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IBS/SIBO article in Daily Mail, quite interesting CF mentioned (not CFS)

Glynis Steele

Senior Member
Newcastle upon Tyne UK
Reading this, it mentions b12 not being absorbed and carb restriction being hugely beneficial. Bolding mine.

For ten years I looked pregnant. Between 1997 and 2007 my bloated belly peered over my waistband as I tried to hold it in. I wasnt overweight or malnourished. Instead, doctor after doctor gave me the same diagnosis: irritable bowel syndrome. About one in ten people have or think they have this horrible condition. Its chief symptoms, apart from bloating, are constipation and diarrhoea, with pain, fatigue and sometimes depression joining in.

It is hardly taboo several celebrities have revealed they suffer from IBS: actress Kirsten Dunst and model Tyra Banks to name a few. But are we being told the truth? Do we all really have IBS?
Four years ago, I began to suspect not. All my symptoms had intensified, in particular, the pain. I tried cutting out some of the known triggers: wheat, alcohol and cheese. I tried yoga and meditation stress is thought to worsen the condition. But still I looked pregnant, and I grew suspicious something else was wrong. Desperate and fed up, I went to my GP and begged to be referred to a gastroenterologist. He prodded at my protruding belly in search of cysts or tumours. He asked about my symptoms and how long I had suffered from them. He ran blood and urine tests to check for diabetes or signs of various cancers. Crucially, he took me seriously. Having eliminated the most serious possible causes, he referred me for two tests at Londons St. Thomas Hospital: one for lactose intolerance and one for something called Small Intestinal Bacterial Overgrowth (SIBO).

The first test involved drinking a sugar solution and every 15 minutes for three hours breathing into a tube to measure the hydrogen levels in my breath. The second was the same except I drank a lactulose solution a type of glucose also used as a laxative. The first test which was looking for a lactose (milk sugar) intolerance came back negative, but the other, for SIBO, was positive. I had never heard of it. So back at home, I plundered Google in search of answers. The same symptoms kept coming up as for IBS: constipation, diarrhoea, bloating, pain and fatigue. Why had none of the doctors I had seen ever mentioned this condition? Most GPs have never heard of it, explains Dr Ian Penman, a consultant gastroenterologist at Edinburghs Western General Hospital.

Small Intestinal Bacterial Overgrowth makes men look as though they are pregnant - a problem Patrick suffered with for 10 years. So what is it? And how many other IBS sufferers could in fact have SIBO? SIBO is a condition whereby the small intestine, which normally has very few bacteria in it, becomes colonised with too many bacteria. In healthy people, stomach acid and the waves of muscular contraction in the small intestine flush most bacteria into the bowel. But with SIBO that doesnt happen. Why? Mostly, Dr Penman says, it is because of four different types of underlying conditions. The first is when stomach acid is not produced because of gastric surgery, such as a bypass, or old age. Another vulnerable group is people whove had multiple operations on their intestines with parts cut out or joined together, such as those with Crohns disease. Thirdly there are people who have other gut disorders. And, finally, people who have had multiple courses of antibiotics. A huge proportion of those who think they have IBS actually suffer from SIBO. People with recurrent chest or urinary infections may have had lots of antibiotics, says Dr Penman. This can upset the delicate ecosystem in the bowel the balance of different types of bacteria which then allows certain bacteria groups to proliferate.
In my early 20s I had a succession of antibiotics for tonsillitis eventually they were removed which may explain my diagnosis. But, says Dr Penman, there are also those who do not fall into any of these categories who think they have IBS but test positive for SIBO, with none of the underlying factors.

We get into the area of could SIBO be the cause of IBS? he says. The answer is that it is unclear. Its difficult to tease out the causes of IBS are multi-factorial: stress, food intolerances, and in some cases, bacterial overgrowth.

A 2005 study published in the journal of Alimentary Pharmacology and Therapeutics found a staggering link between the condition: 98 IBS sufferers were given the hydrogen breath test for SIBO and 64 tested positive. This suggests a huge proportion of those who think they have IBS actually suffer from SIBO.

However, Dr Penman points out: A more recent study found that some people with IBS give false positive results for the SIBO breath test. The reason is that what they really have wrong with them is the time it takes for stuff to go from the stomach to the bowel is too fast. So when we give them lactulose for the breath test, it reaches the bowel too quickly, which causes them to excrete hydrogen in their breath, so we get a positive result. My estimate would be that in fact no more than 10 per cent of IBS sufferers actually have SIBO.
Actress Kirsten Dunst and model Tyra Banks are both believed to suffer from IBS

But if ten percent of Britons have IBS and even five percent of those in fact have SIBO, that would mean 300,000 people with a chronic undiagnosed intestinal disorder. There is no cure. Instead, the condition is managed. [B]If it is not it can lead to vitamins such as B12 and folic acid not being absorbed by the body. This can cause infertility, depression, and chronic fatigue.[/B] What then is the treatment?

