SIBO-IBS
People whose gut housekeeping-mechanism is not working properly and present with SIBO and vagus nerve imbalances
Number of cases
Mean age
Rate of success
Treatment duration
Most common symptom
Most common culprit
symptoms
Our intestinal system is designed to work in a specific way consisting of strong energy-consuming phases and long anabolic repairing phases. The former may be initiated consciously, that is every time we eat something. The latter ones, though, are autonomously regulated, mainly by several hormones but also by the central nervous system itself. Normally, the digestion process produces inflammation, dietary debris, changes in intestinal properties and in the same time, food borne bacteria and toxins must be eliminated adding up to the inflammation and the immune activation. This condition should be restricted only for a specific time during the day. Our intestine must be given enough time to repair its tissue, to resolve the inflammation and prepare itself for the next digestion process. Migration Motor Complex (MMC), is the neurological process, responsible for small intestine cleaning. When it’s not left do its tasks, IBS is inevitable.
Colin was 24 years old post graduate student, very popular with vivid social life. Not a smoker and social alcohol drinker. Many nights out per week and as a consequence always his last was meal after midnight and sleep around 02:00 or 03:00 a.m. The only diagnoses he had was Hashimoto’s hypothyroidism allergies.
In the beginning it was just burping after meals. Then bloating appeared. Then short acute pain in the gut. He visited many gastroenterologists, he removed his gallbladder he was even prescribed antidepressants … nothing worked.
Thyroid diseases, either hypo- or hyper- thyroidism affect the vagal regulation of small intestinal contractions
Constant histamine release modulates both gastric and small intestinal contractions
By eating every 3 hours, the cleaning machinery (MMC) does not have the time to exert its repairing activities
Bile acids are key regulators of Phase III MMC. The removal of the gallbladder produces different bile acid pools (not always) and thus compromizes proper intestinal motility
While the results did not indicated another antibiotic round, SIBO breath test was way too positive. In this regard, a milder antimicrobial treatment could not be avoided. In fact, methane levels at 30 and 60 minutes post provocation were off the limits. Upper endoscopy also revealed antritis, a very common finding in patients who have removed their gallbladder, activated eosinophils in his intestinal mucosa and an additional wealth of diagnostically useful findings.
Digestive residues
Fragments and residues of indigested food particles produce mixed movements of the gut giving rise to alternating defecation pattern
Elevated stool EPX/histamine
Both these substances mediate allergic reactions in the intestine and other organs
SIBO
Bacterial overgrowth of the small intestine interferes with proper absorption of nutrients and may produce gas
Probiotic sterility
Probiotic sterility leads to abnormal fermentation of starch, sugars and fiber. Bloating and gas are main symptoms
In cases like this, the treatment plan should cover the entire gastrointestinal system. Gastric phase, microbial overgrowth in the small intestine and large intestinal microbiome. Although it is a very difficult and possibly time-consuming process, in this case Colin was my ally. He grasped the gravity of his situation for a young man of 26 years. The treatment provided simultaneous antimicrobial activity for both small and large intestine. The exact treatment differs from person to person as it is dependant on the time since gallabladder removal, the extent of SIBO and the age of the patient. The golden rule is “the earlier the intervention, the better the results”.
… our appointment was done by phone because he was out of the city. He told me that although he had seen a significant improvement in his stool pattern -one or two times per day, nearly formed- he had also noticed an increase in his allergic symptoms. I explained to him that this was normal and something desirable. As the histamine producing bacteria die off they release histamine in large quantities. I also explained that this exacerbation of his allergies would be greatly reduced when he completed both antimicrobial treatments. He had managed to eat mostly before 9:00 pm and to take his breakfast after 10 am. Although this was a great accomplishment I urged him to take his dinner even earlier than that …
MMC is the link between the brainstem and the gut. It is like the neurological control panel of the gastric contraction between meals (interdigestive periods) and during fasting. As they are propagated by the vagus nerve itself, MMC contractions must be an ancient mechanism ensuring efficient cleansing after digestion and this is why it is often called the “bowel’s housekeeper”. While we sleep, MMC is naturally downregulated which means that fasting when we are awake is very important. No matter what the exact form of an IBS patient’s symptoms, fasting during treatment always brings better results.
- Habits and substances that inhibit Migration Motor Complex will always favor small intestinal bacterial overgrowth
- Allergies should always be considered as an MMC inhibitor and should be taken into account when assessing IBS
- Post meal symptoms, bloating and stress induced symptoms are the major complains, this kind of IBS patients report
- Vagus nerve plays an important role in the way patients experience and report their symptoms. It is also an obvious proof that IBS is a systemic disorder
- Lifestyle choices play a determining role in the complete remission. The sooner a patients gets his treatment, the better the prognosis
