In today's video, I'm going to talk about Dr. Pimentel's recent SIBO discoveries and
what they mean for you and your IBS, so stay tuned. If you're new here,
welcome my name is Amanda Malachesky. I'm a certified functional nutrition health coach
and a digestive and allergy detective. For weekly videos on how to make sense of the diet
and supplement advice for IBS and SIBO, please consider subscribing, and be sure to hit the
bell to be notified when I post a new video. In the last several years, Dr. Mark Pimentel
of the Pimentel Lab at Cedars-Sinai in Los Angeles, California, has revolutionized our
understanding of the condition we call SIBO or Small Intestinal Bacterial Overgrowth. And so,
because I rely on the most up-to-date information as I coach my IBS and SIBO clients. I wanted
to take a few minutes to share some of these really interesting discoveries with all of you,
so that you can use them to make better decisions about your IBS and SIBO. So let's get started.
Discovery number one is that the microbiome of the small intestine is far different than previously
imagined. The first really important discovery that Dr. Pimentel and his team have found is
that they've identified clearly the actual individual organisms that are responsible for the
overgrowth in the small intestine. In 2020, they released the results from their REIMAGINE study,
and they showed that two particular organisms, E. coli, and another type of bacteria called
Klebsiella are responsible for SIBO. They are the overgrown bacteria in the condition.
And they also show that an overgrowth of these bacteria are correlated with positive SIBO breath
tests by lactulose. And in addition to these two pieces, they also showed that there's not
really a correlation between the microbiome and the small intestine, and the microbiome in the
large intestine. So what does this mean for you? Well, first of all, it means that the lactulose
breath test that's widely used for diagnosing SIBO is pretty accurate. And if it's positive,
it has a high correlation with the actual overgrowth of these specific bacteria. So,
that's helpful to know. Secondly, it means that SIBO symptoms are often being directly
caused by an actual infection with a specific organism. And this is great news because it means
that it's treatable. So this is really important information to know. And finally, it means that
you can't really use stool test results to infer that you have SIBO, because the microbiome, again,
in the small intestine and large intestine are different. So I've seen a lot of people
in forums and even heard from people that have said their practitioners said, "Oh, well, it looks
like you might have SIBO based on the stool test result." And because of Dr. Pimentel's research,
we know that this isn't really true. Number two is that Dr. Pimentel's team
has determined that food poisoning is one of the most significant and most common triggers of SIBO.
If you've had a case of food poisoning and you feel like your gut has never been the same
since that episode, you're not crazy. You actually probably have SIBO. Dr. Pimentel says that getting
food poisoning from organisms like Shigella, or E. Coli, or Salmonella, or Campylobacter,
or other kinds of bacteria, can lead to elevated levels of something called Cytolethal Distending
Toxin, which is abbreviated as CDtb. And this elevated level of toxin that is emitted by these
bacteria that infest your gut when you have food poisoning can actually damage something called
vinculin by creating anti-vinculin antibodies. Vinculin is partly responsible for keeping the
nerves in your gut functioning normally which helps your gut move at a normal pace. This drives
the normal cleaning waves of your gut called the Migrating Motor Complex, and is basically
regulating the speed with which food and other material moves through your digestive system. So,
when the anti-vinculin antibodies damaged vinculin on your gut nerves, this can slow down
the transit time in your gut, and it's the slowing down of the gut that leads to the bacterial
overgrowth with again, E. Coli and Klebsiella. And elevations of these two lab marker, the CDtb
and the anti-vinculin antibodies usually correlate with abdominal pain and diarrhea symptoms. So,
this is primarily high in IBS-D situations. And this also means that SIBO cases triggered by these
antibodies are actually an autoimmune condition. The good news is that Dr. Pimentel and his team
are working on treatments to try and address these issues directly. But in the meantime,
he's developed a test called IBS check, which you can use to check for elevations of the
CDtb or the anti-vinculin antibodies. You just have to request it from your doctor.
It's a simple blood test, and Dr. Pimentel says that if you're positive for both of these markers,
it's basically 98% sure that you have IBS as opposed to other kinds of digestive challenges
like IBD, or Crohn's disease, or celiac disease, or any manner of other digestive problem.
So, this is a really simple option to pursue with your doctor. If you have
unremitting diarrhea-type IBS, especially if your symptoms began after about a food poisoning.
And by the way, you don't even have to remember the episode of food poisoning. You could have
mild food poisoning or food poisoning that you almost didn't even notice, and still develop
these antibodies, which is super frustrating, but I just thought I'd say that in case you're like,
"Well, I've never had food poisoning." If you have unremitting diarrhea, and you've been
unable to figure out what's going on, this is a possible line of inquiry for you with your doctor.
The third important discovery is that there is a third type of SIBO. So, for the last number
of years, practitioners have been looking for two different types of SIBO, hydrogen SIBO, or
methane SIBO, which are documented using a lactulose or glucose breath test. You
done it at home or in a lab. However, sometimes patients would be negative on both of these tests,
but still have evidence of diarrhea-type IBS. And there wouldn't be any clear indicators of what
exactly was going on. And this might even be true after ruling out all the other obvious possible
options. So, Dr. Pimentel's team documented a third type of SIBO called hydrogen sulfide SIBO,
which is caused by an elevation of hydrogen sulfide gas. And hydrogen sulfide,
when elevated in the gut, can cause a lot of abdominal pain and diarrhea. And they found that
levels of this gas on a SIBO test definitely correlate with the severity of symptoms.
