Defiant Health Radio with Dr. William Davis
Defiant Health Radio with Dr. William Davis
SIBO: The Great Masquerader
If you have been following my discussions in this Defiant Health podcast or in my blog, DrDavisInfiniteHealth.com, or my Super Gut book, you know that I have been arguing that there is an epidemic of SIBO going on in the U.S., an epidemic involving every 1 in 2 people. It is an epidemic responsible for an astounding amount of health struggles.
The more we all come to understand small intestinal bacterial overgrowth, or SIBO, the more you have to appreciate all the varied ways this situation can show itself. First of all, for those of you unfamiliar, what is SIBO? SIBO refers to the situation in which modern people, due to exposure to multiple courses of antibiotics and other disruptive factors, have lost hundreds of beneficial bacterial species in our colons. These beneficial species were responsible for suppressing the proliferation of unhealthy microbial species, mostly fecal microbial species such as E. coli, Salmonella, and Citrobacter. The loss of beneficial microbes allows unhealthy fecal species to proliferate, then ascend up from the colon where they originated and into the 24-feet of small intestine. The small intestine is poorly-equipped to deal with this invasion of fecal microbes. The small intestine is, by design, permeable, since that is where the bulk of nutrients such as vitamins, minerals, and amino acids are absorbed. But trillions of fecal microbes in the small intestine, microbes that live for only a few hours, live and die and release their toxic components that can gain access to the bloodstream. One of the primary toxic components is called endotoxin. When endotoxin enters the bloodstream, that’s called “endotoxemia” and endotoxemia is now recognized to be the primary way in which gastrointestinal microbes are able to exert effects tin every organ of the body. It means that SIBO and thereby endotoxemia can be experienced as a wide variety of health problems and diseases.
So, in this episode of Defiant Health, let’s discuss whether this is a situation that applies to you or to someone close to you and what steps you can take to undo these harmful effects.
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Books:
Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose Weight
If you've been following my discussions in this Define Health podcast or in my blog, drdavisinvidenthealthcom, or my Super Gut Book, you know that I've been arguing that there's an epidemic of SIBO going on in the US, an epidemic involving every one and two people. It is an epidemic responsible for an astounding amount of health struggles. The more we all come to understand small intestinal bacterial overgrowth, or SIBO, the more you have to appreciate all the varied ways this situation can show itself. First of all, for those of you unfamiliar, what is SIBO? Sibo refers to the situation in which modern people, due to exposure to multiple course of antibiotics and other disruptive factors, have lost hundreds of beneficial bacterial species in our colons. These beneficial species were responsible for suppressing the proliferation of unhealthy microbial species, mostly fecal microbial species such as E coli, salmonella and citrobacter. The loss of beneficial microbes allows unhealthy fecal species to proliferate, then ascend up from the colon where they originated and into the 24 feet of small intestine. The small intestine is poorly equipped to deal with this invasion of fecal microbes. The small intestine is, by design, permeable, since that is where the bulk of nutrients such as vitamins, minerals and amino acids are absorbed. But trillions of fecal microbes in the small intestine microbes that live for only a few hours, live and die and release their toxic components that can gain access to the blood stream. One of the primary toxic components is called endotoxin. When endotoxin enters the blood stream, that's called endotoxemia. When endotoxemia is now recognized to be the primary way in which gastrointestinal microbes are able to exert effects in every organ of the body, it means that SIBO, and thereby endotoxemia, can be experienced as a wide variety of health problems and diseases. So in this episode of Defiant Health, let's discuss whether this is a situation that applies to you or to someone close to you, and what steps you can take to undo these harmful effects. Later in the podcast, let's talk about the fine health sponsors that include Paleo Valley, who provides fermented grass-fed beef sticks, bone broth, protein rich in collagen, organic super greens and low-carb super food bars and now 100% grass-fed and finished pastured meats. And Biodquest, who provides unique probiotics such as sugar shift to support healthy blood sugars, simple slumber to assist in obtaining healthy sleep and to buy an antidote to help you recover after a course in antibiotics probiotics crafted with the unique property of combining synergistic microbes.
