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SIBO

How much GABA should I use and which GABA product is best?

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The most common question I get about GABA (gamma-amino butyric acid) is the one about the blood-brain barrier and does it even work (it certainly does – read here for information on this one).

The next most common question I get about GABA is this one:

How much GABA should I use and which GABA product is best?

This exact question was actually asked of me a number of times last week after I published: Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth (SIBO). In this blog I share about my trials of using sublingual GABA for the visceral pain and muscle tension in my gut caused by the bloating symptoms of SIBO.

There is no simple answer! It requires a blog post to provide a good answer because we are all unique, have different needs and these needs can even differ at different times depending on the issue and what is going on in our lives at the moment.

Let’s first do a quick recap of GABA (gamma-amino butyric acid) in case this is new to you. GABA is a calming amino acid that can be used as a supplement to raise GABA levels (GABA is also a neurotransmitter. It’s one of the amino acids I use most frequently with my anxious clients (together with tryptophan). GABA helps with the physical anxiety and tension, as well as panic attacks. New research shows it also helps with inhibition of unwanted thoughts and may also offer gut protection after alcohol consumption. It also helps with stiff and tense muscles and muscle pain and spasms.

How I have benefited from GABA

Here is a quick summary of how I’ve benefited from GABA supplements. I use this information to inform my use of GABA to help with the visceral pain I now experience due to my SIBO (more on that below).

If you have never used GABA or if you’ve used it once or twice, reading this should give you a clue as to why there is no one answer and how we need to use a trial approach to figure out what is best for each situation.

This also illustrates that there is no one size fits all for everyone and even for the same person under different situations.

  1. The anxiety and panic attacks I experienced 15 years ago:
    1. I used 1-2 GABA Calm three times a day and a combination GABA product at night. GABA Calm contains 125mg GABA and the GABA product contains 200mg GABA. My anxiety eased and my panic attacks stopped in a few days, giving me immediate relief and hope while I started to address all the other root causes like gluten sensitivity, adrenal issues, low zinc, gut health, low vitamin B6 and more
    2. The doses of GABA I used for my anxiety and panic attacks are typical amounts my clients benefit from and I would not have someone start on 500mg.
    3. If someone is a “pixie-dust” person and very sensitive I’d have them start with a pinch/dab or ¼ of 125 mg GABA Calm.
  1. The “ice-pick” headaches on the top of the skull that I discovered were caused by neck spasms:
    1. Physical therapy, high doses of GABA and high doses of magnesium were essential.
    2. Because of the low doses of GABA I had used for my anxiety years before this, I started with low doses of GABA increasing slowly from 200mg up to 1000mg GABA. This higher amount worked for me at this time for this injury.
  1. Throat spasms and the loss of my voice due to vagus nerve issues caused by a terrifying plane ride:
    1. Based on my prior ice-pick headache experience I now knew I could tolerate higher doses and started with 500mg GABA and used more as needed.
    2. I must have been really low in GABA because I was actually able to use upwards of 5 (and sometime more) doses of 500mg a day and not feel too wiped out, even during the day.
    3. That’s a lot of GABA for me – as I mentioned above 125mg to 250mg used to be enough for the anxiety I experienced 15 years ago.
    4. I write more about all this here: Vagus nerve rehab with GABA, breathing, humming, gargling and key nutrients (with videos to demonstrate immediate effects when using GABA sublingually)
  1. Rectal spasms/proctalgia fugax. These seem to be related to SIBO/IBS and I still experience these from time to time.
    1. I have found that 250mg to 500mg GABA opened onto my tongue works best for me for this particular muscle spasm.
    2. Again, it eases the spasms and pain in a few minutes. I write more about this here: How GABA eases agonizing rectal pain and spasms in under 2 minutes
  1. A back injury in August causing severe muscle spasms and pain.
    1. Again, based on my previous experiences using GABA, right after my fall I started taking 1000mg of GABA powder every few hours (held in my mouth for 1-2 minutes) and then reduced it to 2 or 3 times a day as needed.
    2. I share more in this blog: Acupuncture boosts GABA to reduce back pain and oral GABA further reduces the pain
    3. In the above blog you can also read some research about the mechanism of how GABA supplements ease inflammation and tracheal spasms associated with asthma.
  1. Visceral pain caused by SIBO.
    1. My SIBO is really well-controlled with diet but I’ve been having pain, bloating and insomnia while doing this herbal SIBO protocol. I suspect the cellulose in one of the herbal products is causing this bloating and pain after dinner. It was getting so bad it was keeping me awake (this is typical when I am accidently exposed to problematic foods and get a flare-up).
    2. SIBO patients can have visceral hypersensitivity where their pain can be due to the pressure of the gas that is produced and the muscles in the digestive system actually contracting against this pressure.
    3. It got me thinking about how effective GABA is for relieving muscle tension and how much it’s helped me in the past. I also use GABA with my clients all the time for relief of their physical anxiety and stiff and tense muscles. There are GABA receptors all over the gut and I recently discovered that GABA is important for motility.
    4. Over the last 2 weeks I’ve trialed 300mg GABA (opened on to the tongue) a few times to ease the pain and pressure and it’s been amazing at how much it’s helped and how quickly it’s eased the pain. I’ve used it as soon as I notice the bloating starting and it GABA helps me sleep too (as does the tryptophan I’ve also added). I suspect I could safely double this dose in the evening and may do this if the lower dose isn’t enough some evenings. I’ve also used it some days the next morning when I wake with the bloated ache in my belly.

