December 16, 2023 • 28 mins
If you have been following my discussions in this Defiant Health podcast or in my blog, DrDavisInfiniteHealth.com, or my Super Gut book, you know that I have been arguing that there is an epidemic of SIBO going on in the U.S., an epidemic involving every 1 in 2 people. It is an epidemic responsible for an astounding amount of health struggles.
The more we all come to understand small intestinal bacterial overgrowth, or SIBO, the more you have to appreciate all the varied ways this situation can show itself. First of all, for those of you unfamiliar, what is SIBO? SIBO refers to the situation in which modern people, due to exposure to multiple courses of antibiotics and other disruptive factors, have lost hundreds of beneficial bacterial species in our colons. These beneficial species were responsible for suppressing the proliferation of unhealthy microbial species, mostly fecal microbial species such as E. coli, Salmonella, and Citrobacter. The loss of beneficial microbes allows unhealthy fecal species to proliferate, then ascend up from the colon where they originated and into the 24-feet of small intestine. The small intestine is poorly-equipped to deal with this invasion of fecal microbes. The small intestine is, by design, permeable, since that is where the bulk of nutrients such as vitamins, minerals, and amino acids are absorbed. But trillions of fecal microbes in the small intestine, microbes that live for only a few hours, live and die and release their toxic components that can gain access to the bloodstream. One of the primary toxic components is called endotoxin. When endotoxin enters the bloodstream, that’s called “endotoxemia” and endotoxemia is now recognized to be the primary way in which gastrointestinal microbes are able to exert effects tin every organ of the body. It means that SIBO and thereby endotoxemia can be experienced as a wide variety of health problems and diseases.
So, in this episode of Defiant Health, let’s discuss whether this is a situation that applies to you or to someone close to you and what steps you can take to undo these harmful effects.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
If you've been following my discussions in this
Define Health podcast or in myblog, drdavisinvidenthealthcom,
or my Super Gut Book, you knowthat I've been arguing that
there's an epidemic of SIBOgoing on in the US, an epidemic
involving every one and twopeople.
It is an epidemic responsiblefor an astounding amount of
health struggles.
(00:26):
The more we all come tounderstand small intestinal
bacterial overgrowth, or SIBO,the more you have to appreciate
all the varied ways thissituation can show itself.
First of all, for those of youunfamiliar, what is SIBO?
Sibo refers to the situation inwhich modern people, due to
exposure to multiple course ofantibiotics and other disruptive
(00:47):
factors, have lost hundreds ofbeneficial bacterial species in
our colons.
These beneficial species wereresponsible for suppressing the
proliferation of unhealthymicrobial species, mostly fecal
microbial species such as E coli, salmonella and citrobacter.
The loss of beneficial microbesallows unhealthy fecal species
(01:10):
to proliferate, then ascend upfrom the colon where they
originated and into the 24 feetof small intestine.
The small intestine is poorlyequipped to deal with this
invasion of fecal microbes.
The small intestine is, bydesign, permeable, since that is
where the bulk of nutrientssuch as vitamins, minerals and
amino acids are absorbed.
(01:30):
But trillions of fecal microbesin the small intestine microbes
that live for only a few hours,live and die and release their
toxic components that can gainaccess to the blood stream.
One of the primary toxiccomponents is called endotoxin.
When endotoxin enters the bloodstream, that's called
endotoxemia.
When endotoxemia is nowrecognized to be the primary way
(01:53):
in which gastrointestinalmicrobes are able to exert
effects in every organ of thebody, it means that SIBO, and
thereby endotoxemia, can beexperienced as a wide variety of
health problems and diseases.
So in this episode of DefiantHealth, let's discuss whether
this is a situation that appliesto you or to someone close to
you, and what steps you can taketo undo these harmful effects.
(02:16):
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So many people are unaware thatSIBO that is, small intestinal
(03:01):
bacterial overgrowth.
Recall that this means there's24 feet of small intestine,
stomach, duodenum, jejunum andilium that are infested by
microbes that are meant to be inthe colon only, with sharply
diminishing numbers as youascend into the ilium, etc.
So in SIBO, the entire lengthof small intestine 24 feet, is
(03:21):
infested by trillions ofmicrobes that should have stayed
in the colon.
These are fecal microbes withnames like E coli, Campylobacter
, citrobacter, salmonella andmany others that don't belong
there.
These microbes themselves arevery inflammatory when they
contact the intestinal wall.
But the small intestine, recall, is also very permeable because
that's where you're supposed tobe absorbing nutrients like
(03:45):
fatty acids, amino acids,vitamins and minerals.
But when microbes infest thesmall intestine, they live and
die rapidly, right, thosetrillions of microbes only live
for a few hours at a time, andwhen they die they shed their
toxins into the lumen, into theintestine itself, and some of
those toxins gain access intothe bloodstream, so-called
(04:06):
endotoxemia.
And that's how SIBO, thisprocess in the small intestine,
can export its effects to allthe other organs of the body,
whether it's skin or theintestine itself brain, uterus,
prostate, heart and just aboutall other organs.
Now why do I say that 50% of theUS population, or something in
north of 150 million people havethis.
(04:28):
Well, the science is quiteclear.
Let's take the studies that askthis question In condition
blank.
What proportion of people testpositive for SIBO?
That's usually breath testingfor hydrogen gas.
That's the standard way todetect whether microbes living
in the upper GI tract.
It's all about timing.
If you ingest something thatmicrobes consume, let's say
(04:49):
inulin, a prebiotic fiber, andyou produce hydrogen gas,
because only microbes producehydrogen gas, but you don't.
But if you measure sharp uptakein the quantity of hydrogen gas
within the first 90 minutesafter consumption of that inulin
, it tells you that microbes areliving in the upper GI tract,
because it's 90 minutes is toosoon for that inulin to have
arrived in the colon where thosemicrobes are supposed to be.
(05:12):
So if you turn positive forhydrogen gas at, let's say, 30
minutes or 45 minutes, that ispositive for microbes living in
the small intestine.
Well, if we take thoseconditions, let's just say
obesity.
So of the 110 or so millionAmericans who are obese, we know
with good evidence that 50%would test positive.
