SIBO test results, before & after treatment

[ryan31337]

Hi all,

Thought I would share my recent SIBO tests and attempt at treatment. Would be happy to hear from others that have any experience with this.

Had SIBO confirmed earlier this year with classic twin-peak response:

Have since completed a courses of Rifaximin (10day) & herbal anti-microbials (2month), whilst sticking religiously to my ketogenic diet. Retest results are in:

So I've apparently lost the twin-peak response, replaced with what I think would be considered still positive with a distal-peak. Any thoughts on that?

I knew SIBO was a tough nut to crack but I'm pretty bummed after spending all that money, only to have worsened symptoms and seemingly increased gas production Not to mention my general health and energy levels were considerably worsened during the entire herbal treatment phase....

Ryan

 

[ljimbo423]

I knew SIBO was a tough nut to crack but I'm pretty bummed after spending all that money, only to have worsened symptoms and seemingly increased gas production

Hey Ryan- I've been sitting here for about 5 minutes trying to understand these test results and I must say, I am baffled! It makes no sense to me that your test would come back with higher gas levels. Especially after what you have done to treat it.

It just don't make sense, you did everything right, that I know of, diet, antibiotics, then follow up antibiotic herbs. It seems like, at the very least, the gas levels should have gone down some. Maybe somebody else has some insight into this. Have you talked to your doctor about it?

All the best, Jim

 

[bspg]

It's interesting that your H2 levels are higher overall but don't start showing up until after an hour into the test. It's possible that it's coming from bacteria lower down your intestinal tract but maybe your gastric emptying is slower this time? I don't know why that would happen but it might explain your worsened symptoms.

 

[alicec]

It's interesting that your H2 levels are higher overall but don't start showing up until after an hour into the test. It's possible that it's coming from bacteria lower down your intestinal tract but maybe your gastric emptying is slower this time? I don't know why that would happen but it might explain your worsened symptoms.

Something like that is quite possible, also there is a lot of controversy about interpretation of breath tests - see this article.

 

[ryan31337]

Thanks for the comments guys.

@ljimbo423 - It is confusing isn't it. Waiting to see specialist again, will report back. If it is a worsening of SIBO, here are a few things that crossed my mind, which may be complete nonsense:

1 - I regularly ate some foods deemed 'illegal' on the Bi-Phasic diet approach: peanuts, palm oil and small amounts of artificial sweeteners. These never gave me any symptoms and in light of them being legal in some other popular SIBO diets I figured it wouldn't be a huge issue (especially with keto levels of carbs). Peanut butter was also quite important to me for fat intake with respect to maintaining keto on my very restricted diet.

2 - I ate a 'live' coconut yogurt daily, again for fat intake. Am aware that probiotics seem essential for some but deadly for others.

3 - The herbals really made me feel bad and worsened my POTS and presumably autonomic function - maybe motility was effected throughout too.

4 - On the 2nd test prep day before starving I ate a portion of white rice, the test allowed for it and I wanted to know if I'd still be symptomatic (I was!). Not sure if giving the bacteria 1x single good meal before the test would have any significant effect on gas production the next day though.

---

@bspg & @alicec - It does seem like my transit is delayed by 20mins or so in comparison to most results I've seen. Though not enough to stop my first test being very likely positive by all criteria, the second only positive by the weaker criteria.

The strictest practitioners seem to suggest any response beyond 60mins could reflect a fast transit and colonic activity, which would rule out both tests being positive. However for that to be true in test 1 you'd have to discount the significance of the twin peak, or you'd have to accept that transit speed in test 2 doubled!

On the other hand you've got very experienced practitioners like Siebecker who say late distal peaks are actually most common SIBO presentation and respond well...

