The SIBO Saga: Part 5

sibo5Disclaimer:  As I have said in the past, I’m not a research blogger.  I’m here to mix “data with soul” and give you useful info, but only in the context of my real, human experience.  That is not to say that citation on my part and proper follow-up on your part are not important.  Everything I wrote about in this blog was presented by Dr. Leonard Weinstock at the SIBO Symposium during January 2014 and you can pay to have access to those presentations through the National College of Natural Medicine’s website.

Today’s post is the last of the SIBO series.  I’ve really enjoyed learning about & presenting this info, especially as I start my new health coaching career and see more and more clients who have SIBO as an underlying health issue.  Alot of folks ask me if everyone has SIBO.  The answer is no, but it is really common in certain circles, one of those circles being those with autoimmune disease.  This will be a shorter topic, but I wanted to write about some of the many SIBO connected conditions today.  I think the more folks who know that they may have underlying SIBO the better, since they can take that information to their doctors and potentially find a great deal of relief or even remission with SIBO treatment.

So, the list of associated diseases and syndromes to SIBO is loooong.  A really great list can be found on Dr. Allison Siebecker’s site:  here.  A few mentioned by Dr. Leonard Weinstock at the symposium and that may be really interesting and familiar to the autoimmune community are:

  • Fibromyalgia
  • Scleroderma
  • Acne
  • Pancreatic Insufficiency
  • Diverticulosis
  • Diabetes
  • Crohn’s
  • Celiac
  • Irritable Bowel Syndrome
  • Liver Diseases
  • Hypothyroidism
  • Rheumatoid Arthritis
  • Interstitial Cystitis
  • Restless Leg Syndrome
  • Rosacea
  • Parkinson’s

Dr. Weinstock presented in-depth information on the last three health issues and their connection with SIBO.  The exact reasons that SIBO leads to or exacerbates each of them is complicated and not 100% clear, but treatment brought marked results in each condition.

Dr. Weinstock saw 193 patients with Restless Leg Syndrome in his clinic.  Of that group 56% had positive SIBO testing and were treated, which resulted in huge improvements in their symptoms.  Up to 7% of the population is effected by RLS, with many of these folks getting four hours or less of sleep a night, so finding SIBO and treating could represent a major breakthrough for them.

Dr. Weinstock also worked with Rosacea patients.  He saw 176 patients with Rosacea diagnosis and of that group 66% had positive SIBO testing.  Marked to moderate improvement was seen in 71% of those treated.  I wish I could show you all the pictures that he presented of his patients.  I am sure that the cleared skin was life changing in the lives of some of these patients.

Finally, in the Parkinson’s patients, treatment of SIBO lead to greatly reduced neurological symptoms.  I found this interesting, because it again supports the amazing gut-brain connection.  In the early stages of Parkinson’s the enteric neurons (a mesh of nerve cells that line our GI system) are damaged, which leads to motility problems.  If you remember from earlier SIBO posts, decreased motility is a huge factor in developing SIBO.  A Parkinson’s patient can actually have GI system problems long before the neurological symptoms develop.  When the SIBO is treated, it probably allows some neuron healing which in turn helps with neurological symptoms being suffered by the patient.

For me, the most interesting SIBO-associated health problems on this list are, obviously, Celiac, then acne and pancreatic insufficiency.  My Celiac lead to pancreatic damage and both conditions allowed SIBO to take hold.  First, because I could not properly digest without sufficient enzyme production from my pancreas and second, because I could not properly absorb due to to villi damage from Celiac.  This allowed lots of “food” to reach all the way to my large intestine, where it fed bacteria and helped it rapidly overgrow.  The overgrowth and damage it was causing, lead to horrible acne (which also had other contributors).  Healing my damaged small intestine, mainly by removing gluten, supplementing with pancreatic enzymes, and finally treating the SIBO . . . means I now have much, much clearer skin, not to mention a happier tummy.

Does anything on this list ring a bell?  Have you had an experience of treating SIBO and it resulting in improvement of another condition?  Tell me about it!

I hope you all learned as much from this series as I did.  I will definitely be staying on top of new info in the SIBO world and writing about it more in the future.

You can start at the beginning of the SIBO series here.