Speaker 1:So many people are unaware that SIBO that is, small intestinal bacterial overgrowth. Recall that this means there's 24 feet of small intestine, stomach, duodenum, jejunum and ilium that are infested by microbes that are meant to be in the colon only, with sharply diminishing numbers as you ascend into the ilium, etc. So in SIBO, the entire length of small intestine 24 feet, is infested by trillions of microbes that should have stayed in the colon. These are fecal microbes with names like E coli, Campylobacter, citrobacter, salmonella and many others that don't belong there. These microbes themselves are very inflammatory when they contact the intestinal wall. But the small intestine, recall, is also very permeable because that's where you're supposed to be absorbing nutrients like fatty acids, amino acids, vitamins and minerals. But when microbes infest the small intestine, they live and die rapidly, right, those trillions of microbes only live for a few hours at a time, and when they die they shed their toxins into the lumen, into the intestine itself, and some of those toxins gain access into the bloodstream, so-called endotoxemia. And that's how SIBO, this process in the small intestine, can export its effects to all the other organs of the body, whether it's skin or the intestine itself brain, uterus, prostate, heart and just about all other organs.
Speaker 1:Now why do I say that 50% of the US population, or something in north of 150 million people have this. Well, the science is quite clear. Let's take the studies that ask this question In condition blank. What proportion of people test positive for SIBO? That's usually breath testing for hydrogen gas. That's the standard way to detect whether microbes living in the upper GI tract. It's all about timing. If you ingest something that microbes consume, let's say inulin, a prebiotic fiber, and you produce hydrogen gas, because only microbes produce hydrogen gas, but you don't. But if you measure sharp uptake in the quantity of hydrogen gas within the first 90 minutes after consumption of that inulin, it tells you that microbes are living in the upper GI tract, because it's 90 minutes is too soon for that inulin to have arrived in the colon where those microbes are supposed to be. So if you turn positive for hydrogen gas at, let's say, 30 minutes or 45 minutes, that is positive for microbes living in the small intestine.
Speaker 1:Well, if we take those conditions, let's just say obesity. So of the 110 or so million Americans who are obese, we know with good evidence that 50% would test positive. Well, that's about 55 million people right there. How about the people with fatty liver? Well, that's another about 130 million people, and about 50% test positive. That's another 60 or so million people. Now there's overlap, of course, obese people and fatty liver people, but there's also other conditions like irritable bowel syndrome. Of the 60 to 70 million people with irritable bowel syndrome in the US, about 40% it varies from study to study and the population being studied, but approximately 40% of those people test positive for SIBO. That's another 24 to 30 million or so people right Now. Add that up through other conditions like restless leg syndrome, fibromyalgia, type 2 diabetes, pre-diabetes, people with coronary disease, neurodegenerative disorders, autoimmune conditions. Add it up and you easily exceed accepting some redundancy, some overlap, we easily exceed over 150 million people with SIBO.
Speaker 1:Now what people often don't realize is that process is not confined to only the GI tract, the gas-contestinal tract. This process is able to export its effects to all other organs. Now this was first validated. It's been suspected for many decades, but it was finally validated by a Belgian research group in 2007, dr Patrice Canney, c-a-n-i, and has since been corroborated numerous times.