How much should I use and which GABA product is best?

I have a blog post listing the products I use with clients: The Antianxiety Food Solution Amino Acid and Pyroluria Supplements

Always read the precautions (there is a link on the above blog) and do the amino acid questionnaire (the link is also on the above blog) before starting a trial. I also recommend reading the amino acids chapter in my book The Antianxiety Food Solution so you are a well-informed savvy consumer.

If you’re doing a trial for anxiety and panic attacks:

  • If you can use tyrosine the Source Naturals GABA Calm product is the one I use with most of my anxious clients.
  • The other GABA products listed on the supplements blog need to be opened onto the tongue and started with a low dose (100-200mg is a good starting dose) and increase based on symptom relief. More can often be used at night, especially if sleep is also an issue – sometimes up to 500mg.

If you have SIBO/IBS and are doing a trial for visceral pain:

  • I’d suggest NOT starting with the Source Naturals GABA Calm because the sugar alcohols can be problematic for some individuals. Or if you do, be aware that it may not help and may make things worse in the short-term. Personally, I have not found this product to be an issue with my SIBO and I have very few clients report an issue.
  • The other GABA products listed on the supplements blog need to be opened onto the tongue and started with a low dose and increased based on symptom relief.
  • For a client totally new to GABA I’d start with 100-200mg in the evening and also increase slowly over a few weeks based on symptom relief, up to 500-1000mg.
  • For early morning belly pain I’d start a client on 100-200mg because too much in the day can make you feel tired.    

If you have other pain issues:

  • For a client totally new to GABA I’d start with 100-200mg in the evening and increase slowly over a few weeks based on symptom relief, up to 500-1000mg.  Depending on the pain more may often be needed and higher doses can often be tolerated during the day.
  • Keep in mind that pain can have any many root causes and it may be more than low just GABA or may not be due to low GABA at all. Other factors to consider include but are not limited to: low serotonin, low magnesium, low endorphins, inflammation, structural damage, low omega-3s, gluten issues, Lyme disease etc.  Physical therapy and acupuncture are wonderful approaches to include too.

As you can see from my experiences above it’s a matter of doing trials to find the ideal amount for you for your particular situation.  

If you’ve used GABA supplements for anxiety, visceral pain or other muscles spasms I’d love to hear from you.

This GABA-pain connection is not well recognized and I’d love to have more people know about this as a possible option. The more we share our experiences the more we all learn.

If you plan a trial similar to any of the above I’d also love to hear your questions and feedback.

Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth (SIBO)

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Despite the fact that this paper was published in 2014, it’s still very relevant and I’m just behind in sharing it via a blog post: Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth

Patients with small intestine bacterial overgrowth (SIBO) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success. A growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health. The objective was to determine the remission rate of SIBO using either the antibiotic rifaximin or herbals in a tertiary care referral gastroenterology practice.