Well, that's about 55 millionpeople right there.
(05:34):
How about the people with fattyliver?
Well, that's another about 130million people, and about 50%
test positive.
That's another 60 or so millionpeople.
Now there's overlap, of course,obese people and fatty liver
people, but there's also otherconditions like irritable bowel
syndrome.
Of the 60 to 70 million peoplewith irritable bowel syndrome in
(05:56):
the US, about 40% it variesfrom study to study and the
population being studied, butapproximately 40% of those
people test positive for SIBO.
That's another 24 to 30 millionor so people right Now.
Add that up through otherconditions like restless leg
syndrome, fibromyalgia, type 2diabetes, pre-diabetes, people
(06:17):
with coronary disease,neurodegenerative disorders,
autoimmune conditions.
Add it up and you easily exceedaccepting some redundancy, some
overlap, we easily exceed over150 million people with SIBO.
Now what people often don'trealize is that process is not
confined to only the GI tract,the gas-contestinal tract.
(06:38):
This process is able to exportits effects to all other organs.
Now this was first validated.
It's been suspected for manydecades, but it was finally
validated by a Belgian researchgroup in 2007, dr Patrice Canney
, c-a-n-i, and has since beencorroborated numerous times.
And now we have a consumerdevice, a device you can
(06:59):
purchase on your own, called theAIR device A-I-R-E, made by the
Food Marble Company that I haveno relationship with, by the
way, but you can test yourselfby taking something like Inulin.
We typically take two teaspoonsof Inulin, put it in your
coffee and there's a dietaryprep in the preceding 12 to 24
hours and then you get abaseline level by blowing into
(07:20):
the AIR device.
Then you consume that food,let's say coffee with two
teaspoons of Inulin and then youtest every 30 to 45 minutes for
up to 90 minutes If there's arise of four units.
This device measures hydrogengas on a 0 to 10 scale.
Each unit of one or twocorresponds to five parts per
million hydrogen gas.
If you did hydrogen gas testingin a clinic or lab, but on the
(07:43):
0 to 10 on the AIR device, ifthere's a rise of four or more
units, that is 20 parts permillion or more, that is a
positive result.
So let's say your baselinelevel is 1.2, you consume your
coffee with Inulin and let's sayat 45 minutes your value is 9.8
.
So more than four point rise isa positive test.
You now know you have microbesliving in the small intestine.
(08:05):
If you test positive after 90minutes, you can't tell if
that's hydrogen gas beingproduced in, say, the ilium, the
distal part of the smallintestine, or whether it's the
expected rise in H2 from colonicfermentation.
So after 90 minutes you can'ttell what's going on.
You can still have SIBO, butyou can't tell by this test.
Now this is similar.
(08:26):
This is in parallel to whathappens in sepsis.
So say you had a urinary tractinfection in your bladder that
then ascended into the uretersand into the kidneys.
That's pylonephritis, that is akidney infection.
You get very sick.
Now some people, when they getpylonephritis that is an
infection of the kidneys Some ofthe bacteria can get into the
bloodstream and that's sepsis,or urinary sepsis, with which
(08:49):
you can get very, very sick.
People sometimes go onventilators.
They lose control of theirblood pressure, go into shock,
so they're in very seriouscondition.
In that situation theprevailing level of endotoxin
endotoxemia goes up about 100fold or more over normal.
There's a normal low gradelevel of endotoxemia in
everybody, but it goes up over100 fold when you have sepsis.
(09:11):
Now what we're talking about,that is endotoxemia from SIBO.
It goes up typically only twoto four fold, 200 to 400 percent
.
So not as bad as sepsis, butenough to have effects on all
the organs of your body.
So what kinds of effects canyou expect If there's SIBO and
thereby endotoxemia, high levelsof endotoxin, bacterial
(09:32):
endotoxin, floating around yourbloodstream, around and around
and around.
What's the effect of endotoxinon the brain?
Well, near term it can causedepression, especially
depression that's poorlyresponsive to conventional
therapies.
So this question has been askednumerous times.
There are people who respond tothe serotonin reuptake
inhibitors, the SSRIs.
(09:53):
There are people who don'trespond.
What makes the people who don'trespond unique?
And it's become clear thatpeople who do not respond to
conventional drugs fordepression have higher levels of
inflammation, higher levels,for instance, of C-reactive
protein, interleukin-6,interleukin-1-beta, tnf-alpha
and others.
Well, a German group did thisstudy.
They took the endotoxin andinjected it into normal,
(10:17):
non-depressed volunteers and,remarkably, within three hours
the normal volunteers hadclinical depression.
And, even more remarkably, theydid MRI scans of their brains
and saw all the hallmarks ofdepression.
They did this repeatedly andshowed that an increase in the
blood levels of endotoxin andendotoxinia caused depression.
(10:37):
Now what does that tell youabout the depression that occurs
in people who are poorlyresponsive?
So it suggests, doesn't prove,but it suggests that higher
levels of endotoxemia may be anunderlying cause for depression,
particularly depression notresponsive to other therapies.
So depression is a majorpossible consequence of higher
levels of endotoxemia.
Anxiety is another one, socialanxiety as well as kind of
(11:01):
around the clock anxiety,disruption of sleep and
nightmares is another result ofendotoxemia.
Now there's also chronicneurodegenerative disorders that
can come from chronic,long-standing endotoxin, let's
say SIBO and endotoxin of 10years or more.
That can lead to conditionslike Alzheimer's, dementia,
cognitive impairment, louGehrig's disease, parkinsonism,
(11:22):
multiple sclerosis.
Now there may be other factorsthat enter into the equation,
but we know that endotoxin yes,sibo and endotoxin are major
factors in the development ofthose neurodegenerative
disorders.
How about metabolic conditions,common metabolic conditions
that plague the majority ofAmericans, that is, overweight,
obesity, the accumulation ofabdominal visceral fat, that's,
(11:44):
the fat in the abdomen andcircles of abdominal organs that
is inflammatory, high bloodsugar, high blood pressure.
These conditions are allworsened, caused or worsened by
endotoxin.
Of course, this is the majorityof Americans nowadays who have
these issues.