Speaker 1:And now we have a consumer device, a device you can purchase on your own, called the AIR device A-I-R-E, made by the Food Marble Company that I have no relationship with, by the way, but you can test yourself by taking something like Inulin. We typically take two teaspoons of Inulin, put it in your coffee and there's a dietary prep in the preceding 12 to 24 hours and then you get a baseline level by blowing into the AIR device. Then you consume that food, let's say coffee with two teaspoons of Inulin and then you test every 30 to 45 minutes for up to 90 minutes If there's a rise of four units. This device measures hydrogen gas on a 0 to 10 scale. Each unit of one or two corresponds to five parts per million hydrogen gas. If you did hydrogen gas testing in a clinic or lab, but on the 0 to 10 on the AIR device, if there's a rise of four or more units, that is 20 parts per million or more, that is a positive result. So let's say your baseline level is 1.2, you consume your coffee with Inulin and let's say at 45 minutes your value is 9.8. So more than four point rise is a positive test. You now know you have microbes living in the small intestine. If you test positive after 90 minutes, you can't tell if that's hydrogen gas being produced in, say, the ilium, the distal part of the small intestine, or whether it's the expected rise in H2 from colonic fermentation. So after 90 minutes you can't tell what's going on. You can still have SIBO, but you can't tell by this test.
Speaker 1:Now this is similar. This is in parallel to what happens in sepsis. So say you had a urinary tract infection in your bladder that then ascended into the ureters and into the kidneys. That's pylonephritis, that is a kidney infection. You get very sick. Now some people, when they get pylonephritis that is an infection of the kidneys Some of the bacteria can get into the bloodstream and that's sepsis, or urinary sepsis, with which you can get very, very sick.
Speaker 1:People sometimes go on ventilators. They lose control of their blood pressure, go into shock, so they're in very serious condition. In that situation the prevailing level of endotoxin endotoxemia goes up about 100 fold or more over normal. There's a normal low grade level of endotoxemia in everybody, but it goes up over 100 fold when you have sepsis. Now what we're talking about, that is endotoxemia from SIBO. It goes up typically only two to four fold, 200 to 400 percent. So not as bad as sepsis, but enough to have effects on all the organs of your body. So what kinds of effects can you expect If there's SIBO and thereby endotoxemia, high levels of endotoxin, bacterial endotoxin, floating around your bloodstream, around and around and around.
Speaker 1:What's the effect of endotoxin on the brain? Well, near term it can cause depression, especially depression that's poorly responsive to conventional therapies. So this question has been asked numerous times. There are people who respond to the serotonin reuptake inhibitors, the SSRIs. There are people who don't respond. What makes the people who don't respond unique? And it's become clear that people who do not respond to conventional drugs for depression have higher levels of inflammation, higher levels, for instance, of C-reactive protein, interleukin-6, interleukin-1-beta, tnf-alpha and others.
Speaker 1:Well, a German group did this study. They took the endotoxin and injected it into normal, non-depressed volunteers and, remarkably, within three hours the normal volunteers had clinical depression. And, even more remarkably, they did MRI scans of their brains and saw all the hallmarks of depression. They did this repeatedly and showed that an increase in the blood levels of endotoxin and endotoxinia caused depression. Now what does that tell you about the depression that occurs in people who are poorly responsive? So it suggests, doesn't prove, but it suggests that higher levels of endotoxemia may be an underlying cause for depression, particularly depression not responsive to other therapies. So depression is a major possible consequence of higher levels of endotoxemia. Anxiety is another one, social anxiety as well as kind of around the clock anxiety, disruption of sleep and nightmares is another result of endotoxemia.
Speaker 1:Now there's also chronic neurodegenerative disorders that can come from chronic, long-standing endotoxin, let's say SIBO and endotoxin of 10 years or more. That can lead to conditions like Alzheimer's, dementia, cognitive impairment, lou Gehrig's disease, parkinsonism, multiple sclerosis. Now there may be other factors that enter into the equation, but we know that endotoxin yes, sibo and endotoxin are major factors in the development of those neurodegenerative disorders. How about metabolic conditions, common metabolic conditions that plague the majority of Americans, that is, overweight, obesity, the accumulation of abdominal visceral fat, that's, the fat in the abdomen and circles of abdominal organs that is inflammatory, high blood sugar, high blood pressure. These conditions are all worsened, caused or worsened by endotoxin. Of course, this is the majority of Americans nowadays who have these issues. So it's reasonable to suspect that the majority of people with those common conditions like hypertension or prediabetes also has, as a driver of those conditions, sibo and endotoxemia.