I’ve also decided to post this study now because I’ve been dealing with chronic SIBO for some time and am in the middle of doing the Metagenics herbal protocol (more information on that below).

SIBO symptoms and conditions

Here is a summary of some of the chronic intestinal symptoms: Abdominal bloating (gas), belching, flatulence, abdominal pain, cramps, constipation and/or diarrhea, heartburn (reflux or GERD), nausea and food sensitivities.

Here is a summary of some of the extraintestinal (outside the intestinal system) symptoms and conditions that have been linked to SIBO and/or dysbiosis: disorders of mood and behavior (including anxiety), diabetes, obesity, cardiovascular disease, rosacea, restless legs syndrome, pain, anemia, interstitial cystitis, and other pelvic conditions such as vulvodynia and proctalgia fugax (rectal spasms), chronic prostatitis and polyneuropathy.

During season 3 of The Anxiety Summit, I interviewed Dr. Allison Siebecker on Small Intestinal Bacterial Overgrowth and Anxiety. We talked about the SIBO Questionnaire I use with my clients and she gave me permission to share my modified version. You can find this SIBO questionnaire here. Please check out Dr. Siebecker’s site siboinfo.com for a wealth of information about SIBO.

The herbal treatments in this study

In this study, one hundred and four patients who tested positive for newly diagnosed SIBO by lactulose breath testing were offered either 1200mg rifaximin a day or one of two herbal treatments for 4 weeks. Lactulose breath testing was done again at the end of the treatment.

These are the two herbal treatments that were offered:  

Dysbiocide and FC Cidal (both by Biotics Research): take 2 capsules twice daily of each of these products

or

Candibactin-AR and Candibactin-BR (both by Metagenics): take 2 capsules twice daily of each of these products

The ingredients in each of the products
(from the paper: Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth)

Study conclusion

The study concluded that these herbal therapies are at least as effective as rifaximin for resolution of SIBO. It also states that the herbal products also appear to be as effective as triple antibiotic therapy in patients who don’t respond to rifaximin.

Adverse effects

With regards to adverse effects, they were reported as follows: in the rifaximin treated patients there was 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile; in the herbal group only one case of diarrhea was reported.

A comment about bioindividuality

You’ll notice that the only herb that is in both sets of herbal protocols is Red Thyme Oil or thymus vulgaris and yet both herbal protocols offer a solution. I’ve heard Dr. Siebecker share that of all the different approaches for SIBO (including the elemental diet), at least one approach works for everyone. So, if you’ve tried an approach and it hasn’t worked, don’t give up and move on to the next approach. This points to bioindividuality, and there being no one size fits all approach.

Dr. Siebecker lists the above combination herbal protocols together with the herbal protocol her and team use on her site, which, again, is different from the above: 1-3 of the following herbs x 4 weeks per course, at highest levels suggested on product labels.

  • Allicin from Garlic (the highest potency formula is Allimed)
  • Oregano
  • Berberine- found in Goldenseal, Oregon Grape, Barberry, Coptis, Phellodendron
  • Neem
  • Cinnamon

My protocol and experience

As I mention above, I also decided to post this study because I’ve been dealing with chronic SIBO for some time and am in the middle of doing the Metagenics herbal protocol. I’m 14 days into a 28-day protocol.

I’m actually doing 1 capsule of Candibactin-AR, 3 times a day away from food and 2 capsules of Candibactin-BR, twice a day, and about 10 minutes before food. I landed on this protocol, so I would have enough of each for a 4-week protocol.

When I started on the products I immediately observed the typical SIBO bloating and almost quit but quickly figured out it was from the microcrystalline cellulose and hypromellose in the Candibactin-BR.

It turns out that these are soluble fibers (dispersible in water) and are more easily fermented than insoluble fibers. This fermentation in the small intestine can trigger IBS/SIBO symptoms. Adding 2 capsules of a product with cellulase (an enzyme that breaks down cellulose) has helped.

