Recap on the 2017 SIBO Symposium - Day One

Mark Pimentel, MD - SIBO Overview

• Clinicians worked on creating a standard for breath tests - 8-12hrs of fasting, prep diet, no promotility agents for a WEEK, 10g lactulose. "North American consensus on breath testing" on PubMed for free.
• at least 60% of IBS-D is SIBO
• stress doesn't cause SIBO but makes bowel issues worse and reduces the MMC (migratory motor complex).
• IBSChek - high vinculin antibodies means many treatments will be unsuccessful (incl Rif/Neo). High = 3.0
• IBSDetex - doesn't give raw data like IBSChek, it controls for 1, they use a ratio but theres a problem with a formula (not sure what this means other than "use my test" :)
• Methane is only detectable on breath test when it's at 1 million parts per mil. Methane causes constipation at 10,000 parts per mil.
• If you don't respond to Rifaximin the first round you shouldn't use it anymore, it won't suddenly start working. You need to try something else. Also if you rebound quickly after Rifaximin you need to focus on underlying cause (adhesions).
• SIBO is "Changes in flow in the gut causes the wrong bacteria to overgrow in the wrong place". IBS is a disease. SIBO is caused by another disease.
• They are doing the testing for Hydrogen Sulfide at Cedar-Sinai but still don't know what to do with the results so they are reluctant to give them out to providers/patients.
• Elemental diet is most effective.

Melanie Keller, ND - Risk Factors and Environmental Toxins

Risk Factors (essentially EVERYTHING!)

• Gestation/birth/infancy - traumatic birth, condition of mother, abx use as infant, length of hospital stay
• Procedures/surgery - tolerance of anesthesia, what type of procedures have they had done, sinuses, chronic infections, repair of altered anatomy, dental procedures, abdominal procedures
• Injuries - most notably head injuries, abdominal traumas
• Travel - food poisoning
• Infections - various parasites and bacteria
• Dental Hygiene - wisdom teeth extractions, dry socket, all four removed at once, root canals can never be sterilized so may never heal perhaps in greater than 99% of procedures, implants, veneers, amalgam filling removals, carbonated beverages (turns to carbonic acid in your mouth making it more acidic) - must you a straw then rinse after, apple cider vinegar
• Other - gastric acid, medications, eating disorders (why?), IBD with strictures, connective tissue issues, methylation issues (MTHFR and FUT2)
• Environment - US manufactures 5 trillion chemical compounds, fatal food allergies have increased over 50% in recent years, increase in diabetes and obesity related to environment, many toxins in our environment that have a negative lasting impact on digestion
• Q&A - MMC starts in stomach, go to PHCapsule.com to find where you can get a Heidelberg test - need a referral from provider,  

Mark Pimentel, MD -  Methane and Autoimmunity 

• Food poisoning is NOT related to Methane
• Methane comes from environment and family. If you live in impoverished areas where calories are either hard to come by or hard to extract from low quality foods then methane is protective.
• Methane is not an overgrowth, it's a bloom and may NOT be SIBO (WHAT??)
• The older you get the more likely you are to have methane.
• Methane slows transit time.
• Methane makes you hyperglycemic, impacting both blood sugar and insulin (there is data to support this).
• Methane predictive of obesity. Those who don't lose weight after weight loss surgery may have methane complicating picture.
• Combination therapy (Rif/Neo) does not work well for methane, it often comes back quickly and you can't keep people on therapy two weeks out of every month.
• Methane is not an overgrowth, it's a bloom, outgrowing other bacteria. We don't know how much is in colon and how much is in small bowel. Methane is not dependent on lactulose so it doesn't always go up on the test. It may be mostly in the colon.
• F420 enzyme allows M. Smithii to take hydrogen and make methane, lovastatin blocks this enzyme. Methane production drops in days. Hydrogen bugs the get sick and die from the excess of hydrogen.
• Syn-10 (the lovastatin drug in trial) stays in gut and is not absorbed so none of the same lovastatin side effects. Red Yeast Rice is absorbed so likely not effective the same way.
• C-Diff causes post infectious IBS.
• You can get SIBO via FMT
• Fasting helps, meal spacing necessary
• Methane + high fat diet may be recipe for weight gain as methane makes body more efficient with harvesting calories.
• If you have post infectious IBS, NEVER get food poisoning again. Always travel with Rifaximin and take 1/2 a pill with meals (IMO herbals are just as effective and so much less expensive!).
• Scleraderma the only other autoimmune condition that seems to be linked to high levels of vinculin antibodies.
• Allicin works temporarily for methane.
• Phase 3 research for Syn-10 starts in Sept
• Higher vinculin antibodies predict lack of response to treatment with Rif/Neo (Pimentel stated 3 on the vinculin antibodies is high).
• M. Smithii can use acid and ammonia to make methane so keep those lower in diet (ie lemon juice in water, ACV).
• In the process of investigating separate diet for SIBO and Methane.
• Norovirus can cause IBS even though it doesn't release Cdt-B, they are not sure why.
• Cipro does work for SIBO but generally only the first time and then the bacteria becomes resistant and you take a severe hit to the microbiome.

