Do You Have SIBO? 5 Signs to Look Out For - Dr. Michael Ruscio, DNM, DC

Do You Have SIBO? 5 Signs to Look Out For

Learn how to recognize digestive and non-digestive symptoms related to Small Intestinal Bacterial Overgrowth and find a way to improve your gut health

Are your symptoms coming from your gut or somewhere else? Gut issues like Small Intestinal Bacterial Overgrowth (SIBO) can cause digestive and non-digestive symptoms, making it tricky to understand what to treat and how to find relief. To help you identify if SIBO is the root cause of your fatigue, brain fog, bloating, and thyroid and mood issues, I provide the main signs and symptoms to look out for. Watch the video now to learn more.

In This Episode

Intro… 00:08
What is SIBO?… 02:38
How SIBO occurs… 04:03
Why is SIBO so problematic?… 05:11
The five prominent symptoms of SIBO… 06:19
The connection between SIBO and gluten sensitivity… 08:33
Fatigue and mood… 10:12
What about hypothyroidism?… 14:44
What probiotics can do to help symptoms… 15:30
Close… 17:40

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Hi, everyone. This is Dr. Michael Ruscio. I just want to make a quick preface that the audio that you’re about to listen to is actually the audio compendium to a video, which has appeared both on our YouTube channel and on our Instagram page for your convenience. We want to always release the audio version of a video here on the podcast. However, it’ll be evident in some videos, more so than others, that the visual aids may be heavily referenced and leaned on. In some cases, having a depiction of a concept can be very helpful in portraying and making comprehendible that concept. So in any case, if you are listening to this and you want the visual aids, please see our YouTube and/or Instagram page so you can have access to those. Okay. And here we go to the audio for today’s video.

➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Dr Ruscio:

Hi, everyone. This is Dr. Michael Ruscio. I just want to make a quick preface that the audio that you’re about to listen to is actually the audio compendium to a video, which has appeared both on our YouTube channel and on our Instagram page for your convenience. We want to always release the audio version of a video here on the podcast. However, it’ll be evident in some videos, more so than others, that the visual aids may be heavily referenced and leaned on. In some cases, having a depiction of a concept can be very helpful in portraying and making comprehendible that concept. So in any case, if you are listening to this and you want the visual aids, please see our YouTube and/or Instagram page so you can have access to those. Okay. And here we go to the audio for today’s video.

Dr Ruscio:

SIBO, or small intestinal bacteria overgrowth, can cause digestive symptoms like bloating, constipation, diarrhea, or reflux, but it can also cause non digestive symptoms such as fatigue, brain fog, mood disturbances, and even a connection to thyroid problems. It’s crucial to understand this far reaching impact of the gut because, as I learned myself, problems in the gut very much so, including SIBO, can cause a wide array of symptoms. And this can explain why some people are frustrated and not able to figure out where their symptoms are coming from. This is Dr. Michael Ruscio and let’s detail this very important finding of small intestinal bacterial overgrowth.

Dr Ruscio:

And so what is SIBO, or small intestinal bacterial overgrowth? Well, the name gives you a pretty good indication as to what it is, but it’s an overgrowth of bacteria in the small intestine. Now, there should be some bacteria in the small intestine, however, compared to the large intestine or the colon, there should be relatively few bacteria. When these bacteria overgrow, they can lead to excessive gas because remember, like people, as bacteria eat food they sometimes release gas. And that gas can build up in one’s system, leading you to feel gassy. And this can also explain why distension, bloating, and pressure are some of the other symptoms that are associated with and caused by SIBO. Some evidence has also found that SIBO can lead to damage of the lining of the gut—leaky gut. It’s similar to what’s seen with celiac disease, actually, and can also lead to overactivation of the immune system. And remember, when the immune system reacts, there’s almost always inflammation that’s wrapped into that. So that’s the long/short on SIBO.

Dr Ruscio:

In terms of how it occurs, there are two main theories and they both have some evidence, some plausibility, and it’s probably one or the other or both for some people. Bacteria from the top—meaning the oral cavity and the stomach—make their way down into the small intestine and then overgrow. This can happen when people have lower levels of hydrochloric acid or at least presumably. So this is something that a very elegant study by gastroenterologist Richard McCollum was documented. Now the other hypothesis and way in which SIBO can occur is from the bottom up. Remember we mentioned a moment ago that the large intestine has a relatively dense colonization of bacteria. And in some cases, bacteria from the large intestine can reflux upward and seed and colonize and overgrow in the small intestine. So it can occur in either direction. Not that that’s incredibly relevant for the treatment per se, there’s some relevance, but just to address some of how SIBO occurs.

