How can you know when SIBO is gone?

If you have made efforts to reverse small intestinal bacterial overgrowth, SIBO, how can you know whether you have succeeded?

Here are a number of indicators you can use to decide. After all, reverse SIBO and the endotoxemia that accompanies it provides huge advantages in virtually every aspect of health: emotional, physical, social. 

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What SIBO Can Do To You

William Davis, MD 0:00

Let's discuss how you can know whether you successfully addressed, eradicated your SIBO, your small intestinal bacterial overgrowth. Of course, a situation in which colonic microbes that were supposed to stay in the colon have been allowed to ascend or climb up into the 24 feet of small intestine and wreak havoc on your health in all sorts of ways, emotional health, physical health, social health. It can cause anything from rosacea to dementia to diabetes, type 2 diabetes, to weight gain in the abdomen to coronary disease. And so it's very important to recognize that you have SIBO and then take steps to control it. Now,

The Logic Behind SIBO Yogurt

William Davis, MD 0:45

of course, if you've been following my discussions, you know that my preferred way to deal with SIBO is my formulation that I call SIBO yogurt. It's not yogurt, of course, it looks and smells like yogurt, but it's a fermented dairy product using microbes sourced from humans. So it's very different from the idea of yogurt, even though it looks and smells like it. So we're going to use microbes that are sourced from human bodies, but we're going to choose microbes with very specific properties for this purpose to help push back SIBO. So I've chosen three microbial species for their ability to colonize the small intestine as well as the colon, so you have this effect throughout the entire gastrointestinal tract. And two, the ability to produce bacteriocins. These are natural antibiotics effective in killing the species of SIBO. So if you have too many, let's say, E. coli and klebsiella in your small intestine and colon, you want to get rid of those microbes. Well, the bacteriocins of the species I've chosen are effective in killing those species. Most other probiotic species that we are familiar with don't colonize the small intestine, and many of them do not produce bactericins. So the three I've chosen were chosen specifically for those characteristics: rotteri, lactobacillus gastri, and bacillus coagulants. And they make a very potent combination. Now we go even further by making it into yogurt and using my method of prolonged fermentation. Because what we want is very high counts of these microbes. If you're going to go to battle in the small intestine and colon against trillions, hundreds of trillions of microbes that don't belong there, you need to go in with big numbers, right? And the numbers that you get in a commercial probiotic are just too low. You know, hundreds of millions, a billion, a few billion. Sounds like a lot, but in the way of microbes, it's actually very low numbers. So we're going to increase the numbers to hundreds of billions by using prolonged fermentation. I also add a prebiotic fiber. It's kind of like adding cow manure to your backyard garden. You'll get more tomatoes and bigger cucumbers, right? Same same kind of principle. Now that recipe is in my blog, William DavisMD.com. It's in my super gut book. Um, it's also in my membership website, which is innercircle.dr Davisinfinfinite health.com. So go there for the most recent recipe. I did change the recipe from the original formulation listed in my super gut book. I replaced the Bacillus coagulants with Bacillus subtilis. There's nothing wrong with Bacillus coagulants. It just proved to be somewhat unreliable, fermented in a dairy product. So I switched over to Bacillus subtle, and I think it was a good move because the Bacillus subtellis is also a better producer of bacteria sins, but coagulant remains interesting for other reasons. Anyway, let's say you did that SIBO yogurt, or maybe you did something else, like Xyfaxin, the commercial antibiotic for SIBO. Or maybe you use one of the herbal antibiotic regimens, hopefully one of the two that have actually enjoyed some clinical validation, like the Candobactin regimen or the FC cytyl dysbiocyte regimen. Regardless,

Retesting With Hydrogen Breath Tools

William Davis, MD 4:03

let's say you did that and you want to know if you have eradicated or corrected your SIBO, how do you know that you've had success? Well, one way would be to repeat hydrogen gas breath testing if that's how you identified your SIBO in the first place. So if you went to a lab or a clinic, if your doctor ordered a hydrogen gas breath test, you can go back and have it done after you think you've eradicated your SIBO. Or if you have the air device, A-I-R-E, that allows you to measure hydrogen gas in the comfort of your home, you can repeat it after some time after your SIBO yogurt or other treatment. Now, by the way, I encourage people to take a the use the SIBO yogurt for a minimum of four weeks. If you have severe SIBO, for instance, people with histamine intolerant typically have severe SIBO, you may need several months before you obtain normalization. And the rare person who starts out with such things as uncorrected hypothyroidism or hypochlorohidria, lack of stomach acid, that person may have to do this for the rest of their life. So it's not that big a deal. It has all kinds of benefits in addition to helping push back SIBO. But in order to know whether you've normalized your SIBO, you can retest the hydrogen gas, let's say with the air device. But the thing is, you have to stop the lactobacillus rotori because the rotori, because it colonized the small intestine and produces hydrogen gas. So if you continue to consume the lactobacillus rotori, it will give the appearance of persistent SIBO. So you have to stop the lactobacillus rotori for about two weeks, then retest. And see the protocol in my SuperGut book, in my William DavisMB.com blog, the protocol we follow for testing using the air device. Very simple, but there's a few basic steps you have to follow. So retest hydrogen gas is one way to assess whether you've normalized your SIBO or not. Another

