Defiant Health Radio with Dr. William Davis
Defiant Health Radio with Dr. William Davis
There's a 50:50 chance that you have this epidemic condition
There is a non-infectious epidemic occurring right beneath our noses. The likelihood that you are affected is around 50%. It's the epidemic of small intestinal bacterial overgrowth, or SIBO. In this episode of Defiant Health, I run through the rationale that reveals that, even conservatively estimated, more than 100 million Americans have this condition.
Because of the natural permeability of the small intestine designed for nutrient absorption, invading fecal microbes that have ascended from the colon yield a phenomenon called "endotoxemia," or the entry of bacterial breakdown products into the bloodstream. This is how a disrupted small intestinal microbiome can be experienced as depression, anxiety, neurodegenerative disorders like dementia; heart problems such as coronary disease, atrial fibrillation, and congestive heart failure; skin issues such as as rosacea and psoriasis; muscle and joint issues such as fibromyalgia; gastrointestinal issues such as irritable bowel syndrome and Crohn's disease.
Understand how to recognize this process and manage it and you have been given a huge advantage in regaining control over health.
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Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose Weight
There is a non-infectious epidemic occurring right beneath our noses. The likelihood that you are affected is around 50%. It's the epidemic of small intestinal bacterial overgrowth, or SIBO. In this episode of Defiant Health, I run through the rationale that reveals that, even conservatively estimated, more than 100 million Americans have this condition Because the natural permeability of the small intestine designed for nutrient absorption, invading fecal microbes that have ascended from the colon yield a phenomenon called endotoxemia, or the entry of bacterial breakdown products into the bloodstream.
William Davis, MD:Anxiety, neurodegenerative disorders like dementia and Parkinson's disease. Heart problems such as coronary disease, atrial fibrillation and congestive heart failure. Skin issues such as rosacea and psoriasis. Muscle and joint issues such as fibromyalgia. Metabolic issues such as fatty liver, obesity or type 2 diabetes. Gastrointestinal issues such as irritable bowel syndrome and Crohn's disease. Understand how to recognize this process and manage it, and you have been given a huge advantage in regaining control over your health. I think we have one of the largest epidemics in the history of our country right under our noses and there's a good chance about a 50% chance. I believe that it affects you directly, that is, you personally, as well as about half the people around you, and that's the epidemic of SIBO small intestinal bacterial overgrowth or SIBO, we say S-I-B-O. Why do I say it's epidemic? Well, let's consider all the studies, about a couple of dozen studies that have already been performed that ask this question In condition blank what proportion of people test positive for SIBO, typically using breath hydrogen gas testing for SIBO, typically using breath hydrogen gas testing? Breath hydrogen gas testing is a way to assess or to map where microbes are living in your gastrointestinal tract and it tells us that the sooner your body releases hydrogen gas after consuming some of that, microbes that metabolize, the higher up microbes are in your gastrointestinal tract. So we want to know if microbes are living at high numbers in your stomach, duodenum, jejunum and ileum. So we consume something that microbes metabolize it could be lactulose, sometimes glucose I like to use inulin and then we test for hydrogen gas and how rapidly you release it. And if you have microbes living in the upper 24 feet of your intestines, that is SIBO. You'll test positive within 90 minutes typically. And so if we ask that question once again in condition blank, what proportion of people test positive for SIBO?
William Davis, MD:Let's insert irritable bowel syndrome, ibs. Well, there's 60 to 70 million Americans with IBS and while studies vary, conservatively, 31% will test positive. That's 18 to 20 million people right there and, by the way, I think that's too low. In Dr Mark Pimentel's study, for instance, a number of years ago, he showed that 84% of people with IBS test positive, which is consistent with the idea now that the primary treatment for irritable bowel syndrome is an antibiotic, rifaximin and it has pretty good efficacy, suggesting that IBS is a bacterial disease. All right, let's go on.
William Davis, MD:So how about obesity? There's 110 million Americans with obesity and the studies tell us about 50% of people test positive for SIBO. That's another 55 million people right there. How about type 2 diabetes? Well, 37 million Americans have type 2 diabetes and likewise, about 50% will test positive.
William Davis, MD:How about skin rashes like rosacea or psoriasis or eczema? About 40% of those people test positive. That adds about another 6 million people. Now, there's some overlap in these conditions, right? An obese type 2 diabetic, for instance. But you can see the numbers add up quickly. And we haven't even factored in restless leg syndrome, sleep apnea, type 1 diabetes, diabetes, inflammatory bowel diseases like ulcerative colitis and Crohn's disease, celiac disease, neurodegenerative disorders like Parkinson's disease, cognitive decline and Alzheimer's, lou Gehrig's disease. How about psychiatric or emotional conditions like anxiety, depression, suicidal ideation? In other words, if we add up all the numbers, you can see we easily exceed easily exceed 100 million people. I think, more like 150 or more million people, or roughly half the US population, and it's consistent with what I'm seeing. So many of us will test for SIBO.