About Angie Alt

Angie Alt is a co-founder here at Autoimmune Wellness. She helps others take charge of their health the same way she took charge of her own after suffering with celiac disease, endometriosis, and lichen sclerosis; one nutritious step at a time. Her special focus is on mixing “data with soul” by looking at the honest heart of the autoimmune journey (which sometimes includes curse words). She is a Certified Health Coach through the Institute for Integrative Nutrition, Nutritional Therapy Consultant through The Nutritional Therapy Association and author of The Alternative Autoimmune Cookbook: Eating for All Phases of the Paleo Autoimmune Protocol and The Autoimmune Wellness Handbook. You can also find her on Instagram.


  • […] SIBO Saga:  Part 5 can now be found HERE, at Autoimmune Paleo, where I and my blog partner, Mickey Trescott, now blog.  Thanks for […]

  • Heather Burkhardt says

    I am curious about supplementing with pancreatic enzymes. Long before I had my autoimmune crisis and diagnosis, I saw an iridologist because I was feeling vaguely unwell. She said my pancreas was in a “chronic” condition and that my small intestines were coated with mucoid layers. She said my weak pancreas was the cause of my small intestine situation.. The intervention we did was some food recommendations for the pancreas and then doing an intestional cleanse for my small intestine which was a disaster. While that intervention did not work, I still beleive in the validity of iridology to diagnose. (BTW, she told me to go gluten free and it was to much to deal with when I was 25, now I am 44 and on a low-fodmap version of AIP :). I wonder if I could have avoided AID altogether if I had gone gluten free then)….So, my question is this. did you do testing to find out about the function of your pancreas? How did you determine you needed to supplement and how did you determine your dose? Thanks in advance.

    • Angie Alt says

      Hi Heather-
      I did the GI Effects Comprehensive Stool Profile from Genova Diagnostics w/ my functional MD. You can find it here: Based on the results we saw that my pancreatic enzyme function was low (she felt due to long-term inflammation from previously undiagnosed Celiac disease). She put me on an prescription enzyme & dosage. I would recommend you work w/ a doctor that uses Genova tests & go from there to look into pancreatic function. There are other methods of testing, but they tend to be more invasive.

      • Heather Burkhardt says

        Thanks Angie, I will talk to my functional nutritionist about it.

      • Kristin says

        I am responding to an old comment. I have been dx with low fecal elastase (199) and SIBO. What kind of enzymes did you use and what happened? Were you having pain? I have epigastric pain which worries me about chronic pancreatitis. I see a gastro and a naturopath. My naturopath is more concerned about the SIBO than the low FE but I know that most people are in the 500s so I consider it extremely low and worrisome.

        • Angie Alt says

          Hi Kristin-
          I used Creon, which is a prescription drug. It helped me more effectively digest food & contributed to correcting a problem of the fat atrophy I was experiencing due to being unable to absorb nutrients. I was having a small amount of pain that did correct.

          • Kristin says

            You said “used”. Are you not still using Creon? Did you require the PPI? That is how my dr directed me to take it (I didn’t take the PPI and got BURNING from the creon) How did you treat the SIBO while treating the PI? If I take the PPI, that is counter productive to getting rid of SIBO and backwards from everything I have read about stomach acid (most people are too low in acid, not high) I have the microbial abx in hand to treat the SIBO now, but unsure how to proceed if i need to be on creon. Was your pain worse after eating? Or was it all the time? Thanks. I have a naturopath I work with, its just nice to connect with someone with the same issues.

  • […] You can find Part 5 of the SIBO series here. […]

  • Beth says

    thank you for the informative series. My symptoms and medical history seem pretty aligned with SIBO. My naturopath has run extensive tests for AI conditions and everything has come back negative. She wants me to do the breath test now. I’ve noticed some practitioners forgo the test and treat the SIBO based on their patients symptom presentation. I have limited income and all the other tests have cost me a lot out of pocket. Do you think the breath test is absolutely crucial to perform before starting a treatment protocol? I have been considering speaking with my doctor about other options.

    • Angie Alt says

      Hi Beth-
      If you & your ND feel very sure, based on symptoms, that SIBO is present & she is willing to treat, I would go for it. Chris Kresser has spoken about how he does this w/ many of his clients. That said, the process for treating SIBO can be pretty intensive & the dietary component can be restrictive. For some people, motivation to stay the course only comes w/ diagnosis through breath testing. Also, should you need to go the conventional antibiotic route, you’ll like need positive test results in order to get insurance coverage. I would consider those issues as you work with your ND. Best of luck!

