Read the Episode Transcript...

Welcome back to The Live FAB Life Podcast. I’m your host, Naomi Nakamura.

And the topic of today’s episode comes by listener request.

I love when listeners requests episodes on specific topics so if you have a topic that you’d like to hear me expand on, or cover, please, do reach out and let me know!

Now long time listeners know that I’m pretty much an open book, when it comes to sharing things that I’ve struggled with in my own health and while I’ve often mentioned that I’ve had SIBO, it wasn’t until three episodes ago when I interviewed Dr. Jolene Brighten and mentioned that almost everything she talks about in her book, “Beyond the Pill” are things that I’ve personally experienced, including SIBO that I realized I haven’t done an episode sharing what my experience with SIBO was like.

But then I heard from quite a number of you listeners who said that you were either struggling with SIBO, had at one point, or are just curious about it, so that’s what we’re going to be talking about today.

Before I go any further, I want to reiterate, as always, that I am not a licensed practitioner, nor am I a medical doctor. There are a few thought leaders who are experts on SIBO, who’s works I delved into to help me navigate through this, and by the way, I’ll link to who they are over the show notes for this episode, because lord knows, my own general practitioner and gastroenterologist weren’t very much help (which I’ll get into shortly). But what I’m going to share in this episode is merely my own experience in having SIBO and what steps I took to help me overcome - three times. Yes, I’ve had it multiple times, which is also something I’ll get into.

Okay so let’s dive in...

So for those of you who have never heard of SIBO, it stands for “Small Intestinal Bacterial Overgrowth” and that’s exactly what it is - an overgrowth of (bad) bacteria in the small intestines.

Now it is a good thing to have bacteria in your small intestine. We just want it to be good bacteria vs. bad bacteria.

For example, you may have heard of prebiotics and probiotics. Prebiotics are important because they help maintain the good bacteria that’s already there, and probiotics are important because they help to rebuild and restore good bacteria.

This is just one of the many reasons gut health is so important. And I’ve talked about gut health in a number of past episodes, that you can find over on the show notes on my website and they’re tagged in the “gut health” category. And I will include a link directly to that tag on the show notes for this episode at www.livefablife.com/087.

So it was about five or six years ago, back in 2013 or 2014 that I had really bad IBS, aka Irritable Bowel Syndrome. I was gassy, really bloated, and had irregular bowel movements - all. the. time.

The chronic bloating was the most problematic. It didn’t matter what I ate or how much of it I ate. I could have had just a few grains of rice and I would be so uncomfortably bloated that by the end of the day, I couldn’t zip up my pants and I looked like I was five months pregnant. I’m not kidding here.

But then, by the next morning, I’d be back to my regular size and my clothes would fit just fine. But then by the afternoon, the cycle would repeat itself.

This went on for months and months, at the same time I was also dealing with recovering from overtraining, adrenal fatigue and a bunch of other things.

By this time I had stopped seeing my functional medicine doctor, who you can listen to in Episode 002, because she had closed her practice to move on to do other things. So you could say I was in between providers.

So I went to see my general practitioner who didn’t really have answers for me. She had previously lumped my gastro-intestinal complained all together as “IBS” which really just is an “umbrella” term for a bunch of symptoms but it doesn’t actually address the root cause, or why those symptoms are happening to begin with.

She had told me that “some people are just like this…” but after more questioning and pushing on my part, she happily referred me to a gastroenterologist, which I didn’t actually need the referral because I have a PPO health plan, but that’s how it panned out.

When I went to see the gastroenterologist, he asked me a few questions, but I dived into my whole story on overtraining, adrenal fatigue, how I cleaned up my diet by going gluten-free and dairy-free, etc. At this point, I mentioned SIBO but it wasn’t a route he was willing to go down on - he was focused on addressing IBS.

He ordered some routine lab work which included a liver panel and my results showed that my liver enzymes were high. So then I went in for an ultrasound and it was found that I had a fatty liver.

So when I saw him to review the results, I told him that I didn’t drink alcohol so he started talking to me about how I needed to eat healthy and start exercising.

This was when I quickly realized that he hadn’t really heard anything that I shared about my story leading up to this point. It was frustrating. When I reminded him, his eyes got really big and he said, “Well I don’t know much about nutrition so I’d have to refer you to the nutrition department.

