The SIBO Curse

Have you ever known anyone who no matter what they eat they blow up like a balloon and suffer painful and uncomfortable gas and bloating?  Perhaps you even experience this yourself?  You may have been to every doctor in town and tried every probiotic with no avail.  A lot of your friends, who pay attention to natural medicine, all feel that you most definitely have the dreaded candida (yeast) curse!  I end up hearing so much about candida from my patients that it is surprising really.  So you go on a radical diet, take probiotics and a bunch of anti-candida herbs.  Nothing works.  And in fact you think that it even might have made you worse!  Okay, what already?  What could be causing so much discomfort?

Perhaps it is SIBO…  Small Intestinal Bacterial Overgrowth.  But what in the world does that mean?  Simply put the small intestine should contain virtually little to no bacteria.  The primary location for bacteria along the digestive tract (respectfully speaking… bacteria is of course just about everywhere) is in the large intestine/colon.  When these bacteria in the small intestine overgrow they end up breaking down carbohydrates and fibers too early in the process and produce gas in the wrong compartment!  When this happens in the large intestine the gas can pass rather easily, though not always conveniently of course.  Like on a plane, or in class, or on a first date…  But I digress.  J  But if this takes place in the small intestine that gas will get trapped and build up causing bloating and pain in a lot of cases.  The most common symptom associated with SIBO is frequent bloating after meals.  And this bloating can often be described as looking something like pregnancy!  The tummy can quite literally be round and firm.  There can also be either constipation or diarrhea which may differ from person to person.  In fact the typical “Irritable Bowel Syndrome” (IBS) condition may actually be due to SIBO!  I have heard all too often where a patient was diagnosed by their medical doctor with IBS and given acid reducing medications, case closed.  Did this therapy in fact help?  No!  That is why they found my office after all.  In fact I would argue that the therapy actually made them worse.  I will go into some of the factors leading to SIBO below so that you can better understand how and why each case could be different.

One of the most common reasons for SIBO to develop is low stomach acid.  This is more common than you know.  And this is something that can easily be induced with both prescription and over the counter medications.  Know anyone who parks themselves next to an economy sized bottle of anti-acid tablets?  I do.  These people are neutralizing their stomach acid.  Aside from digesting the food, stomach acid is also responsible for sterilizing the first section of the small intestine.  If this does not occur bacteria can grow there and lead to SIBO!  So I urge you to think twice when someone tells you to cover up your digestive symptoms with acid reducing medications.  I recently went to see a gastroenterologist for something that I was experiencing and wanted a medical opinion about.  They found that it was a mild hiatal hernia and he then prescribed acid reducing medications.  I told him I might try a short trial, but that I didn’t like the idea. (I decided not to.)   I was surprised to hear his reply, “Yeah, they aren’t very good for you.”  It is kind of like any woman with hormone concerns who always gets put on birth control pills.  Most everyone with any digestive concerns almost always get put on acid reducers!  But they may just be leading to larger problems in the end.  If you choose to go this route, please do your research and proceed with caution! 

Another very common situation that can lead to SIBO is poor neurological function.  The gut, like everything else, is stimulated directly by the brain via the Vagus nerve.  If there is damage to this nerve, or even if there is a decline of overall brain function the stimulation to the gut will be hindered.  (Poor brain function will lead to poor Vagus nerve activity and therefore poor gut stimulation.)  This impacts blood flow to the area and certainly the functioning of the various valves sealing off the different compartments of the intestinal tract which can all lead to bacterial overgrowth.  This is something that you see a lot in the elderly who often times suffer from advancing neurological decline.  But rarely does anyone ever make the link between their bloating after meals and their neurological status.  But pay attention.  The next time you talk to someone of advanced age with neurological decline see if you can find out if they are digesting their food well. Most are constipated and bloated.   In these cases simply “fixing the gut” will not get very far.  Brain support is critical for them and in some cases all we can do is stop the progression.  If enough nerve damage has occurred that may just be how it will be going forward.  We can however support the condition to reduce discomfort and make eating a bit more enjoyable while not being so scary.

