Hashimoto s Triggers Book

Transcription

1 Chapter From Hashimoto s Triggers Book Small Intestinal Bacterial Overgrowth By Eric Osansky, DC, IFMCP, CCN, CNS

2 Table of Contents INTRODUCTION: PLEASE READ THIS FIRST Section I: UNDERSTANDING THE AUTOIMMUNE COMPONENT OF HASHIMOTO S Chapter 1: The Autoimmune Timeline: How Hashimoto s Develops Chapter 2: Antecedents, Triggers, and Mediators of Hashimoto's Chapter 3: Hashimoto s and the Immune Gut Connection Chapter 4: Hashimoto s and the Hygiene Hypothesis Section II: THE TRIGGERS OF HASHIMOTO S Chapter 5: Gluten: The Primary Food Trigger of Hashimoto s Chapter 6: Dairy and Other Food Triggers of Hashimoto s Chapter 7: The Impact of Stress on Hashimoto's Chapter 8: Environmental Toxins Chapter 9: The Role of Infections in Hashimoto s Chapter 10: Lyme Disease and Other Tick-Borne Coinfections Chapter 11: Toxic Mold and Chronic Inflammatory Response Syndrome Chapter 12: Estrogen Dominance Chapter 13: Nutrient Deficiencies Chapter 14: What You Need to Know About Iodine and Hashimoto's Chapter 15: Can Overtraining Trigger Hashimoto s? Chapter 16: Postpartum Thyroiditis Chapter 17: Blood Sugar Imbalances Chapter 18: Root Canals, Mercury Amalgams, and Titanium Implants Chapter 19: Is There a Link Between Vaccines and Hashimoto s? Chapter 20: Glyphosate and GMOs Chapter 21: Small Intestinal Bacterial Overgrowth SECTION III: DETECTING YOUR SPECIFIC TRIGGERS Chapter 22: Detecting Your Triggers Through a Comprehensive Health History Chapter 23: Detecting Food Triggers Chapter 24: Can Blood Tests Help to Detect Your Triggers? Chapter 25: Detecting Triggers Through Testing SECTION IV: REMOVING THE TRIGGERS Chapter 26: Eliminating Dietary Triggers and Using Food as Medicine Chapter 27: How to Balance the Adrenals and Sex Hormones Chapter 28: Healing Your Gut Through The 5-R Protocol Chapter 29: How to Reduce Your Toxic Load Chapter 30: Correcting Your Nutrient Deficiencies Chapter 31: Overcoming Infections Chapter 32: How to Overcome Insomnia and Get Quality Sleep Chapter 33: Overcoming Challenging Triggers: Lyme Disease, Toxic Mold, and SIBO SECTION V: QUESTIONS YOU MIGHT HAVE ABOUT HASHIMOTO S 2

3 Chapter 21: Small Intestinal Bacterial Overgrowth S mall intestinal bacterial overgrowth, also known as SIBO, can lead to symptoms such as bloating, gas, and abdominal pain, along with diarrhea and/or constipation. Over the last few years, I have seen more and more cases of SIBO in my patients with Hashimoto s. However, can SIBO be an autoimmune trigger? Different pathogens have been associated with thyroid autoimmunity. These include H. pylori, Yersinia enterocolitica, Lyme disease, Epstein- Barr, and Blastocystis hominis. Of course, I have discussed all of these in Chapter 9. However, it s important to understand that SIBO isn t a pathogenic infection. This condition involves having good bacteria in the wrong place, as most of the bacteria should be located in the large intestine, and only a small amount of bacteria should be located in the small intestine. However, for numerous reasons, an overgrowth of bacteria can occur in the small intestine. SIBO itself doesn t seem to be a direct trigger of Hashimoto s. However, some cases of SIBO are a result of an autoimmune process, 3

