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control and treatment of SIBO and IBS

control and treatment of SIBO and IBS

guest post from Stuart24 over at HealthUnlocked

Hello, this is my general response to help people find a baseline.

First, go to the doctors and get yourself checked for intestinal infections, and whatever other tests they want to do.

Most people find they are all clear, and that IBS is a condition brought on by our modern diet, freely accessible food, sedentary lifestyles and is usually initially set off by a GI infection or other trauma to the GI tract.

The gut becomes hypersensitive to certain triggers, and the official description is that a physical brain-gut dysfunction develops which causes the gut to over-reacts to very mild stimuli.

Be aware that you can get new GI infections, or other GI issues that are not connected to IBS, so you need to be vigilant for this, and if concerned then visit your doctor again.

However this post is to help you to establish a baseline of understanding what is probably down to IBS.

about me

After 27 years of suffering with IBS I have found that the long-term solution that actually works for controlling it is about FOUR key topics:

  • your vitamins
  • daily fasting periods
  • toxins that are freely dished out by the food industry
  • and adrenaline control

You are effectively the manager of a “food nutrient extraction factory”

I know that may be obvious, but I have found that IBS is not about medicines, but about changing the way you run the factory, and learning how to get the best performance out of it.

I don’t recommend any medicines, as they only work in the short-term and eventually become less effective, and I just don’t want to be dependent on medicines until one day when I have no other choice.

nutrition and feeding

This is based on some excellent publications, and also by observing how healthy people live.

But, if you are all clear from the doctor’s, then the first thing to sort out is your vitamins and the timing of your eating and fasting periods.

An incident of food poisoning or infection can start you on a cycle that you need to make a really concerted effort to break out of.

IBS causes vitamin deficiencies which are practically impossible to overcome in most people’s diets, especially because you are probably eating selectively to manage your symptoms.

Your vitamin levels affect the health of your intestines, and the health of your intestines affects your vitamin absorption, so it is a vicious circle that you have to break.

If your farts really stink like something died in your guts, then this is because partially undigested proteins are making it through to your large intestine and the amino acids lysine and arginine are being metabolized by bacteria into cadaverine and putrescine which are the compounds that give the smell to rotting flesh! –

do not worry that you yourself are rotting, this is just temporary, but it shows that you really need to sort your digestion out.

vitamins

So, get some really good, expensive, multi-vitamins (ideally constituted for your age) and take them without fail every day before your breakfast.

Get a blood test for Vitamin D and get you doctor to judge your supplement level required in IU’s to get you well healthy for Vitamin D.

Do not get vitamins with high calcium and magnesium content initially as certainly in large doses these minerals can mess you up as they consume your stomach acid, and magnesium particularly can give you diarrhoea.

You should get enough of these minerals from your diet.

If you are on the low FODMAP diet, go for all lactose free dairy products to boost your calcium, as unfortunately the diet tends to cut out almost all of the good calcium sources.

fasting

Second, sort out your fasting periods immediately.

This is normally overlooked by GP’s, but is an absolutely essential element for resolving IBS.

Your small intestine should be practically sterile, and your stomach acid along with bowel cleaning contractions during fasting (called MMC) will usually do the cleaning.

But, you need to fast for this to be effective, and by that I mean, ABSOLUTELY NO eating in between meals, ideally drinking only water.

Imagine that you never washed your dinner plates and just kept putting food on them all the time!, they would be filthy and full of bacteria.

In your guts, this results in SIBO (Small Intestine Bacterial Overgrowth), which is apparently responsible for 85% of IBS cases, but is only one of factors that you need to address.

You need to give your small intestine plenty of time free of food for cleaning and maintaining the factory.

The modern scenario of have cupboards full of rich foods permanently available day and night is a modern luxury outside of human evolution.

Your stomach will sort itself out when you have got control of your small intestine (although if you’ve got gastritis you’ll need to finish a course of omeprazole first), and then your large intestine will improve later as nutrients are more efficiently absorbed from your small intestine.

