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Yes, Where Do I Start?

SIBO – Can You Recover?

Depending on what you read, and where you read it, you can get very different opinions on SIBO.  Some paint SIBO as a condition one can never recover from, while others call it a fad.  Let’s discuss a reasonable and evidence-based take on SIBO recovery.

Dr. R’s Fast Facts

SIBO stands for Small Intestinal Bacterial Overgrowth

  • An overgrowth of bacteria in the small intestine that can cause gas, bloating, abdominal pain or distention, and either constipation, diarrhea, or both.
  • Food poisoning can initiate an autoimmune process in the gut that damages the Interstitial cells of Cajal (these cells help with motility or the movement of food through the digestive system).
  • When motility is interrupted, it can lead to bacterial overgrowth in the small intestine.

Can you recover from SIBO? Yes

  • Theoretically, we evolved from highly omnivorous hunter-gatherer scavengers, so it’s likely our ancestors were exposed to bad food and were able to recover from it.
  • The Interstitial cells of Cajal are neuromuscular cells. Muscle has a strong ability to heal and regenerate, though nervous tissue does not. However, nervous tissue is really great at rewiring itself to make up for damage.

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SIBO – Can You Recover?

Dr. Michael Ruscio: Can you recover from SIBO?

Hi, this is Dr. Ruscio, and recently someone asked a question on my Facebook page that I thought was worth repeating and doing a video on. Essentially the question was, can I recover from the autoimmune damage that occurs against the intestinal cells called the interstitial cells of Cajal that allow SIBO to occur?

In short, the answer, in my opinion, is yes. Now, before I jump into that, let me just give a quick recap on what SIBO is if you’re unfamiliar. SIBO is small intestinal bacterial overgrowth, and as the name implies, it’s an overgrowth of bacteria in the small intestines that can cause gas, bloating, abdominal pain or distention, and either constipation, diarrhea, or both.

Now, what causes SIBO? Well, the way we think SIBO occurs—right now, anyway—is if you ever suffered a bout of food poisoning or what’s called acute gastroenteritis, so you had a stomach bug or food poisoning, you had a bout of either throwing up, diarrhea, or both, that can then initiate an autoimmune process in the gut, and this autoimmune process damages these cells called the interstitial cells of Cajal that help regulate motility or movement of food through the small intestines. When these cells are damaged, motility is damaged. And when motility of food is interrupted, if food doesn’t move through the intestinal tract at an appropriate pace, quickly enough, and it gets stagnant, then bacteria can overgrow. Kind of like flowing water is safe to drink because it doesn’t allow bacteria to overgrow, but stagnant water does foster bacterial growth, the same thing happens here.

Again, small intestinal bacterial overgrowth, or SIBO, causes gas, bloating, abdominal pain or distention, and constipation or diarrhea, and it’s very common. We’re now realizing that it’s caused after you have an acute bout of gastroenteritis or food poisoning, and that bout causes autoimmunity in the gut against these cells called the interstitial cells of Cajal that are needed to help keep food moving through the intestines. When food doesn’t move through the intestines, you can have this small intestinal bacterial overgrowth.

Then the question is, can you recover from this? I think this is a really great question, because sometimes when people learn that they have an autoimmune condition, they get really scared, there’s a lot of fear, they think they have to manage it for the rest of their life—and in some cases, they do—but in this case, I don’t think that that’s the case, and I want to, hopefully, prevent people from going to a very fearful place, because again, in my opinion, yes, you can fully recover from SIBO and regain function of these ICC, or interstitial cells of Cajal.

Now, here’s why I say so. There are a couple of philosophical reasons why, and there are a few more peer-reviewed medical research reasons why.

From a theoretical or a philosophical perspective, we evolved from highly omnivorous hunter-gatherer-scavengers, and living that sort of dietary lifestyle, if you will, it’s very likely we were occasionally exposed to bad food, rotting food, contaminated food and got food poisoning on occasion. To think that we never evolved any kind of mechanism to cope with that is silly, and to think that as the proverbial caveman, if you ever had food poisoning, you’d be suffering with SIBO or IBS for the rest of your life just doesn’t make any sense, right? So that’s one.

Two is these ICC cells, or these interstitial cells of Cajal, are neuromuscular cells. Muscle, we know, has a very good ability to heal and regenerate. Nervous tissue, however, does not. Yikes. Does that mean that you’re in trouble? Well, not necessarily, because while nervous cells can’t necessarily regenerate, nervous tissue has an incredible amount of what’s called plasticity, meaning if one nerve or neuron is damaged, all the adjacent nerves or neurons can compensate to help you regain full function. This is why, in some cases, when people suffer traumatic brain injuries, they can have a full recovery, because essentially the neural circuits, if you will, rewire themselves to allow the person to get back to full function. Nervous tissue, while it can’t necessarily or isn’t necessarily great at regenerating, is very good at rewiring.

And then thirdly, just from an observational perspective, every day myself and other clinicians that treat SIBO see people treat SIBO, clear SIBO, make a full recovery, and have minimal to no issues in the long run.

Those are the theoretical and philosophical reasons why I say I think, yes, you can make a complete recovery.

The more research-based reasons: We do have some great animal-model data where we’ve either surgically removed these ICC cells or damaged or destroyed them via exposure to certain toxins and chemicals, and what we’ve observed is that these cells can, yes, either regenerate and/or they can rewire themselves, so to speak, and the intestinal function can go back to 100 percent.

To the question, ‘because I have SIBO and we’re learning that’s caused by autoimmunity in the gut, does that mean I have a lifelong condition that I’m going to have to manage and may be an annoyance for the rest of my life?’, in my opinion, no. You can make a full recovery and get on with your life and be very healthy. Some cases are easier than others to get to that full recovery, but I think it’s absolutely possible.

This is Dr. Ruscio, and I hope you’ve found this helpful. Thanks.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.


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