Lastly I wanted to talk briefly about “IBS” while I am at it because it is a very commonly thrown around diagnosis.  I personally take offense to a diagnosis like this because it is nothing more than a description of a set of symptoms.  There is nothing in that “diagnosis” that tells us anything about the root condition!  An irritable bowel can be from a lot of different things.  But regardless this condition often involves constipation and/or diarrhea.  Interestingly in the SIBO spectrum of disorders depending upon the type of bacteria that is overgrown in the small intestine there can either be Methane gas or Hydrogen gas produced by the bacteria present.  Methane tends to decrease intestinal motility leading to constipation and Hydrogen tends to increase motility leading to diarrhea.  So is the proper therapy for these conditions acid reducing medications (which can lead to bacterial overgrowth), smooth muscle relaxants (which can lead to poor valve control in the digestive tract leading to translocation of bacteria from large to small intestine), or something like laxatives/Imodium to quell the symptoms?  Well perhaps that is the way you prefer to go.  But perhaps steps could be taken to address the specific underlying mechanism at play.  Is it low stomach acid?  And if so why?  Is the Thyroid working properly?  Are there medications involved that are working to lower the acid production?  Are there infections in the gut which may be impacting acid production? Or is there perhaps a neurological condition leading to these symptoms?  Was there head trauma? Or is there any developmental disability?  There might even be physical reasons like an abdominal injury or surgery.  Each case is a little different. 

So what can be done?  First like I described above it is important to understand the specific mechanism involved in each case.  That means it is important to find a practitioner who is knowledgeable about the differences and how to pick up on the subtle signs and symptoms of each.  Second you must work to nutritionally support the small intestine itself by providing compounds needed by the intestinal cells to thrive.  Digestive enzyme support is also essential to help the body break down the food more efficiently before the bacteria can get ahead of things.  It is essential to provide good probiotic support to promote optimal bacteria distribution in the gut but make sure that they do not contain any prebiotics (bacteria food).  Most probiotics contain prebiotics which are generally great but not with SIBO!   And lastly in some cases a person may need to work on the neurological function associated with the gut.  There are some tricks for stimulating the Vagus nerve and I am happy to share them with you in person sometime. 

In closing I want to share just a few statistics from a couple of well-respected medical journals.  (Journal of Clinical Gastroenterol & Gastroenterology Hepatology).  The following list are percentages of certain groups of people who show positive for SIBO:
  • ·         66% of patients with Celiac Disease
  • ·         53% of patients who use antacid medications
  • ·         78% of patients who have been diagnosed with Irritable Bowel Syndrome (IBS)
  • ·         33% of patients with chronic diarrhea
  • ·         90% of alcoholics

The consequences of long term SIBO are many.  Over time this can lead to permanent nerve damage to the digestive tract.  Food sensitivities become more and more common. It can be argued that all chronic disease can arise from chronic inflammation in the gut.  SIBO is one way to foster such inflammation.  It has been with us for a while but with the widespread use of antacid medications, poor diets, and poor physical health in general the condition is only getting worse.  I urge you to take your symptoms of gas and bloating seriously.  It isn’t just uncomfortable.  Your body is working hard to try and tell you something is not right.  I am happy to schedule a consultation to go over some of your concerns.  I am here for you.  Call on me anytime!  

The Importance of Struggle

I feel compelled to write a piece here today about the concept of struggle.  We all go through struggle in some form and in differing levels of intensity.  I see it all the time in my clinical practice in people with physical pain or disability.  I see it in people going through any of life’s many painful events such as divorce, deaths, or even final exams for that matter.  I myself am going through it right now. It does not matter about the subject of the struggle each of us go through because the core always remains the same.  In essence we find ourselves at a place in life or circumstance where we do not know how to help ourselves out of the position that we find ourselves.  Or perhaps we do know what we need to do but the steps to get there are just so very large.  It is important therefore to remember that struggle is simply just a mindset that offers us options.  I could go down the road to the left or I could perhaps choose the road to the right.  Each path will have its own pitfalls and rewards.  And for certain each one will have many things to appreciate and observe along the way.  But which one is the right one?  Well, unfortunately that is the rub for a person in struggle.  Decisions are rarely ever easy.  So struggle we must.  If the subject matter is important enough struggle is inherent. 

I feel that it is all too easy to assign negative emotion to the concept of struggling.  Sadness and despair are commonly associated with this experience.  It is of course one thing to struggle physically while on a two hour hike up a nearby mountain.  But it is another thing altogether to struggle physically with the pain and disability of getting up to go to the bathroom which has both physical and emotional implications!  A person might struggle over a break-up or they may struggle with moving on after the death of a loved one.  They are all significant in their own way.  But what if we can change our thinking to accept the struggle and appreciate that this is a necessary part of life?  For without struggle and the stresses we endure we might end up weak and without substance.  Indeed when we are offered a challenge that we think we cannot complete we are offered a choice.  Give up and refuse the challenge which always leads to failure.  Or take the challenge head on.  Risk failure yet move toward success, empowerment, happiness, or whatever you are struggling over.  Either way we are stronger because of it.  We cannot measure success only by the act of reaching the top of the mountain.  Or finishing the race.  Or making it to the bathroom by yourself.  Those are all wonderful of course.  But by accepting the reality of the situation, appreciating the incredible odds against you, and trying your best to achieve your goal, you have done more for yourself than you might not immediately comprehend.  By facing struggle from a perspective of curiosity, determination and empowerment you are taking the steps necessary to face your fears with an open heart and by consequence you become stronger and life quickly has more meaning.  So there is always a gift hidden within struggle.  The right answers will show themselves in time.  To avoid or submit to struggle means missing the most precious gift of all.  All too often we tend to forget this and take the easy road only to be left with a feeling of worthlessness and despair.  Or we may feel anger or depression.  This of course does little for us in the end aside from promoting more failures, less self-empowerment and less healing.

