I attended Dr. Nirala Jacobi’s presentation on at MINDD 2017 practitioner training and here are some highlights from her presentation on SIBO (small intestine bacterial overgrowth) which is the leading cause of IBS and a major cause of leaky gut syndrome. It is the presence of an overgrowth of beneficial bacteria in the small intestine i.e. good bacteria in the wrong place.
She shares that:
Bacterial overgrowth has also been implicated in a host of other conditions such as developmental delay, fibromyalgia, interstitial cystitis, malabsorption syndromes and many more [such as anxiety and depression and even insomnia]. SIBO requires a methodical approach to testing and treatment in order to successfully re-establish a healthy digestive tract.
And some of the typical symptoms SIBO patients experience:
I was not familiar with all these prior surgical procedures being a possible cause but this makes sense. I’ve added gastric bypass, appendix removal, endometrial surgeries, C-section and gallbladder removal (cholecystectomy) to my SIBO questionnaire.
Other possible causes include certain medications, stress and anxiety (which affects how much HCl or stomach acid you produce and gut motility) and overconsumption of simple carbohydrates.
Going back to the #1 possible cause i.e. post-infectious due to a stomach bug, the gastroenteritis and autoimmunity connection was presented. Bacteria which cause food poisoning produce a toxin called CdtB which is similar to human vinculin which is important for nerve function.
Due to the similarity between CdtB and vinculin, the body produces anti-vinculin and anti- CdtB antibodies which lead to an auto-immune attack on the enteric nervous system. This causes damage to the MMC/migrating motor complex and contributes to SIBO.
A press release from Cedars-Sinai and Dr. Pimental: Definitive Tests for Irritable Bowel Syndrome Developed at Cedars-Sinai announce the multicenter study validating the accuracy of the new blood tests:
Dr. Pimentel and fellow researchers studied nearly 3,000 people, comparing IBS patients to those diagnosed with inflammatory bowel disease, celiac disease and those with no GI disease. The blood tests identified the two antibodies associated with IBS – anti-Cdtb and anti-vinculin – with greater than 90 percent certainty.
The tests are marketed under the name IBSchek™ and are produced by Commonwealth Laboratories Inc., in Salem, Massachusetts.
This paper reports this autoimmunity connection: Autoimmunity Links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes Following Campylobacter jejuni Infection in a Rat Model and this paper discusses the two tests: Development and Validation of a Biomarker for Diarrhea-Predominant Irritable Bowel Syndrome in Human Subjects
These blood tests are available in the USA but are not yet available in Australia where Dr. Nirala Jacobi now lives and practices.
Dr. Nirala Jacobi, BHSc, ND (USA) graduated from Bastyr University in 1998 with a doctorate in naturopathic medicine. She practiced as a primary care physician in Montana for 7 years before arriving in Australia. Nirala is considered one of Australia’s leading experts in the natural treatment of small intestine bacterial overgrowth (SIBO), a common cause of IBS. In 2014, she designed the SIBO Bi-Phasic Diet to aid practitioners in simplifying their treatment approach with their SIBO patients. She is the Chief Medical Officer and Director of SIBOtest.com, an online breath testing service and educational portal for practitioners. She frequently lectures to national and international professional audiences on the topic of SIBO and founded the first Australian SIBO Summit in 2016 Nirala has had a busy private practice in Brisbane since 2008 and recently moved her clinic to Wilsons Creek in the beautiful northern rivers region of NSW, Australia.
For SIBO breath testing services in all countries check out the testing page on Dr. Siebecker’s SIBOinfo site
Keep in mind that most SIBO studies are on IBS. According to Dr. Siebecker
Drs. Pimentel and Lin originated the theory that SIBO is the underlying cause of IBS. As with all theories, there is debate and controversy about this idea, with many who agree and many who do not. One thing is certainly clear, the symptoms of SIBO overlap with those of IBS and a large percentage of IBS sufferers test positive for SIBO. One study by Dr Pimentel and team, showed SIBO in up to 84% of IBS patients, though the percentage has been lower in other studies, with an average of 60%.