So it's reasonable to suspectthat the majority of people with
those common conditions likehypertension or prediabetes also
(12:06):
has, as a driver of thoseconditions, sibo and endotoxemia
.
Joint disease like arthritis isnot caused by SIBO and endotoxin
, it's worsened.
In other words, if you haveinflammation of your joints
because you eroded the cartilageof your knees, because you've
been consuming too many carbsand not addressing insulin
resistance that causes highblood sugar, thereby glycation,
(12:28):
discussed in another episode ofDefine Health.
Well, the endotoxin amplifiesthe inflammation and amplifies
the pain.
So it's very common for peopleto address their SIBO and
endotoxin and say things likeyou know what?
My knee pain or my hip pain isgone by 60, 70, 90 percent.
Very common experience All theconditions driven by insulin
(12:49):
resistance.
Insulin resistance is a basic,fundamental driving force in
numerous health conditions,including prediabetes, type 2
diabetes, risk for stroke,coronary heart disease, risk for
cognitive impairment, breastcancer risk and many other
conditions.
And we know with confidence,with good evidence, that SIBO
and endotoxemia are majordrivers of insulin resistance.
(13:12):
That also encourages theaccumulation of abdominal
visceral fat, fat in certainlyabdominal organs.
And you can see there's avicious cycle here, right?
So if endotoxemia leads toinsulin resistance, that in turn
leads to the accumulation ofabdominal visceral fat.
That in turn causes insulinresistance around and around,
(13:32):
making the process worse andworse if you allow this to
proceed.
Autoimmune conditions it looksas if the increased intestinal
permeability of having fecalmicrobes infesting all 24 feet
of the small intestine increases.
So the small intestine isalready very permeable, but
having those fecal microbesadjacent to the intestinal wall
further increases intestinalpermeability and this somehow
(13:55):
leads to this process calledmolecular mimicry, that is,
components of food and microbesare mistaken by your immune
system for components of yourown body and they start to
attack them.
It might attack your thyroid,as in Hashimoto's thyroiditis,
might attack the synovial tissuethat is the lining of your
joints and lead to rheumatoidarthritis.
It might attack your pancreasand you get autoimmune
(14:19):
pancreatitis.
And so many autoimmuneconditions have their origins in
SIBO and endotoxemia and theaccompanying increased
intestinal permeability.
Fatty liver About 35% of the USpopulation has this process
called fatty liver.
That is, infiltration of theliver by fat.
That is, triglycerides.
Fats are triglycerides,triglycerides are fat.
(14:41):
If you've got a bottle of oliveoil, that is a bottle of
triglycerides.
So what starts?
The process is consumption ofcarbs and sugars, such as the
amylopectin A of grains, andthen sucrose and fructose.
So the liver is very good atconverting those carbs to
triglycerides, the process ofso-called de novo lipogenesis
(15:02):
that is, making fats brand newfats.
So your liver is very good atconverting those sugars to
triglycerides.
Some of those triglyceridesmake their way into the
bloodstream.
That's why people with fattyliver, infiltration of the liver
with fat, have higher levels ofblood triglycerides, but some
of the triglycerides, forunclear reasons, also stay in
the liver and plug up the liverin effect, and that is fatty
(15:25):
liver.
Now, when you have SIBO andendotoxemia, the GI tract drains
.
The venous drainage of the GItract is through something
called the portal venous system.
That drains to the liver.
So when you have high levels ofendotoxemia, endotoxin entering
the portal vein system to theliver, that causes your liver to
(15:46):
become inflamed.
So it's already fatty liverfrom triglyceride production,
from carbs.
Now you're amplifying thedamage to your liver by the
endotoxemia in the portal venoussystem.
That is non-alcoholicsteatohepatitis or NASH.
So while SIBO and portal veinendotoxemia may not have been
the initiating factor, they arean exacerbating or a fact that
(16:09):
makes things worse.
Now put this all togetherincreased inflammation,
increased insulin resistance,increased or accelerated
deterioration of joints,increased potential for
cognitive impairment, increasedrisk for neurodegenerative
conditions and autoimmuneconditions.
Put it all together.
This all adds up also toacceleration of aging.
(16:30):
All the phenomena of aging areaccelerated by this process of
SIBO and endotoxemia.
Think about that Microbesliving in the 24 feet of small
intestine have body-wide effectsthat, in effect, also
accelerate your process of aging.
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(16:53):
off to talk about the telltalesigns of SIBO, how to test for
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(19:53):
So you can appreciate that SIBO,and thereby endotoxemia, are
major influences over the wayyou feel, the way you look, how
fast you age and your healthsituation.
So how do you recognize if youhave SIBO or not, whether what I
call telltale signs.
You can look for among thosesigns fat malabsorption, that is
(20:13):
, your poops float, or you seefat droplets in the toilet after
a bowel movement, or you seestaining where the water meets
the porcelain.
So that's evidence that thereare microbes in the duodenum
blocking the action of bile andpancreatic enzymes.
I'm surprised how many peopleoften say they need pancreatic
enzymes when the real problem isthe infestation of fecal
(20:35):
microbes in the duodenumblocking the normal digestive
action of pancreatic enzymes inbile.
The solution, of course notpancreatic enzymes, though that
may make you feel bettertemporarily.
The solution is to address theSIBO, the infestation of fecal
microbes in the duodenum.
Another common telltale sign ofSIBO are food intolerances.
(20:55):
So many people have anintolerance to legumes, fod maps
that is, fibers and sugars.
Night shades, histaminecontaining foods on and on
People who had testing for IgGtesting, that is, intolerances
that are evidenced by an immuneresponse against foods.
These are all variations on thesame theme that is SIBO.
(21:17):
Those things are causing thefood intolerance and while you
can eliminate or reduce theintake of those foods to produce
symptom relief, it doesn'taddress the problem that is SIBO
.
And the implication, theconsequence of uncorrected SIBO
are quite serious.
So you do not want to dismiss afood intolerance as just a food
(21:37):
intolerance.
You want to get at the rootcause, which is small intestinal
bacterial overgrowth.
And then there are conditionsthat are virtually synonymous
with SIBO.
