Solutions to Small Intestinal Bacterial Overgrowth (SIBO)
By Dr. Justin Marchegiani
I see patients every day walking to my clinic with small intestinal bacterial overgrowth (SIBO) symptoms. Have you ever felt your stomach pooch out after eating certain foods? Do you ever feel like you can’t quite digest your food all the way? Small intestinal bacterial overgrowth can also contribute to leaky gut syndrome!
There are millions of people with SIBO-like symptoms covering them up with medications that don’t fix the underlying problem. SIBO can affect our immune system and compromise our body’s ability to break down food and absorb nutrition.
Below are 5 signs you may have SIBO:
1. Burping or belching
3. Indigestion/low nutrient absorption (low B12, proteins, and fats)
4. Diarrhea or constipation
5. Abdominal pain
What Causes SIBO?
1. A lack of stomach acid
When we have low stomach acid, or achlorhydria, our body lacks the ability to activate protein-digesting enzymes in our stomach, called pepsin. We need a low pH (acidic), right around 2, to ensure our body’s optimal digestive capabilities. This is why people on proton-pump inhibitors (drugs that block stomach acid) are at an increased risk for SIBO.
A low pH also provides an inhospitable environment for bad bacteria to grow. When bad bacteria overpopulate the stomach, it’s easy to see the increase in intra-abdominal pressure. This increase in intra-abdominal pressure can open up the esophageal sphincter and allow acids from the stomach to rise up and create irritation or burn the esophageal tissue. Without adequate levels of stomach acid, SIBO is almost certain!
2. Pancreatic insufficiency
Without adequate enzyme production, our body has a difficult time digesting proteins and fats. When our body doesn’t break down these proteins and fats fully, they putrefy, rancidify, and ferment in our intestinal track. This is not good!
HCl is the first important step for enzyme production. Without an acidic pH, the foods that are released from our stomach into our small intestine will not provide enough stimulation to trigger the gallbladder to release bile acids and pancreas to produce protein (trypsin and lipase) and fat-digesting enzymes. Without the crucial release of these enzymes, our body is at an increased risk for small intestinal bacterial overgrowth, or SIBO.
3. Chronic infections
Many infections are opportunistic and are able to take hold of the person’s body because of an accumulation of physical, chemical, and emotional stress. When this happens, we tend to have a decrease in immunoglobulin A (IgA). IgA is a protective mucous membrane barrier that lines our intestinal tract and plays an important role at preventing SIBO. Because 70 to 80% of our immune system is located in the lymphoid tissue in our intestinal tract, this has the ability to throw our immune system out of balance.
Chronic infections can lower stomach acid and decrease our body’s ability to break food down. With low IgA and a lack of stomach acid, our body is a sitting duck for an infection. Bacterial and parasitic infections are known to produce toxins (endotoxin and lithocolic acid) that can actually suppress our immune system. If you’re having chronic SIBO-like symptoms, feel free to click here to see if an infection connection is possible.
Other predisposing factors for SIBO
There are many other risk factors for SIBO, including fibromyalgia and IBS. These other conditions have common threads along with the main causes of SIBO that are above.
When our immune system is compromised by various infections, we have an inability to break down, absorb, and assimilate food due to an increase in physical, chemical, and emotional stress. This accumulation of stress eventually breaks the weak link in your chain. Because the gut is so central to the immune system, so many different conditions have a common link with small intestinal bacterial overgrowth. I would go as far to say that it is impossible to have a chronic disease without some type of gut dysfunction!
What Is SIBO?
SIBO is typically caused by a migration of bacteria from the large intestine making its way back upstream into the small intestine.
“SIBO may be accompanied by both maldigestion and malabsorption. Bacteria in SIBO might significantly interfere with enzymatic, absorptive and metabolic actions of a macro-organism.”
When our digestive system becomes stressed, our ileocecal valve can become loose. The slack in the ileocecal valve makes it easier for bacteria to migrate up the gastrointestinal tract. If more bacteria starts making its way up the GI tract, it makes it harder for the healthy gut bacteria in our small intestine to produce important nutrients, like vitamin K, vitamin D, iron, and various B vitamins.
What Type of Bacteria Is Found in SIBO?