Pain, gas and GABA

I also remembered that Dr. Siebecker shared on the SIBO SOS I summit about how SIBO patients can have visceral hypersensitivity where their pain can be due to the pressure of the gas that is produced and the muscles in the digestive system actually contracting against this pressure. It got me thinking about how effective GABA is for relieving muscle tension. I use GABA with my clients all the time for relief of their physical anxiety and stiff and tense muscles. And GABA helps me and many others with proctalgia fugax (rectal spasms)  which seems to be related to IBS/SIBO.

Over the last week I’ve tried sublingual GABA a few times to ease the pain and pressure and it’s been amazing. I’ve used it as soon as I notice the bloating starting AND even the next morning when I wake with the bloated ache in my belly.  I’ve been using the NFH GABA-T SAP opened on to my tongue. This product contains 300mg GABA and 150mg of theanine.  

I’m going to keep this in mind in case of a future flare up of my IBS/SIBO if I’m accidentally exposed to a food I can’t tolerate – assuming this protocol doesn’t clear it up for me. I suspect, as Dr. Siebecker reports, and based on the fact that I have chronic SIBO, that I’ll need a few more rounds anyway.

There is research supporting why this works: there are GABA receptors all over the gut and GABA is important for motility. (Stay tuned for a detailed blog post on this topic).

As well as the initial bloating and pain, I’ve also experienced some die-off symptoms like brain-fog and feeling blah, together with some sleep issues a few nights. The GABA helps with this and so does the tryptophan that I’ve also added.

If you’ve used GABA for this purpose or medications like Gabapentin or others to achieve similar results, I’d love to hear from you.

I’ll share more as I progress through the protocol. I’m also going to be speaking on SIBO SOS summit (the 3rd one) hosted by Dr. Allison Siebecker and Shivan Sarno. I will share more about my SIBO journey then, as well as all my results with this herbal protocol and any other challenges I face along the way.

Please also share if you’ve had success with any of the above herbal protocols or other approaches for your SIBO.

And feel free to post any questions below.

Fecal microbiota transplants and helminth therapy on the SIBO SOS Summit

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Mark Davis covers fecal microbiota transplants and helminth therapy on the SIBO SOS Summit part II. The title of his interview is: No Holds Bar Conversation About Fecal Transplants (yup, we go there) From a Fearless Expert. You will discover:

  • How Helminth therapy benefits autoimmune conditions & allergies
  • Fecal Matter/ microbiota Transplants: The shocking treatment with incredible results
  • New options for treating C Diff
  • Why not all parasites are bad! Parasite, commensal, and mutualistic organisms explained

This is what Mark has to share about helminths (microscopic worm-like organisms) and SIBO

My understanding of Dr. Pimentel’s hypothesis is that SIBO is really autoimmune enteritis. It’s your own body’s immune system launching antibodies either against cytolethal distending toxin B (CDT) or against vinculin in the gut. That’s an autoimmune process.

What these microscopic worm-like organisms, helminths, do for us is they invoke a robust T-regulatory cell response. T-regs are responsible for telling the rest of the immune system when to calm down.

If you’ve ever looked at the great book, Epidemic of Absence, the premise of the book is how absence of exposure to microbes, including helminths—your ancestors were exposed to them over and over again—absence to all that might be causing an epidemic of allergic and autoimmune disease today.

He also shares that his favorite helminth is one called Necator Americanus.

That’s the new world human hookworm. I have about 30 of them living in my gut right now. I’ve worked with dozens of patients using these.

Mark also shares what fecal microbiota transplantation is and how it is delivered:

taking the microorganisms that are alive in stool, which you have tens of trillions of them in and on you right now, and it is filtering and processing those in a way to isolate the important parts, as much as you can, and then delivering those to the gastrointestinal tract of somebody with a dysbiotic gut flora. That can be via capsule or upper endoscopy or via lower endoscopy or enema. Those are the most common ways to deliver it.

He goes on to share how effective a FMT is for a C. diff infection (when nothing else works, the FDA rulings about it only being allowed for C. diff or as part of a study, and how he is guiding his ulcerative colitis and Crohn’s disease patients through a DIY version.