Furthermore, you should be able to avoid future bouts of gastritis as during the fasting periods, your stomach acid is more neutral at nearly pH 4.

suggested eating schedule

As a basic program, eat a good breakfast at say 7am (porridge with 50% almond milk or lactose free milk) or what suits you and then a good lunch at 12 o’clock – absolutely no food in between.

After lunch, no food at all for at least 5 hours, and eat well again for your evening meal because it has got to get you through the night.

Ideally, no food after 7 pm, no supper or snacks, no food or milk at all until breakfast the next day.

You will feel hunger in the fasting periods, but you will not starve, and this is doing you good!,

You must NOT respond to the hunger – only with water or black tea.

This is CRITICAL.

Unless you are in a very healthy GI state, a mid-morning or afternoon snack interrupts your set meal digestion, causing SIBO and driving premature advancement of food into your colon resulting in the putrid gases mentioned above.

stick to the plan

Importantly, when you are feeling better, do not resort to your old ways, you are still recovering as you villi repair and become more efficient, and you need to make a life-style change to have this level of discipline in your eating and continue with it.

It takes a few weeks at least, and you need to persevere with this.

You then need to maintain a healthy and consistent way of eating and always keep the vitamins topped to prevent you from relapsing.

In a couple of weeks, you should be able to be getting off the low FODMAP diet, and begin mixing back in the higher FODMAPs.

Eventually, you can almost forget about low FODMAPs altogether, depending on how well your small intestine is performing and your fasting discipline.

every day toxins

The third aspect of IBS is that some food additives are quite simply toxic for you and cause direct inflammation of the colon, allergic reaction of the colon, or they are laxatives that give you diarrhoea that you didn’t realise you were eating.

These are to be considered separate to the usual SIBO and vitamin mechanisms that you are dealing with above:

trans-fats

Try to seek out and eliminate “trans-fats”.

These cause direct inflammation of the colon, and you will be more sensitive than most people and this confuses what is causing you trouble.

Chips, hash browns, butter, doughnuts, popcorn and things cooked in cheap or old frying oil as you find in many restaurants and commercial products can give you colon pain directly through inflammation.

It can take up to three or four days to recover from this inflammation, but trans-fats are bad for you in a myriad of ways (cardio-vascular and diabetes), not only by inflammation of the colon.

There is evidence that as cooking oil is re-used that the trans-fats (and other compounds) increase.

So, if you want fried food as a treat, do it at home with good oil at a low temperature, and use it only once.

Ideally, starches should only be boiled, rather than fried.

carrageenan

E407, or “Carrageenan” – is a food additive derived from a red seaweed, which is only present in small quantities as a thickener, but even at low levels it has been shown to be “highly inflammatory to the digestive tract” and associated with IBS, colitis and other GI diseases.

There is loads of literature and objections to this substance on the internet.

It is present in cheap Crème Caramels, and many other dairy and meat products.

After weeks of good health, just one of these products knocks me out for 24 hours with colon bloating and pain.

I have found this by trial and error several times.

Food tests show that even the food grade carrageenan contains between 2 and 25% of the non-approved “degraded” carrageenan, which is colon damaging and carcinogenic.

Some food agencies now prohibit this additive altogether, and it may be responsible for a lot of IBS cases.

It might be found in chocolate milk, cottage cheese, cream, crème caramel, ice cream, almond milk, diary alternatives, such as vegan cheeses or non-dairy desserts, coconut milk, creamers, hemp milk, rice milk, soy milk, and particularly processed meat.

It is used extensively in cheap meats and is even injected into beef joints – so always get organic or local butcher fresh good quality meat!).

It may be labelled as E407 or Carrageenan, but if you’ve got IBS, consider it as highly toxic for you.

carboxyl methyl cellulose (CMC)

In the same category is carboxy methyl cellulose (CMC) which is more widely used in the food industry, but has similar toxicology in animal studies, giving inflammation of the colon.

However, the jury is still out on CMC to its impact on humans.

mono-sodium glutamate (MSG)

I’ll also mention here mono-sodium glutamate (MSG).