A gastroenterologist, a specialist of the digestive system, didn’t know much about nutrition. Mind. Blown.

Because I was in between providers, I had consulted with a fellow practitioner who helped me navigate the Low FODMAPS diet to try to manage my symptoms. If you’re not familiar with the Low FODMAPS diet, its a nutritional therapeutic approach to help manage IBS symptoms.

FODMAPS is an acronym for fermentable oligo-, di-, mono-saccharides and polyols. These are different kinds of carbohydrates that have been known to cause IBS symptoms like gas and bloating. These starches can be found in foods like wheat, dairy, fruits - especially ones high in sugar and even in onions and garlic.

It’s a very restrictive and challenging diet to follow and I followed it for a year. It’s not something I recommend anyone follow for a long period of time, because the foods you are avoiding do have other nutritional values. In fact, when I finally decided to stop following it, the very first time I ate onions and garlic I felt almost like an awakening in my body because it had been deprived of the sulfur and other nutrients in it.

It’s also challenging in trying to use it as a framework for an elimination diet because there’s so many foods that are eliminated that trying to individually reintroduce each food - well that can take an extended period of time.

Anyhow, while the Low FODMAPS diet helped to manage my symptoms, it didn’t do anything to address the root cause or resolve it. Especially in a case like SIBO where you have to get rid of the bad bacteria.

In my case, after a year I just stopped feeling any relief even on the Low FODMAPS diet and given all the things that I had read and studied, my practitioner friend and I both suspected I had SIBO and she urged me to get tested for it.

So I went back to my gastroenterologist and asked him to order a SIBO test for me.

Now there’s a few ways of testing for SIBO, and I went with the lactulose breath test. A conventional doctor can order the test and it’s administered right in their offices by the nursing staff. In terms of cost, I was lucky because my insurance partially covered the cost of the test. lI think I only had to pay something like $50 out of pocket.

The test itself is quite the process.

First, for at least two weeks before doing the test, you have to stop all probiotics - foods and supplements - and eat ALL the FODMAPS. That’s because you don’t want any of the bad bacteria suppressed - you want it all “out” in its abundance which you can imagine feels VERY uncomfortable on the body. The symptoms are usually at its very worst.

The day prior to the test they advise you to eat a pretty bland meal - something like chicken and rice - I usually just got a Chipotle burrito bowl of chicken and rice. But you have to eat it early because you have to fast for, I think like 12 hours before the test, which is why you want to schedule the test early in the morning.

On the day of the test you can only drink water minimally (like when you brush your teeth).

When you go in for the test, they give you a lactulose drink which may or may not upset your stomach. I’ve taken this test at least five times and a few times it did and the other times it didn’t.

After you down the lactulose drink, which helps to bring out the bad bugs, the person administering the test will then have you breathe into a tubular-like bag. There’s device at the end of the bag that will trap your breathe in it, which then attaches the bag to a machine that reads what kind of gases are in your breathe.

It will being either hydrogen or methane because those are two different kinds of SIBO - hydrogen-dominant or methane-dominant.

People who are hydrogen-dominant typically experience diarrhea and loose stools and those who are methane-dominant typically experience constipation. Again, not always, but this is what’s been commonly found.

When the machine reads the gases from the tube-like bag, it will output numeric numbers that indicate levels of each gas.

You will repeat giving a breath sample every 20-minutes for three hours.

That’s pretty much the extent of the test. There’s no needles or blood drawing, no x-rays, its just a rather involved breath test.

After having done the test at least five or more times, here’s some times I have for you.

Have a snack or food with you because as soon as the test is over you will be starving! Bring a book or your laptop or something to do during the test because you will also be bored out of your mind. As your samples are being read by the machine, write them down. In my experience, I’ve never had anyone tell me if I was hydrogen or methane dominant. They always just said, if it was positive or negative. It matters to know which gas was dominant and also what the readings were because you’ll likely have to take the test more than once if you really want to know if the SIBO was eradicated and its nice to have numbers to compare to see how extensive your SIBO was. I simply wrote my readings down on a note on my phone, then plugged it all into a Google Sheet so I could compare readings. My first test was in September 2015 and the last one I’ve taken to date was in December 2017.