Firstly, we look for any underlying case are they making no acid, do they have Crohns or have they had surgery? Says Dr Penman. If we can treat those factors we will. But otherwise the treatment is cyclical courses of antibiotics to reduce the number of bacteria in the small intestine. We rotate several different antibiotics one after the other to try and prevent resistance or side effects. Another strategy would be four weeks on antibiotics and then four weeks off. A change in diet is also essential. I recommend small, frequent meals, making sure you get a good intake of vitamins, and a reduction in intake of carbohydrates.

Dr Penman advises SIBO patients to take a multi-vitamin supplement and peppermint capsules to help with bloating. Im also a fan of pro-biotics, he says. Not so much the yoghurt-y drinks from the supermarket but a dried formulation of acidophilus from a pharmacy. The treatment works. After a few courses of antibiotics my symptoms all but vanished. Concerned about taking them long-term, however, I started taking probiotics instead every day, and only taking antibiotics every year or so. The most potent, and therefore helpful, probiotics I could find are called VSL3, and are available over the internet from this country. I also take vitamins pills and peppermint capsules.

Sticking to the dietary guidelines are not easy when - as I do - you have a problematic cupcake obsession. But, annoyingly, limiting carbohydrates has proved to be the most effective way of managing the condition. Although I give in now and again, cutting out cake, I can report with some sadness, is the only way to avoid looking like Im in my second trimester.

I am already gluten intolerant so no wheat and bread and pasta for me. I can find rice pasta and other equivalents but I tried to eat a diet poor in grain but then no grain = too much veggies = diarhea for me. I have to go back to eating some rice


Senior Member
There are thousands of CFS patients who take B12 and some form of folic acid and all of us have tried probiotics. We all should be cured by now if this is the cause.


Senior Member
A large amount of research has been done since the 2005 study cited in this article. Changes in diet can provide a bit of help at the margins but I have found that simply modifying diet falls far short of an adequate treatment.

This has been discussed at length on this site. Search PR for SIBO.

This NEJM article was cited as one of the top ten gastroenterology "Game Changers" for 2011 by PubMed. It is one of many published in the last few years showing that much of what was once thought of as IBS is actually SIBO. Rifaximin is expensive and strong but it is non-systemic. However, I have found that it is amazingly effective when combined with the probiotic prescribed by gastroenterologist. Good Luck.

Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation
Pimentel, et al,
N Engl J Med 2011;364:22-32.

Evidence suggests that gut flora may play an important role in the pathophysiology of the irritable bowel syndrome (IBS). We evaluated rifaximin, a minimally absorbed antibiotic, as treatment for IBS.

In two identically designed, phase 3, double-blind, placebo-controlled trials (TARGET 1 and TARGET 2), patients who had IBS without constipation were randomly assigned to either rifaximin at a dose of 550 mg or placebo, three times daily for 2 weeks, and were followed for an additional 10 weeks. The primary end point, the proportion of patients who had adequate relief of global IBS symptoms, and the key secondary end point, the proportion of patients who had adequate relief of IBS-related bloating, were assessed weekly. Adequate relief was defined as selfreported
relief of symptoms for at least 2 of the first 4 weeks after treatment. Other secondary end points included the percentage of patients who had a response to treatment as assessed by daily self-ratings of global IBS symptoms and individual symptoms of bloating, abdominal pain, and stool consistency during the 4 weeks after treatment and during the entire 3 months of the study.

Significantly more patients in the rifaximin group than in the placebo group had adequate relief of global IBS symptoms during the first 4 weeks after treatment (40.8% vs. 31.2%, P = 0.01, in TARGET 1; 40.6% vs. 32.2%, P = 0.03, in TARGET 2; 40.7% vs. 31.7%, P<0.001, in the two studies combined). Similarly, more patients in the rifaximin group than in the placebo group had adequate relief of bloating (39.5% vs. 28.7%, P = 0.005, in TARGET 1; 41.0% vs. 31.9%, P = 0.02, in TARGET 2; 40.2% vs. 30.3%, P<0.001, in the two studies combined). In addition, significantly more patients in the rifaximin group had a response to treatment as assessed by daily ratings of IBS symptoms, bloating, abdominal pain, and stool consistency.
The incidence of adverse events was similar in the two groups.

Among patients who had IBS without constipation, treatment with rifaximin for 2 weeks provided significant relief of IBS symptoms, bloating, abdominal pain, and loose or watery stools. (Funded by Salix Pharmaceuticals; ClinicalTrials.gov numbers, NCT00731679 and NCT00724126.)