William Davis, MD:And there's a home device, by the way, in case you want to know. It's called the AIRE device A-I-R-E. This is the original that tests for hydrogen gas. This is a more recent version. Tests for hydrogen gas. This is a more recent version. Tests for hydrogen gas and methane. And what you do is you consume one of those fibers. A fiber such as lactulose I like to use inulin because it's more broadly metabolized by microbes you blow into. It, talks to your smartphone. Zero to ten for hydrogen gas and any rise of four units after consumption of the fiber tells you have microbes living in the upper GI tract where they don't belong.
William Davis, MD:Now think about this the 1918 flu epidemic affected about 25 million people. The flu this year is expected to involve about 40 million people. So we're talking about one of the worst epidemics ever in the history of our species on this planet. But it's not, of course, an infectious epidemic. It involves bacteria, but it's not really infectious. You can't pass it on to another person, for instance. It is one of the epidemics of lifestyle that is, a man-made epidemic, like type 2 diabetes and obesity, and so we have this man-made epidemic that is affecting about one in two, roughly, people.
William Davis, MD:Now, no one has done this, taken, say, 10,000 people and tested them all for hydrogen gas to see really what proportion tests positive. We don't really need to know that, right, the evidence is already pretty solid that in all those conditions, a good proportion, a significant proportion, tests positive. Now why is that important? Well, there's gastrointestinal consequences of this SIBO.
William Davis, MD:If you're unfamiliar with this conversation, all that means is that because we've been exposed to numerous factors like antibiotics, often repeatedly, glyphosate and other herbicides, food additives like preservatives and emulsifying agents and all kinds of other things that have caused a decline in beneficial species. In fact, there's a recent study five days of an antibiotic killed off more than a thousand species of the gastrointestinal microbiome, and you can't get them back. At least you can't regrow them spontaneously. Right, once you kill something it's gone. So just that's one course of antibiotics. So we have lost numerous species in our colons because of all those factors.
William Davis, MD:Well, those species, those beneficial species served to suppress and keep at bay fecal microbial species that are generally resistant to antibiotics. These are species in the group of proteobacteria, species such as E coli, klebsiella, campylobacter, pseudomonas, many others. You might recognize those names, by the way, because they're also very important pathogens causing sepsis and urinary tract infections and other infections. Well, those same fecal microbial species, when they're not suppressed anymore by beneficial microbes because of all those exposures, will ascend, will over-proliferate in the colon, where they belong, but then ascend into the small intestine where they don't belong.
William Davis, MD:24 feet of small intestinal colonization by fecal microbes. Feet of small intestinal colonization by fecal microbes. And the small intestine is not well equipped to deal with this. It has a thinner mucus barrier. It's very permeable because that's where we're supposed to absorb nutrients like vitamins and minerals and fatty acids. And so when the fecal microbes trillions of them, invade the small intestine, that alone is very inflammatory and increases the already permeable small intestine. It makes it more permeable.
William Davis, MD:These microbes only live for a few hours. When they die, these fecal microbes release. These are called gram-negative microbes because they stain a certain way, because they have something called lipopolysaccharide endotoxin in their cell walls when they die, when these trillions of microbes die because they only live for a few hours. They release that lipopolysaccharide endotoxin into the bloodstream and that's how SIBO in the small intestine can be experienced. In other organs it could be experienced as anxiety or depression, or cognitive impairment and Alzheimer's. In the brain it could be experienced as atrial fibrillation, coronary disease, myocardial infarction, heart attack or sudden cardiac death. When endotoxin involves the heart and the coronary arteries, it could lead to rosacea, psoriasis in the skin. It could lead to joint pain and inflammation, such as that in fibromyalgia and rheumatoid arthritis. In other words, microbes living in the small intestine, where they don't belong, export their effects body wide and now this effect, this, this process, now involves, I believe, 50, 50% of people.
William Davis, MD:You know I would have been skeptical at first when I first started thinking about this a number of years ago, until this air device and, by the way, I have no relationship with the air device, the company is called Food Marble, if you're interested, invented by an Irish PhD engineer. When that device came out and I got hold of it, this is going back almost a decade I saw people testing positive left and right. Now you might say well, is the test valid? It has been validated, by the way. But is the test valid? Is it accurate? Well, here's confirmation.
William Davis, MD:I believe that the test is useful. Someone will say have ulcerative colitis or Crohn's disease or it'll bowel syndrome or have a weight loss plateau or has a hemoglobin A1C of 11.7 percent. They eradicate the SIBO and thereby the endotoxemia and you see, these conditions improve dramatically. Somebody who say lost weight by going low carb, say they lost maybe 48 pounds but they still have another 40 to go. But they plateaued. They addressed the SIBO and endotoxemia and their weight plateau finally gives way. Or a type 2 diabetic goes low carb and does other good things, drops the hemoglobin A1C, say, from 11.7% to 6.4%. Much better still, not good. We're aiming for 5.0% or less. They addressed the SIBO and endotoxemia. Now their hemoglobin A1C is 4.8%. That's typical, in other words, people who test positive and then test negative after eradication of the SIBO. That process seems to correlate with clinical improvement in some, or actually many, conditions. So the SIBO, I believe, is a real thing. It's been debated for now about over 30 years, but the science has become clearer and clearer. That SIBO is a real thing phenomenon that's very important and, I would argue, is far more common than anyone ever thought.
