The Dr. Hyman Show - Why Small Intestinal Bacterial Overgrowth (SIBO) Rarely Occurs On Its Own

Episode Date: May 14, 2021

Why Small Intestinal Bacterial Overgrowth (SIBO) Rarely Occurs On Its Own | This episode is brought to you by Athletic Greens More than 500 different species of microbes live in our gut and our gut bacteria regulate many of our bodily functions, from creating vitamins to controlling our immune system, metabolism, brain function, and more. Simply put, they are critical to our long-term health. Imbalances in the gut ecosystem often trigger or exacerbate small intestinal bacterial overgrowth (SIBO), along with many other issues. In this mini-episode, Dr. Hyman sits down with Dr. George Papanicolaou to explain what SIBO is, how they diagnose and treat it in their patients, and why it is almost always paired with a number of other health issues. Dr. Hyman also shares his personal experience battling SIBO along with mercury poisoning. George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. Upon graduation from his residency he joined the Indian Health Service. He worked on the Navajo reservation for 4 years at the Chinle Comprehensive Medical Facility where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He called that philosophy, “Whole Life Wellness”. Over time as the healthcare system made it harder for patients to receive this kind of personal care Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health—a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou to join The UltraWellness Center in 2017. This episode is brought to you by Athletic Greens. Athletic Greens is offering Doctor’s Farmacy listeners a full year supply of their Vitamin D3/K2 Liquid Formula free with your first purchase, plus 5 free travel packs. Just go to athleticgreens.com/hyman to take advantage of this great offer. Find Dr. Hyman’s full-length conversation with Dr. George Papanicolaou,  “The Power Of Food To Heal Everything From Autoimmune Disease To Traumatic Brain Injury” here: https://DrMarkHyman.lnk.to/DrGeorgePapanicolaou

Coming up on this episode of The Doctor's Pharmacy. The food baby is this, basically. You're fermenting food where you shouldn't be. Food's meant to be fermented in the large intestine, and that's like Florida, right? But, you know, what's happening with small intestinal bacterial overgrowth, bacteria are up in Maine, and the food's coming in the Maine. Maine's not ready for gas. So now, all of a sudden, you've got this gas where it doesn't belong geographically, you feel very uncomfortable. Hey everyone, it's Dr. Mark. My main goal with diet is to use food as medicine. But even when

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bones, and many of us are not getting enough of them. I use the Athletic Greens powder and their D3K2 formula to make sure I get extra nutrients that complement my diet. They're also going to give you five free travel packs as well. Just go to athleticgreens.com forward slash hyman to get your free year supply of vitamin D3 and K2 and five free travel packs with your first purchase. You'll get it delivered straight to your door and I promise you'll feel the difference Athletic Greens can make in your daily wellness routine. Again, that's athleticgreens.com forward slash Hyman. Now let's get back to this week's episode of The Doctor's Pharmacy. Hi, I'm Kea Perot, one of the producers at The Doctor's Pharmacy. Did you know that your gut house is 70% of the cells that make

up your immune system? And this is just one reason why your gut health is so central to your overall health and well-being. The health of your gut determines what nutrients are absorbed and what toxins, allergens, and microbes are kept out. When your gut health gets out of balance, it can affect every other aspect of your health. Dr. Hyman spoke to his colleague at the Ultra Wellness Center, Dr. George Papadnikolaou, about one common reason why the gut gets thrown off balance

and the ways in which this condition is linked to so many other conditions. We treat something a lot that's called SIBO. Now, when I went to medical school, this wasn't even a thing, but essentially it means small intestinal bacterial overgrowth, which means bad bugs growing in the small intestine where they should be sterile that have an impact on our health. So what are the symptoms? How would people know they have it? And what kinds of problems are they connected

to? And let's kind of get deep into what our approach to diagnosing and treating is going to be. Okay. What's SIBO? Okay. Well, it's going to be symptoms, bloating, distension. I feel like you've used the term food baby. There's something always in my gut. Yeah. When you have a food baby, something and you feel your belly blowed up, that's called SIBO. Right, that is SIBO. You don't feel like you fully evacuate when you have a bowel movement, you're fatigued, you get depressed, and you can actually feel your depression, and it's related to how your gut feels. I had that food baby, I'm anxious, I feel depressed, it impacts my ability. And it can link to all sorts of other diseases, right? Yeah, fatigue, and then when we think about fibromyalgia, you know, we need to think about the gut and