Dr Ruscio:

And why is SIBO so problematic? Well, as we outlined a moment ago, you can probably infer a number of reasons why. But to tie those to a number of reasons why, specifically, because 90% of your calories are absorbed in the small intestine. Most nutrients are absorbed in the small intestine. And the small intestine—again, where SIBO occurs—is the most immunoactive. In fact, the largest density of immune cells in the entire body resides in the small intestine. And this is where leaky gut and the connection to auto immunity come in. So a lot is happening in the small intestine. And when we have dysfunction like SIBO there, it can cause many problems.

Dr Ruscio:

Now, as a quick aside, one fairly simple way to help quell SIBO and reduce symptoms is an elemental diet reset. And we’ve put together a free guide if you wanted to obtain some advice on how to do this simple, safe therapy at home. And again, that link is in the description. Okay.

Dr Ruscio:

So five of the more prominent symptoms of SIBO would be digestive—including IBS, gas, bloating, constipation, diarrhea, abdominal pain, but not limited to that—fatigue, mood disorders, brain fog, and thyroid function. And let’s detail these a bit more. Now with SIBO it’s very important to understand the connection to IBS, and this will become more relevant in a moment, but let’s start with the connection between SIBO and IBS, because SIBO is a lab finding and we want to make sure to be careful that we tie a lab finding to have meaning. In essence, that this lab finding correlates with you feeling differently. Because there are lab markers that don’t really have any meaning, and one can get very easily swept up into running all these labs, especially in progressive realms of medicine that aren’t validated and really have no meaning.

Dr Ruscio:

And some of these labs, sadly, are even fraudulent and have been shut down by the FBI or the FDA. So, in 2018, a meta-analysis, which is a summary study, examining over 50 studies published in the Journal of Clinical Gastroenterology, found that more than 1/3 of IBS patients—so these patients who have digestive symptoms—tested positive for SIBO. And other data have found an even higher association between SIBO and IBS. So it’s a moderately safe inference that if you have digestive symptoms, you could have SIBO. If you have IBS, you could have SIBO. And I want to make that connection because there’s a lot of research on IBS and we’ll borrow from some of that to draw another inference in terms of what symptoms SIBO may cause because there’s more evidence on IBS. And so again, sometimes we can borrow from this to help you better understand what you can do to improve your health and to get rid of if it be brain fog or fatigue, so that you can feel better.

Dr Ruscio:

Now, one other thing we should tie in here is the connection between SIBO and gluten sensitivity. This is very important to understand that celiac patients—and this is the, of course, most severe intolerance, even auto immunity in reaction to consumption of gluten—celiac patients who were unresponsive to a gluten-free diet had two times the rate of SIBO when compared to healthy controls. And there’s even other evidence that has found that treatment of SIBO will lead to resolution of symptoms in those who are non-responsive to a gluten-free diet. So if you’ve gone gluten free and seen some result, but not complete, it could be that SIBO is present.

Dr Ruscio:

And outside of IBS—like we detailed a moment ago, the gas, the constipation, the bloating, the abdominal pain— other evidence has also tied SIBO to reflux and indigestion. A 2021 study found that 60% of chronic reflux patients had either dysbiosis and imbalance in the ratios or SIBO and overgrowth. And another 2021 study found that 71.4 [percent] of dyspepsia, or indigestion, patients tested positive for SIBO when compared to only 8% positive in healthy controls. So again, SIBO can associate to IBS, to non-responsiveness or partial responsiveness to gluten-free dieting, and also even to reflux and indigestion.

Dr Ruscio:

Now what about non-digestive or extra intestinal manifestations of SIBO? Well, in another meta-analysis it was found that more than 50% of IBS patients had fatigue. And this is not the only finding that has associated IBS to fatigue. Very important to understand that fatigue can come from your gut. And many people who have digestive symptoms, especially in the clinic will comment, “the worse my gut is (digestive symptoms) the worse my fatigue is. The better it is, the better I feel.” And importantly, interventions that help with either SIBO or IBS have been shown to improve fatigue. Namely, a low FODMAP diet has been shown to improve fatigue in IBS patients and in another study, treating leaky gut reduce fatigue in patients with chronic fatigue syndrome.