If you have some of theseconditions, you can be very
confident that you have SIBO.
Among those conditions arefatty liver we mentioned very
high likelihood obesity, type 2diabetes at least a 50-50 chance
(21:59):
that you have SIBO.
If you have fibromyalgia, someevidence tells us that there's a
100% likelihood that you haveSIBO.
Likewise, restless leg syndromethis thing that keeps you from
sleeping properly, disrupt yoursleep that is up to 100% High
likelihood to be SIBO.
Autoimmune conditions,neurodegenerative conditions
(22:20):
very high likelihood to haveSIBO.
So if you have any of theseconditions that are virtually
synonymous with SIBO, or atleast very high likelihood of
being associated with SIBO andeither initiating that disease
or making it worse, you can beconfident that you likely have
SIBO and can take steps toeradicate it.
Now you can also test for SIBOto be sure whether or not you
have it.
As I mentioned earlier, you cando a 100-breath testing in a
(22:43):
lab or clinic.
It's a hassle, it costs somemoney, but that is one way to do
it.
Another way to do it is to havean endoscopy, where the
gastroenterology retrieves asample from your duodenum or
upper jejunum and then submitsit either for culture or other
analysis.
That's rarely done, of course,and rarely done just to diagnose
SIBO.
It's often done in hopes ofanswering some other question,
(23:05):
like do you have a bleedingulcer or some other problem, and
so typically the culture sampleis obtained.
Incidentally, and, by the way,many hospitals will culture the
sample, which does not revealall the microbes of SIBO.
It reveals only a minority ofmicrobes, because most microbes
that cause SIBO cannot becultured.
It's thereby an imperfect wayto assess for SIBO.
(23:26):
But if you're having anendoscopy for other reasons, it
would not hurt to ask thegastroenterologist to make it an
aspirate to sample it for study.
But the way we do it at home isto use the air device, aire
from the company Food Marble,and this, as I talked about
earlier, is a way to assesswhether there's production of
hydrogen gas that only microbescan produce.
(23:47):
We can't produce it afterfeeding them something that they
can metabolize.
The best choice, I think, isInulin.
In a lab or clinic they uselaculose or glucose, which I
think are poor choices.
Because if we look at thespecies of SIBO, the species
that occupy colonize the smallintestine.
Many of them can't consume thelaculose, so you want to
(24:08):
identify the hydrogen gas fromthose species.
Likewise, glucose ismetabolized by us, by you and me
, and that limits the exposureof the microbes to the glucose.
Inulin cannot be metabolized byhumans, but only by microbes
and by the widest variety ofspecies.
So if you want the best choiceso far, the best choice is
(24:29):
Inulin, and that's what we use,not the laculose or glucose.
Now, a major advantage inassessing yourself or someone
else for SIBO and endotoxymen isif we could measure the blood
levels of endotoxin.
You can do that in a researchsetting.
It is not available yetclinically.
In other words, you cannot goto one of the laboratories and
(24:49):
have them measure your endotoxin.
That may become possible in thefuture, but right now it's
simply just not available.
So we're left with thispresumptive identification of
endotoxemia.
If you have SIBO, it's a safeassumption to assume that you
have endotoxemia accompanyingthe SIBO.
Now, unfortunately, if you askyour doctor, your primary care
or even your gastroenterologist,do I have SIBO?
(25:12):
Most won't know what you'retalking about.
It's not because it'smake-believe, it's because it's
just common knowledge thatpracticing physicians are about
a generation behind the science.
They didn't receive this kindof education in their training
or in medical school, so they'reunaware of it, or they poo-poo
it or they make fun of yourrequest, and so don't be
(25:32):
surprised if they discourage youfrom pursuing testing.
Just assume your doctor doesknow something about it.
What they'll usually do is sendyou to a lab or clinic test for
hydrogen gas.
If it's positive, they'llprescribe an antibiotic called
Xifaxin or Rhafaximin, which isabout 50 to 60% effective.
So a lot of failures.
Has side effects, including thepotential for Clostridium
(25:53):
difficile and or colitis C diff,which is a very devastating
though uncommon side effect oftaking an antibiotic.
It costs a lot of money it'sabout $1,200 and typically not
covered by insurance, so notvery effective.
Lots of potential problems.
We did use some herbalantibiotics.
Only two regimens have beenvalidated, that is, have been
(26:13):
scrutinized scientifically.
There are many others that havenot, so I would not bother with
those.
But the two that have beenvalidated with some evidence are
the Kandabactin AR, kandabactinBR regimen and the Biotics
Research FC Cytol withDisbiocide regimen.
Those have worked.
My experience we've had goodresults, but more recently we've
(26:34):
been doing something differentand that is going back over a
year now.
I ask these questions If youhave SIBO 24 feet of infestation
of fecal microbes in your smallintestine and you took a
commercial probiotic off theshelf, what's the likelihood
that your SIBO will go away?
Very low, it almost never goesaway.
So I ask these questions whatif we chose microbes that
(26:56):
colonize the small intestine andthat's where SIBO occurs right
and produce what are calledbacteriocins, natural antibiotic
effective against the speciesof SIBO?
Well, I chose three microbesand strains, species and strains
A strain of lactobacillusgastroi, a strain of
lactobacillus rhodo-i.
Both of those species colonizethe small intestine and produce
(27:19):
numerous bacteriocins.
I threw in bacillus quagulantsand other strain because it also
produces one or twobacteriocins, does not colonize
the upper GI tract, but it's gota good track record for
reducing a lot of the symptomsof erobalus syndrome, which for
many people is the same as SIBO.
We combine them and co-fermentthem to get very high numbers
using my method of prolongedfermentation, which you'll find,
(27:41):
by the way, in the super gutbook or in my
drdavsinfanthealthcom blog.
Show you how to where to sourceall the microbes, how to do
this using prolongedfermentation and so far, about
50 people who've done this, 90%convert to hydrogen gas negative
by the air device.
In other words, we seem to havestumbled into a way that is
(28:03):
superior to conventionalantibiotics and likely superior
to the herbal antibiotics, sothat you find that recipe and
you can easily make it.