what's been impacted there. And we think about Parkinson's. 50% of people with Parkinson's actually have SIBO. Yeah. Asthma. Right. And we don't know. Autoimmune diseases. We know there's an observational connection there. We don't know anything about causality, but it's something you have to consider when you're thinking about other diseases. So the fatigue, the brain fog, the potential inflammation and joint pain, all of the gut issues, that's SIBO. And a lot of SIBO, we don't know all the causes. There used to be some standard ideas what the causes were, but now we know that it's hard to determine. So the use of proton pump inhibitors and other acid blockers. It's acid blockers like Prolocec, Prevacid, all that stuff.

All that stuff. And then we have stress plays a major role. And so that's some of the cause that's what SIBO can look like. And now how do we address it? Because we're talking about the food baby. When I got sick from mercury poisoning almost 30 years ago, one of the things mercury does is it interrupts all your enzymes and your function so my gut became very dysfunctional and I remember literally having food babies all the

time I literally almost couldn't eat anything without my stomach blowing up and feeling like someone just pumped my intestines up like a bicycle tire yeah and at that point of time we didn't really think about SIBO. We didn't really name it. And we weren't really aggressively treating it. I was trying things that I thought would work. But it was really tough. Until I got rid of the mercury, I couldn't get rid of the SIBO. Right. And the food baby is this, basically. You're fermenting food where you shouldn't be. Food's meant to be fermented in the large intestine. And that's like Florida, right? But what's happening with small intestinal bacteria,

the bacteria are up in Maine, and the food's coming into Maine. Maine's not ready for gas. So now, all of a sudden, you've got this gas where it doesn't belong geographically, and you feel very uncomfortable. And it starts to impact everything we talked about. Your nutrition, your inflammation, and that translates to that gut brain connection the brain

gets affected that's why we see so much benefit when we treat diseases like SIBO and dysbiosis in our patients with neuropsychiatric disorders from ADHD to OCD to anxiety and depression and you've noticed it and I would say that very rarely do I see SIBO by itself and and why is that because Mark you've already talked about it. It's the microbiome. So the microbiome is this ecosystem of bugs in our gut. It's trillions of bacteria. It outnumbers our cells by 10 to 1

and outnumbers our DNA by 100 to 1. And it has been linked to everything from autoimmune disease to cancer to heart disease to diabetes to obesity to autism to Alzheimer's. I mean, the list goes on and on. When the microbiome is disordered as it is in SIBO and you have these bacteria growing or they shouldn't grow. And so you're now changing how food is processed,

you're changing where it's processed, and you're changing the body's ability to absorb it. And what we know about the microbiome is those bacteria actually train our immune system. They're very closely related to our immune system. And our immune system identifies antigenic material from the bacteria, and the bacteria is able to tell the immune system, here's what you need to be worried about, here's what you don't need to be worried about. And so when we alter that gut immunity, we can create inflammation. And when we create inflammation, we begin to break down that membrane that's responsible for opening and closing and letting

good compounds and good nutrients in and keeping the bad guys out. When that breaks down, we have leaky gut. And now all of a sudden, our immune system starts to see proteins that have not been completely processed down to the peptide level that they're accustomed to, and they start making antibodies against commonly eaten foods. So now this person with SIBO is sensitive to a plethora of foods that they eat every day, which they might not be allergic to those foods, but they're sensitive to them. So now they're not eating. So they're coming with all these symptoms.

It gets exacerbated by almost everything they eat in their diet. And because now the disease process- Or they're eating and they don't know what to do, not eat, because everything bothers them. Right, right. And so now they can come in that sick. Now that their immune system's triggered,

they have muscle aches, they have joint pains, they have brain fog, because now they're having- Fatigue. They have fatigue. Their mitochondria are being affected. Their brains are inflamed.

They're being affected. So now this person comes in and they may say to me, I have brain fog. I have this, I have that. I get the whole story and I hear the gut. Always start in the gut, right? So now what do we do?

