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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.

SIBO / Small Intestinal Bacterial Overgrowth Questionnaire

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sibo-bacterial-overgrowth

During season 3 of The Anxiety Summit, I interviewed Dr. Allison Siebecker on Small Intestinal Bacterial Overgrowth and Anxiety.

I talked about the SIBO Questionnaire I use with my clients and said I’d share it (with her permission).

There is a real SIBO-anxiety connection. I wrote about this in my book the The Antianxiety Food Solution.

Studies have found that people with digestive complaints such IBS, food allergies and sensitivities, small intestinal bacterial overgrowth and ulcerative colitis frequently suffer from anxiety and, to a lesser extent, depression (Addolorato, Mirijello, D’Angelo, Leggio, Ferrulli, Abenavoli, et al. 2008).

One study (Lydiard 2001) found that 50 to 90 percent of people with IBS who visited a doctor for treatment also suffered from various anxiety disorders (panic disorder, generalized anxiety disorder, social phobia, and post-traumatic stress disorder) and major depression.

I have all my clients who have any digestive issue (which is most of them), do the SIBO questionnaire and then talk to their doctor about doing the SIBO breath test/ hydrogen breath test or SIBO test. Genova offers this or you can ask your conventional doctor to order this.

Keep in mind that this is just one questionnaire/test of many that can be used to try and figure out the root cause of your anxiety. (I write about this and other questionnaires/testing here: Nutritional testing for figuring out the root cause/s of your anxiety.)

SIBO Symptoms, Clues and Associated Conditions

The main symptoms of SIBO are those of Irritable Bowel Syndrome (IBS).  SIBO has been shown to exist in up to 84% of IBS patients and is therefore theorized to be the underlying cause.  It is associated with many other disorders as well, as an underlying cause or as an after effect of the pre-existing disease.

In particular, if the symptoms of IBS are present, or one of the associated diseases along with digestive symptoms is present, consider SIBO.

According to Bures et al, “It is mandatory to consider SIBO in all cases of complex non-specific dyspeptic complaints (bloating, abdominal discomfort, diarrhea, abdominal pain), in motility disorders, anatomical abnormalities of the small bowel and in all malassimilation syndromes (malabsorption, maldigestion).”

Check off or highlight all that apply:

IBS Symptoms
Abdominal bloating (gas)
    – belching, flatulence
Abdominal pain, cramps
Constipation, Diarrhea, both

Other symptoms
Heartburn (Reflux or GERD)
Nausea

Leaky Gut Symptoms (Leaky Small Intestine)
Food Sensitivities
Headaches
Joint Pain
Fatigue
Skin symptoms (such as eczema or rashes)
Respiratory symptoms (such as asthma)
Mood symptoms (depression/anxiety/OCD)
Brain symptoms (such as in autism)

Malabsorption Symptoms
Steatorrhea (fatty stool – stool that floats)
Anemia (Iron or B12)

Associated Conditions– see SIBO Diseases for Study links
Acne Roseacea
Acromegaly (excess growth hormone)
Age: Elderly
Alcohol Consumption (moderate intake)
Anemia
Autism
Celiac Disease
Chronic Fatigue Syndrome
CLL (Chronic Lymphocytic Leukemia)
Cystic Fibrosis
Diabetes
Diverticulitis
Erosive Esophagitis
Fibromyalgia
GERD (Gastroesophageal Reflux Disease)
H pylori Infection
Hyprochlorhydria/low HCl
Hypothyroid/ Hashimoto’s Thyroiditis
IBD (Inflammatory Bowel Disease)
    -Crohn’s
    -Ulcerative Colitis
IBS (Irritable Bowel Syndrome)
Interstitial Cystitis
Lactose Intolerance
Leaky Gut
Liver cirrhosis
Lyme
Muscular Dystrophy (myotonic Type 1)
NASH/NAFLD (non-alcoholic: steatohepatitis/fatty liver disease)
Obesity
Pancreatitis
Parasites
Parkinson’s
Prostatitis (chronic)
Restless Leg Syndrome
Rheumatoid Arthritis
Scleroderma
Surgery:  Post-Gastrectomy

The above list of SIBO symptoms has been adapted from the site of Dr Allison Siebecker and used with permission here on the blog. Please check out Dr. Siebecker’s site siboinfo.com for a wealth of information about SIBO.

Risk factors/other possible clues*: (* all the following added by Trudy Scott, based on what I see with clients)
C-section birth (yours)
Not breast-fed
Probiotics cause digestive distress
Prebiotics (such as inulin) cause digestive distress
Have seen some symptom relief after a course of antibiotics
Symptoms appeared after a bad bout of gastroenteritis
Low triglycerides
Digestive enzymes help
Markers of poor enzyme status on a stool test
Pyroluria (see the Pyroluria Questionnaire here)
Low niacinamide
Low ferritin
Low vitamin D
Carb intolerance
Fat intolerance
Markers of fat malabsorption on a stool test
Low fatty acid levels on a fatty acid test
Have done well on gluten-free diet
Have done well on GAPs/Paleo diets (no grains, no starchy vegetables, no legumes)
Carb/sugar craving/addiction
Other addictions
Low zinc
Low GABA
Low serotonin
Low endorphins
Low catecholamines
Blood sugar issues (for low GABA/serotonin/endorphins/catecholamines and low blood sugar see Amino Acid Questionnaire here)
Stressed
Eat on the run i.e. not sitting down
Low secretary IgA (stool or saliva)
Adrenal fatigue
Heavy metals/environmental toxins
Appendix has been removed (it stores bacteria needed for motility motor complex)