Clinical trials and several scientific articles connect MSG with IBS, so given the option to avoid it you should avoid it.

aloe vera

Also, NICE advises against the use of Aloe Vera for IBS – although I would say for skin burns it is miraculous, so get a tube of the pure plant gel for your medicine cabinet for minor burns.

others

E338, E339, E340, E341, E450, E451 and E452, are phosphates, diphosphates or polyphosphates as different salts.

Natural phosphates are essential for life, and your body is full of organically bound phosphates, however, free ionic phosphates have several problems.

Firstly, they are laxatives and will give you diarrhoea (sodium phosphate was once used to prepare patients for colonoscopies!).

Secondly, they are associated with cardiovascular disease and accelerated aging.

Since the 1990’s we are now exposed to twice the amount of added phosphate in foods, and this is bad.

There are calls to have added phosphate labelled on products as a health warning.

Particular culprits are mass produced sausages and processed ham and chicken slices (and other meats), some cheeses, and cola (both diet and normal).

Personally, for me all phosphate additives make me ill.

low calorie sweeteners

Aspartame and other sweeteners definitely have a negative role to play in IBS for many people.

As with the other toxins above, your ability to cope with them varies on a spectrum.

If you look at some of the work of K.J. Mielke, many of these additives can be allergens or “pseudoallergens” and with time you can develop a reaction to them.

The best sweetener for IBS is normal table sugar (sucrose), but it will rot your teeth in tea / coffee all day unless you do extra teeth cleaning.

Ideally, general advice is to cut down on these stimulants, no more than 3 cups a day is the NICE guidance.

You must remember that there are many different causes of IBS, and one person’s solution may not be another’s – because of the allergies that you may or may not have developed, plus all other factors in play.

Adrenaline

The fourth major topic in treating IBS, is adrenaline control.

The GI tract is very sensitive to adrenaline.

There is some literature about serotonin along a similar vein.

A friend of mine says that “adrenaline not used by your muscles goes to your guts” and there may be some truth to this.

If you have a busy life, you are probably not coasting along on a bed of feathers, and you probably not aware of your almost constantly high adrenaline levels – that is until you start actively lowering them.

Personally, listening to whale music doesn’t lower my adrenaline, nor does yoga, because immediately afterwards I’m back in the busy life again.

Crucially, what does work, is hard exercise to burn up your adrenaline and stop it interfering with the nervous system of your guts – and this is a powerful effect.

My advice is to do something every day, two or three times if you can just before eating.

Do whatever you can manage in your busy life, because it will all help.

It will improve your gut motility, general health, bone strength, relieve tiredness, help you sleep better, improve your mental agility and help get your anxiety under control.

To many people, exercise may seem like a waste of time, but it is equivalent to spending a bit of time sharpening an axe – it is not wasted time, but time very well spent in servicing your whole body and mind.

Other points…

red meat

Red meats generally take a long time to digest, and also contain some trans-fats, but are usually tolerable.

Only have them once a day, ideally for lunch, and just a light salad to go with them, not a load of starchy food or grains, as they have long digestion times.

You don’t want carbohydrates being held up in transit because of heavy meat digestion late in the day.

L-Glutamine

There is a lot of support for L-glutamine to help with repair of your small-intestinal lining;

this means buying 500g of the bodybuilder powder type and having a couple of tea-spoons of this a day –

one before breakfast and one just before you go to bed, and you can have this in a light cordial drink.

I don’t think this is a permanent requirement, but I think can help you recover more quickly from long term issues.

probiotics

I am not a fan of probiotics,

I have never found that they actually do anything, although some people may disagree.

However, I am a fan of prebiotics, which is basically food for your large intestine good bacteria.

This helps to strengthen the lining of your colon, and further improve your resilience to potential trigger foods and inflammation.

Again, I would only use these short-term to help you back to a good state which you can then manage with the other good behaviours.

It’s not that they do you any harm, but you want to be as self-sufficient as possible.

hormones

I should also mention hormone changes in women can be connected with IBS, affecting the brain-gut nervous system, but I have no personal experience in this.