When they tell me there's symptoms, we order a test. It's called a small intestine. Before you do the test, I just want to recap what you said was so profound. Yeah. Which is that- I like being profound, thank you. No, I mean, it's a total frame shift. So most doctors don't think much about the gut

unless you have direct digestive symptoms. And even when you do, they treat it kind of in a very linear way. But what you're saying is when those bugs that should be in our large intestine migrate up to the small intestine for various reasons, it causes an imbalance in there. And that leads to a breakdown in the barrier, which causes this leaky gut.

And then all these foreign proteins and bacterial components leak into the system. Your immune system goes, ah, that's not me. And it starts creating a response. And then you get systemic inflammation, which is why you get brain fog and muscle aches and fatigue and joint pain, all these things, skin rashes, eczema, acne, whatever. And people think these are all not connected, but they're all connected. That's why SIBO is such a great topic to start with. Yeah.

Because it connects the entire matrix. So tell us how we test for it. Now let's get into a case. Okay. So testing will be with a breath test. It's called a SIBO breath test. And we starve you for a day. Basically, we want to starve out those bacteria

that are living in the small intestine so they become metabolically inactive. And then you wake up in the morning and you take some lactulose, which is- Which is like a non-absorbed sugar. Non-absorbed sugar. But before you do that, you breathe into a little balloon, and then we put that aside as your baseline test.

Then you drink the sugar drink, and now the bacteria are like, whee, we got some food. We're excited, we're starving out, thought we were doomed. And now the bacteria are like, we got some food. We're excited. We're starving out. Thought we were doomed. And then they get very metabolically active. And then within 30 minutes or 60 minutes, when they're metabolically active, they start producing the exhaust of their metabolism.

Hydrogen and sometimes methane and even sometimes sulfur gases. So it's not just the cows that are burping methane? Nope. Humans? Nope. Yeah. Uncle Art's been belching methane. So if you have SI the cows that are burping methane? Nope. Humans? Nope. Yeah, Uncle Art's been belching methane. So if you have SIBO, you're contributing to climate change, is that it?

Yup. That was going to be, when we get to the magic wand question, I'll talk about my wife. But anyhow. There's also other tests, like urine tests, you can look at metabolites. Right, yup. You can look at, yeah, so we at where it metabolites that will show us markers for dysbiosis in the gut using an organics test. So an organics test is when we look at all the organic acids that are products of your metabolism. And so we're able to tell, we know what should be

in the metabolism appropriately, and we can look at organic acids and we do that as a part of our GI work. Which is a test that traditional doctors don't do. They'll do the traditional breath test, but they're not going to do an organic acid test. Organic acid test or something even more advanced called an ion profile that looks at all of your amino acids. And that's important when I do a SIBO workup because if I look at your amino acids and you're depleted, then I know you're really in trouble with your SIBO because you're not getting good nutrition. You're not absorbing.

You're not absorbing. And then I can see markers of inflammation on the ion test. I can also see the organic acids are really critical because there are things that the bacteria produce that will end up in our urine that indicate to us that wow, those things are in the urine because you have bacteria overgrowing or don't belong in your gut.

And now we find out. I think you're right. I'm gonna jump in with a case that just reminded me of a little girl I saw years ago who was nine years old and she was pretty little sweet looking girl who was a monster, like a terror. She would constantly get kicked out of class. She literally couldn't make it home on the bus

without the bus driver having to stop 10 times to settle her down she was violent she would rip you know her pictures of a part of her family at home she would terrorize her sister and i'm like what's going on with this girl right and we did a whole workup and we found her organic acid test and we found she had massive levels of overgrowth of bacteria yep and she had overgrowth of yeast which is not called SIBO but SIFO or small intestinal fungal overgrowth and what I did was I gave her an antibiotic and any fungal and literally the girl completely transformed so you think you're treating a psychiatric disorder with antibiotics and antifungals. How does that make sense?

Well, it makes sense when you understand the connections between the gut and the brain. I mean, this was over 10 years ago. And I remember writing about it in the Ultra Mind Solution. I was like, wow, you know, the gut is so connected. I had another one with OCD, the same thing. She had high levels of ammonia and she had severe OCD. She wouldn't put anything off the floor.

I gave her an antibiotic and literally she became like a neat freak. It was the weirdest thing. Oh, yeah. So in those cases, in the cases I've seen, SIBO is very commonly related to neuropsychiatric disorders. So when I have people with memory loss,

brain fog, ADHD, just as you said, I've had multiple patients of mine, right? Autism. The first thing we do is treat their SIBO, change their diet. And within the first six weeks, we're starting to see significant change in their behaviors with ADHD and in their verbal abilities with autism kids. So often there's something underlying, right? There's often a root cause. I've seen people with gut issues that maybe were caused by Babesia, for example. It was a tick infection.