Speaker 1:Joint disease like arthritis is not caused by SIBO and endotoxin, it's worsened. In other words, if you have inflammation of your joints because you eroded the cartilage of your knees, because you've been consuming too many carbs and not addressing insulin resistance that causes high blood sugar, thereby glycation, discussed in another episode of Define Health. Well, the endotoxin amplifies the inflammation and amplifies the pain. So it's very common for people to address their SIBO and endotoxin and say things like you know what? My knee pain or my hip pain is gone by 60, 70, 90 percent. Very common experience All the conditions driven by insulin resistance.
Speaker 1:Insulin resistance is a basic, fundamental driving force in numerous health conditions, including prediabetes, type 2 diabetes, risk for stroke, coronary heart disease, risk for cognitive impairment, breast cancer risk and many other conditions. And we know with confidence, with good evidence, that SIBO and endotoxemia are major drivers of insulin resistance. That also encourages the accumulation of abdominal visceral fat, fat in certainly abdominal organs. And you can see there's a vicious cycle here, right? So if endotoxemia leads to insulin resistance, that in turn leads to the accumulation of abdominal visceral fat. That in turn causes insulin resistance around and around, making the process worse and worse if you allow this to proceed.
Speaker 1:Autoimmune conditions it looks as if the increased intestinal permeability of having fecal microbes infesting all 24 feet of the small intestine increases. So the small intestine is already very permeable, but having those fecal microbes adjacent to the intestinal wall further increases intestinal permeability and this somehow leads to this process called molecular mimicry, that is, components of food and microbes are mistaken by your immune system for components of your own body and they start to attack them. It might attack your thyroid, as in Hashimoto's thyroiditis, might attack the synovial tissue that is the lining of your joints and lead to rheumatoid arthritis. It might attack your pancreas and you get autoimmune pancreatitis. And so many autoimmune conditions have their origins in SIBO and endotoxemia and the accompanying increased intestinal permeability.
Speaker 1:Fatty liver About 35% of the US population has this process called fatty liver. That is, infiltration of the liver by fat. That is, triglycerides. Fats are triglycerides, triglycerides are fat. If you've got a bottle of olive oil, that is a bottle of triglycerides. So what starts? The process is consumption of carbs and sugars, such as the amylopectin A of grains, and then sucrose and fructose. So the liver is very good at converting those carbs to triglycerides, the process of so-called de novo lipogenesis that is, making fats brand new fats. So your liver is very good at converting those sugars to triglycerides. Some of those triglycerides make their way into the bloodstream. That's why people with fatty liver, infiltration of the liver with fat, have higher levels of blood triglycerides, but some of the triglycerides, for unclear reasons, also stay in the liver and plug up the liver in effect, and that is fatty liver.
Speaker 1:Now, when you have SIBO and endotoxemia, the GI tract drains. The venous drainage of the GI tract is through something called the portal venous system. That drains to the liver. So when you have high levels of endotoxemia, endotoxin entering the portal vein system to the liver, that causes your liver to become inflamed. So it's already fatty liver from triglyceride production, from carbs. Now you're amplifying the damage to your liver by the endotoxemia in the portal venous system. That is non-alcoholic steatohepatitis or NASH. So while SIBO and portal vein endotoxemia may not have been the initiating factor, they are an exacerbating or a fact that makes things worse. Now put this all together increased inflammation, increased insulin resistance, increased or accelerated deterioration of joints, increased potential for cognitive impairment, increased risk for neurodegenerative conditions and autoimmune conditions. Put it all together. This all adds up also to acceleration of aging. All the phenomena of aging are accelerated by this process of SIBO and endotoxemia. Think about that Microbes living in the 24 feet of small intestine have body-wide effects that, in effect, also accelerate your process of aging. Now let's pause for a moment to hear something about Defiant Health's sponsors. Now we'll come back and pick up the conversation where we left off to talk about the telltale signs of SIBO, how to test for SIBO and how we now manage it with some new methods.