I love this comment from Mark when we he is asked about the ick factor of working with poop:

It doesn’t feel like I’m processing poop. It feels like I’m mixing up a magic brew to help my patients.  

Here is some background on Mark Davis, ND: He practices at the IBD Specialty Center in Silver Spring, Maryland, and once per quarter at Bright Medicine Clinic in Portland, Oregon. He specializes in natural gastroenterology, especially the care of adults and children with inflammatory bowel disease. He is one of the few clinicians in North America with significant clinical experience using fecal microbiota transplantation (or FMT) as a therapeutic intervention, and has written and lectured extensively about FMT and helminthic therapy. He sits on the board of directors of the Fecal Transplant Foundation, and serves on the editorial board of the Natural Medicine Journal.

Mark is one of the speakers on the SIBO SOS Summit Part II. SIBO (Small Intestinal Bacterial Overgrowth) is a leading cause of IBS (irritable bowel syndrome). The most common SIBO symptoms are digestive issues, pain and bloating, and there are many other complications such as leaky gut and yeast overgrowth that make it difficult to diagnose and treat SIBO. Anxiety, depression and insomnia are common symptoms too.

FMT is not actually for used for treating small intestinal bacterial overgrowth (SIBO) and Mark shares this caution for about 5% of SIBO sufferers:

When you’re delivering [FMT] via capsules or upper endoscopy, some or all of them may end up in the small bowel. Ninety-five percent or more of the time, that ends up not being a problem, but if people already have impaired motility in the small bowel or an existing autoimmune process, or an existing small intestinal bacterial overgrowth (SIBO), that can compound the problem.

Part II of the SIBO SOS is all new interviews and is a great resource. Here are just a few of the guests and topics:

  • Dr. Allison Siebecker, Shivan Sarna, and Kristy Regan—Delicious Nutrient Rich Foods to Eat Even When You Have SIBO
  • Susanne Breen—When a SIBO Patient is Also a SIBO Doctor: The Obstacles and Strategies That Work For Her and Her Patients.
  • Dr. Megan Taylor: Been There, Done That! Help For Patients From a Doctor With Chronic SIBO
  • Dr. Norm Robillard—Choosing Diet Over Drugs
  • Angela Privin—How a Gut Health Coach Cured Herself of IBS After One Year of Paleo Done Right
  • Whitney Hayes—The Art and Science of SIBO Treatment
  • Jason Wysocki—The Importance of Neurology on GI Health and SIBO

You can register for the SIBO SOS Summit Part II here (it runs from Oct 21 to Oct 29)

How GABA eases agonizing rectal pain and spasms in under 2 minutes

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Proctalgia fugax is described as a condition that leads to rectal spasms and sharp fleeting pain in the lower rectum or anus. In some people it can be more than fleeting and is often described as excruciating and agonizing.  

This paper describing proctalgia fugax shares how this pain can

recur over weeks, is localized to the anus or lower rectum, and can last from seconds to several minutes with no pain between episodes. There is no diurnal variation. There are numerous precipitants [preceding factors] including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger.

Although the cause of proctalgia fugax is unclear, spasm of the anal sphincter is commonly implicated. The condition may be more likely to occur after sclerotherapy for hemorrhoids and vaginal hysterectomy. There are also associations with other functional pathologies, such as irritable bowel syndrome and anxiety.

My story

I have experienced this awful anal sphincter spasm and pain myself so I want to shine some light on this condition and offer the simplest and most effective solution: oral and sublingual GABA. It works to completely eliminate the pain in 1-2 minutes! And it can also be used to prevent a full-on spasm if you catch it in advance. More about this below.

Let me first share my story so you can relate to the pain. I started to experience this a few years ago. It was right after my aunt died from rectal cancer and my immediate thought was that I was dying of cancer. That’s how bad the pain was. It’s like nothing I’ve ever experienced and I’ve had some pretty bad pain experiences: shingles, a tick bite headache, ice-pick headaches from a neck injury and poking my eye on a tree-branch while hiking.

For me, since it initially used to happen during the night, it felt like I was in bad dream and was lying somewhere injured and in agony. I would half wake-up moaning in pain, not quite grasping how the pain I was feeling could be so bad. Then I would come fully awake and feel the need to bear down (as in needing to have a bowel movement) but this would actually make it worse.

