SIBO test interpretation

New article from Drs. Siebecker and Sandberg-Lewis

Confused about how to interpret the results of breath tests?  Dr. Sandberg-Lewis and I recently published an article with pictures of many test examples and scenarios of interpretation.  See it here in the Jan NDNR edition online.

Note: The article was written before Dr. Pimentel presented his new methane level of 3ppm as positive at the SIBO Symposium (see below)

SIBO Symposium highlights

New info from the 2014 SIBO Symposium

For anyone who missed it — the 2014 SIBO Symposium webinar recordings are now available for purchase, either as individual classes or together as the whole. It was a fantastic event packed with info. Between webinar participation and in person, close to 600 people attended the symposium. We’re planning the next Symposium for 2015 (date to be determined).

Dr. Sandberg-Lewis and myself lecturing.

Dr. Pimentel lecturing in front a sold-out audience.

Here are some points of interest from the symposium (from the notes of Dr. Nirala Jacobi and myself):  

• SIBO is caused by something (obstruction, decreased motility/ICC damage, non-draining pockets…); don’t stop at SIBO treatment — find the cause
• Cdt B toxin from bacterial food poisoning, triggers autoimmunity to vinculin on ICC nerve cells, slowing motility — the cause of a majority of SIBO cases is autoimmune nerve damage
• Too much protein for dinner during the prep diet (a big steak) is contraindicated as it slows transit
• Hard-aged cheese, which is lactose free, is OK on the prep diet
• Methane of 3ppm at any place during the lactulose test is positive
• Flat lining of both hydrogen and methane on the test is indicative of hydrogen sulfide gas
• Rifaximin is bile-soluble but not water-soluble — it can penetrate the small intestine biofilm and then loses effect in the large intestine due to crystallization
• Neem potentiates other herbals
• .5mg Resolor (prucalopride) is a good starting dose for SIBO prevention in most — previous common starting dose was 1mg
• Leaky gut is only present in about half of SIBO patients and heals within one month of eradication — without supplements
• Leave 4-5 hours between meals on any SIBO Diet to allow MMCs — no snacking
• Clover honey has a 50:50 glucose to fructose ratio- according to breath testing, it absorbs normally in fructose malabsorbers

Questions? –See the webinar recording

New Youtube video

Great 6 minute video Interview with Dr. Pimentel on IBS and SIBO

New podcast interview

With Dr. Siebecker — I really enjoyed this one because hosts Darren and Diane asked me some different questions than I usually get and were wonderful to chat with:  Wellness Warrior Radio

Updated handout

“SIBO Symptomatic Relief Suggestions” has been updated to include a homemade electrolyte recipe

Update to website

Discussion of semi-elemental formula was removed since clinically these have not proven effective. (not to be confused with elemental formulas which have an excellent success rate)

New FODMAP book

Diet inventors Drs. Shepard and Gibson came out with an official book last year — The Complete Low-Fodmap Diet.  It contains both explanations and recipes.

Hot Off the Press — 2014 PubMed Articles on SIBO:

• Methanogens, Methane and Gastrointestinal Motility.
• Small intestinal bacterial overgrowth: what it is and what it is not.
• Irritable bowel syndrome and small intestinal bacterial overgrowth: Meaningful association or unnecessary hype.
• Prolonged orocecal transit time enhances serum bile acids through bacterial overgrowth, contributing factor to gallstone disease.
• Increasing duodenal intraepithelial lymphocytosis found at upper endoscopy: time trends and associations.
• In vitro activity of rifaximin against isolates from patients with small intestinal bacterial overgrowth.
• Relationship of cytokines, oxidative stress and GI motility with bacterial overgrowth in ulcerative colitis patients.
• SIBO in Gastroparesis: Sci-fi or Science Fact?
• Small intestinal bacterial overgrowth in gastroparesis.
• Role of small intestinal bacterial overgrowth in severe small intestinal damage in chronic non-steroidal anti-inflammatory drug users.
• The impact of alcohol consumption and cholecystectomy on small intestinal bacterial overgrowth.
• The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation.
• Ascorbic acid suppresses endotoxemia and NF-κB signaling cascade in alcoholic liver fibrosis in guinea pigs: a mechanistic approach.
• Pathological bacterial translocation in liver cirrhosis.

2014 FODMAPs Articles

• Dietary fructose intolerance, fructan intolerance and FODMAPs.
• A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro-cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients.
• Gut microbiota influences low fermentable substrate diet efficacy in children with irritable bowel syndrome.
• Role of dietary FODMAPs in IBS-related symptoms.
• Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI.
• A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.

Warmly,

Dr. Allison Siebecker, ND, LAc
siboinfo.com