SIBO

I have been a very good student of my own health lately. Be prepared for a lot of heavily-researched medical terminology. I had a breath lactulose test on Wednesday to check for Small Intestinal Bacterial Overgrowth, and tested... positive.

SIBO, as it's otherwise called, is defined as "a bacterial population in the small intestine exceeding 10^5–10^6 organisms/mL." For reference, a healthy person's small intestine contains around less than 10^3 organisms/mL, and most of these are the good bacteria. In less mathematical terms, that 's 1000 little bacterias swimming around in one milliliter of your average person's small intestine, and over 100,000 to 1 million per milliliter for someone who has tested positive for SIBO.

Surprisingly enough for me to remember, Dr. Amy Myers, who wrote The Autoimmune Solution I followed last year, also discusses SIBO in her book, since "disturbances in gut immune function... increases the likelihood of developing SIBO." She interestingly notes that certain types of probiotics taken can actually exacerbate some SIBO symptoms. I've been taking probiotics religiously for years, believing it would help my lactose intolerance... so this makes sense. I haven't taken any since before my EGD, and thinking back, I would accurately say that my symptoms (abdominally at least) have been slightly less agitated lately. I even ate cheese ravioli at Olive Garden the other day without following pain! I have also been taking hyoscyamine, an intestinal muscle relaxer, before meals that I know may cause "stomach anger" (like the cheese ravioli) at the request of my GI doctor, which seem to be helping as well.

Referring back to the gastritis findings from the EGD, the same source mentions that "bacterial overgrowth may induce an inflammatory response in the intestinal mucosa, further exacerbating the typical symptoms of SIBO." Although the chronic inflammation was found in the gastric region (stomach) and not the intestine, this is one possible explanation for it. I was seen in the ER for an e. Coli infection obtained from our cruise last month, where they also found some possible mesenteric adenitis—a fancy term for more inflammation, but this time in the mesentary, the tissue that attaches your GI tract to your abdominal wall. This wasn't very surprising, but it made me think that maybe all this inflammation is just happening everywhere, and wasn't the cause of my overall GI issues after all. The gastritis might have happened because of SIBO, or even vice-versa, as "small intestine dysmotility" (food either passes too slow or too fast or both) can create a great little atmosphere for all of the bad bacteria to grow out of control.

My GI doctor, when first discussing the SIBO test, mentioned that treatment for it is a lot like getting rid of overgrown weeds on your lawn. The best way to make sure it doesn't come back, or at least prolong their regrowth for as long as possible, is to rip out the whole layer of weeds and the grass, replant the grass, and feed it daily with a combination weed killer and grass food. He explained that for SIBO, you follow a similar pattern of treatment: kill all of the bacteria in the intestines (good and bad) with a strong antibiotic treatment, take specific probiotics to encourage the regrowth of the good bacteria, and follow a specific diet to make sure we keep the bad bacteria at bay. This diet is the one Dr. Myers outlines in portions of The Autoimmune Solution. I've started my course of antibiotics and should be moving along with new probiotics soon.

Overall, what I've gained from all of this is just a general understanding that IBS (what my GI doctor was previously using as a diagnosis of exclusion) and SIBO have very overlapping symptoms. There are many differing studies and scientific opinions on whether one causes the other, or whether they are opposing diagnoses in patients with identical symptoms, with the differential factor being the outcome of the lactulose breath test results. I'll want to follow the anti-inflammatory diet as I tried to before (of course, for longer than three days this time), but also follow the SIBO guidelines that are included. My doctor mentioned having me start a FODMAP diet, which I believe is rather similar in nature. FODMAP, or the Low F.O.D.M.A.P. Diet, simply implies the elimination of foods in the following groups:

Fermentable (foods that are fermented in the colon) Oligosaccharides ("few sugar" makeup), Disaccharides ("two sugar molecule" makeup), Monosaccharides ("single sugar" molecules), And Polyols (sugar alcohols).

Dr. Myers' book simply has a much more step-by-step (less scientific!) and holistic approach to the diet, but I believe it has the same general structure: get rid of carbs and sugars—the little breeding grounds for bacteria. However, something I will be keeping a very close eye on, and will discuss with my rheumatologist, is that SIBO and Scleroderma actually have a researched connection. My positive Scl-70 factor has been on and off over the last few years, but according to my latest research, it may be the cause of my intestinal issues as I originally suspected.

"Scleroderma (systemic sclerosis) is a chronic connective tissue disease that affects the gastrointestinal tract in more than 80% of patients. Severe small bowel involvement by scleroderma can present as SIBO. The reported prevalence of SIBO in scleroderma was 43% to 56%." (Bures)

My non-GI autoimmune symptoms have been worsening gradually since I last saw my rheumatologist as well; I think I'm finally starting to develop Raynaud's syndrome. It started in a single toe, around April/May, and has now spread to all my toes and occasionally the fingers on my left hand. I've been seeing a lot more spider-veins in my legs as well, and my hand pain is only worsening. Thankfully, my PCP gave me a topical anti-inflammatory that I've been using on my hands and wrists that works better than any cooling cream I've previously tried.

In all, I'm ready to start being serious about the connections between all of my symptoms. I originally thought that my autoimmune symptoms and GI symptoms must have a connection, and now I'm slowly starting to receive results confirming that suspicion.

I really appreciate all the encouragement I've received from friends and coworkers about my health condition. Hopefully all these new discoveries will lead to some positive results!

Sources

Bures, J., Cyrany, J., Kohoutova, D., Förstl, M., Rejchrt, S., Kvetina, J., … Kopacova, M. (2010). Small intestinal bacterial overgrowth syndrome. World Journal of Gastroenterology: WJG, 16(24), 2978–2990. doi.org/10.3748/wjg.v16.i24.2978

Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small Intestinal Bacterial Overgrowth: A Comprehensive Review. Gastroenterology & Hepatology, 3(2), 112–122.

www.amymyersmd.com/2018/04/10-signs-small-intestinal-bacterial-overgrowth-sibo/