So, when it comes to methane SIBO, the team is clarified that an excess of methane gas means
that there are organisms called archaea, which are kind of older than bacteria. They're not
exactly bacteria. And those are the organisms that are responsible for the methane gas production.
And because of this, they're now calling methane SIBO, Intestinal Methanogen Overgrowth or IMO.
It's still SIBO, but it's just slightly different. It's clarifying who's causing the problem.
And then finally, of course, hydrogen SIBO is the other option. Hydrogen's been a little confusing
because it doesn't really seem to correlate with symptom severity. In other words, the higher the
hydrogen, you don't have worse symptoms. What the team has clarified is that the hydrogen
sulfide SIBO and the Intestinal Methanogen Overgrowth actually thrive on the hydrogen.
And the hydrogen is used as a food source for the organisms that are producing these other gases.
So, that's partly why hydrogen elevations can be a sign of other problems, but they don't directly
correlate with symptoms specifically. So, what does all this mean for you? Well, basically it's
really important to know which specific type of SIBO that you have because the treatment
approaches and protocols are different depending on which specific problem you have. And so,
Dr. Pimentel's team has developed a new SIBO test called the trio-smart test, which actually tests
for all three gases in one test. Unfortunately, this test isn't yet widely used. We're still
relying often on the test that just looks for high hydrogen and methane, but I think eventually
practitioners will be using this test that looks at all three gases because it gives a much more
complete picture of what's happening in the small intestine and what we need to do to address it.
Have you ever tested for SIBO? Tell me about it in the comments. Okay. Discovery number four from Dr.
Pimentel's team is that Dr. Pimentel at this point estimates that approximately 60% of IBS cases are
caused by SIBO, specifically. So, I regularly hear from people whose practitioners aren't willing to
test them for SIBO or tell them that, SIBO's not really a real thing, that's all just BS. And these
are the same practitioners who are then willing to diagnose these people with IBS, which is really
just an umbrella term that means that they've had abdominal pain, and bowel changes for several
months in a row. In many cases, it's not very helpful. One of the most exciting and vindicating
things that Dr. Pimentel has determined from his research is that, again, 60% or so of IBS cases
are actually directly caused by SIBO. And he says that there are 25 separate peer-reviewed studies
out there that show that breath tests are more often positive in IBS patients.
Now, IBS of course, is quite common and there are lots of different possible reasons for it.
But up until now, there hasn't really been much meaningful dialogue about the possible underlying
causes, or what to do about it. And doctors often conclude that, oh, it's really just a problem with
your stress. Or the more enlightened doctors might say that, oh, it's related to your diet
and you can alter it depending on what you eat. But with the clarity that up to 60% of IBS cases
are caused by a specific type of bacterial overgrowth, and that food poisoning is a specific
trigger. For many of these cases of IBS, not only is IBS is something that's not
being imagined by patients, it's also something that can be directly treated,
which is a really wonderful piece of news for a significant portion of IBS patients.
So, discovery number five is something that I found very surprising, and I think you will too.
And it's that you should not supplement with BT and HCl, or other stomach acid supports if
you have SIBO. This really surprised me, but Dr. Pimentel reported that these items, BT and HCl,
lemon juice and apple cider vinegar, vinegars per se, can worsen SIBO symptoms. And he was saying
that earlier people suspected that PPIs, so Proton Pump Inhibitors or acid reducing medications
would be a risk factor for SIBO because they would reduce the stomach acid that's kind
of our first line of defense against incoming bacteria. And this was kind of operating under
the assumption that SIBO was caused by ingesting bad bacteria. And now we know that it sort of is,
but indirectly, right? But anyways he found the opposite that people who were on PPI medication
actually have lower rates of SIBO than people who do not use PPI medication.
And he also commented that he's heard from several of his patient that felt worse when using stomach
acid supports. Apparently the BT and HCl, or the vinegars, provide food and stimulation for the
hydrogen-producing bacteria, and this makes more food for the methanogens or the hydrogen sulfide
SIBO that might be present. So, this is just a little bit surprising because as a health coach,
I was trained to support people's stomach acid as a way to encourage healthy digestion.
But the long and the short of this is that you want to wait to support that stomach acid function
until you've cleared SIBO. And if you suspect you might have SIBO, you might want to hold off
on that until you confirm that you have it or not. And this is a really good reminder that we always
want to customize our approach to things, and not just use blanket protocols or recommendations,
because they may not be right for us. And we have to understand what those tools are
trying to do for us, and whether or not they're right for us before we experiment with them.
Do you need help figuring out whether you have SIBO or how to manage it? Helping clients with
SIBO is just one of the many ways that I help my clients inside the calm digestion method, which
is a new online program that I'm offering. Doors are currently open for the calm digestion method,
and if you're interested, or you think I might be able to help you, I'd like to invite you to
apply for a seat in the program by scheduling a free 45-minute discovery call with me.
I will leave a link for you below this video for where to schedule that, but you can head over to
confluencenutrition.com forward/contact and pick a time that works for you,
and I will look forward to meeting with you to figure out how we can help get you feeling better.
If you like this video, please click like and consider subscribing, and go ahead and share
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go ahead and check those out too. And I look forward to seeing you next time.