And what we're really doingwith that so-called what I call
SIBO yogurt is we're replacingkeystone microbes that you
should have had all along.
So I encourage people to dothis for four weeks if they have
SIBO, but then to consume itperiodically, maybe two or three
(28:25):
times a week.
Long-term, they preventrecurrence Cause these are very
important microbes, not justuseful for eradicating SIBO, but
for bringing order andstructure back to the
gastrointestinal microbiomecause.
They're keystone orfoundational species.
Now, if you learned somethingfrom this episode of Defiant
Health, I encourage you tosubscribe to your favorite
podcast directory.
(28:45):
Leave a review, leave a comment, tell your friends.
Let's build this movement ofself-empowerment and health.
Thank you for listening.
We'll see you in the next video.
L-l-l-e-e, m-n-l-o-g-y-h-e-n-oT Welcome.
If you've been following my discussions in this
Define Health podcast or in myblog, drdavisinvidenthealthcom,
or my Super Gut Book, you knowthat I've been arguing that
there's an epidemic of SIBOgoing on in the US, an epidemic
involving every one and twopeople.
It is an epidemic responsiblefor an astounding amount of
health struggles.
(00:26):
The more we all come tounderstand small intestinal
bacterial overgrowth, or SIBO,the more you have to appreciate
all the varied ways thissituation can show itself.
First of all, for those of youunfamiliar, what is SIBO?
Sibo refers to the situation inwhich modern people, due to
exposure to multiple course ofantibiotics and other disruptive
(00:47):
factors, have lost hundreds ofbeneficial bacterial species in
our colons.
These beneficial species wereresponsible for suppressing the
proliferation of unhealthymicrobial species, mostly fecal
microbial species such as E coli, salmonella and citrobacter.
The loss of beneficial microbesallows unhealthy fecal species
(01:10):
to proliferate, then ascend upfrom the colon where they
originated and into the 24 feetof small intestine.
The small intestine is poorlyequipped to deal with this
invasion of fecal microbes.
The small intestine is, bydesign, permeable, since that is
where the bulk of nutrientssuch as vitamins, minerals and
amino acids are absorbed.
(01:30):
But trillions of fecal microbesin the small intestine microbes
that live for only a few hours,live and die and release their
toxic components that can gainaccess to the blood stream.
One of the primary toxiccomponents is called endotoxin.
When endotoxin enters the bloodstream, that's called
endotoxemia.
When endotoxemia is nowrecognized to be the primary way
(01:53):
in which gastrointestinalmicrobes are able to exert
effects in every organ of thebody, it means that SIBO, and
thereby endotoxemia, can beexperienced as a wide variety of
health problems and diseases.
So in this episode of DefiantHealth, let's discuss whether
this is a situation that appliesto you or to someone close to
you, and what steps you can taketo undo these harmful effects.
(02:16):
Later in the podcast, let'stalk about the fine health
sponsors that include PaleoValley, who provides fermented
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So many people are unaware thatSIBO that is, small intestinal
(03:01):
bacterial overgrowth.
Recall that this means there's24 feet of small intestine,
stomach, duodenum, jejunum andilium that are infested by
microbes that are meant to be inthe colon only, with sharply
diminishing numbers as youascend into the ilium, etc.
So in SIBO, the entire lengthof small intestine 24 feet, is
(03:21):
infested by trillions ofmicrobes that should have stayed
in the colon.
These are fecal microbes withnames like E coli, Campylobacter
, citrobacter, salmonella andmany others that don't belong
there.
These microbes themselves arevery inflammatory when they
contact the intestinal wall.
But the small intestine, recall, is also very permeable because
that's where you're supposed tobe absorbing nutrients like
(03:45):
fatty acids, amino acids,vitamins and minerals.
But when microbes infest thesmall intestine, they live and
die rapidly, right, thosetrillions of microbes only live
for a few hours at a time, andwhen they die they shed their
toxins into the lumen, into theintestine itself, and some of
those toxins gain access intothe bloodstream, so-called
(04:06):
endotoxemia.
And that's how SIBO, thisprocess in the small intestine,
can export its effects to allthe other organs of the body,
whether it's skin or theintestine itself brain, uterus,
prostate, heart and just aboutall other organs.
Now why do I say that 50% of theUS population, or something in
north of 150 million people havethis.
(04:28):
Well, the science is quiteclear.
Let's take the studies that askthis question In condition
blank.
What proportion of people testpositive for SIBO?
That's usually breath testingfor hydrogen gas.
That's the standard way todetect whether microbes living
in the upper GI tract.
It's all about timing.
If you ingest something thatmicrobes consume, let's say
(04:49):
inulin, a prebiotic fiber, andyou produce hydrogen gas,
because only microbes producehydrogen gas, but you don't.
But if you measure sharp uptakein the quantity of hydrogen gas
within the first 90 minutesafter consumption of that inulin
, it tells you that microbes areliving in the upper GI tract,
because it's 90 minutes is toosoon for that inulin to have
arrived in the colon where thosemicrobes are supposed to be.
(05:12):
So if you turn positive forhydrogen gas at, let's say, 30
minutes or 45 minutes, that ispositive for microbes living in
the small intestine.
Well, if we take thoseconditions, let's just say
obesity.
So of the 110 or so millionAmericans who are obese, we know
with good evidence that 50%would test positive.
Well, that's about 55 millionpeople right there.
(05:34):
How about the people with fattyliver?
Well, that's another about 130million people, and about 50%
test positive.
That's another 60 or so millionpeople.
Now there's overlap, of course,obese people and fatty liver
people, but there's also otherconditions like irritable bowel
syndrome.
Of the 60 to 70 million peoplewith irritable bowel syndrome in
(05:56):
the US, about 40% it variesfrom study to study and the
population being studied, butapproximately 40% of those
people test positive for SIBO.
That's another 24 to 30 millionor so people right Now.
Add that up through otherconditions like restless leg
syndrome, fibromyalgia, type 2diabetes, pre-diabetes, people
(06:17):
with coronary disease,neurodegenerative disorders,
autoimmune conditions.
