# SIBO - Everybody is right and everybody is wrong!



## Linda Barber (Feb 28, 2013)

I read stuff on this site from time to time and I'm not sure why because I usually come away with information overload - some good advice and some not-so-good advice. So, I guess I might as well put my 2 cents worth in - EVERYBODY IS DIFFERENT! I try to find people with similar symptoms and who don't have too much advice! I have an alive and working bullshit detector. Here's my story:

I just started having terrible awful nausea that would last for several days maybe 4 years ago (I'm 60)where I literally stayed in the bed all day - nothing seemed to cut the nausea including the standard nausea drugs. I couldn't eat or drink and then in a day or two it would pass. This happened about every 3 weeks. I lost about 10-15 lbs. I was constipated a lot in between episodes and bloated no matter what I ate. No diarrhea. Went to Gastroenterologist who gave me an Indicans urine test. I know. This is not the 'gold standard' test for SIBO but frankly, the gold standard of the breath test isn't very 'gold' either or at least not 'shiny gold'. There are a lot of false positives and negatives. My gastro's thought is that since I've had colonoscopy and endoscopy and we've ruled out a lot of 'bad things' that the indicans is a fast test that documents I have too much bacteria. So that is the test he uses and it has worked so far. If my levels are high and usually I know just by my symptoms, he puts me on 550mg of Rifaximin three times a day and twice daily neomycin for 14 days. I usually get 6-8 months of no symptoms and then I get it again and then go back on antibiotics. I've never really tried too hard to watch my diet but this time I am trying to follow the Mark Pimental diet recommendations in his book (google him). I've taken probiotics and frankly, I couldn't tell a difference either way. So, that's what I'm doing and it is working for me fairly well but of course, like you, I wish I didn't have this stuff! But this is life and like my Mississippi Daddy said, "It ain't fair, darling,'" so I consider myself lucky just to be here! Good luck with your symptoms whatever they may be and don't forget to trust yourself!


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## Kathleen M. (Nov 16, 1999)

FWIW the breath test is common, but usually the "gold standard" for SIBO is the much rarer take a sample from inside the small intestine and culture it.

You get a pretty decent break from symptoms, some of our folks only get a week or three and that sometimes hardly makes the treatment worth it.

Probably worth trying Pimental's diet, not sure if you'd be a good candidate for low dose erythromycin (which is sometimes used to help keep things cleared out) since you get a pretty long period of feeling better.


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## IndianRopeTrick (Jul 25, 2013)

A while ago, my GI Doctor did not even consider doing a breath test for me because in his knowledge, SIBO is only a hypothesis. That is, there is no proof to show if SIBO is even a real medical condition to begin with. Is there any scientific evidence which demonstrates this or otherwise ?


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## tummyrumbles (Aug 14, 2005)

The proof is in the pudding. If a low-flatulogenic diet eases symptoms and speeds up bowel evacuation, that's all the proof you need.

A Systematic Review of Diagnostic Tests for Small Intestinal

Bacterial Overgrowth

http://www.gastro.ucsd.edu/fellowship/Documents/SmallBowel2.pdf

This study says more accurate testing is needed. Even the culture test is far from accurate with high readings suggesting stagnant loop, or blind loop, terms for volvulus - which is very serious colonic obstruction. Volvulus is believed to be caused from gas from too much high fibre.

The final paragraph says:

"Until better diagnostics are available, the most practical method to evaluate SIBO in studies at this time would be a test, treat, and outcome technique."

Use and abuse of hydrogen breath tests

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856094/

This study also refers to the limitations and pitfalls of testing and often erroneous conclusions.

I think the best approach is for everyone to just assume they have SIBO and go on a low starch, low fibre, low FODMAP diet. Don't bother with testing. That's what I've been doing since December and symptoms have improved a lot. Before then I relied solely on complete evacuation, which was very time consuming. It still takes a long time most days but if I stick to this diet properly it's a lot quicker. My main problem is willpower and cheating on the diet. Jaffles are my downfall.

I used to get nausea from constipation. The constipation itself can be caused by a gas, methane, which causes non-propagating contractions, which basically causes spasms that binds food up in the colon. The best diet is low-flatulogenic for a lot of us. You might not be able to absorb starch properly. Also excess gas from fibre and FODMAPs can exacerbate symptoms. I tend to eat a small amount of protein with well-cooked low FODMAP vegetables. I can usually tell now by the amount of gas I produce whether my evacuation the next day will be quicker or slower. It's the gas itself that might be causing IBS. I believe there's a good chance SIBO is IBS.

This starch site is my bible. I've printed out all these. It's amazing how much starch is in fried potato, breads, cereals like Rice Bubbles, Corn Flakes etc. All our favourite foods. You'll need tons of willpower.

http://nutritiondata.self.com/foods-000007000000000000000.html


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## Kathleen M. (Nov 16, 1999)

SIBO as a cause of IBS is a new way of looking at things.

SIBO was associated with more serious illnesses prior to the IBS thing

So does he not believe anyone ever has it, or that if you had it you would also have one of these things that makes you generally a lot sicker than people with IBS ever are?

http://www.ncbi.nlm.nih.gov/pubmed/25062877

http://www.ncbi.nlm.nih.gov/pubmed/22703785

http://www.ncbi.nlm.nih.gov/pubmed/23170161

http://www.ncbi.nlm.nih.gov/pubmed/4767766

http://www.ncbi.nlm.nih.gov/pubmed/4975350

http://www.ncbi.nlm.nih.gov/pubmed/23126582

For some examples of other SIBO causes.

The lit on SIBO in IBS from the main doc studying it.

http://www.ncbi.nlm.nih.gov/pubmed/?term=pimentel+rifaximin


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