Here is the most recent study showing the mental health effects of IBS (which we could presumably extrapolate to SIBO and confirm with the testing discussed above) – Neuroendocrine Dysregulation in Irritable Bowel Syndrome Patients: A Pilot Study
Irritable bowel syndrome (IBS) is a multifactorial disorder, involving dysregulation of brain-gut axis
Prevalent psychological symptoms in IBS were maladjustment (60%), trait (40%) and state (17%) anxiety, obsessive compulsive-disorders (23%), and depressive symptoms (23%).
If you are not getting anxiety symptom resolution with dietary changes, the use of targeted individual amino acid, adrenal support, addressing dysbiosis and other biochemical approaches it’s time to work with a practitioner to rule out or address SIBO as a causal factor.
Hi Trudy. I know you aren’t taking new clients, so I was wondering if you could recommend someone in the US, preferably near Chicago that could help my son. He’s 13 with general anxiety and OCD. I would like to work with someone over the summer. He has gut issues that have been a problem since he was 2. He was tested for mercury in his stool 6 years ago and it was off the charts. Please let me know if you can suggest someone. Thank you so much. I have followed you for several years and have read your book many times.
Sincerely,
Diane Thomas
Diane
I’ve reached out to my community for a referral for gut health and heavy metals for your son. In the meantime if I was working with you and your son I’d have you follow the dietary recommendations in my book and doing a trial of GABA, tryptophan and even inositol (based on the questionnaires) for some immediate relief for your son. Here’s a blog post about a mom doing just this – to inspire you if you have not gone this route yet http://www.everywomanover29.com/blog/anxiety-ocd-inositol-instead-of-tryptophan-or-5-htp/
Thank you Trudy.
Diane Thomas
Hello Trudy Great information.. I am a poster child for SIBO, Took many antibiotics had food poisoning constipation food sensitivities and yes now anxiety I am taking antimicrobials now for SIBO and hope it will be resolved soon How do you deal with the anxiety while under treating ?
I have your book but because the anxiety is caused by SIBO how does that change the treatment as far as supplements
Thanks you
Marie
I would use the same approach for SIBO because it can cause a leaky gut (and hence nutritional deficiencies), dysbiosis and an out of balance microbiome (which can affect GABA and serotonin). So I’d start with trials of GABA or tryptophan and look for low zinc, low B6, low D, low iron, low HCl etc and optimize the diet (autoimmune, nutrient-dense and gut-healing). Stress-reduction would be key too – so yoga or meditation, nature, laughter. Looking at inflammation and liver support may be needed too.
Did your doctor have you do the SIBO breath test? and the two antibody tests?
I did do breath test one year ago and waiting for results of another( tested high for both methane and hydrogen )
Is it possible that B complex causes excess bloating ? I will try B6 only and your other recommendations
Doctor did not order antibody test She had heard of it but didn’t think it would be helpful
Frustrating but I am moving to Canada from US next week (stressful move) and hope to settle down
and find a practitioner able to help
Trudy I need help finding a practitioner that knows their s***! I’m a mom of three and have suffered a host of medical problems from endometriosis, ovarian cysts, cystic acne, infertility took three years to get pregnant with our first child, I have gut issues especially chronic gastritis/gerd and some IBS, had gallbladder taken out after my second baby. Ever since having my babies I am very emotional, I don’t cope with anything well at all, I’m very dramatic, depressed, negative thoughts even intrusive scary thoughts at times that taunt me to death. After having my first baby I had what I would call psychosis I had extremeeeeee paranoia, scary thoughts like extremely scary(happens still but not often), scared of everything, I feel extremely lethargic a lot of the time I can barely make it through the afternoon without a nap, I rage very bad at times when I’m feeling impatient and on edge I lash out with my mouth and yell curse and scream at my close ones. I have tried many things but I’m running in circles I feel like. I honestly don’t have the money to fork out for a practitioner though. I’m at a loss. I have itleast 100 supplements I have bought in the past three years. All my babies have been back to back. I just want my life back and be able to function my moods are horrific. There is no balance in me at all. I’m struggling so bad with my moods.
Hi trudy,
I had appendectomy lately. I had bloating after surgery so I suspected sibo and took rifaximin for a while which helped with the bloating but ever since I have very high anxiety uncharacteristic of my older self.
Is it because of the antibiotics that I have this anxiety or is it because of the operation and the appendix removal?
Please help!