Natalie Gustafson, PharmD - LDN and LDE

Not much new here just explanations of risks and mechanisms of LDN and LDE

• LDN must be taken on an empty stomach
• LDN can be taken at night if it interrupts with sleep
• Always ask compounding pharmacy what kind of filler they use
• LDN upregulates Toll Like Receptor 4 so helps decrease inflammation
• LDE at 50mg does not appear to impact the microbiome
• LDE does have the very rare potential of QT elongation which increases cardiovascular risk
• LDE does block certain liver enzymes so make sure the check crossreactivity.  Will make berberine less effective.
• Enteric coating contains phalates so most pharmacies don't use this coating because they have to have special equipment and ventilation (I don't think she meant all enteric coatings are made from phalates)

Melanie Keller, ND - Managing Treatment Failures in SIBO, IBS & IBD

Many, many rabbit holes in this talk. Dr. Keller clearly deals with SIBO cases that require a much deeper dive into the body to resolve. My guess is is that most people with SIBO do not require such a deep investigation to heal.

• Step one - no more supplements.  She is seeing correlation that certain nutrients feed certain bacteria and if you are low there is a reason. If you simply supplement you could just be feeding the overgrowth of bacteria.
• Test for stomach acid levels - she sees people with both low and high stomach acid.  Both cause issues with digestion.  She believes that people with high stomach acid are actually more sensitive to foods than those with low. (link above to PHCapsule.com to find a Heidelberg test office near you).
• Her theory is that high baseline methane could be in the stomach. H.Pylori used to be erradicated with two medications, now it takes quadruple therapy. Is there some sort of correlation??
• There is a complex communication happening between bacteria, hormones, enzymes, etc. that we don't quite understand yet. Research currently being done.
• Hormones are an important component, need to make sure adequate growth hormone, not too much sex hormone binding globulin, etc.
• Amalgam filling removal - does not like to treat these patients as they don't do well, don't seem to recover.
• She utilizes www.scorecard.org to determine common pollutants in people's area.
• Using Strategene can help answer why some people do well with some things and not others.  She looks at methylation pathways of a person to determine which pharmaceuticals may work best.

I listened to this one twice and still just can even begin to grasp how she noodles all this stuff out.  Dr. Keller is also very interesting in environmental toxins and how they impact the body.  For example, research has shown Agent Orange acts as a xeno-estrogens and caused a rise in endometriosis for women and diabetes for men.  Ulcerative Colitis and Crohn's appear to have doubled from 1996 to 2006.

Next steps for dealing with methane while not actively killing....

While I wait for my antibodies to clear so my nerves can heal and restore function to my migratory motor complex in the small intestine I need to do something to keep the methane at bay.  I tried a 90 day protocol and that clearly didn't do much at all.  So what to do??  I don't want to dive into more killing so I may go back to the (possible) methane inhibitors.

Methane inhibitors
Red Yeast Rice - we know that Dr. Pimental is testing a lovastatin type drug to see if it inhibits methane production.  See here for information, scroll to bottom.  Red Yeast Rice does contain a natural form of lovastatin. I've used it in the past and was able to keep my methane numbers mostly in the single digits.  Once I got them to a certain level they wouldn't go lower but with Primary SIBO (aka the food poisoning induced autoimmune variety), getting the numbers down and maintaining them seems better than having them go up and down. And, it made goats fart less so why not us :) 

"At the genus level, the predominant archaea in the rumen of goats was Methanobrevibacter, 

which was significantly inhibited with the supplementation of red yeast rice. 