Dr Ruscio:

Now what about mood? This is something else that you watching this may have experienced—when your gut flares, your mood flares. But keep in mind that you can have silent digestive problems. And seemingly so your mood problems are coming from nowhere. This is what I experienced myself. I had brain fog, fatigue, and depression with no digestive symptoms coming from a problem ultimately in my gut. But just a flag for you here that depression and anxiety are common in IBS and also thankfully gut treatments—namely probiotics and gut friendly diets—have shown the ability in interventional and clinical trials to improve depression and anxiety. Perhaps the most robust and compelling evidence here is a 2021 meta-analysis—remember, this is a summary, in this case of 16 randomized control trials, the pinnacle of scientific evidence—looking at overall 1100 patients and they found that probiotics improve depression and anxiety. The evidence is stronger for depression, but a signal also exists for probiotics being able to improve anxiety.

Dr Ruscio:

Hi, everyone. If you are in need of help, we have a number of resources for you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is the clinic—the Ruscio Institute for Functional Medicine—and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path, health coaching support calls every other week, and also we offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, etc. There’s also the store that has our Elemental Diet line, our probiotics, and other gut health and health-supportive supplements. And for clinicians, there is our FFMR—the Future of Functional Medicine Review—database which contains case studies from our clinic, research reviews, and practice guidelines. Visit DrRuscio.com/resources to learn more.

Dr Ruscio:

And what about brain fog? Well, brain fog is somewhat common in on either SIBO or IBS. And again, more good news, a randomized control trial found that probiotics improve cognitive performance in those with mild cognitive impairment. Rifaximin, an antibiotic that is FDA approved to treat SIBO, has also been demonstrated to improve cognitive function. And there’s an interesting connection here in that this occurs predominantly in what’s known as hepatic encephalopathy. And what this means is that when the liver is burdened and can’t adequately filter the blood, toxins in the blood make their way into the brain, and this causes cognitive impairment. And Rifaximin, which treats SIBO and improves gut health, has been shown to reduce this whole cascade because the gut drains to the liver and if you fix a problem in the gut, you fix a problem in the liver. And in this case, gut affects liver, affects toxins affects brain. And this is how Rifaximin has been shown at least in a handful of trials to improve this hepatic encephalopathy, right? It’s the gut-liver-brain connection.

Dr Ruscio:

And what about hypothyroidism? This is actually a bit of a newer finding over the past maybe three to four years. You’ve been seeing this breadcrumb trail of evidence being published. One of the more compelling studies was in a grouping of over 1800 patients and they found that hypothyroidism was the condition most tightly associated with small intestinal bacterial overgrowth. What was shocking about this finding was the researchers were expecting acid-lowering drug use, intestinal surgery to be the most tightly associated with SIBO. And what they found was being hypothyroid was the most tightly associated. So this was a fairly landmark finding.

Dr Ruscio:

And another seminal paper in this regard found that probiotics may reduce the need for thyroid medication. And to quote this paper, “TSH (or thyroid-stimulating hormone) concentrations, levothyroxin dose, and fatigue severity all decreased after a intervention on probiotics.” So very compelling. And likely what’s happening here is those who are taking thyroid hormone, levothyroxin, have a degree of impaired absorption of that medication and the probiotics, through potentially addressing SIBO and/or at least improving gut health and therefore improving absorption (as a study found) reduced TSH while also needing less of a dose. Meaning you took less medication and the medication worked more effectively at lowering TSH. And also you saw improvements in fatigue. So very, very interesting information here.

Dr Ruscio:

And I also wanted to draw your attention to this one graph. This is a patient’s TSH over time. Now, ideally when on thyroid hormone medication, the TSH should be 2.5 or below. And what you’re seeing in this graph is I drew in a green line showing you the 2.5 cutoff. And month over month over month over month, this patient (and this is a published case study by the way) was unable to get their TSH into the normative range until they took Rifaximin, which again, treats SIBO. And then they were able to see improvements in their TSH levels. And finally, see the normalized. In fact, just yesterday, we went through the final draft of a six-patient case series that we will be publishing in a peer-reviewed medical journal, if it’s accepted, showing this sort of thing in a number of cases where improving the gut was actually the final missing piece allowing a patient to then respond more fully to their thyroid care.

Dr Ruscio:

Okay. So in close, remember that SIBO can cause digestive symptoms, bloating, constipation, diarrhea, reflux, et cetera, but it can also cause non digestive symptoms like fatigue, brain fog, mood disturbances, and even thyroid problems. And when we understand this, we can hopefully uncover the root cause of our symptoms and then have a path forward to address them. I hope this helps. And I’d also be curious to hear what your experience has been with SIBO, with gut health, and if you have any other questions or are looking for advice on your path forward. Okay, again, this is Dr. Michael Ruscio and I hope this helps.

 

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