Streptococcus 60%, Escherichia coli 36%, Staphylococcus 13%, Klebsiella 11% and others, as well as 117 anaerobes (Bacteroides 39%, Lactobacillus 25%, Clostridium 20%, and others) are found in SIBO.
How Do You Test for SIBO?
1. Hydrogen or methane breath test
A solution of glucose or lactulose is consumed. Hydrogen or methane levels are measured after the test, and if hydrogen or methane is found in amounts greater than or equal to 20 ppm, it is considered a positive test for SIBO. Ammonia is a common by-product from the intestinal bacteria. Ammonia has a pH of 11, so it’s easy to see how bacteria can affect intestinal pH!
2. Comprehensive stool test
The pathogenic bacteria mentioned above can be found in the stool by a comprehensive stool analysis. All lab companies are not created equal when it comes to this type of specialized testing. I recommend only using the best companies to ensure that you are getting accurate results. My three favorite lab companies for stool testing are Biohealth Diagnostics, Genova Diagnostics, and Doctors Data. If you are trying to get assessed for SIBO or any other infection, feel free to click here!
3. Organic acid test: This test can look for metabolic by-products of SIBO, including benzoate, hippurate, phenylacetate, phenylpropionate, p-hydroxybenzoate, p-hydroxyphenylacetate, indican, tricarballylate.
How do you treat SIBO?
Conventional Treatment Options
Conventional treatments typically consist of taking specific antibiotics, such as metronidazole and rifaximin. Antibiotics are powerful medicines, and I typically recommend a natural herbal approach first. The herbs tend to be more gentle on the body and don’t have all of the side effects.
Natural Treatment Options
There are many herbal medicines that can help eradicate SIBO. One of my favorites is oil of oregano. Other great herbs include berberine, artemisia, cat’s claw, colloidal silver, and ginger.
Sometimes it’s more than just SIBO causing the problem. If you are having any of the above symptoms, it’s good to get checked by a functional-medicine doctor to make sure there are no other infections driving the problem.
Some of these bacteria use biofilms as a means to protect themselves from the antimicrobials. It can get a little more nuanced when addressing the stubborn infections. Feel free to click here if you need help!
I find many patients do better at making diet and lifestyle changes first and addressing the adrenals and hormonal system second before addressing the gastrointestinal system. When patients go right to the GI system, the side effects tend to be much higher!
FODMAPs: Removing fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) from the diet is also important. These FODMAP sugars can fuel the pathogenic bacteria in the gut, which then leads to more toxic metabolic by-products. Many people notice great improvements in stomach distention, gas, and flatulence after removing these foods from the diet. I personally find a combination of diet, lifestyle, and herbal medicines tend to be the trick to addressing the underlying cause of the problem.
Resistant starch: Adding resistant starch type 2 or 3 into your diet can also help feed the beneficial bacteria in the gut. The beneficial bacteria in the gut produce a short-chain fatty acid called butyrate. Butyrate helps keep the pH in the gut lower, tightens the ileocecal valve, and provides fuel for the cells of the colon. Watch the above video for more information on how resistant starch can help improve your SIBO.
My Favorite Resistant Starch
- Type 2 resistant starch—unripened banana flour by Wedo.
- Type 3 resistant starch—potato flour by Bob’s Red Mill.
Instructions: If you have significant SIBO, start with just 1 tsp of resistant starch and work up to 2 tbs. If you have any significant gas or bloating after taking the resistant starch, half the dose the next day. When in doubt start slow. Gas and bloating are surefire signs that you have SIBO.
I can take 2 tbs of resistant starch two times per day without any symptoms. Some people may have to use herbal medicines to significantly knock down the SIBO before the resistant starch can be tolerated. Make sure you work with your functional-medicine practitioner to support you in the process.
On a low-carbohydrate diet, the E.rectale and the Roseburia bacteria can significantly decline. Adding in resistant starch can help prevent this decline in beneficial bacteria while maintaining a low-carbohydrate eating plan. Some people are carbohydrate sensitive and need to keep their carbohydrates down, and this provides an excellent option to get the best of both worlds.
Feel free to click here if you need help!