In conclusion, red yeast rice is a potential feed ingredient for mitigation of 

enteric methane emissions of goats." 
https://www.ncbi.nlm.nih.gov/pubmed/27467559

The link above is to a brand I used in the past. I might try a different brand this go 'round.

Ideal Bowel Support - this is a probiotic containing only 

Lactobacillus Plantarum which according to Chris Kresser can degrade methane.  I quite literally have a shelf of this stuff in my refrigerator.  Can't hurt!

Atrantil - This seemed so gimmicky when it first came out.  And there were so many "worked like a charm" and "didn't do squat" type comments on message boards that I really was skeptical. But I listened to Dr. Brown on a few recent podcasts and given my current situation (anti-vinculin antibodies negatively impacting motility) I thought I should at least try it.  It made me feel better, lighter.  I don't know how else to explain it.  I should say that I did use it after fasting so I was already feeling lighter and I do have most my digestive symptoms under control but wouldn't it be nice to be able to expand my diet without the usual repercussions. I think yes!  So I'm going to add it in while I focus on boosting motility and supporting healing.

Prokinetics
Cause if things aren't moving you are just generally screwed.  In hindsight I would have started taking these the second I learned I had SIBO.  Keeping things moving through the GI tract is the easiest way to prevent more overgrowth (in my opinion).  And note, not all of these are actual prokinetics, some have a more laxative effect, I realize that.  Slowing anywhere in the GI is just not good, makes you feel toxic, sluggish and ornery.
  
LDN - Low dose Naltrexone, although it really doesn't seem to actually have a prokinetic effect much if at all.  For those with Primary SIBO, LDE (low dose Erythromycin 50mg at bedtime) or Resolor (Prucalopride) seem to be the prescription of choice.  I don't tolerate Resolor because it has a teeny tiny amount of lactose.  Maybe you are luckier than I and tolerate dairy. Resolor is available through Canadian pharmacies.  I may ask for a script for LDE the next time I'm in office but I just hate the idea of more antibiotics even though it is a minidose. So for now I continue on LDN since it's beneficial for autoimmune issues.

Motilpro - Taken at bedtime, helps stimulate the cleansing waves of the small intestine at night.  In the beginning of my treatment it was recommended to take between breakfast and lunch as well but I don't really eat before lunch so I just wait until bedtime. Sometimes I take Ginger capsules in between breakfast and lunch.  The stuff is mega ginger burntastic so make sure to swallow it down with a LOT of water about a 1/2 hour before you actually go to bed.  

Vagal Tone - This shows some promise.  It was recommended by my ND but sadly I am reactive to the chamomile and it gives me a headache within seconds of application. Ugh! Similar to Iberogast in that you use it with meals and at bedtime, only it's external, apply a tiny dab on your occiput.

Magnesium - Most people recommend Magnesium citrate because it's not absorbed well into the system so does the trick. But it's acidic and can burn on the way out. Yikes!  Oxide is also not absorbed well and is not acidic, but I like a blend, that way your body can use some of the more absorbable forms and the rest can do it's job of pulling water into the colon and flushing the system.  I take it at dinner and bedtime so it can go to work in the evening and overnight.

Triphala - My new love.  LOL!  I used to swear this stuff did nothing but made me super constipated (and frustrated).  Turns out you just need to keep increasing to find your optimal dose.  I take 4 capsules at bedtime unless I've indulged and then I take a couple extra. Carbs and nuts do nothing but stop me up but oh how I love the taste of them!

I used Iberogast for a while but it started to not sit well.  It was the chamomile. Now the company has been sold to Bayer and is either being reformulated or completely taken off the market.  Either way pretty sad since I know it's used by many. I also try to use bitters before meals but got out of the habit and now forget a lot of the time.  These things can have a positive impact on motility as well.

Most of us have heard of the physical things we can do to stimulate the vagus nerve.  The vagus nerve stimulates the migratory motor complex so it's important that it's strong and active.  According to Dr. Kharrazian there is (vigorous) gargling, gagging and singing.  I also know from yoga that breathing stimulates the vagus nerve, most notably deep belly breaths followed by restricting and extending the exhale. It's your exhale that stimulate the parasympathic response. It's easiest to do this lying down.