William Davis, MD:Now what do you do if you have it? Well, there's a number of choices, but if you followed my advice, I would consume what I call SIBO yogurt and all it is. It's not yogurt. It looks and smells like yogurt. You can't buy it in the store. It's nothing like the stuff you buy in the grocery store that has some kind of boring microbes in it and has sugar and high fructose, corn syrup and mixing agents. So you don't want that stuff.
William Davis, MD:We're going to make it, but we're going to use some unusual methods. First we're going to choose microbes with specific characteristics. Then we're going to ferment it for a prolonged period. To ferment it for a prolonged period, microbes don't have sex, right? There's no male and female microbes. They have asexual reproduction. So one microbe doubles itself to become two, two becomes four and so on. So the microbes we're going to use double every one to three hours and I'm going to add some prebiotic fiber like the fibers used in SIBO testing. We'll use I like to use inulin, so inulin added.
William Davis, MD:Prolonged fermentation microbes chosen for very specific characteristics. So the microbes I choose lactobacillus eryderi, lactobacillus gasteri and bacillus subtilis. I chose those microbes because they either colonize or germinate in the small intestine. It's unusual, most microbes don't do that. They germinate or they colonize the colon. Well, these microbes colonize or germinate in the small intestine. They take up residence in the small intestine where SIBO occurs, and all three are very powerful producers of something called bacteriocins natural antibiotics effective in killing this species of SIBO. So they're really good at killing E coli and Klebsiella, for instance, and for that matter, some other microbes too, like Staphylococcus and Enterococcus.
William Davis, MD:So we ferment these three microbes for a prolonged period 36 hours. So we ferment these three microbes for a prolonged period 36 hours and when we count the microbes we get hundreds of billions per half cup or 120 milliliters serving, and we consume it. Now, the best way to do this is to ferment each microbe individually, because that way we get the super-duper high counts. Like rhodori fermented by itself, for instance, for 36 hours we get about 300 billion per half cup serving. You can co-ferment all three, but you'll get lesser numbers. It's less potent, but it does work for the majority. So you still can do that. But the only thing I ask is that should you do that, start over, start from scratch, maybe every fifth or sixth batch or so? We don't know what happens to the relative counts, the proportions of microbes as you make subsequent batches from a little of the prior batch.
William Davis, MD:Now, if you want the details on all this, see my blog. I have thousands of posts on my WilliamDavisMDcom blog. Of course, my Supergut book shows you how to make this Seabull yogurt and other yogurts. How to ferment other microbes for other purposes also seabull yogurt and other yogurts. How to ferment other microbes for other purposes also the recipes. In those two locations.
William Davis, MD:Supergut and my blog used bacillus coagulans rather than bacillus subtilis. I replaced the coagulans with subtilis because the coagulans, when we perform quantitative counts, really didn't achieve the high numbers we wanted when fermented in dairy. There's nothing wrong with the microbe. It's not the greatest for fermenting in dairy. There's nothing wrong with the microbe, it's just it's not the greatest for fermenting in dairy. Coagulants is actually very interesting for other reasons. But the subtlest is a reliable fermenter and it's easy to ferment. In fact, if you ferment the subtlest alone, you can ferment it for 24 hours because it doubles faster than the other two species. So see my blog, see my Super Gut book.
William Davis, MD:But if you'd like some assistance, some guidance, I invite you to join my conversations we have frequently on my inner circle dot. Dr davis, infinite health dot com know that you have the option of this very benign way to deal with SIBO that you can make in the comfort of your kitchen, consume. We consume it, by by the way, for four weeks or longer. I also encourage people to consume it intermittently afterwards, even after you've eradicated SIBO, because SIBO loves to come back. Even if you took the antibiotic rifaximin for it, which is only about 55, 60, maybe 70% effective, it comes back as a rule. So we're going to use the SIBO yogurt formulation intermittently, maybe three times a week, to prevent recurrence and because those microbes also have spectacular benefits, especially the rhodori and to some degree the gasteri, beyond just eradicating SIBO.
William Davis, MD:One caution don't test with the air device or other means of hydrogen gas testing unless you hold off on the Roteri for two weeks, because the Roteri will cause hydrogen gas positivity and it'll screw up your ability to detect whether your SIBO has been eradicated or not.
William Davis, MD:I know it's a complexity, it took us a while to figure that out, but if you're going to test again at the end of your SIBO yogurt adventure, wait two weeks without the Roteri. You can take the other ones, you can take the Gaseri and the Sutilis, but don't take the Roteri. Wait two weeks test if you want to see if you're negative or not and then resume your Roteri. Now learn these lessons for yourself and then educate the people around you, because it's half the world now, half the people around you. If you know four people in your family, probably two of them, maybe more, because you're all sharing utensils and food and other habits, but it's not uncommon for entire families to test positive. So educate the people around you because they're dealing with high blood, glucose, obesity, neurodegenerative disorders or risk for autoimmune conditions, skin rashes, depression, anxiety. So these are ways to start dealing with these conditions by getting rid of the invading fecal microbes in the 24 feet of your small intestine.