Other possible causal factors **:  (** added June 2017 after the MINDD 2017 practitioner conference, courtesy of the SIBO presentation by Dr. Nirala Jacobi ND) 

Medications:  Proton Pump Inhibitors, Opiates/pain meds, possibly calcium channel blockers
Endometrial surgeries, C-section, and/or gallbladder removal (cholecystectomy) and other pelvic surgeries (such as a hip replacement)

Testing: 

Positive SIBO breath test (methane, hydrogen and a 3rd gas that can’t yet be measured)

Positive anti-Cdtb and anti-vinculin antibodies indicating post-infectious cause (details here)

Also, here is a more recent blog post on this topic: MINDD 2017 practitioner conference, courtesy of the SIBO presentation by Dr. Nirala Jacobi ND 

 

The Anxiety Summit – Small Intestinal Bacterial Overgrowth and Anxiety

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Dr. Allison Siebecker ND, LAc, SIBO specialist, was interviewed on the Anxiety Summit by host of the Anxiety Summit, Trudy Scott, Food Mood Expert and Nutritionist, author of The Antianxiety Food Solution.

Small Intestinal Bacterial Overgrowth and Anxiety

  • An overview of SIBO/small intestinal bacterial overgrowth and recent research
  • The SIBO connection to IBS and anxiety/depression
  • Using a SIBO questionnaire and SIBO testing
  • SIBO treatment: medications, a herbal approach and diet
  • Gut motility and low serotonin

Here is the information on the 2015 SIBO Symposium, June 6–7, 2015.

Designed for the medical doctor, alternative medicine practitioner, and the public, the 2nd Annual SIBO Symposium features the nation’s leading experts on the topic to present an evidence-based educational program on managing small intestine bacterial overgrowth.
Here is the definition of SIBO from the SIBO Symposium site:
Small intestine bacterial overgrowth (SIBO) is a chronic bacterial colonization of the small intestine.  These bacteria normally live in the gastrointestinal tract, however, in SIBO they have overgrown in a location not meant for so many bacteria. The bacteria interfere with our normal digestion and absorption of food and are associated with damage to the lining or membrane of the small intestine. These mechanisms in turn lead to myriad other disorders—gastrointestinal, systemic, and neurological.

Dr Siebecker has this quote on her site www.siboinfo.com (which has a wealth of information)

According to Bures et al,

It is mandatory to consider SIBO in all cases of complex non-specific dyspeptic complaints (bloating, abdominal discomfort, diarrhea, abdominal pain), in motility disorders, anatomical abnormalities of the small bowel and in all malassimilation syndromes (malabsorption, maldigestion).

I said there were no studies linking SIBO and anxiety but there are many studies connecting SIBO and IBS, and there are many studies connecting IBS and anxiety/depression

However I wrote this in my book the  The Antianxiety Food Solution. (published in 2011)

Studies have found that people with digestive complaints such IBS, food allergies and sensitivities, small intestinal bacterial overgrowth and ulcerative colitis frequently suffer from anxiety and, to a lesser extent, depression (Addolorato, Mirijello, D’Angelo, Leggio, Ferrulli, Abenavoli, et al. 2008).

One study (Lydiard 2001) found that 50 to 90 percent of people with IBS who visited a doctor for treatment also suffered from various anxiety disorders (panic disorder, generalized anxiety disorder, social phobia, and post-traumatic stress disorder) and major depression.

Here is a list of the symptoms of SIBO

Here are some of the papers we mentioned:

Serotonin and Its Role in Colonic Function and in Gastrointestinal Disorders

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

You’ll find many more papers on Dr. Siebecker’s siboinfo.com research section

This is the book Dr Siebecker mentioned:  A New IBS Solution: Bacteria-The Missing Link in Treating Irritable Bowel Syndrome, written by Dr Mark Pimentel

mark pimentel IBS book

 

 

 

 

 

 

 

 

If you are not already registered for the Anxiety Summit you can get live access to the speakers of the day here: www.theAnxietySummit.com

Missed this interview or can’t listen live? Or want this and the other great interviews for your learning library? Purchase the MP3s or MP3s + transcripts and listen when it suits you.

You can find your purchasing options here: Anxiety Summit Season 1, Anxiety Summit Season 2, and Anxiety Summit Season 3.

SIBO Symposium 2015

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2015 SIBO Symposium, June 6–7, 2015

Designed for the medical doctor, alternative medicine practitioner, and the public, the 2nd Annual SIBO Symposium features the nation’s leading experts on the topic to present an evidence-based educational program on managing small intestine bacterial overgrowth.

Small intestine bacterial overgrowth (SIBO) is a chronic bacterial colonization of the small intestine.  These bacteria normally live in the gastrointestinal tract, however, in SIBO they have overgrown in a location not meant for so many bacteria. The bacteria interfere with our normal digestion and absorption of food and are associated with damage to the lining or membrane of the small intestine. These mechanisms in turn lead to myriad other disorders—gastrointestinal, systemic, and neurological.

Presenters

Mark Pimentel, MD

Gerard Mullin, MD

Allison Siebecker, ND, MSOM, LAc

Leonard Weinstock, MD

Lisa Shaver, ND, MSOM, LAc

Steven Sandberg-Lewis, ND

Melanie Keller, ND

Mona Morstein, ND

Ilana Gurevich, ND

I’m planning to attend and look forward to hearing from these experts.

I recently had the pleasure of interviewing Dr. Allison Siebecker on The Anxiety Summit and really look forward to learning more from her and meeting her in person.

You can register for the SIBO Symposium 2015 here