How do others describe the pain?

When I shared this paper on facebook one woman said her rectal pain and spasms last 20-30 minutes and is bad a childbirth.

Someone else shared that her husband “complained of feeling like a knitting needle was being driven through his anus.”

What do I think my triggers are?

I have not had sclerotherapy for hemorrhoids or a vaginal hysterectomy. I do have a history of anxiety and panic attacks (in my late 30s) and do have IBS/SIBO right now and I suspect that both low GABA and IBS/SIBO are my biggest root causes. I no longer have any anxiety but since I respond so well to GABA I assume my GABA levels are not optimal (likely due to the SIBO). I suspect exposure to hidden sources of gluten could also be a factor, and this could also affect my GABA levels.

Medications or heating pads as a solution?

I didn’t ever consider the conventional approaches which include: botox, benzodiazepines, SSRIs, Gabapentin, lidocaine, oral diltiazem, topical glyceryl nitrate, nerve blocks or salbutamol.

A warm bath has been reported to help but I was looking for a 1-2 minute fix (and less if possible). Once you’ve experienced this pain you’ll understand that you not imagine running a bath in the midst of a spasm and waiting to get in it.

Heating pads do also work but can take 20 minutes to take effect and that is simply too long for most people.

The first solution for in-the-moment relief (takes 2 to 12 minutes)

After the first episode I started searching online and because I didn’t know it was called proctalgia fugax I searched for “rectal cramp”, “rectal spasm”, “anal cramp” and came across forums with hundreds of women asking about it and describing their pain.

But no-one really had a solution and many had seen their doctors without much success. The best solution that many people use is 30-60 seconds of finger pressure (with the finger wrapped in toilet paper) in the anal sphincter during a spasm. Sometimes this is needed for up to 2-3 mins and sometimes doing this 2 or 3 times a few minutes apart is needed. Think about how you put pressure on a calf muscle spasm to stop the cramps. This works well but the agony can last for the entire 2 to 12 minutes (depending on how many times it has to be done).  Adding a small amount of arnica cream onto the toilet paper seems to helps too.  

How common is it?

It took more searching and reading and then I discovered what it was called. Once I found a name for it and started looking into I was surprised to see how common it is:

The prevalence of proctalgia fugax in the general population may be as high as 8%–18%. Many patients present to primary health care physicians and often do not require further consultation because the symptoms are fleeting. This condition is more common among women than among men, and usually affects patients between 30 and 60 years of age.

Although it’s more common among women I worked with a male client who experienced this. During one of his episodes, the pain was SO bad he actually passed out and hit his head on the bathroom floor.

The best solution for almost-immediate relief (takes 1 minute)

I know that GABA works amazing well for physical anxiety and stiff and tense muscles and I decided to try GABA in the midst of a spasm. It worked amazingly well and within 1 minute the terrible pain started to ease. It does need to be taken sublingually and I have found that 250mg to 500mg opened onto my tongue works best for me.

Each person would need to find the ideal amount for their needs but at night this should be a reasonable amount. During the day this could be too much and make you sleepy or too relaxed.

I’ve also used a combination of sublingual GABA and theanine with similar results.

I know GABA isn’t readily available everywhere so I did an experiment with taurine and found I needed more (at least 1000 mg) and it did take longer (2-3 minutes) to get relief, but it did work.

THE immediate solution for preventing the spasm

But I have now gotten to the point where I can nip it in the bud and prevent the spasm altogether – by taking sublingual GABA at the very first hint of an ache or twinge. I’ve been fortunate that when this does happen (about once a month and sometimes every 2 months) it’s around 8-11pm.

The long-term solutions for getting to the root cause/s?

We always want to get to the root cause of an issue and that is the next step. I reached out to the practitioners in my community to ask them how they help their clients and patients with this and what approaches they have used to end the spasm and pain. I will be sharing some of their solutions and how to get to some of the root causes in part 2.

UPDATE: Here is part 2 – How to address rectal spasms with GABA, pelvic floor work, gluten removal and squats

I’d love your feedback!