Food Intolerances As A Reality Check

William Davis, MD 5:57

would be if there's a reversal of food intolerances. Let's say prior to eradicating your SIBO, you were intolerant to FODMAPs or nightshades like eggplant or tomatoes, or to histamine containing foods, or legumes, or fructose-containing foods, or any number of other foods, and then you engage in the process of eradicating your SIBO, you can now test a small piece of that food that you're intolerant to. If the symptoms recur, you haven't succeeded yet. If they don't recur, that's a pretty good sign you've successfully addressed your SIBO. Now don't confuse food intolerances with food allergies. That's something different, that's unrelated. So if you reverse a food intolerance, that's a pretty good sign that you have reversed SIBO. Another sign would be breaking a weight loss plateau. Let's say you did my basic programs, elimination of wheat, grains, and sugars, some of the common nutrients we used to normalize insulin resistance. That's the process that causes weight gain and blocks weight loss. So vitamin D, omega-3 fatty acids, iodine, magnesium. And let's say that process, you lose 50 pounds. Well, you have another 40 pounds to go, but you're stuck at a weight loss plateau where you address the SIBO, and if that weight finally falls off, which it often does, you know that you eradicate, you corrected your SIBO. And by the way, that happens because you've corrected the insulin resistance that comes from the SIBO through the endotoxemia associated with the SIBO. Remember that? That is when you have SIBO, when you have trillions of microbes, fecal microbes in the small intestine, the small intestine is permeable and many breakdown products of those fecal microbes enter the bloodstream. And that's called endotoxemia. That's a major driver of insulin resistance. When you correct the SIBO and endotoxemia and insulin resistance, the weight falls off of you and you break that long-standing weight loss plateau. Related to that, if you see your waist shrinking, if you see a reduction in waste circumference, let's say it goes down a couple of inches. Once again, you know that you reversed insulin resistance that was coming from the SIBO and endotoxina. And by the way, losing abdominal visceral fat is a huge advantage. You'll see that yield even more health benefits from loss of that very inflammatory form of fat.

Weight Plateaus, Waist Size, Insulin Resistance

William Davis, MD 8:26

Another sign you can look for, another collection of signs you can look for that reflects correction of your SIBO, are looking at various biomarkers. You know, it's astounding that Cbone endotoxemic can result in a whole constellation of abnormal metabolic markers. And reversing the Cbone endotoxemia, you'll see these things improve. So you'll see triglycerides drop dramatically. You'll see HDL cholesterol go up, though it takes a year. It takes a long time for HDL. For unclear reasons, HDL is very slow to respond. Measures of blood glucose. Fasting glucose goes down, fasting insulin goes down, hemoglobin A1C will go down eventually. Like HDL is very slow to respond. So you typically need six months minimum for a reduction in blood glucose to be reflected in your hemoglobin A1C. Inflammatory measures like C reactive protein, or if you have some other measures like various interleukins or TNF alpha, you'll see those drop to the floor. Blood pressure will drop. If you're tracking liver enzymes like AST and ALT that are elevated in fatty liver, you'll see those drop. If you're tracking lipoproteins like NMR lipoproteins, you'll see a marked drop in VLDL and small dense LDL. The real causes, by the way, of coronary disease, not the silly outdated idea of LDL cholesterol. So by addressing endotoxema, you have addressed, in effect, a major dangerous cardiovascular risk factor. And you'll see that reflected in the drop in VLDL, small LDL, as well as inflammatory measures and blood pressure. All that adding up to dramatic improvement, dramatic reduction in your risk for cardiovascular disease. Another

Biomarkers, Bowel Changes, Stool Clues

William Davis, MD 10:12

thing to look for is a change in bowel habits, a good change in bowel habits. If you were previously constipated or had intermittent diarrhea or bloating or abdominal discomfort, if those things go away, that's a pretty good sign that you reversed SIBO. Another sign to look for is if you had stool testing prior to eradicating your SIBO and you saw a pattern in the results that suggest you had too much proteobacteria. That's the broad category of fecal microbes, sometimes also called enterobacteriacea, which is a subcategory within proteobacteria. So if your stool testing platform said you have, let's just say, 11% of your entire gastrointestinal microbiome was proteobacteria, you engage in whatever method you use to eradicate your SIBO, and you retest, you submit another stool test. And now it's a 3% proteobacteria or enterobacteracea. That's pretty good evidence that you eradicated your SIBO. You can't be 100% sure because remember, when you submit stool for stool testing, it's really a rectal sample. It's not a small intestinal sample, right? It's not even a transverse colon sample. It's a rectal sample. So you can only be presumptive, you can only have presumptive evidence that you correct the SIBO when you do stool testing. But it is reassuring when you have that big drop in proteobacteria. And then lastly, if you had a situation, a condition that you believed was due to SIBO, it could be hypertension, it could be recurrent bouts of atrial fibrillation, it could be rosacea or psoriasis, it could be some cognitive impairment, it could be joint pain or iteral bowel syndrome. Name your condition. So many conditions can be blamed on SIBO that either makes it worse or initiates it. So if you get relief in any of those conditions that you thought was due to SIBO, that's a good sign that you have normalized SIBO. I can't stress enough how crucial it is to your health that you understand how to correct SIBO and then how to know that you've succeeded. Because that is a gate to have huge benefits in health. Now,

Conditions Improving And Next Steps

William Davis, MD 12:24

if you need some clarity on this, feel free to join my conversations in my inner circle.dr Davisinfant Health dot com, where we have two way Zoom conference conversations, and of course, my books, blogs, and Define Health Podcasts.