Today I sat down with Robert, who had already been diagnosed with small intestinal bacterial overgrowth (SIBO). He was suffering from weight loss, constant bloating, stomach pressure, belching, and constipation. He had been working with his gastroenterologist and seeing some results, but still had room for improvement. We used herbal medicines, digestive enzymes, and made a few dietary changes. Bob did very well with this approach, he gained weight and saw his digestive symptoms improve.
Success Treating SIBO
Dr. Michael Ruscio: Hi, this is Dr. Ruscio. I’m here with Robert. And Robert was a really interesting case. He came in pre-diagnosed with SIBO and had a pretty progressed case of it. And when you had come in, what were some of the chief symptoms that you were having? I know weight loss was one of the big ones.
Robert: Right. Right. I think the major symptom was what I call constant stomach discomfort.
Dr. Ruscio: Right.
Robert: And belching and, really, pressure in my stomach were the major symptoms that I had.
Dr. Ruscio: With that burping.
Robert: Yeah, right.
Dr. Ruscio: Yeah, yeah.
Robert: And it, at various times, was very severe.
Dr. Ruscio: Sure. Yeah, when you came in, though, it was your typical presentation of SIBO, where the weight loss was getting to a point where he was getting concerned about it. And a lot of upper GI discomfort.
And SIBO, for those of you who don’t understand it, is small intestinal bacterial overgrowth. And it’s where the bacteria in the colon can overgrow into the intestines and cause bloating, gas, constipation, loose stools, burping, bloating, pain, things like that—and also weight loss because it can actually damage the intestinal lining and interfere with nutrient absorption.
So he had come in, and you had been through a whole bunch of endoscopies through both ends and testing. He had had a good workup. And you had had some response, but you weren’t really all the way there.
Robert: Yeah, I’m not sure I got to the point where I felt like I was in control of it. But I was pretty much at wit’s end because I think I did every test known to man and some of them twice and a couple of them with so-called experts in the field.
Dr. Ruscio: Right.
Robert: So I was diagnosed as creating a lot of excess methane gas.
Dr. Ruscio: Sure.
Robert: And that was the primary culprit for the discomfort.
Dr. Ruscio: Right.
Robert: So methane production was the element that we couldn’t get a handle on.
Dr. Ruscio: Sure. Sure. And usually SIBO will present as one of two ways—either a hydrogen predominant, a methane predominant, or a mixed type. And so that was methane predominance, what we saw with Robert.
And we built upon some of the stuff he had done in the past. We went through a course of herbal antibiotics to help beat down the methane SIBO a little bit more.
Also, I think one of the key things for you is using the hydrochloric acid, because I don’t think you were making nearly enough hydrochloric acid. And he had a lot of burping.
And a lot of times, burping and gas in the upper half of the intestinal tract is an issue of not having enough hydrochloric acid. And if you don’t have enough hydrochloric acid, that can actually feed SIBO. And some of the studies have shown that if you use long term acid suppressing medication, that’s one of the risk factors for SIBO.
So we were looking at that in the opposite where we needed to get more acid in the stomach. That combined with—we did find Epstein-Barr virus was reactivated as well as another bacteria in conjunction with that. This one, we had to work with it.
Dr. Ruscio: Some cases are quick. But this one, we had to work at it for a little bit. And we had a fairly intensive middle stage of therapies there where we were using a lot of different antimicrobials and different things.
But you’ve been on some weight.
Robert: Yeah, yeah.
Dr. Ruscio: What has it been? About 10 pounds now?
Robert: Yeah, I lost about 30 pounds. I got 10 of it back. And I’ve plateaued. I still need a little bit more weight. But I seem to be getting back to what I should be.
Dr. Ruscio: Right. Right. And then the GI distress is much less?
Robert: Much less. I do have to watch what I eat. I continue to watch what I eat and try to balance the hydrochloric acid.
Dr. Ruscio: And you’re very, very FODMAP sensitive.
Robert: Right. Right.
Dr. Ruscio: Which is something that can be an important part of managing—especially a chronic form of SIBO—trying to limit the FODMAP foods, because these high FODMAP foods feed it. I think you found that firsthand where you’ve tried to test the waters. And it hasn’t gone too well.
Robert: Right. You do, and then you know you shouldn’t.
Dr. Ruscio: Right.
Robert: But sometimes, you’ve got to do it before you know it doesn’t work.
Dr. Ruscio: Yeah. You’ve got to burn your hand on the stove a few times.
Robert: Exactly. Exactly.
Dr. Ruscio: Cool. So yeah, I think that’s a pretty good synopsis.
Robert: Yeah, yeah. Yeah, we’re in a maintenance mode right now. And hopefully, we’ll keep tweaking it until we get the right combination.
Dr. Ruscio: Yeah, and I think we’ve got you pretty much out of the woods. A few little tweaks going forward for Robert. But luckily, we got some weight back on.
Dr. Ruscio: And most of the chief symptoms out of there and a couple little things maybe that we can get going in the future. But I think overall you’ve done really well. And I’m happy to see that we were able to help you.
Robert: Right. Good.
Dr. Ruscio: Well, thank you for talking to us.
Robert: Okay. All right.