As a final thought I also want to impress upon you that struggle is a very personal experience.  Those of us standing outside may have the need to try and help our loved ones out of their pain or their struggle.  And of course we should, but the way in which we do this is extremely important.  If we swoop in and try and take the pain away, or take the burden on ourselves we have done that person a huge disservice.  Your help may have solved that immediate problem for them but what have you done for them in the end?  Does this mean I wish you to neglect your fellow person?  No, I suggest that you appreciate their struggle, love that person totally, help lightly and stand with a supportive presence that they can look to for encouragement or guidance along their path.  We all need to know that we have the power to pull up our own bootstraps, heal ourselves and help ourselves thrive.  Yes we can seek the assistance of others along our path, but we cannot allow others to take our burden for us.  I think of this in the same way as asking for someone in the gym to lift my weights for me.  Or completing a marathon while being pushed in a stroller.  Where is the empowerment?  How does avoiding struggle make us stronger?

So no matter what you are struggling with currently.  And you are struggling with something.  I ask you to really look hard at what that thing really is.  What do you really think about it?  What might you be telling yourself about it that might not be true?  What types of stories are you telling yourself and others that work to cloud or protect you from needing to face the core of the struggle?  I feel that if you really ask yourself these questions with an open heart the answers will surely come.  You will all of the sudden have a path laid out for you that was there all along yet you just could not see it. You will have more choices.  You will have gifted yourself with increased empowerment and control over your life. And you will quite possibly be able to help yourself out of your struggles and emerge a totally different person in the end.   

Basic Brain Health Made Easy

It is interesting…  In medicine we tend to cut the head off and treat mostly the body.  That is of course unless you are a Psychiatrist in which case you cut the head off and treat the head.  Very rarely do practitioners consider the entire body and how the brain plays into the basic physiology of the person in general.    I find this troubling because the brain is everything.  Without healthy brain function we do not sense our surroundings well, we do not digest our food well, and we do not move our bodies well.  In fact there is not one system in our body which is not directly controlled by the nervous system.  It is common therefore in neurological decline scenarios for there to be problems in seemingly unrelated systems.  Take for example an elderly person who needs to eat simple foods whereas before they could eat anything they pleased.  This same person struggles with constipation and bloating.  And in fact if that person were to pay attention they might find that these symptoms get worse when they are tired or over worked. A long drive for example might induce uncomfortable digestive symptoms.  So is this a problem with the digestive system itself?  Perhaps.  But I would wager a bet that there is a neurological component to the condition as well.  I would then ask the question, “If we only provide digestive support (symptom support) and forget the brain part of the equation, are we offering good medical help?”  I say no.  To overlook the brain and neurological health for any chronic condition is tantamount to bailing water out of a leaking boat without fixing the leak!  Not good medicine indeed.
So it is my intention here today to offer just a few basic concepts to help keep your brain as healthy as it can be.  Now avoiding activities which directly damage the brain is obvious, and there is much more to the story and good fodder for future articles, but here are three things which everyone should do as a matter of basic brain hygiene:

·         Optimize your blood sugar.  Blood sugar imbalances are epidemic in this modern first world age of convenience and garbage “foods.”  If the brain does not get a steady supply of glucose (blood sugar) the neurons or brain cells simply cannot function optimally.  If a person is low blood sugar or hypoglycemic then there simply isn’t enough sugar.  This person will often crave carbs, feel shaky/irritable between meals, and may even wake up in the middle of the night as a regular pattern.  These are the people who have also worn out their snooze button.  Waking up for them is very difficult.   But if the person has too much glucose in the system they become Insulin Resistant or develop frank Diabetes.  In this case even though there is plenty of glucose the body loses the ability to get it into the cells so they end up starving just like the hypoglycemic person.  Insulin Resistance people generally get sleepy after meals, are often struggling with weight issues, have depression or something like it, and may have trouble falling to sleep.  And they often wake up not rested even if they slept for 10 hours!  So it is extremely important that you maintain a healthy blood sugar for brain health specifically, but for general health as well.  Most major diseases or nasty conditions that kill us are directly promoted by poor blood sugar. Poor blood sugar = inflammation.  Inflammation = disease.   So eat your veggies people and keep your simple non-fibrous carbs to an absolute minimum.  That at least is the very short answer.