Now when it comes to eradicating SIBO, some prefer to take the holistic approach of using a combination of supplements like Berberine and Oregano Oil, or even one called Atrantil. Each person’s protocol and how much of each will be unique to the individual.

I tried that approach and it didn’t work for me.

The other approach is to take antibiotics.

I tend to cringe and be resistant to antibiotics because I was prescribed it unnecessarily for years as a treatment for acne and it wrecked my gut. Because antibiotics doesn’t just kill bad bacteria, it kills ALL bacteria, even the good ones that keep our gut healthy. So antibiotics can be very damaging your gut health and ironically, make yourself susceptible for SIBO.

However, there a combination of antibiotics of Rifaximin and Neomycin has been found to be effective in treating SIBO and minimizing damage because its effects are localized to one area.

When my suspicions of SIBO were confirmed with that very first breath test, in fact that first test had my highest readings ever, I knew going in that this combination of Rifaximin and Neomycin was the treatment found to be most effective for eradicating SIBO.

But of course, when I asked my gastroenterologist to prescribe it, he didn’t. He was concerned about the cost factor because Rifaximin can be a VERY expensive pharmaceutical. In fact, I know some folks who actually had it shipped over from Australia because the cost for it was so high - in the thousands. I’m fortunate to have really excellent insurance from my full-time job so it only cost me $50.

When I explained this to him he relented and prescribed the Rifixamin but didn’t budge on prescribing the Neomycin to go along with it. Rixfixamin addresses hydrogen and Neomycin addresses methane so maybe because I was hydrogen-dominant, he declined to prescribed the Neomycin. But just because it wasn’t dominant doesn’t mean it wasn’t present.

So my first round of antibiotics was Rifixamin only for 10 days. I wasn’t convinced ten days was enough but I took what I could get. And it wasn’t until the last day or so that I finally felt symptoms start to wane.

So I had to do another test, but again, because we need two weeks of no probiotics and eating all the FODMAPS, to bring the bad bacteria out, it was a while before I could retest.

The second time my test results still read positive so this time, he put me on Flagyl. Flagyl is an antibiotic used to address a number of different things. I mean, even my dog has been prescribed Flagyl when she has an upset stomach.

It did not help AT ALL and left me feeling even worse than before I started taking it.

So I had to go through the extensive process of a third round of test, which to no surprise I tested positive for again. This time my GI doctor finally relented, prescribing the Rifixamin and Neomycin. When I went back for my fourth tests, low and behold - I tested negative and I felt SO MUCH BETTER!

It’s felt weird - I had lived with the SIBO symptoms for so long, I had forgotten what it felt like to not have them - and it was pretty amazing to not be so bloated all the time. My first test to my negative test spanned a SIX month period. As you can imagine, it was a time of much angst and frustration for me where I felt totally unheard and dismissed by my GI doctor.

But this is how I learned how to be proactive and my own advocate for my health.

I learned not to be intimidated, to speak up and remind my doctor that I had a voice in my treatment.

I had done my own research and came to my visits with prepared questions, data from my Food Mood Poop journals and took notes on what we discussed during my appointments.

And that’s the best advice I can give you, not only if you’re dealing with SIBO, but in any type of medical situation you find yourself in.

Be your own advocate.

Do your homework.

Go to your appointments prepared with written-down data on what’s going on day-to-day in your health.

Have prepared questions and don’t be afraid to ask more questions.

In short, build a relationship with your doctor where you can work together in partnership.

I’m so fortunate to have that now with my integrative doctor. In 2017, I suspected that I might have SIBO again and when I showed up at an appointment with my data from my Food Mood Poop journal showing why I suspected it, he ordered the lactulose breath test without any hesitation.

When the test results came back mildly positive, and I asked for the Rifaximin + Neomycin combination treatment, he prescribed it without hesitation and guess what? The SIBO was nipped in the bud - much quicker than a six month period.

When I brought this up to him, he pointed out that SIBO is something that is relatively new that doctors are still trying to figure out. That made me have a little more grace for my first GI doctor. :)

So that’s it, that’s my SIBO story, which I hope you found helpful if this is something you are or suspect that you are struggling with but more than anything, what I want you to take away is to use your voice and be your own advocate in your health!

That’s it for this week, next week I’ll be back with a brand real people story on overcoming orthorexia. I think it’s something that MANY of you will relate to so you definitely don't want to miss it!