Similarly, hypnosis is actually recommended by NICE as the best alternative therapy, again trying to get a grip on the nervous dysfunction.

Personally, I’ve yet to try it, but I wouldn’t rule it out.

Dealing with Flare-ups…

First thing is, fix your SIBO as described above.

If you still have SIBO symptoms, oregano oil capsules are very good, it is bactericidal and can help with acute SIBO problems.

It is not “gassy” as you may find with peppermint oil.

Fixing your SIBO has got to be your priority.

If you are on top of your SIBO, then a bowel toxin such might hit you 5 to 8 hours later as the food gets to your large intestine.

The first line of attack in this case is ibuprofen which is far more effective than paracetamol for bowel pain, and I find that 200 mg alone is enough.

Second, a couple of Buscopan will stop the cramps.

linseed aniseed tea for stomach cramps

Have available in advance some linseed (seeds) and natural aniseed (Star Anise), and make the following tea: in a saucepan, add

  • 1 teaspoon of linseed
  • ½ to 1 anise star
  • 1 teaspoon of sugar
  • a squirt of lemon juice (bottled is fine)
  • and one mug full of water

Boil to simmer for 3 to 5 minutes, then sieve off the hot liquid back into the mug.

This is a very effective remedy that I have used countless times, and it really does help.

The reason that it helps (anecdotally) is that the “gooey” linseed extract coats the intestinal lining.

There may be some truth to this, as some propose that the mechanism of bowel inflammation is a chemical attack on the mucus lining of the intestine which then allows food particles be exposed to the more delicate tissues underneath, causing inflammation.

The linseed goo would provide a temporary replacement to the mucus lining, preventing further inflammation.

In fact, NICE recommends oats and linseed for daily consumption for IBS patients.

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My Breath Smells Like An Open Sewer

My Breath Smells Like An Open Sewer

Guest Post from WholeHealth Chicago

Robert’s breath had become his worst nightmare and as a consequence he knew was starting to isolate himself socially. For three years, he’d tried every over-the-counter remedy. When he walked, Tic Tacs rattled in several pockets.

Robert had seen specialists, had his teeth cleaned every three months, and followed a twice-daily oral regimen that included flossing, brushing, and jet-streaming his gums. The finale was a vicious tongue-scraping that left his taste buds raw and aching. He’d then blast whatever was left with undiluted mouthwash.

Robert had tried everything.

“The tongue-scraping is especially horrible,” he told me. “I can actually smell that sewer odor coming from that guck I scrape off.”

One doctor said it was all in his mind, that he should see a good psychiatrist because his breath might be a symbol of some deeper issue and that he might be sinking into the terrain of obsessive-compulsive disorder. Robert was intelligent enough to consider this for a moment, but because his wife had recently remarked that his breath was interfering with their lovemaking he skipped checking the mental health benefits on his insurance.

An otorhinolaryngologist (ear, nose, throat specialist) scoped his sinuses and pronounced them clean. A gastroenterologist (GI) scoped his esophagus and stomach and found nothing out of the ordinary. The GI doc was less than hopeful. “My brother has had bad breath since he was 20. He’s 50 now and spent a fortune trying to figure it out. Nothing. Nada. He lives on Certs.”

Robert offered the doctor a Tic Tac and left the office.

My meeting with Robert


When I first saw Robert I was not hopeful. First of all, I couldn’t smell a thing, which isn’t saying much because I have a dreadful sense of smell. He’d already read one of my previous Health Tips citing poor digestion as a possible cause of bad breath, but a month of digestive enzymes and betaine didn’t make a dent.

I reviewed Robert’s entire health history and there wasn’t much. He did have some heartburn (gastroesophageal reflux disease, or GERD) that he’d self-treated on an as-needed basis with Nexium, one of the proton-pump inhibitors that reduce stomach acid. Robert told me he had frequent bloating, but generally his bowels were regular and there were no particular foods that gave him trouble. Except for seeing a dermatologist for some stubborn rosacea, there was nothing really wrong with him that decapitation couldn’t cure (I knew he’d laugh when I told him this).