 

[ljimbo423]

@ljimbo423 - It is confusing isn't it. Waiting to see specialist again, will report back. If it is a worsening of SIBO, here are a few things that crossed my mind, which may be complete nonsense:

1 - I regularly ate some foods deemed 'illegal' on the Bi-Phasic diet approach: peanuts, palm oil and small amounts of artificial sweeteners. These never gave me any symptoms and in light of them being legal in some other popular SIBO diets I figured it wouldn't be a huge issue (especially with keto levels of carbs). Peanut butter was also quite important to me for fat intake with respect to maintaining keto on my very restricted diet.

2 - I ate a 'live' coconut yogurt daily, again for fat intake. Am aware that probiotics seem essential for some but deadly for others.

3 - The herbals really made me feel bad and worsened my POTS and presumably autonomic function - maybe motility was effected throughout too.

4 - On the 2nd test prep day before starving I ate a portion of white rice, the test allowed for it and I wanted to know if I'd still be symptomatic (I was!). Not sure if giving the bacteria 1x single good meal before the test would have any significant effect on gas production the next day though.

I don't think any of these things would make a really big impact on your treatment. I don't really know what happened but my gut feeling (excuse the pun) is there is either something wrong with the test or the reading of it.

It just seems to me that after spending almost 2 1/2 months nuking these bacteria and a keto diet, your gas levels should have come down significantly. I'll be very interested in what the specialist says. Good luck to you!

Jim

 

[ryan31337]

So here's a random and probably very naive thought: could SIBO treatment efficacy be reduced by taking mast cell stabilisers?

Link between mast cells and bacteria: Antimicrobial defense, function and regulation by cytokines
http://www.sciencedirect.com/science/article/pii/S0306987717301445

We can conclude that mast cells fight bacteria

 

[adreno]

There are problems with both the validity and reliability of "SIBO" tests - seems like a huge mess to me. I wouldn't base any treatment on these tests.

 

[unicorn7]

I think you can't just treat SIBO without treating hyperpermeable bowel (leaky gut).

I have taken three rounds of rifaximine, with probiotics in between, to make a difference. I felt better, but it came back after about half a year. I have had more treatment now and my bowel is good again: no pain, no bloating.
Don't know how long it will last now.

 

[mrquasar]

If you read up on the literature on SIBO, the current testing is still very imprecise (I've read in some cases it's no more accurate than chance). And there are potential issues with the current testing methodology that remain unresolved (for example, I read that some species of 'bad' bacteria don't even produce hydrogen, whereas some species of 'good' bacteria too. And your personal mix will depend entirely on your personal gut microbiome.)

So to me, it would only seem reasonable to evaluate your progress based on your symptoms. What were your initial symptoms that made you suspect SIBO? Have they improved/resolved after treatment?

 

[unicorn7]

Dr. Meirleir treats a lot of patient for SIBO and hyperpermeable bowel, he doesn't use these tests. He does test your microbiome, I think it is important to know which bacteria are overgrowing.

I think the treatment of the bowel is very complicated, with lots of different factors.

 

[mrquasar]

He does test your microbiome, I think it is important to know which bacteria are overgrowing.

Not to be quarrelsome, but if you look at the medical literature, we're still in the very early stages of understanding what a healthy vs. diseased microbiome even looks like. The compositional balance of bacterial species in the gut varies significantly across race, geography, age, and even between individuals of those subgroups. One's gut microbiome may even be as unique as one's fingerprint. I think I've even read (I may be wrong here) that some "bad bacteria" genera/species can function as beneficial bacteria under normal circumstances until a molecular switch makes them go haywire.

Furthermore, the tests for gut bacteria are also pretty questionable. Stool tests can't tell you what the makeup of your small intestine or stomach is, for example. Also, the makeup of bacteria may also vary across the length of the colon, and you're only getting a snapshot of it with a stool test.

I know this makes for a messy picture, but I think it's a fair assessment. The science in this area is at a baby stage of development so pursuing treatments for your gut microbiome is questionable at best (aside from taking certain probiotics, which have been shown to help with digestive complaints and inflammation).

Just my two cents.