4 and having one autoimmune condition can make someone more susceptible to having another autoimmune condition. So perhaps having SIBO can lead to another autoimmune condition such as Hashimoto s, but the connection hasn t been made yet. However, even if this isn t the case, SIBO can cause a leaky gut, which, in turn, can set the stage for the development of an autoimmune thyroid condition. 4 Potential Causes of SIBO Four different factors can cause someone to develop SIBO: 1. Dysfunction of the migrating motor complex (MMC). This is the main reason why people develop SIBO. The MMC is a small wave that cleanses the small intestine of debris. If the MMC isn t working properly, then bacteria and other debris are no longer swept through the lumen of the small intestine, which can lead to SIBO. 502,503 Food poisoning is the most common cause of a dysfunctional MMC, but other causes include hypothyroidism, diabetes, or an infection such as C. difficile, giardia, or Lyme disease. Certain drugs such as opiates and antibiotics can also affect the MMC. 2. Altered anatomy. This can interfere with the clearance of bacteria. For example, adhesions due to surgery or endometriosis are potential causes of SIBO. Other anatomical anomalies include a narrowing of the small intestine, fistulas, and diverticuli. 3. Hypochlorhydria (low stomach acid). Millions of people take acid blockers, which is a huge problem. Besides being necessary to break down nutrients, stomach acid also can help to eradicate harmful pathogens, and prevent the overgrowth of bacteria. 4

5 However, you don t need to take acid blockers to have low stomach acid, as having a hypothyroid condition alone can decrease production of stomach acid. Stress can also decrease the production of stomach acid. 4. Absent or inefficient Ileocecal valve. The ileocecal valve is the barrier that separates the small intestine from the large intestine. It prevents backflow from the large intestine into the small intestine. If this is absent or dysfunctional, it can cause the bacteria from the large intestine to migrate into the small intestine, thus leading to SIBO. The Relationship Between IBS and SIBO Infectious gastroenteritis, more commonly known as food poisoning, can result in the production of toxins by bacteria that can damage the nerves that play an important role in gut motility. The specific name of the toxin is cytolethal distending toxin (CDT). The immune system forms antibodies to this toxin (called anti-cdtb antibodies), but antivinculin antibodies are also produced. 504 Vinculin is a protein that helps connect the interstitial cells of Cajal (ICC) so that they can communicate properly to help the MMC. The CDT toxins harm the ICC, and, in a case of mistaken identity, the immune system attacks vinculin, which has a negative effect on gut motility. To summarize, food poisoning is the most common cause of irritable bowel syndrome with diarrhea (IBS-D). The food poisoning causes an autoimmune process involving anti-vinculin antibodies, which has a negative effect on gut motility, and the problem with gut motility leads to SIBO. A blood test called IBSchek by Commonwealth Laboratories 5

6 can determine if someone had IBS-D associated with anti-cdtb and anti-vinculin antibodies. A few other labs offer similar testing, including Quest Diagnostics and Cyrex Labs. How Is SIBO Diagnosed? Although one s symptoms can provide a lot of valuable information, if SIBO is suspected, then one should do a breath test that measures hydrogen and methane. I discuss this in greater detail in Chapter 25. I will say here that the breath test is looking for bacterial fermentation, and it determines this fermentation by measuring the levels of hydrogen and methane. In other words, if someone has SIBO, there will be more fermentation, which will lead to higher levels of hydrogen, methane, or both gases. Other Health Conditions Are Associated With SIBO Here are some other health conditions associated with SIBO: Acne Rosacea Chronic fatigue syndrome Fibromyalgia Gastroesophageal Reflux Disease (GERD) Inflammatory bowel disease (Crohn s disease, ulcerative colitis) Interstitial Cystitis Pancreatitis Restless legs syndrome Rheumatoid arthritis Scleroderma 6

