut infection. I use this kit after the 3 week mark of antimicrobials. Includes the revolutionary Measporebiotic, MegaPrebiotic (potent food for MegaSpore, rendering it 5 times more effective), and MegaMucosal to repair and restore gut lining.
- 11 Strain powdered Probiotic- Customs: best choice for powerful probiotic enemas.
Probiotic Enema Instructions:
Probiotic enemas are very powerful as the beneficial bacteria is bypassing the acidity of the stomach and has the opportunity to actually live and colonize. They are a powerful adjunct to restoring gut health.
Buy a fleet enema bottle at Wallgreens, empty out solution, rinse, and refill just under half way), empty it out and rinse well with hot water. Fill back up ¾ of the way with filtered (non-chlorinated) water. Put 4-6 teaspoons of powdered probiotic formula in bottle. Gently shake; you want to disperse powder but not too much to risk damaging strains. Insert and try to retain for as long as possible- overnight is ideal, it will just get absorbed. I know some folks cannot retain overnight or long at all. Even 20-30 minutes will provide some benefit, longer is always better.
You can repeat this every night or every other night for as long as you wish, until you see improvement. Usually doing one every night for 3-5 days will bring some degree of benefit. Probiotic Enema Instructions:
Step #4: REPAIR
The mucosal lining of intestines has been compromised. The infection has caused inflammation, hence resulting in leaky gut. To repair the tight junctions of the colon walls, support the body with things such as glutamine and collagen. Repairing the lining of the intestines is no small feat, however. However, once you really eradicate the infection, the lining will naturally begin to repair itself because the inflammation will have greatly decreased. While this healing process is what will naturally organically occur, it is really beneficial to take supplements that support and enhance this process. In my opinion, collagen is ideal along with soothing herbs. Collagen is made up of powerful amino acids (and they are not synthetic) that the cell walls of our colons need to heal. For a more in depth look into leaky gut, what's involoved in repairing the lining of the intestines with supplements and a look at the best amino acids for this process check out my blog "Plugging Away the Holes of Leaky Gut."
*** Glutamine Awareness ***
Glutamine has shown fantastic results for some, others have an adverse reaction to it. If you have severe leaky gut, glutamine should be approached with caution. Glutamine is the precursor to glutamate- one of two excitatory neurotransmitters in the brain. Because of the gut-brain axis (they intricately affect one-another), glutamine can potentially cause extreme anxiety among other symptoms in some people. Amino acid therapy is not black and white, it can go either direction. Glutamine supplementation has become a fad in the alternative medicine world yet alternative doctors are not educating people on the potential side effects. I have seen equally as many patients (as well as myself) have an adverse reaction to glutamine as I have positive. Now, for those that glutamine benefits, it seems to really benefit, which is why I include it and not dismiss it entirely. However, this comes with some reservation. As always, be your own detective, monitor closely, and begin with small doses.
- GI- Revive by Designs for Health: this is one of the best as far as formulas that include glutamine go. It also includes glucosamine and soothing herbs that aid in repairing the lining such as slippery elm, marshmallow and licorice root.
- MegaMucosal- Microbiomelabs: This is probobly my favorite simply because it is also Is an IgG product, which is like turning the immune syetem on while simultaneously repairing the gut lining.
- Gastromend – Designs for Health: alternative for glutamine. Superb formula for mucosal repair that also includes soothing herbs as well as mastic gum, zinc carnosine and Vitamin U.
- Gret Lakes Collagen Hydroysate- there are many sources out there these days. Some are very expensive and I’m not sure they need to be. Again, it’s become a fad. If you are on a budget, Great Lakes brand (1/3rd of the price as others) will do just fine. Otherwise Vital Proteins and Dr. Ax have great options/claims on their collagen.
- MegaMucosal – Microbiomelabs: cmy top choice. Contains dairy-free immunoglobulins to enhance immune function along with amino acids to repair and restore gut lining.
- GI Encap- Thorne: Contains high doses of slippery elm, marshmallow root, licorice root, aloe, and nothing else.
- Great Lakes Collagen Hydrolysate- there are many sources out there these days. Some are very expensive and I’m not sure they need to be. Again, it’s become a fad. If you are on a budget, this collagen (1/3rd of the price as others) will do just fine. Otherwise Vital Proteins and Dr. Ax have great options/claims on their collagen.
Slippery Elm and Marshmallow Root- These herbs are incredibly soothing onto the lining of the gut. If you have a lot of pain and cramping, these herbs, in very high doses, could be your new best friend. While I was healing my colon, these were a staple. I needed VERY high doses and could not afford taking ¼ bottle of pills of them. If this is the case for you, order these herbs by the pound from one of the following companies. Make smoothies and throw tablespoons of each in. Or put a heaping teaspoon of each in hot water and make a tea. You can do this multiple times a day. These herbs are very gentle and have zero side effects. They become quite gooey or gelatinous if you let them sit for too long in a smoothie or tea. There’s a reason why all of the top supplements for mucosal healing include these herbs. They really work.
- Mountain Rose Herbs (most expensive)
- Starwest Botanicals (medium expensive)
- Tame the Spirit Herbs (least expensive yet very good quality)
This concludes the 4 R Protocol. Of course there are endless amounts of other supplements that could be beneficial in healing. I’m not a huge fan of Vitamin C (ascorbic acid) because it is made from corn, usually GMO, and folks with digestive disturbances often do not tolerate it well, even if they don’t realize it. Only a food sourced supplement of Vitamin C should be taken. Other than that, take whatever else feels right for your body. The ONE additional supplement that I feel everyone should take without question (especially those with bowel issues), is Magnesium.