Add it up and you easily exceedaccepting some redundancy, some
overlap, we easily exceed over150 million people with SIBO.
Now what people often don'trealize is that process is not
confined to only the GI tract,the gas-contestinal tract.
(06:38):
This process is able to exportits effects to all other organs.
Now this was first validated.
It's been suspected for manydecades, but it was finally
validated by a Belgian researchgroup in 2007, dr Patrice Canney
, c-a-n-i, and has since beencorroborated numerous times.
And now we have a consumerdevice, a device you can
(06:59):
purchase on your own, called theAIR device A-I-R-E, made by the
Food Marble Company that I haveno relationship with, by the
way, but you can test yourselfby taking something like Inulin.
We typically take two teaspoonsof Inulin, put it in your
coffee and there's a dietaryprep in the preceding 12 to 24
hours and then you get abaseline level by blowing into
(07:20):
the AIR device.
Then you consume that food,let's say coffee with two
teaspoons of Inulin and then youtest every 30 to 45 minutes for
up to 90 minutes If there's arise of four units.
This device measures hydrogengas on a 0 to 10 scale.
Each unit of one or twocorresponds to five parts per
million hydrogen gas.
If you did hydrogen gas testingin a clinic or lab, but on the
(07:43):
0 to 10 on the AIR device, ifthere's a rise of four or more
units, that is 20 parts permillion or more, that is a
positive result.
So let's say your baselinelevel is 1.2, you consume your
coffee with Inulin and let's sayat 45 minutes your value is 9.8
.
So more than four point rise isa positive test.
You now know you have microbesliving in the small intestine.
(08:05):
If you test positive after 90minutes, you can't tell if
that's hydrogen gas beingproduced in, say, the ilium, the
distal part of the smallintestine, or whether it's the
expected rise in H2 from colonicfermentation.
So after 90 minutes you can'ttell what's going on.
You can still have SIBO, butyou can't tell by this test.
Now this is similar.
(08:26):
This is in parallel to whathappens in sepsis.
So say you had a urinary tractinfection in your bladder that
then ascended into the uretersand into the kidneys.
That's pylonephritis, that is akidney infection.
You get very sick.
Now some people, when they getpylonephritis that is an
infection of the kidneys Some ofthe bacteria can get into the
bloodstream and that's sepsis,or urinary sepsis, with which
(08:49):
you can get very, very sick.
People sometimes go onventilators.
They lose control of theirblood pressure, go into shock,
so they're in very seriouscondition.
In that situation theprevailing level of endotoxin
endotoxemia goes up about 100fold or more over normal.
There's a normal low gradelevel of endotoxemia in
everybody, but it goes up over100 fold when you have sepsis.
(09:11):
Now what we're talking about,that is endotoxemia from SIBO.
It goes up typically only twoto four fold, 200 to 400 percent
.
So not as bad as sepsis, butenough to have effects on all
the organs of your body.
So what kinds of effects canyou expect If there's SIBO and
thereby endotoxemia, high levelsof endotoxin, bacterial
(09:32):
endotoxin, floating around yourbloodstream, around and around
and around.
What's the effect of endotoxinon the brain?
Well, near term it can causedepression, especially
depression that's poorlyresponsive to conventional
therapies.
So this question has been askednumerous times.
There are people who respond tothe serotonin reuptake
inhibitors, the SSRIs.
(09:53):
There are people who don'trespond.
What makes the people who don'trespond unique?
And it's become clear thatpeople who do not respond to
conventional drugs fordepression have higher levels of
inflammation, higher levels,for instance, of C-reactive
protein, interleukin-6,interleukin-1-beta, tnf-alpha
and others.
Well, a German group did thisstudy.
They took the endotoxin andinjected it into normal,
(10:17):
non-depressed volunteers and,remarkably, within three hours
the normal volunteers hadclinical depression.
And, even more remarkably, theydid MRI scans of their brains
and saw all the hallmarks ofdepression.
They did this repeatedly andshowed that an increase in the
blood levels of endotoxin andendotoxinia caused depression.
(10:37):
Now what does that tell youabout the depression that occurs
in people who are poorlyresponsive?
So it suggests, doesn't prove,but it suggests that higher
levels of endotoxemia may be anunderlying cause for depression,
particularly depression notresponsive to other therapies.
So depression is a majorpossible consequence of higher
levels of endotoxemia.
Anxiety is another one, socialanxiety as well as kind of
(11:01):
around the clock anxiety,disruption of sleep and
nightmares is another result ofendotoxemia.
Now there's also chronicneurodegenerative disorders that
can come from chronic,long-standing endotoxin, let's
say SIBO and endotoxin of 10years or more.
That can lead to conditionslike Alzheimer's, dementia,
cognitive impairment, louGehrig's disease, parkinsonism,
(11:22):
multiple sclerosis.
Now there may be other factorsthat enter into the equation,
but we know that endotoxin yes,sibo and endotoxin are major
factors in the development ofthose neurodegenerative
disorders.
How about metabolic conditions,common metabolic conditions
that plague the majority ofAmericans, that is, overweight,
obesity, the accumulation ofabdominal visceral fat, that's,
(11:44):
the fat in the abdomen andcircles of abdominal organs that
is inflammatory, high bloodsugar, high blood pressure.
These conditions are allworsened, caused or worsened by
endotoxin.
Of course, this is the majorityof Americans nowadays who have
these issues.
So it's reasonable to suspectthat the majority of people with
those common conditions likehypertension or prediabetes also
(12:06):
has, as a driver of thoseconditions, sibo and endotoxemia
.
Joint disease like arthritis isnot caused by SIBO and endotoxin
, it's worsened.
In other words, if you haveinflammation of your joints
because you eroded the cartilageof your knees, because you've
been consuming too many carbsand not addressing insulin
resistance that causes highblood sugar, thereby glycation,
(12:28):
discussed in another episode ofDefine Health.
Well, the endotoxin amplifiesthe inflammation and amplifies
the pain.
So it's very common for peopleto address their SIBO and
endotoxin and say things likeyou know what?
My knee pain or my hip pain isgone by 60, 70, 90 percent.
Very common experience All theconditions driven by insulin
(12:49):
resistance.