7 Dietary Options for SIBO Although I prefer that most of my patients with Hashimoto s start on an autoimmune Paleo (AIP) diet, no diet fits everyone perfectly. The same concept applies with SIBO. While all cases of SIBO involve the overgrowth of bacteria in the small intestine, the bacteria will differ from person to person. Thus, one person with SIBO might be able to tolerate foods that someone else with SIBO can t tolerate, and vice versa. In addition, some people might be able to eat small quantities of a certain food, but if they eat larger quantities, they experience bloating and gas. However, there are certain diets people with SIBO should consider following, although there will be some modifications depending on the person. I m going to discuss the different diets that are recommended for patients with SIBO. The primary goal of each of these diets is to feed the person while starving the bacteria. Low FODMAP diet. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Examples of high FODMAP foods include fermented foods (i.e., sauerkraut), starch (grains, beans, starchy vegetables), soluble fiber (grains, beans, fruits, vegetables), sugar (fruit, agave), and resistant starch (legumes, whole grains). This doesn t mean that everyone with SIBO needs to avoid all of these foods. For example, some people with SIBO are able to tolerate sauerkraut, while others can t eat any fermented foods without experiencing gas, bloating, and other symptoms. Some people are 7

8 able to eat small amounts of these foods, while others are unable to tolerate certain foods altogether. Thus, you need to listen to your body. Specific Carbohydrate Diet. The Specific Carbohydrate Diet (SCD) is similar to a Paleo diet in that it allows meat, fish, eggs, nuts, seeds, vegetables, and fruit. It differs in that it does allow some lactose-free dairy and certain beans. The dairy products that are allowed include yogurt, aged cow and goat cheeses, butter, ghee, and cottage cheese. The allowed beans include white beans, navy beans, lentils, split peas, lima beans, kidney beans and black beans. In order to make the beans easier to digest, you soak them overnight. GAPS diet. GAPS stands for Gut and Psychology Syndrome, and the diet was developed by Dr. Natasha Campbell-McBride. The diet is very similar to the Specific Carbohydrate Diet, and involves minimal supplementation. The only legumes allowed on the GAPS diet include lentils, split peas, and white navy beans, and they need to be soaked first. Dairy is initially eliminated, but the person is then allowed to slowly reintroduce ghee, followed by butter, yogurt, sour cream, kefir, hard cheese, and cream. One of the main differences between the GAPS diet and the Specific Carbohydrate Diet is that the GAPS diet involves going through a 6-stage introduction diet before moving onto the full GAPS protocol, which is usually followed for one or two years. SIBO Specific Diet. This diet, created by Dr. Allison Siebecker, is a combination of the Specific Carbohydrate Diet and the low FODMAP diet. While it s a great diet for those who have SIBO, it s important to understand that this is a very restrictive diet, so you can always try one or more of the other diets first. If you don t do well with the other diets, 8

9 then you might want to consider trying this diet. For more information, I would visit SIBO Bi-Phasic Diet. This is a protocol put together by Dr. Nirala Jacobi, and is based on the SIBO Specific Food Guide created by Dr. Allison Siebecker. This uses a phased approach to the diet and treatment for SIBO patients, and, according to Dr. Jacobi, it helps to limit side effects associated with die-off. In addition, this diet focuses on gut healing prior to having the patient take antimicrobials, which is the opposite of the "5-R Protocol," which I ll discuss in Chapter 28. The first phase focuses on reducing foods that feed the bacteria (fermentable starches and fiber), and repairing the gut while doing things to improve digestive health. Phase 2 then focuses on using antimicrobials to remove the remaining bacteria and fungi from the small intestines, while restoring the motility of the small intestines, usually by giving the person a prokinetic. I ll discuss prokinetics in Chapter 33. Elemental diet. Although this is referred to as a diet, it is also considered to be an antimicrobial treatment. Thus, I ll discuss the elemental diet in Chapter 33. In that chapter, I ll discuss treating not only SIBO, but also Lyme disease and toxic mold. Should Someone with Hashimoto s Also Follow an AIP Diet? Many people with Hashimoto s follow an AIP diet, and they might want to know if they should continue following an AIP diet when trying to 9