5 Natural Remedies for Anxiety and Depression
By Dr. Justin Marchegiani
There are millions of people that suffer from anxiety and depression. Natural remedies for anxiety and depression tend to be the last option most people utilize instead of the first!
The main solutions available from conventional medicine are dangerous medications with common side effects (including potential increased risk of suicide) and are proven by research to not be as effective in the long term.
Why would you want to be on a medication long term but not fix the underlying problem? You would never drive your car with the check-engine light on that you’ve covered with a piece of tape. This wouldn’t make you feel confident and happy that you have a long-lasting solution.
Some psychotropic medications may be necessary in the short run to prevent a dangerous episode from occurring, but with a broader understanding of how the body is connected, it’s easy to see the long-term solution is still being ignored.
Everything Is Connected
The question I have for you is this: Do you want to treat the effect or fix the cause of your mood imbalances?
Below we are going to address five common factors that can contribute to anxiety, depression, and other symptoms of moodiness.
The food you eat, especially the quality of the food, is very important to achieving optimal health. It’s nearly impossible to be healthy and suffer from depression and anxiety long term. It’s normal to feel sad when someone in your family passes or when you lose a job. My main concern is the long-term depression and anxiety that goes on unaddressed with the only option whispered being a pharmaceutical one. The symptoms of depression and anxiety are typically signs that something’s out of balance in your daily life.
The Quality of Food We Put in Our Body Has a Direct Effect on Our Health.
Fat-soluble nutrients are very important for blood sugar stabilization and are building blocks for our brain. Did you know that 70% of the solid portion of our brain is made from cholesterol and saturated fat? Cholesterol makes up the raw material that lines our neurons, called myelin. This cholesterol padding around the nerves helps conduct our nerve impulses and is important to maintaining healthy cell membranes. Our cell membranes need to be flexible, too, so they can communicate with other cells in our body. Without healthy saturated fats and cholesterol in our cell membrane, our cells don’t have the ability to communicate with other cells optimally.
Refined Vegetable Oils
Eating refined vegetable oils or fake trans fats puts stress on our body. These fats are magnets for free radicals, which cause damage to our DNA. These trans fats also make our cell membranes stiff and hard, which decreases the ability for cells to communicate to other cells.
Omega-3 Fatty Acids
Omega-3 fatty acids found in fish oil, especially EPA fat, are shown to help with depression. These fats are also important in reducing inflammation. Half the cells in our brain are microglial cells, which are specialized immune cells found only in the brain. The more inflammation and stress we have in our body, the increased chance we have of turning on our brain’s immune system. Unlike our body’s immune system, our brain’s immune response doesn’t turn off very easily. That’s why a traumatic blow to the head can have deleterious side effects unlike any other area of the body.
A common sign of inflammation in the brain is brain fog. Eating a healthy, nutrient-dense, anti-inflammatory, low-toxin diet with adequate amounts of anti-inflammatory cholesterol and fatty acids can be very helpful at optimizing brain health and keeping inflammation in the body and brain at bay.
Adequate consumption of protein is very important for brain health. All of our neurotransmitters are made from protein or amino acids. We need amino acids to make beta endorphins, serotonin, GABA (gamma-aminobutyric acid), and dopamine. Without consuming or absorbing enough of these amino acids, mood-related issues can occur. It only makes sense if we are deficient in raw material. Let’s use the example of building a house—the house won’t get completed no matter how hard you try. When we’re missing essential building blocks, our body systems (hormones, digestion, detoxification to name a few) tend to bear the burden.
Adequate stomach acid is very important for healthy digestion and the breakdown of protein into amino acids and the ionization of minerals. We need a low pH (acidic) in our stomach to trigger the domino cascade of digestion that occurs in our small intestine, pancreas, and gallbladder. Without an acidic pH of chyme (ground-up food in our stomach mixed with hydrochloric acid, or HCL) released from our stomach into the small intestine, our body’s ability to further break down, assimilate, and absorb fats and proteins becomes impaired.
Minerals, like magnesium, have a very relaxing or calming effect on our nervous system and are needed for over 300 enzymatic reactions in our body. Magnesium is one of those minerals that tends to be deficient in our food supply. If we have low stomach acid, it’s going to be even more difficult for us to get enough magnesium without proper supplementation of HCl combined with a highly absorbable magnesium supplement.