Insulin resistance is a basic,fundamental driving force in
numerous health conditions,including prediabetes, type 2
diabetes, risk for stroke,coronary heart disease, risk for
cognitive impairment, breastcancer risk and many other
conditions.
And we know with confidence,with good evidence, that SIBO
and endotoxemia are majordrivers of insulin resistance.
(13:12):
That also encourages theaccumulation of abdominal
visceral fat, fat in certainlyabdominal organs.
And you can see there's avicious cycle here, right?
So if endotoxemia leads toinsulin resistance, that in turn
leads to the accumulation ofabdominal visceral fat.
That in turn causes insulinresistance around and around,
(13:32):
making the process worse andworse if you allow this to
proceed.
Autoimmune conditions it looksas if the increased intestinal
permeability of having fecalmicrobes infesting all 24 feet
of the small intestine increases.
So the small intestine isalready very permeable, but
having those fecal microbesadjacent to the intestinal wall
further increases intestinalpermeability and this somehow
(13:55):
leads to this process calledmolecular mimicry, that is,
components of food and microbesare mistaken by your immune
system for components of yourown body and they start to
attack them.
It might attack your thyroid,as in Hashimoto's thyroiditis,
might attack the synovial tissuethat is the lining of your
joints and lead to rheumatoidarthritis.
It might attack your pancreasand you get autoimmune
(14:19):
pancreatitis.
And so many autoimmuneconditions have their origins in
SIBO and endotoxemia and theaccompanying increased
intestinal permeability.
Fatty liver About 35% of the USpopulation has this process
called fatty liver.
That is, infiltration of theliver by fat.
That is, triglycerides.
Fats are triglycerides,triglycerides are fat.
(14:41):
If you've got a bottle of oliveoil, that is a bottle of
triglycerides.
So what starts?
The process is consumption ofcarbs and sugars, such as the
amylopectin A of grains, andthen sucrose and fructose.
So the liver is very good atconverting those carbs to
triglycerides, the process ofso-called de novo lipogenesis
(15:02):
that is, making fats brand newfats.
So your liver is very good atconverting those sugars to
triglycerides.
Some of those triglyceridesmake their way into the
bloodstream.
That's why people with fattyliver, infiltration of the liver
with fat, have higher levels ofblood triglycerides, but some
of the triglycerides, forunclear reasons, also stay in
the liver and plug up the liverin effect, and that is fatty
(15:25):
liver.
Now, when you have SIBO andendotoxemia, the GI tract drains
.
The venous drainage of the GItract is through something
called the portal venous system.
That drains to the liver.
So when you have high levels ofendotoxemia, endotoxin entering
the portal vein system to theliver, that causes your liver to
(15:46):
become inflamed.
So it's already fatty liverfrom triglyceride production,
from carbs.
Now you're amplifying thedamage to your liver by the
endotoxemia in the portal venoussystem.
That is non-alcoholicsteatohepatitis or NASH.
So while SIBO and portal veinendotoxemia may not have been
the initiating factor, they arean exacerbating or a fact that
(16:09):
makes things worse.
Now put this all togetherincreased inflammation,
increased insulin resistance,increased or accelerated
deterioration of joints,increased potential for
cognitive impairment, increasedrisk for neurodegenerative
conditions and autoimmuneconditions.
Put it all together.
This all adds up also toacceleration of aging.
(16:30):
All the phenomena of aging areaccelerated by this process of
SIBO and endotoxemia.
Think about that Microbesliving in the 24 feet of small
intestine have body-wide effectsthat, in effect, also
accelerate your process of aging.
Now let's pause for a moment tohear something about Defiant
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(16:53):
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(19:53):
So you can appreciate that SIBO,and thereby endotoxemia, are
major influences over the wayyou feel, the way you look, how
fast you age and your healthsituation.
So how do you recognize if youhave SIBO or not, whether what I
call telltale signs.
You can look for among thosesigns fat malabsorption, that is
(20:13):
, your poops float, or you seefat droplets in the toilet after
a bowel movement, or you seestaining where the water meets
the porcelain.
So that's evidence that thereare microbes in the duodenum
blocking the action of bile andpancreatic enzymes.
I'm surprised how many peopleoften say they need pancreatic
enzymes when the real problem isthe infestation of fecal
(20:35):
microbes in the duodenumblocking the normal digestive
action of pancreatic enzymes inbile.
The solution, of course notpancreatic enzymes, though that
may make you feel bettertemporarily.
The solution is to address theSIBO, the infestation of fecal
microbes in the duodenum.
Another common telltale sign ofSIBO are food intolerances.
(20:55):
So many people have anintolerance to legumes, fod maps
that is, fibers and sugars.
Night shades, histaminecontaining foods on and on
People who had testing for IgGtesting, that is, intolerances
that are evidenced by an immuneresponse against foods.
These are all variations on thesame theme that is SIBO.
(21:17):
Those things are causing thefood intolerance and while you
can eliminate or reduce theintake of those foods to produce
symptom relief, it doesn'taddress the problem that is SIBO
.
And the implication, theconsequence of uncorrected SIBO
are quite serious.
So you do not want to dismiss afood intolerance as just a food
(21:37):
intolerance.
You want to get at the rootcause, which is small intestinal
bacterial overgrowth.
And then there are conditionsthat are virtually synonymous
with SIBO.
If you have some of theseconditions, you can be very
confident that you have SIBO.
Among those conditions arefatty liver we mentioned very
high likelihood obesity, type 2diabetes at least a 50-50 chance
(21:59):
that you have SIBO.
If you have fibromyalgia, someevidence tells us that there's a
100% likelihood that you haveSIBO.
Likewise, restless leg syndromethis thing that keeps you from
sleeping properly, disrupt yoursleep that is up to 100% High
likelihood to be SIBO.
Autoimmune conditions,neurodegenerative conditions
(22:20):
very high likelihood to haveSIBO.
So if you have any of theseconditions that are virtually
synonymous with SIBO, or atleast very high likelihood of
being associated with SIBO andeither initiating that disease
or making it worse, you can beconfident that you likely have
SIBO and can take steps toeradicate it.