Most people are actually living with a Magnesium deficiency and don’t know it. I put every patient on a starting dose of 400 mg of elemental magnesium just before bed. Some are in need of double that. If you are taking Magneisum Citrate (very poor source) you are absorbing little to no magnesium.
Magnesium is responsible for well over 300 biochemical processes in the body. 300! It regulates blood sugar, which in turn can prevent diabetes. It relaxes arteries, which means it has the ability to lower blood pressure. It also prevents calcium build up in the body that could make the arteries harden, as it chelates extra calcium. Of course, it is essential to digestive health because it is necessary for digestive enzyme synthesis. And last but not least- it seriously relaxes the nerves and basically allows the body to take a deep breath. Great for tight muscles and restless leg syndrome as well. This is why you see all these ‘Calm’ type formulas that are ridiculously over-priced…..it’s just Magnesium! Most of those formulas do not even contain a very high quality, absorbable form of Magnesium. If you are taking Magneisum Citrate, you are absorbing very little, if any.
- Magnesium Buffered Chelate (Pill) – Designs for Health: the most bioavailable form of elemental magnesium.
- Magnesium Chelate (Powder) – Designs for Health: most bioavailable form of elemental magnesium in powder form for those who don’t want to take more pills, or want to put in smoothie (orange flavor).
- Colon Rx – Designs for Health: for those that want to take magnesium strictly as a mild laxative. In this case, one of the above formulas should also be taken.
A Traditional Chinese Medicine Perspective on SIBO
Differing constitutions of individuals will elicit a unique Chinese Medical diagnosis. I do know that Chinese theory will not make sense to most, but I find it important to at least offer the most common differential diagnosis in Chinse terms so that the reader can begin down the path of understanding their illness specific to their constitution. This differential diagnosis could also be a contributing factor as to why people respond differently to medications/supplements.
The most common diagnosis of SIBO in Chinese terms is damp-heat in the lower jiao; this would almost always be the primary pattern, while depending on the patient’s constitution, the following patterns may be underlying. Oriental medicine sees things in terms of energetics; heat is basically a synonym for inflammation. It is very common to see the Spleen energy deficient, as in TCM the strength of our Spleen determines our overall digestive health.
Differential diagnosis of patterns SIBO according to Chinese diagnosis:
- Spleen Qi Deficiency- benefit from herbs that nourish the Spleen and build blood
- Stomach Heat- benefit from herbs that clear stomach heat
- Liver Qi Stagnation- benefit from herbs that move the Qi of the Liver
- Liver overacting on Spleen/Stomach with Heat- benefit from herbs that sooth and cool the Liver qi while clearing damp-heat from the Spleen and Stomach
- Blood Deficiency- benefit from herbs that build blood
- Stomach Yin Deficiency – benefit from herbs that nourish and sedate the Stomach
Chinese Medicine and Functional Medicine run parallel in their approach to treating SIBO when it comes to botanicals. Chinese medicine advises Huang Lian Su (Berberine) for diarrhea type cases (usually more hydrogen producing), and Da Suan (garlic) for constipation type SIBO (usually more methane producing). This may be interesting to take into account when choosing supplements. Chinese medicine is very aware of the energetics of a plant; they observe every herb as either being hot, warm, cold, cool etc. Every patient is observed uniquely- some patterns of SIBO would benefit from more cooling herbs (hot, smelly, explosive diarrhea) and some might benefit more from warming, dispersing herbs (constipated, distended, bloated cases). Of course these are huge generalizations- a skilled oriental practitioner can pick up on the nuances in each patient, and often use a combination of herbs energetically, with precision (targeting specific organs). There may be correlation energetically between more hydrogen producing cases vs methane (one tending towards more heat, the other more cold), but this needs further investigation and again, diagnosis always very individual. This is just to get you understanding the fundamentals of Chinese Medicine. It also lends itself to deeper understanding of why some supplements (specifically anti-microbials in this case) may work for one person and not for you- plants are vast in their properties and application. This is why it often takes a little trial and error to find the herb(s)/formulas that work for YOU. These days, we are so disconnected from the actual life of a plant, but our ancestors (who actually went into the woods, picked and cultivated them) were very aware of their ‘vibration.’ Nowadays, we pick a bottle off the shelf, take a pill and want it to perform miracles. It’s just not that simple……our bodies are all so unique. Herbalism honors this- whether you do or not. So keep searching for the plants your body needs. And if your really inspired- get to know the plants that heal you. It can be a lifelong love affair.
Often 2 Chinese Herbal formulas are needed- one to address the primary disharmony and another for the secondary pattern of disharmony. I will be writing further material on each disharmony so that individuals can become educated on the nuances of each.
Of course Chinese herbs are only a part of my approach in treating Candida, but they are a powerful adjunct to any regime aimed at resolving symptoms. Chinese herbs can energetically change the terrain; clear heat (inflammation). These formulas, combined with functional medicine strategies can be a powerful means of reversing even the most stubborn cases.
For a more in depth discussion of what Chinese herbs are and what exactly they do, please read my blog Why Chinese Herbs. It will give you a more in depth understanding of the energetics of herbs and how herbal prescriptions are prescribed per individual. Chinese herbal medicine is sophisticated alchemy……not hocus-pocus. For the aforementioned 10 patients, each one would receive a unique herbal prescription.