SIBO. That acronym strikes fear into my heart. It stands for Small Intestine Bacterial Overgrowth. SIBO happens when bacteria (and sometimes yeast & fungi too) that would not normally be in the small intestine show up there and throw a giant party. According to Dr. Allison Siebecker, "Simply put, Small Intestine Bacterial Overgrowth is a chronic bacterial infection of the small intestine. The infection is of bacteria that normally live in the gastrointestinal tract but have abnormally overgrown in a location not meant for so many bacteria." (You can go to Dr. Siebecker's SIBO website here, to get all the in-depth details behind everything mentioned in the post.)
There are lots of theories on how and why these bacteria show up in the wrong place, in the wrong numbers. One is that decreased gastric acid leaves foods not well digested before they reach certain points in the digestive tract, which gives the bacteria something to feed on. Another is that motility (muscular activity) of the small intestine decreases, making it hard for the small intestine to do one of its jobs . . . sweeping bacteria into the colon. Soooo, guess who is especially at increased risk for SIBO infections? Yep. Peeps with digestive system diseases. Celiacs (lucky me), those with Crohn's, those with Chronic Pancreatitis, etc. Another group that has a greater risk are those with diseases that can affect the muscles or nerves that operate the digestive tract, like Diabetes or Scleroderma.
The reason SIBO is so serious is that it messes up normal digestion and absorption of nutrients while it is busy damaging your small intestine lining. That damage leads to or exacerbates intestinal permeability (leaky gut). And once you can't get proper nutrients from your food and you're leaking bacteria and food particles into other parts of your body, you've got LOADS of new issues to tackle. Here's the other thing, SIBO is painful. Really painful. Symptoms can vary, but there is generally extreme bloating, constipation, and cramping.
Now the bad news. I have a SIBO infection again. (Come on! Universe! What the bleepy-bleep-bleeped do you want from me?) I have recently undergone a whole series of tests as part of my one year post diagnosis follow-up for Celiac Disease. My GI doc practices some pretty serious functional medicine (lucky me), so he tested the heck out of me (not lucky me). He wanted to know what was up with my old frenemy, so he ordered a SIBO test.
There are three kinds of breath tests used to detect potential SIBO. Last year, around this time, I did the Lactulose Breath Test. You drink a sugary drink that the bacteria respond to and use to begin creating hydrogen and methane gases. These gases are measured over three hours while you basically blow them out of your mouth into a tube. Last year, when I got positive results, I took a course of an antibiotic called Metronidazol. Metronidazol is Awful with a capital A. Each dose would give me a headache and reduced me into a blubbering emotional wreck. This was a very noticeable reaction, because at the time I had just begun AIP and one my first huge improvements was mood stability. My husband coaxed me through the full course, but even he was shocked at how extreme the antibiotic was on my emotional state.
SIBO is very difficult to treat and people often have chronic infections. I was luckily eating AIP and adapting to the Paleo lifestyle, so one course of the antibiotics worked. I had no symptoms of SIBO until very recently. So what changed? Why did my SIBO return?
My theory is that it was a combination of things. First, I take a pancreatic enzyme to help aid digestion. It is a prescription enzyme and I ran out. I called my primary care doc for a refill. The request wasn't answered. I called again. I finally spoke to her nurse, but then there was apparently a series of extrodinary miscommunications and the doc's office became completely incapable of indentifying what pharmacy I use (same one the whole time I've been your patient, duh) and the pharmacy became completely incapable of identifying me (What do they need beyond my name, DOB, and address? Do these people need a flipping DNA sample?). The result? No enzymes for well over a month. At the same time, I was, probably unwisely, trying to cut back on my use of apple cider vinegar to aid stomach acid, in an effort to understand if my own acid production was normalizing. My digestion practically ground to a halt. Dang.
Second, I seriously think the sugary little drink I took on the day I did my repeat Lactulose Breath Test is what put the whole thing over the top. That day the bloating returned. I also followed the breath test with a camera endoscopy. For those not familiar, it means swallowing a gigantic capsule with a tiny battery and camera in it, which transmits pictures of the full length of the GI tract back to a recorder which your doc can use to help evaluate you. Totally. Freaked. Me. Out. I think it freaked my system out too. I have autoimmune troubs, so any foreign objection is bound to send my body into "total annihilation" mode. Double dang.
What to do now? I think there are three ways to approach treating SIBO. A) Give up. Putting on a pair of terrible ugly elastic waisted pants that accomodate the bloating and then sitting in my closet while drinking wine, crying, and composing hate mail to the universe (Dear Dirtbag . . . ) with a tiny flashlight, seems tempting. B) I can take another course of antibiotics combined with the strictest adherence to AIP and hope that it clears up as quickly as it did last time. C) I can tell my doc that it will be a cold day in hell before I take those nasty antibiotics again. To which he will reply, "Okay, then I'd like you to take this blend of botanical extracts that act as antimicrobials and follow a low FODMAP diet." And I'll go, "For real? You had another approach for people that don't like poisoning themselves? Aaaawesome."
Obviously, I chose option C. I am taking the botanical blend my GI doc recommends, I am going low FODMAP (avoiding complex sugars will help starve the bacteria) in addition to retreating back to very strict AIP, and I am getting back on enzymes and ACV. I am also incorporating lots more bone broth and kraut, but I am laying off probiotic supplements, as they can sometimes make SIBO worse. I'm also doing yoga for digestion, to help the muscular activity of my intestine pick up. Last but not least, I am trying limited use of oil of oregano. I say limited, because it is really powerful stuff and the die-off reaction is pretty intense. In fact, Chris Kresser recommends people not use it without a professional's guidance. My first exposure resulted in all over aches, pains, and increased anxiety. I had to take a serious detox bath to calm everything down, so I tend to think he is right.
Am I a little depressed to be reaching my one year Paleo-versary and having to get even more strict to deal with an old adversary? Yes. I'm telling true stories here, so it would be a lie to say no. However, there's a part of me that is celebrating anyway. I know so, so much more than I did a year ago. I already know what SIBO is, I know that there are alternative ways to treat it, I know I could further adjust my diet to beat it, and I know how to tell the doctors what I will and will not do to my own body. Most importantly, I KNOW I am capable of healing myself. I believe my body was designed to fight and knows just what to do if I will aid it in battle. That's not depressing. That's miraculous.