Gut and Liver Support
Zinc Carnosine and L-Glutamine.  That's really all I have found that isn't mucilaginous and doesn't feeds the darned bugs.  I capsule up my own Glutamine because it's cheaper and I can avoid the fillers.  A lot of people drink it in water and it supposedly helps with sugar cravings, I just never liked doing it that way.  I recently added in a small dose of copper when I take extra zinc, apparently you are supposed to keep them balanced and not take zinc longterm on it's own.  Don't ask me where I read this, I cannot recall.

I always taking some sort of liver support because your liver takes the brunt of filtering whatever leaks through the intestinal wall.  If we are permeable and/or killing, your liver could use some assistance cleaning all that garbage out of the blood stream.  I've taken everything from plain Milk Thistle to ayurvedic formulas to herbal combinations.  I rotate formulas. 

Soil based probiotics remain my protocol (I would call it "my stack" but that seems really weird for some reason!).  I still take both PrescriptAssist and MegaSpore. I've done so much killing since my initial diagnosis that I feel it's necessary to support the microbiome in whatever way I can.  

Nerve Support
For those with Primary (autoimmune) SIBO, taking supplements that benefit nerve healing may be helpful.  It may not, who really knows.  I add Lion's Mane and Sunflower Lecithin to my hot chocolate and take Acetyl L-Carnitine in the morning. They talked about using Lion's Mane and Acetyl L-Carnitine at the SIBO Symposium a couple of years ago. 

The other thing I take that may or may not be of any help at all is Fibrenza.  My ND feels it may help remove antibodies in some way.  I have no idea how that would work but the idea of having something that scavenges the body seems good to me.



Please note - I do not make anything off these links I just included them for ease and examples.  All the links are products that I have used and companies I have purchased from.  Make your own decisions with your healthcare provider and buy from someone you trust.  Personally I don't like to buy supplements off Amazon unless I know it's coming straight from the company itself.  There are many rumors of counterfeit supplements out there.

Resolor - Day 2

Ahhhh, much better!  I took 1/4 of a 1mg tablet an hour before bed last night.  My stomach did some mild gurgling and contracting but no mad dash for the bathroom.  I feel like it moved things along as they would more normally transition.  No headaches, no hunger.  I wouldn't say my morning trip to the bathroom was normal but much closer than the night before last!!

It's weird to not be taking a bunch of stuff to keep my bowels moving.  I have taken magnesium every night for as long as I can remember at least until I added in the ox bile.  If you're bound up, look into it.
Article on WiseGeeks, not sure how accurate but I like the explanations
An article from Livestrong

Having some excellent discussions regarding SIBO, Intestinal Permeability and testing with the mentor group for the nutrition certification course I am taking.  It's so much fun to bounce around ideas.  Their current standard is to recognize that while someone likely has SIBO you should test for IP instead and treat that first.  My belief is it should be the other way around. Who cares if you have IP if you have SIBO.  The IP will resolve once SIBO goes away and you can't repair IP until SIBO is gone.  It scares me a little that I think talking about all this is so much fun.  I also got a package during lunch and was sad to discover it was Amazon and not my DUTCH test.  There is seriously something wrong with me!

Resolor - Day One

At the SIBO Symposium Dr. Seibecker said, take someone with constipation and give them diarrhea and they won't mind much.  Take someone with diarrhea and give them constipation and they will NOT be happy.

I took Resolor for the first time last night at bedtime.  I cut a 1mg pill in half.  About an hour later my gut started contracting, not painful but noticeable from my stomach all the way down. I was out of bed and in the bathroom expelling everything and I mean EVERYTHING shortly after. To the point of almost being nauseous.  This was exactly what was going through my head. Ha ha!

At the end I was starving, not sure my body was done digesting my dinner :) and a bit head-achy, which is understandable since it was almost instantaneous dehydration. I had measured my belly at bedtime so measured again and I was down more that 1/2 inch. Wowsa!  I know there are people who take a ton (more than 2mg) without any relief and I think this shows either the power of methane gas and it's ability to paralyze the gut or ICC damage from food poisoning.