Oh, absolutely. So Lyme disease- Which can paralyze the gut. Right, so if I have a SIBA patient that's not getting better, I think two things. One is I think about Lyme disease because if one of the symptoms of Lyme disease and is a trigger to test somebody for Lyme

is when they get Bell's palsy. Lyme disease can affect the nervous system. And so Bell's palsy is when you have your facial nerve is paralyzed and it can be caused by Lyme is when they get Bell's palsy. Lyme disease can affect the nervous system. And so Bell's palsy is when you have your facial nerve is paralyzed and it can be caused by Lyme. The same thing can happen in the gut. You can get a paralysis and a dysfunction of the migrating motor complexes and now the peristalsis of the intestine is declining.

The intestine won't move. Now these bacteria can stay there and populate. So again, it's all these things that can impact it. And that's the thing, you know, when you go to a traditional gastroenterologist, you might say, okay, we do the breath test, you have SIBO, take these antibiotics, forget about the yeast stuff, and like I'll see and help cause things. And there's so many times it fails because they're not getting the root cause. So the root cause may not be SIBO, it might be something that's causing the SIBO,

like Lyme or like mercury or something else. And there's something else too, going back to lifestyle. When I can't get a person better with SIBO and I start going around the matrix again, are you sleeping? Are you exercising? Are you, how's your marriage? How are your relationship? Do you have a toxic relationship?

And that is basically, are you dealing with your stress? The people that aren't dealing with their stress, aren't getting their sleep, aren't exercising. And how would a stress have to do with your intestines? That's another podcast. Come on. Give us a nugget here. Okay. So stress. So stress is probably the start of all disease. It impacts everything from your hormones in your own body, but stress actually creates some neurochemical changes in your brain. And there's a communication between your brain and your gut microbiome. And your gut, it's called the second brain. It's the second brain. Some people think the gut was the first brain.

Maybe. And that our brain only developed once mitochondria we're starting to make energy force and then we're able to convert use that energy to make a second brain that allowed us to reason and so forth however um once you have that gut brain connection stress can actually you know we have this vagus nerve it's a it's a superhighway from the gut to the brain and more there's actually relaxation nerve it's the relaxation nerve and your brain can communicate anxiety and stress to your gut microbiome and actually change the makeup of your gut microbiome and your nervous system right and you're nearly paralyzed stress hormones literally

paralyze your gut your sympathetic nervous system and your fight-or-flight you don't want to be digesting your food when you're running from a tiger. You want your gut to shut down so you don't have to poop or do anything else. So your gut shuts down. And that's what happens. We live in a state of chronic stress and our gut's not working. It's not working. And then you end up with, you know, now you create that environment for SIBO to develop. Yeah. And the treatment for this is all the things you mentioned. It's diet. Right, we start with diet. It's really diet lifestyle. And by the time patients get to me, as I said before,

SIBO is just part of the whole complex. Because once you've affected diet, then you're affecting how your hormones are working, your autoimmunity and so forth. So we always start with diet because we can impact all the systems with a good diet. So diet, we can include a FODMAP diet. It can include elemental diet.

It can include autoimmune paleo. And our nutritionists here at the Ultra Wellness Center, we work very closely with. And when a patient is here, after I see them, I will consult with our nutritionists, and we will customize the diet plan for each particular patient that has SIBO. It's not always going to be the same diet. One of the reasons functional medicine is so transformative is that it recognizes disease does not occur in isolation.

If one part of the body is compromised, the entire body is thrown out of balance. SIBO is a great example of this. It rarely occurs on its own and it's often paired with a number of other issues. When we focus on healing the gut in these instances, the entire body shifts for the better. If you'd like to learn more about anything that you heard today, I encourage you to check out Dr. Hyman's full-length conversation with Dr. George Papadnikolaou called The Power of Food to Heal Everything from Autoimmune Disease to Dramatic Brain Injury. If you enjoyed this episode, please consider sharing it and leaving us a review below. Thanks for tuning in. Hi, everyone.

I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained,

who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.