10 address SIBO. So for example, should they follow an AIP diet and at the same time follow a specific diet for SIBO? Doing this is extremely difficult, and what you usually want to do is prioritize the eradication of SIBO. In other words, it s usually okay to stray from the AIP diet while trying to address SIBO, which falls into the Remove category of the 5-R protocol. Then once the bacterial overgrowth has been removed you can focus more on gut healing by following the AIP diet, along with eating gut-healing foods and taking certain nutrients. I ll discuss the 5- R protocol in greater detail in Chapter 28. Conventional and Natural Treatment Options for SIBO In section four, I'll discuss both conventional and natural treatment options for eradicating SIBO. In this chapter, I briefly mentioned the elemental diet, which can be a very effective treatment option for SIBO, although most people prefer to follow one of the other two options, which are prescription antibiotics and natural antimicrobials. In Chapter 33, I'll discuss the pros and cons of both conventional and natural treatment options. What Is SIFO? Whereas SIBO is small intestinal bacterial overgrowth, SIFO stands for small intestinal fungal overgrowth, and is characterized by the presence of an excessive number of fungal organisms in the small intestine associated with gastrointestinal symptoms. 505 The most common 10

11 symptoms associated with SIFO include belching, bloating, indigestion, nausea, diarrhea, and gas. 505 Two recent studies showed that approximately one quarter of patients with unexplained GI symptoms had SIFO. 505 Keep in mind that someone with SIFO can also have extraintestinal symptoms such as fatigue, joint pain, brain fog, headaches, and other symptoms that can improve with treatment. How can one differentiate SIBO from SIFO? Although there is no diagnostic test currently available that evaluates for SIFO, if someone has symptoms similar to SIBO but has a negative breath test, then this can be suggestive of SIFO. Or if someone with a confirmed or suspected case of SIBO doesn t respond to treatment, then SIFO should be suspected. This is especially true if the person took Rifaximin and didn t respond. Of course, when this is the case, there is always the chance that a second round of treatment with the antibiotics is necessary, or perhaps a different treatment approach (i.e., natural antimicrobials) is warranted. But there is also a chance that the person has SIFO, and not SIBO. Can Treating SIBO Help Reverse Hashimoto s? SIBO doesn t seem to be a direct trigger of Hashimoto s. However, SIBO can cause an increase in intestinal permeability. Because of this, if someone has SIBO and a leaky gut, then in order to heal the gut, it is necessary to get rid of SIBO, and, if the trigger is also removed, then this can put the person into remission. Thus, while eradicating SIBO might be necessary for healing a leaky gut, in order to get someone with an autoimmune thyroid condition into remission, it is still necessary to find and remove the trigger. 11

12 Chapter Highlights: Although SIBO itself doesn't seem to be an autoimmune trigger, some cases of SIBO are a result of an autoimmune process, and SIBO can cause a leaky gut, which is a factor in thyroid autoimmunity. Four potential causes of SIBO include 1) dysfunction of the migrating motor complex, 2) altered anatomy, 3) low stomach acid, and 4) an absent or inefficient ileocecal valve. Many people with irritable bowel syndrome will develop SIBO. SIBO is detected through either a lactulose or glucose breath test. Some other health conditions associated with SIBO include acne rosacea, chronic fatigue syndrome, fibromyalgia, inflammatory bowel disease, interstitial cystitis, restless legs syndrome, and rheumatoid arthritis. The different diets that can benefit people with SIBO include the low FODMAP diet, the specific carbohydrate diet, the GAPS diet, the SIBO Specific Diet, the SIBO Bi-Phasic diet, and the elemental diet. Prescription antibiotics, herbal antimicrobials, and the elemental diet can help with the eradication of SIBO. SIFO stands for small intestinal fungal overgrowth, and it is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal symptoms. 12