SIBO stands for Small Intestine Bacterial Overgrowth. It occurs when too many bacteria colonize the small intestine. The majority of the bacteria in the GI tract should reside in the colon, where they help to ferment and break down foods. If the small intestine becomes overrun with bacteria, fermentation takes place there and gas, bloating, abdominal pain, constipation and diarrhea can occur, along with decreased nutrient absorption.
The underlying causes can vary. I’ll discuss them more in a future blog post.
But first, here’s my story. (I apologize in advance that I’m not going to give explanations of everything in this article, it’s just meant to be an overview.)
Growing up, my digestion was pretty impeccable. I had a bowel movement every morning like clockwork and rarely suffered from a stomach bug.
Then about four years ago in 2011, everything changed.
I began to have extreme gas and bloating after eating. I alternated between constipation and loose stools, but mostly constipation. My formerly flat(ish) stomach now always looked like I was full of air, even first thing in the morning.
I tried digestive enzymes, betaine HCL, and several different brands of probiotics. Some of the products helped, but they seemed to decrease in effectiveness over time.
Within the past six months, I developed abdominal pain after eating and the bloating got even worse.
I cut out gluten completely. I had been avoiding it for the past few years because I didn’t tolerate it well but I cheated on the weekends. Now it was out of my life completely. I added bitters to my meals and drank apple cider vinegar to stimulate acid production. I made sure to chew my food thoroughly and not drink water when eating, so as not to dilute my stomach acid. These tricks provided minor relief.
After A LOT of online searching, I finally came across SIBO. I knew, deep down in my gut (ha) that this was the problem I had. I went to a GI doc and first she tested me for Celiac disease (I had to eat gluten during this time- not fun!). It came back negative. She also tested me for enzyme production (normal) and H. Pylori infection (negative).
Finally she ordered a SIBO breath test.
Never in my life have I been so ecstatic to see a positive test result. I had high levels of hydrogen and my methane levels went up as well.
That was April 28, 2015.
When you are searching for years to understand the underlying cause for your health issues, any sort of diagnosis can seem a blessing in disguise. At least now I had some direction.
I was nervous to jump right into antibiotics, so after much more research I began a low FODMAP/SIBO diet and started the 4 week herbal antibiotic protocol used in this John Hopkins study, which showed that the herbal treatment was just as effective as the antibiotic Rifaximin. I used the Metagenics Candibactin AR and Candibactin BR protocol.
I finished the herbal protocol on June 8, 2015. No better, no worse.
Discouraged, I went back to the research on the antibiotics. I found that Rifaximin was considered a relatively safe antibiotic, as it’s not known to be absorbed systemically or contribute to antibiotic resistance. I also learned that for constipation-predominant SIBO, like I had, a combination of Rifaximin and Neomycin was more effective than either antibiotic alone.
I spoke with my GI doc again and she only wanted to give me Rifaxamin (more on her incompetence in another post). I trusted her (a mistake) and started the antibiotics with hope that I would finally get some relief.
I read on a lot of forums that many people began to feel better within a few days of starting to the antibiotics. For me…14 days later, nothing.
Along the way, I did find a few things that helped give me relief from the bloating.
But I don’t want to have to rely on these products for the rest of my life. A modified diet I can handle, but always having to have pills or products timed right whenever I want to eat anything is not a nice way to live.
I was discouraged and felt hopeless yet again.
Aside from the discomfort and pain of being bloated all the time, I felt fat and not sexy. My libido was below sea level and even when I did want to get intimate many times my stomach issues prevented me. I also have begun to feel what may be nutrient depletion effects from the bacteria absorbing the foods I eat. Also, the gases produced by the bacteria are likely contributing to my extreme brain fog and low energy levels, and inability to lose weight despite eating a very low calorie diet.
I went back to my GI and she prescribed me a “wonderful” medication for constipation. I fired her. I don’t want to treat the symptoms with medication. I can take herbal senna for my constipation. I want to find out what is the underlying cause of my SIBO and how do I address it? Is it lack of GI motility due to poor thyroid function? (I have low T3.) Is it an autoimmune condition? (In the past I had elevated markers for scleroderma.) Is there a structural defect that needs to be addressed? Are pathogenic bacteria or parasites an issue? What is going on??
I saw a second GI doc, who didn’t even think I had SIBO while looking directly at my labs results. What?
I’m sort of at a loss of what I should do next. Try antibiotics again with both Rifaximin and Neomycin? Insist I get a prokinetic drug? Try an elemental diet? Pay thousands of dollars to go see a SIBO expert? Try a different round of herbal antibiotics?
At the end of January, I have an appointment with Dr. Ruscio, who is an expert in gastrointestinal issues and stays current on the latest science. He’s out of network and I’ll be paying out of pocket for it all, but maybe he can help get this figured out.
Interestingly, things have actually been a lot better lately. Maybe due to this.
Anyway, my hope is that by sharing my story, I’m able to help others going through this same condition and having the same questions.
Update on my new doc and treatment plan 2/29/16
Latest update on the completion of that treatment. 6/7/16