·         Provide optimal oxygen/circulation.  This seems obvious of course but it is a very common problem for two reasons.  The first concept is that of anemia.  I of course use the Functional Blood Chemistry approach to things like this.  That means that I do not wait until people get so out of balance that their doctor calls it a problem.  That is WAY too long.  The Functional approach uses smaller reference ranges so we see patterns developing early.  This is preventative medicine at its best.  Why wait until we are drop dead anemic to act?  The truth is that even mild anemia patterns start to add stress to your body.  If I were to put you in a room and cut the oxygen levels to some % of what you are used to breathing you would feel the difference.  This is what people live like all the time.  Finding and fixing these patterns early is a big deal in protecting your brain.  Without oxygen those nerve cells simply don’t work well.  And when a nerve cell fails to work well it usually dies early as do all of the nerves downstream from it!  So that is part one.  Part two involves circulation.  You could have wonderful Red Blood Cell health and could be saturated with oxygen but if your blood vessels are blocked or shut down then you lose the ability to deliver that yummy oxygen to the nerve cells, not to mention removing all the damaging waste products from the brain to be eliminated.  Know anyone with cold hands and feet?  Or how about toe nail fungus. These are all signs that circulation is not up to par.  If you are not circulating blood to your extremities then you are probably not circulating blood adequately to your brain either.  You can also do a quick test on yourself to look for circulation.  Simply press on your fingernail so that the tissue underneath turns white. Release and a nice pink color should return in a second or two.  This is called capillary refill time.  If it does not return quickly circulation is poor.  And if it is always white and your fingers are cold then you definitely have circulation problems!  At the very least, get yourself out there and exercise!  Move that blood.  And get in touch with me.  I have other stronger ways to get those vessels open.

·         Stimulate your brain!  Stimulation is essential for a healthy brain.  Simulation in its simplest form can just involve engaging yourself in something more than watching Maury Povich television shows or some other mindless drivel.  (Is that show even still on?)  But more specifically, the brain needs to be challenged.  It is one thing to be a wiz at cross word puzzles.  But that isn’t enough.  The brain likes new challenges.  If you are a wiz at cross words then move to Sudoku puzzles or something else.  Or really challenge yourself and learn a language.  Or learn an instrument.  Even listening to music is a wonderful practice for brain health.  But there is nothing better for brain than exercise.  The amount of stimulation that a person receives while on a jog or a hike is enormous.  Or learn dancing.  This activity is very complex and works the mental and the physical stimulation concepts.  So take this part to heart.  Doing these things is so good for you in so many ways.  Once we get out of our holes, socialize, become active, life all of the sudden gets better.  And your brain will get better as a result.

So in closing, remember that there is more to your health, or your specific symptoms than you think.  Believe it or not, there is a master controller that dictates every part of your body.  Brain health, even in young people, could easily have something to do with symptoms you might otherwise think are not related.  But don’t let that silly brain fool you.  The trouble with brains is that they often forget themselves, when in reality it is them that we should look to first.  Fix the brain and you may be surprised that the bloating in your belly improves as well!    

Hormone Replacement Therapy… Let’s Trump Mother Nature Shall We?

I was reading recently in Aging Matters Magazine (Issue 2, 2013), and came across an article by a Dr. Richard Lippman. I want to thank the good Doctor for his opinions on the topic of anti-aging. They exemplify exactly what we as the humble patient need to be cautious of while seeking medical help.  

What I see all the time in the mainstream medical practice is a “God-like” attitude and an absolute black and white view of health and the human body.  Indeed it appears that if the information did not come directly from the Pharmaceutical companies themselves it does not exist in the mainstream clinic.  

Bio-identical hormone therapy is no different, it is just the newest thing.  So what we are told as patients is that without these powerful treatments we are lost.  Without things like Hormone Replacement Therapy (HRT) we humans are doomed to suffer the terrible consequences of physical and sexual atrophy, cancer, depression, etc.  Without them we will most certainly suffer, and who would be so silly as to allow that to happen?