“Impaired digestion of protein has been suggested by a few studies. Small intestinal bacterial overgrowth in hypochlorhydria probably leads to putrefactive breakdown of the metabolically useful products of protein digestion, thereby reducing their availability for certain essential pathways. The possible lowering of tryptophan, tyrosine, and phenylalanine in the blood may be a precipitating factor in depression in hypochlorhydric patients.”
The Infection Connection
Chronic infections, like H. pylori, are also shown to have an effect on depression by decreasing hydrochloric acid production as well. It’s possible that many people’s digestive issues are caused by a combination of a chronic infections that may also be driving low stomach acid production. The more you learn about functional medicine in the body, the more it’s impossible to ignore the constant connection between other body systems.
Many people have leaky gut caused by the above digestive issues. If you think you may have leaky gut, feel free to click here!
3. Adrenals and Blood Sugar
Eating high amounts of refined carbohydrates and/or sugar can give us a false sense of comfort by altering our mood. The reason why sugar makes us feel good is it shuttles more of the amino acid tryptophan across our blood-brain barrier. This amino acid gets converted to serotonin in our brain, which is the feel-good neurotransmitter. The problem with doing this long term is that our cells become insulin resistant and we need more and more sugar to get the same effects. The more sugar we eat also increases the amount of inflammation in our brain, a double whammy!
“The ingestion of a high-carbohydrate/low-protein meal facilitates entry of tryptophan into the brain.”
Our adrenal glands’ main job is to help create energy and stabilize blood sugar. The more we have ups and downs in our blood sugar due to a poor diet and refined sugar, the harder our adrenal glands have to work to buffer out the highs and lows. Cortisol levels that are chronically high due to stress can create mood, memory, and depressive symptoms.
Many people already have adrenal fatigue, click here to learn more about adrenal fatigue!
Chronic adrenal stress affects our hypothalamic-pituitary-adrenal (HPA) axis. This is essentially the feedback loop from our brain talking to our adrenals. Chronic stress can disrupt this feedback loop. This is very similar to an analogy of a thermostat in your house breaking. The thermostat is there to help regulate the temperature in your house, just as the HPA axis is there to help your body regulate stress in your life.
The better you can manage your physical, chemical, and emotional stressors, the better you feel and perform. One simple thing you can do is eat high-quality protein, fat, and healthy carbohydrates for your metabolic type. This takes a tremendous amount of stress off your adrenal glands. When your sympathetic nervous system (fight-or-flight system) isn’t chronically turned on, your body finally has the ability to use your parasympathetic nervous system (rest and digest) to repair and heal.
Exercise has powerful antidepressant and mood-altering effects by stimulating the production of a compound known as beta-endorphins. Beta-endorphin is a compound synthesized by our body that consists of 19 amino acids (protein is needed to make this). This is why diet and digestion is so important for mental health!
The typical runner’s high that most marathoners experience is that exact thing: a release of beta-endorphin. My recommendation is to be careful of excess aerobic exercise as it can stimulate increased cortisol levels and cause your body to break down at an accelerated rate. This type of exercise can be very addicting because of this great endorphin rush. My recommendation is to perform higher intensity, short-duration exercise that will help mitigate cortisol stimulation and increase anabolic hormones, such as HGH (human growth hormone), which actually help build your body back up.
Studies have shown, higher intensity exercise is followed by a decrease in depression, fatigue, and anger after the exercise.
Some people with adrenal fatigue need to dial in their exercise specific to their energy levels. When your adrenals are fatigued, your body’s ability to repair from exercise decreases, so it’s important to make sure the exercise intensity, duration, and frequency is specific to your level of adrenal fatigue.
It’s known as far back as 1933 that our body’s internal toxins can actually cause bouts of depression.
According to a study in the journal of brain behavior and immunology, inject of an endotoxin can increase feelings of depression and social disconnection (see graph below).
I understand the toxin is being introduced via a needle and may not be introduced the same way in the real world but I think it’s important to note that these toxins can influence our mood and emotions. The study also showed that these toxins create mood changes via cytokines which are a product of inflammation.