For now I'm taking Ox Bile completely out.  I was taking around 250mg with meals.  Tonight I will cut one of the Resolor caps into quarters so I am taking 0.25mg.  I'll eat dinner earlier and take it an hour before bedtime to see if that makes a difference.  Fingers crossed!

Good appointment, horrible commute!

My ND may be super hard to get an appt with, but his prices are reasonable and he gets the job done.  I walked in and he asked, "what are we doing today?".  I explained that I was having lower abdominal pain and so he did visceral manipulation.  He was so great about describing what he was doing on a picture of the body - sort of pulling my uterus away from my rectum (sorry, TMI I know!) and making sure they was proper movement in the tissue down there.  It's not uncomfortable at all.  He also showed me a spot on the colon where the nerves from the small intestine branch in and he wants me to massage it to stimulate it daily.    He asked about how my SIBO was and I said would like a prescription for Resolor and a breath test.  He hadn't heard of Resolor, which isn't surprising because his focus is not SIBO but did not hesitate to give me a prescription after I explained what it does and the dosing that is on Dr. Siebecker's site.  After I explained what happened with Dr. Keller (increasing prices to $500/hr with a 1/2 hr skype appt required to receive breath test results) he happily logged on, set up an account and ordered me a breath test even checking the box so the results come directly to me.  So nice!  It takes at least 3 months to get just a follow up appointment with him so it's nice that he realizes he doesn't want the hassle of having to send out test results himself. He was pretty shocked that Dr. Keller raised her prices that high.

So on to the guar gum.  It is still gross but if you stir quickly and chug it goes down fine.  I've been eating FODMAPs too and honestly I'm suddenly feeling pretty darn good, not sure if it's because my bugs are fed and happy or if it's because they are dying.  Either way, I need to do a probiotic/resistant starch retention enema tonight to help the good guys in my colon out. 

I've also jacked up my prokinetics so that could be helping.  I was in Seattle for my appt yesterday so decided to splurge and eat something I normally wouldn't.  I was contemplating Thai even though last time I ate it I felt like crap for days.  Hunger led me to gluten free, vegan, aoili pizza at the Flying Apron.  I had to stop in to pick up a couple of donuts for my son and just couldn't resist.  Not what most people would consider a cheat! But seriously, how easy is it to find gf/df pizza without tomato sauce that's actually edible!?!

So I'm currently taking Rifaximin, Allicin, and Oregano with guar gum 3 times a day - breakfast, mid day and bedtime.  For prokinetics I'm doing Iberogast with meals, Motilpro mid morning, and Motilpro, LDN and Magnesium at bedtime.  Resolor is supposed to be the strongest prokinetic so I am eager to see if I can reduce some of the other stuff by adding it slowly in (I asked for a script for 0.5mg pills).  Once I'm done with the Rifaximin I'm going to add in Biocidin, Olivirex and Candibactin-BR and continuing with the Allicin and Oregano.  Not sure if I'm going to continue with the guar at that point or just eat FODMAPs.  After I'm done I'll test and see where we are at.  If I'm not clear at that point I may just give up :) Not really, but I'll definitely need to give my good colon bacteria a break.

After my appointment I raced down the freeway only to get completely stopped by the President of China.  They completely closed the two highways he was traveling, waited for them to clear and he drove down them, during rush hour. What a freaking mess! There were police on every single overpass. It would have been much cheaper, not to mention less disruptive and more efficient, to put him in a helicopter!  45 minutes to Seattle, 3 hours home.

Also got a call that our stolen vehicle has been recovered. It was in the process of being stripped but the sheriff's office put it back together and drove it out of the woods. The thief left behind their key, and their kid's booster seat and their tools. Who takes their toddler out with them boosting/stripping cars????

New Protocol - Repair

Just to remind all of you, I am not a healthcare provider of any kind.  I just do a little research and add what I feel works for me.  SIBO is such a strange animal so you have to figure out (hopefully with a qualified provider) what works for you.

I've decided to work on gut repair and motility since my reactions to foods are mostly in the form of belly itchiness which I contribute more to permeability and not SIBO per se.