I’d love your feedback so I can learn what works, so we can all learn from each other and so others get answers quicker than I did.

Have you ever experienced this rectal pain and spasms? And what has worked for you?

I’d love to know if it is more common after sclerotherapy for hemorrhoids and vaginal hysterectomy? Have you had either? Or any surgery in the abdominal area?

Do you also have IBS/SIBO?  What about celiac disease or gluten sensitivity?

Do you currently have anxiety or mood issues or have a history of anxiety or mood issues?  How many low GABA and low serotonin symptoms do you have – here is the questionnaire  (a paper from 1965 mentions that patients with proctalgia fugax have been described as irritable, perfectionistic, meticulous, obsessional, tense, and anxious)

If you’ve tried GABA or these other approaches (or decide to try them) please come back and share.  Too many people don’t know about this and it needs to change!

Dr. Allison Siebecker’s treatment approach: SIBO SOS Summit

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The SIBO SOS Summit starts today June 24th and runs to June 28th.

SIBO (Small Intestine Bacterial Overgrowth) is the #1 leading cause of IBS and other digestive problems and can cause bloating, chronic constipation or diarrhea (or both!!), anxiety, depression, pain and a host of other symptoms.

Shivan Sarna and co-host Dr. Allison Siebecker (a SIBO expert and hero of mine), are bringing some of the foremost experts in the country together to discuss this potentially life altering disease. Over 5 full days of expert interviews Shivan will take a deep dive into the causes, treatment options and expert opinions on everything from diet, to medication you need to know about to regain your optimal health and how to beat SIBO (even if you didn’t know you had it!)

You’ll also meet a host of patients who have lived with SIBO and have learned how to heal themselves… their passionate stories will give you the hope you need.

In her SIBO treatment interview Dr. Siebecker shares the following:

There’s several layers that we can aim our treatments at. I would say the top layer is the symptoms. And of course we want to get somebody feeling symptomatically better as soon as we can. And this is in regards to SIBO, it could apply to other diseases but specifically SIBO. The next layer down would be the bacteria. That’s the actual SIBO, the accumulation of bacteria in the small intestine aiming at eliminating those bacteria. And then the bottom layer would be the underlying cause of the SIBO. And that’s really where most of us probably want to focus our treatment because if we can get rid of the underlying cause well then we can get rid of SIBO and we can cure it, but that isn’t so easy.

I love these 2 tips she shares for the painful bloating:

something that helps a lot is charcoal, activated charcoal because it actually absorbs… gas into its little pockets and chambers inside the charcoal. That can really help people, especially if you’re having pain from the bloating that can really help.

Another thing is you can lie face down on your stomach and it puts the anatomy in a position where it can allow gas to be burped out and you can get some relief that way.

I’ve used the latter face down position but didn’t know about the charcoal tip, which is why I love these summits – I always learn something new!

Dr. Siebecker goes on to share in detail about

  • pharmaceutical antibiotics
  • herbal antibiotics (you would need to add in the allicin/Alimed if you had constipation type of SIBO or high methane)
  • prokinetics like triphala, MotilPro and Iberogast (and some pharmaceutical prokinetics) to assist motility
  • the elemental diet
  • visceral manipulation, massage and acupuncture

She ends with how important stress reduction is and that’s where my work comes in!

I hope you can join us. You can register for SIBO SOS here

Anxiety is a common symptom of IBS/SIBO: breath and antibody testing at MINDD 2017

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I attended Dr. Nirala Jacobi’s presentation on at MINDD 2017 practitioner training and here are some highlights from her presentation on SIBO (small intestine bacterial overgrowth) which is the leading cause of IBS and a major cause of leaky gut syndrome. It is the presence of an overgrowth of beneficial bacteria in the small intestine i.e. good bacteria in the wrong place.

She shares that:

Bacterial overgrowth has also been implicated in a host of other conditions such as developmental delay, fibromyalgia, interstitial cystitis, malabsorption syndromes and many more [such as anxiety and depression and even insomnia]. SIBO requires a methodical approach to testing and treatment in order to successfully re-establish a healthy digestive tract.