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Speaker 1:So you can appreciate that SIBO, and thereby endotoxemia, are major influences over the way you feel, the way you look, how fast you age and your health situation. So how do you recognize if you have SIBO or not, whether what I call telltale signs. You can look for among those signs fat malabsorption, that is, your poops float, or you see fat droplets in the toilet after a bowel movement, or you see staining where the water meets the porcelain. So that's evidence that there are microbes in the duodenum blocking the action of bile and pancreatic enzymes. I'm surprised how many people often say they need pancreatic enzymes when the real problem is the infestation of fecal microbes in the duodenum blocking the normal digestive action of pancreatic enzymes in bile. The solution, of course not pancreatic enzymes, though that may make you feel better temporarily. The solution is to address the SIBO, the infestation of fecal microbes in the duodenum.
Speaker 1:Another common telltale sign of SIBO are food intolerances. So many people have an intolerance to legumes, fod maps that is, fibers and sugars. Night shades, histamine containing foods on and on People who had testing for IgG testing, that is, intolerances that are evidenced by an immune response against foods. These are all variations on the same theme that is SIBO. Those things are causing the food intolerance and while you can eliminate or reduce the intake of those foods to produce symptom relief, it doesn't address the problem that is SIBO. And the implication, the consequence of uncorrected SIBO are quite serious. So you do not want to dismiss a food intolerance as just a food intolerance. You want to get at the root cause, which is small intestinal bacterial overgrowth.
Speaker 1:And then there are conditions that are virtually synonymous with SIBO. If you have some of these conditions, you can be very confident that you have SIBO. Among those conditions are fatty liver we mentioned very high likelihood obesity, type 2 diabetes at least a 50-50 chance that you have SIBO. If you have fibromyalgia, some evidence tells us that there's a 100% likelihood that you have SIBO. Likewise, restless leg syndrome this thing that keeps you from sleeping properly, disrupt your sleep that is up to 100% High likelihood to be SIBO. Autoimmune conditions, neurodegenerative conditions very high likelihood to have SIBO. So if you have any of these conditions that are virtually synonymous with SIBO, or at least very high likelihood of being associated with SIBO and either initiating that disease or making it worse, you can be confident that you likely have SIBO and can take steps to eradicate it.
Speaker 1:Now you can also test for SIBO to be sure whether or not you have it. As I mentioned earlier, you can do a 100-breath testing in a lab or clinic. It's a hassle, it costs some money, but that is one way to do it. Another way to do it is to have an endoscopy, where the gastroenterology retrieves a sample from your duodenum or upper jejunum and then submits it either for culture or other analysis. That's rarely done, of course, and rarely done just to diagnose SIBO. It's often done in hopes of answering some other question, like do you have a bleeding ulcer or some other problem, and so typically the culture sample is obtained.
Speaker 1:Incidentally, and, by the way, many hospitals will culture the sample, which does not reveal all the microbes of SIBO. It reveals only a minority of microbes, because most microbes that cause SIBO cannot be cultured. It's thereby an imperfect way to assess for SIBO. But if you're having an endoscopy for other reasons, it would not hurt to ask the gastroenterologist to make it an aspirate to sample it for study. But the way we do it at home is to use the air device, aire from the company Food Marble, and this, as I talked about earlier, is a way to assess whether there's production of hydrogen gas that only microbes can produce. We can't produce it after feeding them something that they can metabolize.
Speaker 1:The best choice, I think, is Inulin. In a lab or clinic they use laculose or glucose, which I think are poor choices. Because if we look at the species of SIBO, the species that occupy colonize the small intestine. Many of them can't consume the laculose, so you want to identify the hydrogen gas from those species. Likewise, glucose is metabolized by us, by you and me, and that limits the exposure of the microbes to the glucose. Inulin cannot be metabolized by humans, but only by microbes and by the widest variety of species. So if you want the best choice so far, the best choice is Inulin, and that's what we use, not the laculose or glucose.