“This study demonstrates that inflammation can have social psychological consequences, which may play a role in cytokine-related depressive symptoms.“
Science is starting to show inflammation plays a very important role in chronic disease. We can modulate inflammation by managing our stress and diet which helps put the controls of our health back in our hands!
Conventional medicine commonly ignores these factors and based on my clinical experience, when patients gut bacteria improves as well as their diet so does their mood and emotions.
The reabsorption of toxins from our fecal material can be a major stressor on our body. If we have a healthy gut, our body should evacuate stool in about 20 to 24 hours from when the food was originally eaten. If this time frame becomes delayed, our body has an increased chance of absorbing toxins (mycotoxin and endotoxin to name a few) from our stool. These toxins can be very dangerous and stressful on our body.
“In books such as The Conquest of Constipation, The Lazy Colon, and Le Colon Homicide physicians on both sides of the Atlantic warned that the contents of the colon were ‘a burden, fermenting, decomposing, putrefying, filling the body with poisonous substances’ and creating ‘sewer-like blood’; that auto-intoxication ‘is the cause of ninety per cent of disease’; and that ‘constipation shortens life.’”
Adequate production of HCl and a decrease in consumption of inflammatory foods, such as grains and pasteurized dairy, can help eliminate constipation. Some people’s constipation may be caused by a chronic infection or thyroid condition. If you are having any of these health issues, feel free to click here!
There’s a laundry list of external environmental toxins that can affect our health. Here are just a few: organochlorines, heavy metals, bisphenol A, benzene, persistent organic pollutants, and dioxin.
If you have a couple hours to kill, do a Google Scholar search and type in any disease you like followed by any of the above toxins. There is a good chance that you’ll find a connection. These toxins affect our body’s ability to methylate, essentially turn on and off specific genes and run our detoxification pathways (cytochrome P450 oxidase—phase 1 and phase 2), which help our body eliminate these toxins.
Many of these toxins are estrogen-like compounds (xenoestrogens) and can cause cell proliferation (increased cell growth, like in cancer). Hormones are chemical messengers and are essentially molecules of emotion. Any woman can empathize with the mood changes she may experience around menstruation. These mood changes are caused by hormonal fluctuations. You can imagine the potential hormonal changes we may experience due to all these fluctuations of xenoestrogens in our environment.
Environmental chemicals also have the capacity to destruct our glucocorticoid hormones (cortisol). Evidence suggests that organotins (antibacterial or antifungal pesticides) inhibit the enzymes that help form cortisol. Cortisol is important for stabilizing energy, blood sugar balance, immune support, electrolyte balance, and blood pressure levels. Fluctuations in our blood sugar can create cravings for refined carbohydrates. Eating refined sugar can set our blood sugar up for a roller coaster of disaster, creating states of excitation followed by depression. If you ever felt the highs and lows after consuming a candy bar, you know exactly what I’m talking about.
There is a family of herbs that is known as adaptogens. These herbs have the ability to adapt to someone’s physiological state. If someone is in a state of excitation, these herbs help bring them down. If they’re in a state of depression, the herbs can help bring them up. These herbs have the ability to help balance adrenal stress and immune modulation, support healthy sex hormone levels, and balance blood sugar.
Below are a few of my favorite adaptogenic herbs:
1. Ashwagandha, or Indian ginseng
2. Eleuthero, or Russian ginseng
3. Panax, or Korean ginseng
4. Macca, or Peruvian ginseng
If you need support with your mood feel free to click here!
Is Your High Cholesterol Caused By Hypothyroidism?
By Dr. Justin Marchegiani
High cholesterol and Hypothyroidism
When thyroid hormone levels are low (hypothyroidism), your body doesn’t break down and remove LDL cholesterol as efficiently as usual. LDL cholesterol can then build up in your blood. Even people with mildly low thyroid levels, called subclinical hypothyroidism, can have higher than normal LDL cholesterol.
Without enough thyroid hormone, many of our bodily functions begin to slow down (weakened metabolism), and our body temperature tends to drop. Thyroid hormone is essential to health and is needed to help break down the building blocks (cholesterol) of our hormones into our active hormone constituents such as estrogen, cortisol, progesterone, and testosterone. If there is an inability to break down our hormonal raw material on the front end, we tend to see a decrease in supply of hormone on the back end. This can create a bottleneck regarding our body’s ability to create hormones.