And some of the typical symptoms SIBO patients experience:

I was not familiar with all these prior surgical procedures being a possible cause but this makes sense. I’ve added gastric bypass, appendix removal, endometrial surgeries, C-section and gallbladder removal (cholecystectomy) to my SIBO questionnaire.

Other possible causes include certain medications, stress and anxiety (which affects how much HCl or stomach acid you produce and gut motility) and overconsumption of simple carbohydrates.

Going back to the #1 possible cause i.e. post-infectious due to a stomach bug, the gastroenteritis and autoimmunity connection was presented. Bacteria which cause food poisoning produce a toxin called CdtB which is similar to human vinculin which is important for nerve function.

Due to the similarity between CdtB and vinculin, the body produces anti-vinculin and anti- CdtB antibodies which lead to an auto-immune attack on the enteric nervous system. This causes damage to the MMC/migrating motor complex and contributes to SIBO.

A press release from Cedars-Sinai and Dr. Pimental: Definitive Tests for Irritable Bowel Syndrome Developed at Cedars-Sinai announce the multicenter study validating the accuracy of the new blood tests:

Dr. Pimentel and fellow researchers studied nearly 3,000 people, comparing IBS patients to those diagnosed with inflammatory bowel disease, celiac disease and those with no GI disease. The blood tests identified the two antibodies associated with IBS – anti-Cdtb and anti-vinculin – with greater than 90 percent certainty.

The tests are marketed under the name IBSchek™ and are produced by Commonwealth Laboratories Inc., in Salem, Massachusetts.

This paper reports this autoimmunity connection: Autoimmunity Links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes Following Campylobacter jejuni Infection in a Rat Model and this paper discusses the two tests: Development and Validation of a Biomarker for Diarrhea-Predominant Irritable Bowel Syndrome in Human Subjects

These blood tests are available in the USA but are not yet available in Australia where Dr. Nirala Jacobi now lives and practices.

Dr. Nirala Jacobi, BHSc, ND (USA) graduated from Bastyr University in 1998 with a doctorate in naturopathic medicine. She practiced as a primary care physician in Montana for 7 years before arriving in Australia. Nirala is considered one of Australia’s leading experts in the natural treatment of small intestine bacterial overgrowth (SIBO), a common cause of IBS. In 2014, she designed the SIBO Bi-Phasic Diet to aid practitioners in simplifying their treatment approach with their SIBO patients. She is the Chief Medical Officer and Director of SIBOtest.com, an online breath testing service and educational portal for practitioners. She frequently lectures to national and international professional audiences on the topic of SIBO and founded the first Australian SIBO Summit in 2016 Nirala has had a busy private practice in Brisbane since 2008 and recently moved her clinic to Wilsons Creek in the beautiful northern rivers region of NSW, Australia.

For SIBO breath testing services in all countries check out the testing page on Dr. Siebecker’s SIBOinfo site

Keep in mind that most SIBO studies are on IBS. According to Dr. Siebecker

Drs. Pimentel and Lin originated the theory that SIBO is the underlying cause of IBS.  As with all theories, there is debate and controversy about this idea, with many who agree and many who do not.  One thing is certainly clear, the symptoms of SIBO overlap with those of IBS and a large percentage of IBS sufferers test positive for SIBO.  One study by Dr Pimentel and team, showed SIBO in up to 84% of IBS patients, though the percentage has been lower in other studies, with an average of 60%.

Here is the most recent study showing the mental health effects of IBS (which we could presumably extrapolate to SIBO and confirm with the testing discussed above) – Neuroendocrine Dysregulation in Irritable Bowel Syndrome Patients: A Pilot Study

Irritable bowel syndrome (IBS) is a multifactorial disorder, involving dysregulation of brain-gut axis

Prevalent psychological symptoms in IBS were maladjustment (60%), trait (40%) and state (17%) anxiety, obsessive compulsive-disorders (23%), and depressive symptoms (23%).

If you are not getting anxiety symptom resolution with dietary changes, the use of targeted individual amino acid, adrenal support, addressing dysbiosis and other biochemical approaches it’s time to work with a practitioner to rule out or address SIBO as a causal factor.