I should also note that there is a bit of a brouhaha right now about FCO (fermented cod liver oil).  You can read about it here (and in many other places).  I am opting to continue with my bottle but not sure I will buy it again.  It's fairly difficult to keep fish oils from becoming rancid and they are expensive.  It's better to include some fatty fish in your diet a couple of times a week.  If you've been following along you might remember that on my Array 10 I am reacting to salmon, tilapia, trout, tuna, squid, and shrimp.  I did not react to sardines but for some reason they are making me nauseaus when I eat them.  My guess is it's a placebo thing.

Pre-meals     
Bitters (2 droppers)

Iberogast (2 droppers)

Red Yeast Rice       

LiverCare

Serrapeptase

Breakfast    
Multivitamin (2)

All-zyme

Magnesium Glycinate

Betaine HCL (1-2)

Fermented Cod Liver Oil

Vit C

Vit D 4000 iu (2 drops)

Vit K-2

Thyrosol

Adrenomend (2 capsules)

OrthoBiotic (every other day)

                  

9-10AM
T3 – 22.5mcg

Primal Defense (on days when no OrthoBiotic)

L-Glutamine (1)

GastricSoothe (2)

                  
Lunch           
Multivitamin (2)

All-zyme (1)
Magnesium Glycinate

Betaine HCL (1-2)

Vit C

PrescriptAssist (1)

Adrenomend (2 capsules)

Adrenaplex (2 capsules)

Dinner         
Multivitamin (2)

All-zyme (1)

Betaine HCL (1-2)

Magnesium Glycinate

Fermented Cod Liver Oil

Thyrosol (1 tablet)

Turmeric

9pm             
LDN – 5mg

Motilpro (3)

GastricSoothe (2)

L-Glutamine

Lion’s Mane (2)*

Magnesium Citrate (PRN)

*I haven't added the Lion's Mane in.  I added in the Motilpro last night and will add the GastricSoothe in tonight.  I've been taking Endozin for a while so shouldn't have a problem with the L-Glutamine and GastricSoothe since it's the same ingredients.  In a few days if all goes well I will add in the Lion's Mane.

Weight and bloat SLOWLY resolving..

It would be so nice if all the weight and the bloat disappeared as quickly as it comes on.  2 lbs of water weight went away pretty quickly after my half bottle of wine but the big ole belly has been hanging around.  I BINGED on chocolate yesterday, like 5 mini homemade mini Reeses peanut butter cups AND a whole chocolate mint pie from Whole Foods.  This morning my belly is down to normal size and I've even come down another 1/2 lb.  Imagine if chocolate were the cure!  LOL!

So with this bloat my mind has been busy contemplating options.  I have 5 days of Rifaximin in my cabinet and a bunch of Allicin.  I know a few people who are trying the Guar Gum (up to 1 tsp) 20-30 minutes before you take your antimicrobials.  I'm intrigued to say the least. My numbers are low but my symptoms indicate the need for continued treatment.  I'm also contemplating Candibactin AR & BR.  I tested positive for thyme (on the Array 10) but I cut it out for several weeks and recently had it in a batch of soup and did not react so I may be good to go.  We obviously know the fish is still a no go.

In the meantime I am adding the OrthoBiotic back in with breakfast to see how it goes and have ordered Motilpro to add in at bedtime.  Serrapeptase will be added before meals, it may help break down biofilms and even if it doesn't it helps with protein digestion which I still need. I am continuing with the Endozin (Zinc-Carnosine and L-Glutamine) and the PrescriptAssist at lunchtime.  So rebuild, refeed and keep sweepin'.