Healthy hormone balance helps keep our body in a healthy anabolic state, where we can heal and stay youthful versus breaking down and staying inflamed or in pain.
Imagine you are a construction worker trying to build a house. You tell your foreman you needed 100 pieces of wood to build the frame of a house, but you show up the next day and have only 50 pieces of wood at the construction site. What do you do? When it comes to your body’s inadequate levels of thyroid hormone, it will be difficult to have optimal hormonal balance, control inflammation, and produce energy until this problem is fixed.
“Patients who have been diagnosed with high cholesterol should ask their physician about having their thyroid checked. If they have an underlying thyroid condition in addition to their high cholesterol, the cholesterol problem will be difficult to control until normal levels of thyroid hormone are restored.”
~Richard A. Dickey, MD
The Hard Science!
Below I am going to break down some of the science proving that thyroid function has an effect on our lipid and cholesterol levels. If you feel overwhelmed, just take a deep breath, and as long as you understand the key concepts, you are on the right track.
Thyroid hormone has influence on a compound known as cholesteryl ester transfer protein (CETP) activity, which converts cholesterol esters from high-density lipoprotein (HDL) to very low-density lipoprotein (VLDL) and helps with the break down of triglycerides.
Thyroid hormone also has an effect on the lipoprotein lipase, which helps break down triglycerides and helps convert HDL into intermediate-density lipoprotein (IDL) compounds.
T3 thyroid hormone also helps up-regulate apolipoprotein AV. Apolipoprotein AV helps regulate triglyceride metabolism. With adequate levels of T3, our body has the ability to help keep our triglyceride levels at a healthy balance.
Thyroid Hormone Affects Our Genes!
T3 also has an effect on the thyroid hormone response elements (TRE’s). On the left side of the picture below, TRE is circled. The TREs impact the expression of the LDL gene receptor site. With adequate T3 levels, it also protects the LDL cholesterol from oxidation. It’s almost as if adequate levels of thyroid hormone are an antioxidant. This is important because cholesterol helps create a healthy cell membrane, keeping it fluid, flexible, and stable.
If you need to get your thyroid hormones assessed, click here!
Thyroid Hormone and Blood Sugar
Adequate levels of thyroid hormone are shown to help with insulin sensitivity. With hypothyroidism, insulin resistance goes up. As our body makes more insulin, this can stimulate our liver to make more cholesterol. By regulating thyroid function and blood sugar, we have a direct effect on our body’s ability to produce cholesterol.
Thyroid Hormone Recap
We have two types of thyroid hormone, generally speaking: T4 and T3. Consider T4 a storage hormone—its metabolic effects on the body are insignificant. Consider T3 your active thyroid hormone—it is four times more potent than T4. Most people only get their thyroid assessed using a few specific lab markers, including thyroid stimulating hormone (a brain hormone) and maybe T4. The most important hormone of them all is T3, which is very rarely assessed, and it’s free and total fractions. But again T3’s what has the real metabolic effect on the body.
Simple Ways to Assess Thyroid Function
We mention that thyroid hormone has an effect on our metabolism. A simple way to measure our metabolism is via body temperature. With healthy thyroid function, your body temperature should be between 97.8°F and 98.2°F in the axillary or armpit area.
Body temperature does go off slightly if you are measuring it via your mouth or oral area. In your mouth, normal body temperature should be between 98.2°F and 98.6°F. If your body temperature is in this range, this is a good sign that you have adequate thyroid function.
These are simple assessments you can do at home without getting any blood work just to see how your thyroid function is doing. Again, it’s possible to have low body temperature and not have it be purely a thyroid issue. Many other issues can cause low body temperature, including chronic infections, adrenal fatigue, and anemia to name a few. Many thyroid conditions are autoimmune in nature, which is when your immune system begins to attack it’s thyroid tissues. Both situations call for different measures of treatment to ensure success.
A good functional-medicine doctor will rule out all of these things one by one to make sure nothing is missed. To get assessed, click here!