      • Cubby says

        I recommend using Commonwealth Labs for your SIBO breath test, Beth. After I took the test, the lab sent me a letter saying that if my insurance did not cover the test (many of them do not), they would only charge me $175. It might seem like a lot if you’re on a limited income, but for someone like me who has suffered with IBS for nearly 30 years, paying $175 to figure out a solution seemed like an absolute bargain.

  • Katherine says

    Thank you for this great series. I have been battling IBS for my entire adult life. I’ve had several different GI specialist. Only one was open to supplements to treat symptoms, another suggested I try a gluten free diet several years ago, and one most recently introduced me to FODMAP. I have begged for diet suggestions and feel angry that most doctors said it wasn’t necessary. After telling one doctor I had some relief going gluten free, he simply said it wasn’t necessary, I had IBS and should, “suck it up and live with it!”
    I obviously left that practice and have found one with a good reputation. I saw a PA who suggested a low FODMAP diet. At the same time, I was given another book on autoimmune diet. I’ve been doing the diet for just over a week and while I feel lousy still, I have already found a few culprits. I am wondering why SIBO has never come up from my doctors before. Is it rare? Is it seen as an alternative diagnosis? I go back next week and am hoping to have a discussion about it with the doctor. I have gastric polyps from long term Nexium use and non bleeding erosions in the small intestine. I think I have SIBO with constipation. I can’t thank you enough for all the information here. I have learned so much and feel empowered to go back and hopefully get well!

    • Angie Alt says

      Katherine, I am so glad this series was helpful! SIBO is not uncommon & is the underlying reason for many, many IBS cases. There are lots of greats doctors that are learning about it & starting to apply diagnosis & treatment methods for their patients & there are some doctors still behind the curve. Good luck w/ presenting this new info to your doctor & trying to uncover root issues for new health wins!

  • Ellen says

    Dear Angie!
    Absolutely enjoyable informative well written material. I am thrilled to find so much information about medical condition I been misdiagnosed for years. Starting my meds this week and FODMAP diet for SIBO. Planning on getting your cooking book and follow your blog.
    Thank you so much for generously sharing your knowledge with me and all other people who are so much in need.
    Sincerely, Ellen

  • Emily says

    This is amazing info! I am in the midst of treating SIBO with herbal antibiotics, and it has been taking forever. This information will help! I found out I have celiac last year, and so have been doing gluten free, aip, and moderate low fodmop (but could do better at it). My question is: what is life like after treatment? Will I always have to be aip + low fodmop? Is there a point I won’t have to worry about Sibo coming back? I am finishing up college this next year, and am interning in Ecuador. What I was reading about how some SIBO started in developing countries makes me really apprehensive about going! Also, I am limited in what treatments I do as I am paying for school, working to support myself, and have no insurance. I just want to be well again. Ah! I would appreciate any thoughts.

    • Angie Alt says

      If you are able to successfully treat the SIBO, you will not need to always eat a Low-FODMAP diet. Eating Low-FODMAP is just a way to manage symptoms, it’s not a treatment. If you can eradicate the overgrowth with herbal or conventional antibiotics, you should be able to slowly start reintroducing FODMAP foods again. You shouldn’t need to eat AIP elimination phase forever either. Once you begin to heal & make progress w/ autoimmune-related symptoms, you should be able to begin reintroductions & eat an expanded diet. In terms of SIBO coming back, it depends. Some people are more prone to relapse, but that is very individual. I would not give up your internship in Ecuador. That’s an amazing opportunity! Now that you are aware of the possible issues, you can take precautions while still taking advantage of the opportunity to travel & work in developing countries.

  • Nicole S. says

    Wow, so glad I found this series. I was recently diagnosed with hydrogen dominant SIBO, which my gastroenterologist said was not really SIBO, but my ND said was(so glad I have my ND!). So we have just started treatment with berberine and I’ll go on a special diet in a few weeks. I’m already doing AIP, which I have been on for over a year. It just wasn’t enough to help me heal completely, as there is also other stuff going on we are still figuring out. Thanks for writing this series, so helpful to read about it somewhere on the ‘net.

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