Clinical testing

Since he already had a primary physician (who had pronounced him healthy) and had been pretty thoroughly tested by other doctors, I ordered two tests of his gastrointestinal function.

stool analysis

For the first, a Comprehensive Stool Digestive Analysis, he would send stool specimens to Genova Labs to determine if he was digesting and absorbing his food normally. This test would also look for intestinal parasites and determine if there were any imbalances in his intestinal bacteria. Robert’s results were normal. He was digesting and absorbing his food well.

breath test

The second test would measure the contents of his breath for two gasses, hydrogen and methane. This test would determine if there were an overgrowth of bacteria in his small intestine, called SIBO for small intestine bacterial overgrowth. Some bacteria in the small intestine is allowable. But an overgrowth can produce all sorts of mischief, including bloating and impairing your digestion and absorption of food.

For the SIBO test (done at home), Robert would drink a small amount of lactulose, a harmless sugar that’s like cotton candy to the target bacteria, which promptly respond to this treat by producing more gas than ever. For the next two hours, Robert would collect samples of his breath by blowing into a specially designed balloon and then attaching a vacuum tube to extract an air sample. He’d send off six tubes of air, which looked empty, but definitely were not.

When the test results came back from the lab, I knew we had an answer. Robert’s hydrogen-methane content started rising at the 20-minute point and remained at the very top of the graph for the rest of the two-hour collection period. His was among the highest gas levels I’d ever encountered.

Treating Robert’s SIBO


Robert’s response to Xifaxan, the antibiotic most widely prescribed for SIBO, was dramatic. On the fourth day of his ten-day Xifaxan prescription, the nauseating odor from his tongue scraping had vanished. By the tenth day, neither he nor his wife could detect any breath odor whatsoever and I hoped they were now able to resume their passions.

Just why Robert had developed SIBO is hard to say. Some people get it if they have a chronic intestinal inflammation, like Crohn’s disease. Some get SIBO as a consequence of using the Nexium family of meds, which reduce the stomach acid necessary to keep the small intestine’s bacterial population in check. SIBO has also been linked to anything that slows intestinal motility (movement), like underactive thyroid or constipation-dominant irritable bowel syndrome. But for most people with SIBO, the “why me?” is left unanswered.

Fortunately, as in Robert’s case, treatment can be dramatically successful. The only caveat is that the bacteria are stubborn and a return of symptoms can occur. We reduce this possibility using an antibiotic blend of herbs and a quality probiotic, since nobody needs to be carpet-bombing what helpful bacteria they do have by taking an antibiotic regularly.

Three intriguing points worth mentioning


First, the question of the garbage-y odor itself since the two gasses measured with SIBO testing, hydrogen and methane, are both odorless. The likely reason for the odor is that the bacteria are producing other gasses, especially hydrogen sulfide, the villain behind your odiferous farts. You’re better off not thinking about this too much.

Second, a few weeks after treatment, Robert’s rosacea had disappeared. The link between SIBO and rosacea is relatively new, first described by a group of Italian physicians in 2008. Unfortunately, testing for SIBO has been slow among US dermatologists seeking a rosacea cure, but the connection might explain how Flagyl (metronidazole) works. Flagyl, the top-prescribed drug for rosacea can also be used to treat SIBO if Xifaxan is unavailable. Perhaps dermatologists prescribing Flagyl are inadvertently curing SIBO, which in turn cures the rosacea.

Third, I have to wonder if something as thoroughly annoying as having horrible breath ever affects celebrities and other beautiful people. There’s a real imbalance in the universe. I mean, if Brad Pitt or Taylor Swift or Princess Kate had socially isolating breath problems, they’d be able to compensate by saying, “Thank god I’m Brad Pitt” or “Wow, at least I’m Taylor Swift” or “I’d be even more miserable if I weren’t a princess.”

Instead, this stuff strikes plebes like you and me. No justice.

Be well,
David Edelberg, MD