Now you can also test for SIBOto be sure whether or not you
have it.
As I mentioned earlier, you cando a 100-breath testing in a
(22:43):
lab or clinic.
It's a hassle, it costs somemoney, but that is one way to do
it.
Another way to do it is to havean endoscopy, where the
gastroenterology retrieves asample from your duodenum or
upper jejunum and then submitsit either for culture or other
analysis.
That's rarely done, of course,and rarely done just to diagnose
SIBO.
It's often done in hopes ofanswering some other question,
(23:05):
like do you have a bleedingulcer or some other problem, and
so typically the culture sampleis obtained.
Incidentally, and, by the way,many hospitals will culture the
sample, which does not revealall the microbes of SIBO.
It reveals only a minority ofmicrobes, because most microbes
that cause SIBO cannot becultured.
It's thereby an imperfect wayto assess for SIBO.
(23:26):
But if you're having anendoscopy for other reasons, it
would not hurt to ask thegastroenterologist to make it an
aspirate to sample it for study.
But the way we do it at home isto use the air device, aire
from the company Food Marble,and this, as I talked about
earlier, is a way to assesswhether there's production of
hydrogen gas that only microbescan produce.
(23:47):
We can't produce it afterfeeding them something that they
can metabolize.
The best choice, I think, isInulin.
In a lab or clinic they uselaculose or glucose, which I
think are poor choices.
Because if we look at thespecies of SIBO, the species
that occupy colonize the smallintestine.
Many of them can't consume thelaculose, so you want to
(24:08):
identify the hydrogen gas fromthose species.
Likewise, glucose ismetabolized by us, by you and me
, and that limits the exposureof the microbes to the glucose.
Inulin cannot be metabolized byhumans, but only by microbes
and by the widest variety ofspecies.
So if you want the best choiceso far, the best choice is
(24:29):
Inulin, and that's what we use,not the laculose or glucose.
Now, a major advantage inassessing yourself or someone
else for SIBO and endotoxymen isif we could measure the blood
levels of endotoxin.
You can do that in a researchsetting.
It is not available yetclinically.
In other words, you cannot goto one of the laboratories and
(24:49):
have them measure your endotoxin.
That may become possible in thefuture, but right now it's
simply just not available.
So we're left with thispresumptive identification of
endotoxemia.
If you have SIBO, it's a safeassumption to assume that you
have endotoxemia accompanyingthe SIBO.
Now, unfortunately, if you askyour doctor, your primary care
or even your gastroenterologist,do I have SIBO?
(25:12):
Most won't know what you'retalking about.
It's not because it'smake-believe, it's because it's
just common knowledge thatpracticing physicians are about
a generation behind the science.
They didn't receive this kindof education in their training
or in medical school, so they'reunaware of it, or they poo-poo
it or they make fun of yourrequest, and so don't be
(25:32):
surprised if they discourage youfrom pursuing testing.
Just assume your doctor doesknow something about it.
What they'll usually do is sendyou to a lab or clinic test for
hydrogen gas.
If it's positive, they'llprescribe an antibiotic called
Xifaxin or Rhafaximin, which isabout 50 to 60% effective.
So a lot of failures.
Has side effects, including thepotential for Clostridium
(25:53):
difficile and or colitis C diff,which is a very devastating
though uncommon side effect oftaking an antibiotic.
It costs a lot of money it'sabout $1,200 and typically not
covered by insurance, so notvery effective.
Lots of potential problems.
We did use some herbalantibiotics.
Only two regimens have beenvalidated, that is, have been
(26:13):
scrutinized scientifically.
There are many others that havenot, so I would not bother with
those.
But the two that have beenvalidated with some evidence are
the Kandabactin AR, kandabactinBR regimen and the Biotics
Research FC Cytol withDisbiocide regimen.
Those have worked.
My experience we've had goodresults, but more recently we've
(26:34):
been doing something differentand that is going back over a
year now.
I ask these questions If youhave SIBO 24 feet of infestation
of fecal microbes in your smallintestine and you took a
commercial probiotic off theshelf, what's the likelihood
that your SIBO will go away?
Very low, it almost never goesaway.
So I ask these questions whatif we chose microbes that
(26:56):
colonize the small intestine andthat's where SIBO occurs right
and produce what are calledbacteriocins, natural antibiotic
effective against the speciesof SIBO?
Well, I chose three microbesand strains, species and strains
A strain of lactobacillusgastroi, a strain of
lactobacillus rhodo-i.
Both of those species colonizethe small intestine and produce
(27:19):
numerous bacteriocins.
I threw in bacillus quagulantsand other strain because it also
produces one or twobacteriocins, does not colonize
the upper GI tract, but it's gota good track record for
reducing a lot of the symptomsof erobalus syndrome, which for
many people is the same as SIBO.
We combine them and co-fermentthem to get very high numbers
using my method of prolongedfermentation, which you'll find,
(27:41):
by the way, in the super gutbook or in my
drdavsinfanthealthcom blog.
Show you how to where to sourceall the microbes, how to do
this using prolongedfermentation and so far, about
50 people who've done this, 90%convert to hydrogen gas negative
by the air device.
In other words, we seem to havestumbled into a way that is
(28:03):
superior to conventionalantibiotics and likely superior
to the herbal antibiotics, sothat you find that recipe and
you can easily make it.
And what we're really doingwith that so-called what I call
SIBO yogurt is we're replacingkeystone microbes that you
should have had all along.
So I encourage people to dothis for four weeks if they have
SIBO, but then to consume itperiodically, maybe two or three
(28:25):
times a week.
Long-term, they preventrecurrence Cause these are very
important microbes, not justuseful for eradicating SIBO, but
for bringing order andstructure back to the
gastrointestinal microbiomecause.
They're keystone orfoundational species.
Now, if you learned somethingfrom this episode of Defiant
Health, I encourage you tosubscribe to your favorite
podcast directory.
(28:45):
Leave a review, leave a comment, tell your friends.
Let's build this movement ofself-empowerment and health.
Thank you for listening.
We'll see you in the next video.
L-l-l-e-e, m-n-l-o-g-y-h-e-n-oT Welcome.
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