Speaker 1:Now, a major advantage in assessing yourself or someone else for SIBO and endotoxymen is if we could measure the blood levels of endotoxin. You can do that in a research setting. It is not available yet clinically. In other words, you cannot go to one of the laboratories and have them measure your endotoxin. That may become possible in the future, but right now it's simply just not available. So we're left with this presumptive identification of endotoxemia.
Speaker 1:If you have SIBO, it's a safe assumption to assume that you have endotoxemia accompanying the SIBO. Now, unfortunately, if you ask your doctor, your primary care or even your gastroenterologist, do I have SIBO? Most won't know what you're talking about. It's not because it's make-believe, it's because it's just common knowledge that practicing physicians are about a generation behind the science. They didn't receive this kind of education in their training or in medical school, so they're unaware of it, or they poo-poo it or they make fun of your request, and so don't be surprised if they discourage you from pursuing testing. Just assume your doctor does know something about it. What they'll usually do is send you to a lab or clinic test for hydrogen gas. If it's positive, they'll prescribe an antibiotic called Xifaxin or Rhafaximin, which is about 50 to 60% effective. So a lot of failures.
Speaker 1:Has side effects, including the potential for Clostridium difficile and or colitis C diff, which is a very devastating though uncommon side effect of taking an antibiotic. It costs a lot of money it's about $1,200 and typically not covered by insurance, so not very effective. Lots of potential problems. We did use some herbal antibiotics. Only two regimens have been validated, that is, have been scrutinized scientifically. There are many others that have not, so I would not bother with those. But the two that have been validated with some evidence are the Kandabactin AR, kandabactin BR regimen and the Biotics Research FC Cytol with Disbiocide regimen. Those have worked. My experience we've had good results, but more recently we've been doing something different and that is going back over a year now.
Speaker 1:I ask these questions If you have SIBO 24 feet of infestation of fecal microbes in your small intestine and you took a commercial probiotic off the shelf, what's the likelihood that your SIBO will go away? Very low, it almost never goes away. So I ask these questions what if we chose microbes that colonize the small intestine and that's where SIBO occurs right and produce what are called bacteriocins, natural antibiotic effective against the species of SIBO? Well, I chose three microbes and strains, species and strains A strain of lactobacillus gastroi, a strain of lactobacillus rhodo-i. Both of those species colonize the small intestine and produce numerous bacteriocins.
Speaker 1:I threw in bacillus quagulants and other strain because it also produces one or two bacteriocins, does not colonize the upper GI tract, but it's got a good track record for reducing a lot of the symptoms of erobalus syndrome, which for many people is the same as SIBO. We combine them and co-ferment them to get very high numbers using my method of prolonged fermentation, which you'll find, by the way, in the super gut book or in my drdavsinfanthealthcom blog. Show you how to where to source all the microbes, how to do this using prolonged fermentation and so far, about 50 people who've done this, 90% convert to hydrogen gas negative by the air device. In other words, we seem to have stumbled into a way that is superior to conventional antibiotics and likely superior to the herbal antibiotics, so that you find that recipe and you can easily make it. And what we're really doing with that so-called what I call SIBO yogurt is we're replacing keystone microbes that you should have had all along. So I encourage people to do this for four weeks if they have SIBO, but then to consume it periodically, maybe two or three times a week. Long-term, they prevent recurrence Cause these are very important microbes, not just useful for eradicating SIBO, but for bringing order and structure back to the gastrointestinal microbiome cause. They're keystone or foundational species.
Speaker 1:Now, if you learned something from this episode of Defiant Health, I encourage you to subscribe to your favorite podcast directory. Leave a review, leave a comment, tell your friends. Let's build this movement of self-empowerment and health. Thank you for listening. We'll see you in the next video. L-l-l-e-e, m-n-l-o-g-y-h-e-n-o T Welcome.