Clinical Pearls from the SIBO Symposium

The webinars from the SIBO Symposium have finally been released. They are a bit hard to hear but I spent a couple of hours last night listening to the Clinical Pearls section that we missed. Providers had the opportunity to come up and talk about cases and things they are trying or noticing in their patients. They each had 5 minutes. Some takeaways: Farshid Rahbar, MD presented on SIBO and tick borne illness (Lyme). He found that patient with abnormally high levels of hydrogen or methane often had tick borne illness. 65% of people that he has seen that have tick borne disease also have SIBO. Dr. Morstein (ND) uses the generic Rifaximin from Canada and has great success but she always pairs it with 1 tsp of guar gum in 8oz of water. She never treats SIBO without including Lactoprime Plus. She has the client take them with lunch. She felt that if you just treated the SIBO you would end up creating a dysbiosis in the large intestine and then you would be stuck fixing that next. (I have to say I kind of agree, after last summer's war against the archaea I ended up with a bad dysbiosis in my colon.) She also uses Hercius Erineus and Acetyl L-Carnitine to help heal any nerve damage in the small intestine. (My guess is this is the product she uses.) Whitney and Stephanie Hayes, NDs presented on SIBO and infertility. They found if they got rid of a woman's SIBO she often became fertile again. Pretty fascinating since you wouldn't think they would be linked. They think SIBO testing should be considered in any woman with pelvic pain/dysfunctions. Dr. Elena Guggenheim talked about autoimmunity and how the bacteroides seem to modulate the immune response. She presented a case on RA and said that once she got the woman's SIBO under control (only symptom was diarrhea), her RA symptoms greatly reduced and she was able to resume normal activities without daily use of medications. Kelly Reis (sp?), ND was great. She bought her own Quintron so she could get results fast. She also does thermography and finds that people with autoimmune issues have a cooling spot above their T2 thoracic spine. (I had this done before my SIBO diagnosis and I didn't have anything blue (cold) in this area. Fascinating!) She runs a facebook page for clinicians which is a valuable resource since everyone seems to be guessing a bit on the harder cases. Nora Jacoby, ND talked about diet. She has a diet handout that she gives patients and there is access to it for clinicians only on her website www.sibotest.com. She gave no details to say how it was different that the SIBO specific diet. She strongly recommends Dr. Kharrazian's gargle/gag method, breathing exercises and use of cascara sagrada. She also mentioned Heart Math (which I really want), to help you get into rest and digest mode before meals and to help train yourself overall to easily get into parasympathetic mode. Using a Squatty Potty or step stool will help retrain the bowels. If you like local and sustainable (aka expensive) go herehttp://gostool.com/shop/ Dara Perkins, MD has found that with low weight SIBO patients she often has them eat high quality fermented sourdough bread and organic corn products such as polenta for a starch and most have success. One of her patients found that if you combine LDN with antihistamines you may have nightmares. Dr. Ruscio came up and talked about how he tracked patients taking biofilm agents and some who were not and so far hasn't found any difference in effectiveness. He will release his finding later this summer. BIofilm disrupters are a must if the overgrowth is fungal.  He brought up how the microbiota is the next big thing but that a lot of the information going around on blogs is not based in research. He's not ready to jump on the feed the microbiota carb bandwagon. He said prebiotics need to be taken on a case by case basis and you should be gunshy with SIBO patients. He is beginning a study of prokinetics in the next 2-4 months. To be in this study you have to be ending your treatment and SIBO clear when he starts his research. Information at www.drruscio.com Mark Davis, ND talked extensively about FMT and said that even when people swallow (ewwww!) an FMT capsule it does not cause SIBO. He bases this on a study where they sprayed fecal material into the duodenum of people and the bacteria migrated back down to the colon. Allison Siebecker, ND indicated that any kind of self care whether it be acupuncture, massage, yoga, meditation, colonics, deep breathing, etc improves patient outcome. Dr. Moore, ND uses a food allergy test to see if patients have leaky gut, if there are lots of positives or mildly positives it indicates leaky gut. (other NDs mentioned this as well). Expressed need for mentoring program for clinicians treating SIBO (the new GastroANP.org for providers will provide some of this). A doctor asked a question about how to regenerate nerve function in the small intestine. The same herbs were brought up (as above) by Dr. Morstein, acupuncture, colon hydrotherapy, cranial-sacral therapy. Dr. Ruscio brought up again that ICC cells will regenerate on their own once SIBO or antibodies are gone. Steven Sandberg Lewis, ND brought up the whole gut brain connection. He said if there has been any mild traumatic brain injury - former soccer player, non-diagnosed concussion, black eye, broken nose, whiplash (me two or three times), any of those impacts can affect the gut neurology. Neurofeedback is a great way to address it. The general consensus with all the providers was SIBO is either easily treated or very, very difficult. There doesn't seem to be a lot of middle ground. Guess I know where fall!

Another great perspective from the SIBO Symposium

From my friend, Tim.

http://www.dharmaworks.net/Tim/sibo-symposium-recap/