Hi there, it’s Dr. Davis again, and today I’ll be talking about one of the more common tests I use in the office for testing SIBO or Small Intestinal Bacterial Overgrowth.
If you haven’t herd about SIBO, it’s a condition where bacteria migrate into the small intestine, where they’re not supposed to be. This interferes with the assimilation of nutrients from food, along with causing bad smelling gas, bloating and pain. Sounds a lot like IBS doesn’t it. Well, that’s because most people with IBS have SIBO. In fact, some researchers like Dr. Mark Pimentel at UCLA feel that SIBO is present in the vast majority of IBS patients. This is based on experimental and clinical studies that show that when SIBO is treated effectively, the symptoms of IBS many times can be completely resolved. That’s big news for IBS sufferer’s who’ve been told that they have to just manage their symptoms.
To keep the bacteria in their proper place-in the large intestine, the ileocecal valve that separates the large and small intestine, prevents the bacteria from backing up. And if those options don’t do the job, the immune system lining the GI tract goes to work and attacks the foreign bacteria and pathogens preventing them from getting a foothold.
There are a few ways to test for overgrowth. One way is to sample the the bacteria in the GI tract with endoscopy to enter the stomach, but this can only sample the upper portion of the small intestine.
Colonoscopy is another option, but this only measures the lower end of the small intestine.
The gold standard, and the test I use is the Hydrogen/Methane Breath test to measure the gases that bacteria produce. This is a great test because it’s not invasive and it accurately measures possible overgrowth over the entire length of the intestine. Hydrogen and methane cause the symptoms in IBS and result in damage to the microvilli that lead malabsorption, fatigue, hormonal imbalances, restless leg syndrome and neurological symptoms. In addition, the production of methane decreases the cleansing wave activity in the the small intestine, slowing movement and almost always leads to constipation.
The SIBO Breath Test is performed by taking a breath measurement of hydrogen and methane at base line, and then every 20 minutes after drinking a solution of lactulose sugar while the food particles move through the intestine.
This is an example report of a hydrogen/methane breath test. A hydrogen increase of over 20 ppm as we see here signifies a positive test for SIBO. The cutoff for a normal methane test is below 3 ppm, and so In this table you can see that methane is elevated as well, showing that this patient is positive for methane too.
In this test result, hydrogen elevates in the second hour which is typical in infections of the lower small intestine. When we look at the methane level, we can see that methane hovers at or about 3 ppm until the lactulose solution, at the end of the second hour, reaches the large intestine. In this case, I would rate the hydrogen test as severe and the methane test as borderline.
On this last test, we see that the purple methane line in the graph begins over 20 PPM and raises further to over 50. This is clearly a positive methane SIBO test. Now take look at the blue hydrogen line. It starts below the cutoff, raises a bit in the second hour but never elevates over the 20 ppm cut off. This would be a clear negative hydrogen test.
So what does this mean to you? Well, treatment would depend on the severity and the kind of overgrowth involved. For instance, certain antibiotics such as Refaximin that are commonly used for SIBO are much less effective for the methane generating bacteria called archea. We have found, and the research supports this, that natural herbal antimicrobials like berberine and others are more effective in SIBO with less side effects.
One of the reasons for this is that plant substances like herbs have a broad spectrum of activity along with many active compounds, and so it is less likely that organisms will develop resistance to a botanical treatment unlike standard antibiotics. Also the botanicalsI use are in the form of formulas where many different herbs are combined to form synergistic and more functional compounds. In addition, I have found that in our clinic the relapse rate is far below that of the published 50% of the drug approach.
Of course, after the SIBO is controlled it is imperative that you solve the problem that brought on the overgrowth in the first place, like leaky gut, inflammation, H. Pylori infections in the stomach, or bad eating habits and then restore the health of the gut with a low grain diet and sequential probiotics and prebiotics. Biofilm disruptors and GI moility supplements can be helpful as well.
So, the take away here is that to know if you have overgrowth you simply have to be tested with the correct test. Then after you know exactly what kind of SIBO you have, natural antimicrobials are the way to go to get this taken care of. After that, a clear and hopefully, program to heal your intestines will get your guts working like you wish they did.
If you are interested in additional information about natural ways to solve your IBS problem, please visit our site and subscribe to make sure you are getting all our updates and new videos as they come online. And if you would like to work with me personally, you can let me know there too so that we can get that set up as soon as possible. .. Heath is on the way.