Now with due credit to Dr. Lippman, he does indeed recommend healthy diet and lifestyle, though these recommendations only amounted to two sentences of the entire article.  Salads, sushi, avoiding fast food, tennis and swimming are examples of healthy choices Dr. Lippman recommends.  In this we are in agreement, but if I may point out a few of his other more telling statements… 

“Bio-identical hormones are the only practical way to avoid stroke, blood clots, and cancer and to enhance one’s sex life.”  

“Nature is out to destroy our bodies by limiting our hormones and nutrients.  Correcting our hormones will trump Mother Nature’s rampage that often starts in middle age.” 

Now this is the type of statement that should automatically concern the average person.  It reeks of fanaticism and closed-mindedness to the mountains of other well cited and peer reviewed research articles on the subject.  This is downright dangerous when put into practice with such inherent authority.  Remember, the status of the MD has risen to that of a noble lord.  To question the authority is tantamount to blasphemy and to do so means that you are adrift on your own with no chance of salvation. At least that is the feeling we get right? 

So if I may just contribute a few thoughts:

  • First I want to highly recommend the book The Menopause Industry, by Sandra Coney.  This book was previously “banned” in America due to pressure on the publisher from the Pharmaceutical Industry.  You gotta love banned books!  It is a must read for every woman and anyone practicing hormone based medicine. This book provides a very accurate description of the female hormone system and how the American brand of medicine has crafted very specific scare tactics regarding hormone health (such as seen above).  

  • Regarding HRT being the only practical way to avoid stroke, blood clots and cancer…  Let’s not forget that there have been hormone replacement studies that have had to be stopped due to increased deaths associated with certain hormone protocols.  No not every hormone strategy mind you, but please people, these things are very powerful medicines!  And yes they can kill you.  There was one particular study I read about many years ago that touted the vascular benefits of HRT in women.  It clearly stated that the proposed mechanism of benefit was that it appeared to elevate blood levels of the Omega 3 Fatty Acids found in fish oils which are known to have anti-inflammatory effects and benefit vascular health. Therefore they concluded that HRT was valuable for heart disease. I had to chuckle at this one.  Why not just take the fish oils if that was the proposed value? 

  • Regarding the cancer specifically…  The real concern for people here is the rampant inflammatory scenario that we are all wallowing in these days.  How about we focus on the terrible corporate provided diets that permeate our daily life?  How about we talk about the Xenoestrogens and Bisphenol A that we consume every day while we suckle from our plastic topped corner store coffee cup or our bottled waters?  How about we discuss the raging food sensitivities which are shown to drive cancers of all kinds and increase all causes of mortality?  Is the medical system really looking out for our greater good?  Or do they just want to sell more medicine?

  • Regarding the concept of “anti-aging” itself.  Why is it that these anti-aging doctors focus so squarely on the Endocrine system?  Hormones aren’t everything that’s for sure.  They are potent and they can produce immediate benefits.  But I can speak from experience that there is a price to pay eventually.  If you really think about it, aging is not really a matter of hormonal decline.  Everything that we are, including the hormone system, is a function of brain health.  Neurological decline is everything and it takes more than hormone replacement therapy to keep a brain healthy.  I would hope that these “anti-aging specialists” will soon clue into that concept.  It will do their patient populations wonders and may even require less replacement therapy in the process.  Now isn’t that the goal anyway?  One school of thought drives dependence and the other drives empowerment.  Hmmm…  Just try getting off of your HRT sometime if you are already on it.  It is generally not a comfortable thing to go through.

  • And finally, if you think that you can “trump mother nature” you are sadly mistaken.  It certainly has not stopped us from trying to manipulate the weather, or genetically modify the food chain, or eventually terra-form Mars!  I guess this is no different.   But I suppose that is the largest difference between the mainstream and “alternative” practitioners.  We alternative folks aren’t trying to pull one over on nature or the body.  Shame on those who would propose this way of life!  If you are in constant opposition to nature and your own body how can you be a part of them in a healthy way?  A much better goal in my opinion would be to work with nature and the body.  You would be surprised what nature has to offer.  And just because the doctor does not understand natural medicine does not mean that it is not a perfectly valid and effective way to reduce cancer, heart disease, stroke, depression, or sexual decline.  Give me 6 months and a compliant patient and I would challenge any medical protocol in not only lowering these risk values but in improving overall quality of life. 

So I hope that this little article offers at least a little food for thought.  I admit that I can get a little steamed from topics like this because I see it as a gross abuse of power and influence over an often desperate and under informed patient population.  I can tell you one thing though…   If your doctor or any other medical practitioner comes off like our good Dr. Lippman, touting outlandish tales like these, I recommend that you look for another doctor.