How to cure bloating?

[Michael569]

@Vision This is a position of British Association of Gastroenterology on SIBO testing and interpretation. 

https://www.bsg.org.uk/wp-content/uploads/2019/12/AGIP-Best-Practice-Statement-for-HMBT_24.01.19.pdf

"The recent North American Consensus document on breath testing (2) suggests that a rise above the baseline hydrogen level of >=20ppm of hydrogen within the first 90 minutes following ingestion of the provocation dose (lactulose or glucose) is normally considered positive for assessment of SIBO."

Also, have a look at the preparation bit they list. Have you been told to be mindful of these things? Many things can skew the results if there was not a sufficient preparation for the test on page 2

[Leo Gura]

2 hours ago, Vision said:

$150 is being spent on every appointment with her

Hehe, welcome to the wonderful world of idiot doctors. $150 is cheap. It gets a lot worse.

In fact, you got a double case of SIBO: hydrogen and methane. Which will be harder to cure.

P.S. You cannot use any garlic if you have SIBO. You should avoid all spices to be safe. Just use salt.

[Preety_India]

What are the symptoms of SIBO?

 

[Michael569]

1 hour ago, Leo Gura said:

Hehe, welcome to the wonderful world of idiot doctors. $150 is cheap. It gets a lot worse.

 I know naturopaths who charge 250£ per session, holly f...ing shit!! Talk about not doing this for the money...

1 hour ago, Leo Gura said:

In fact, you got a double case of SIBO: hydrogen and methane

What was the case you had? Have they tested for hydrogen sulphite? I see this is done rarely where in fact a lot of people only get low hydrogen because there is competition with hydrogen sulfide in the bacteria and so it gets misdiagnosed as false negative because hydrogen sulfide is nearly never assessed 

[Leo Gura]

7 minutes ago, Michael569 said:

What was the case you had?

I have hydrogen.

[Arcangelo]

@Vision Do you drink coffee?

[Vision]

@Michael569

Thanks for the info.

11 hours ago, Michael569 said:

Also, have a look at the preparation bit they list. Have you been told to be mindful of these things? Many things can skew the results if there was not a sufficient preparation for the test on page 2

Yes, I followed it to a T. I only ate plain chicken (no spices) and eggs. 

[Vision]

10 hours ago, Leo Gura said:

In fact, you got a double case of SIBO: hydrogen and methane. Which will be harder to cure.

P.S. You cannot use any garlic if you have SIBO. You should avoid all spices to be safe. Just use salt.

 

What about nutritional yeast? Healthy fats like Cod Liver Oil and Extra Virgin Olive Oil??

 

4 hours ago, Arcangelo said:

 

@Vision Do you drink coffee?

 

No. I haven’t had coffee in almost 2 years. I don’t consume caffeine. 

[Vision]

I’m going to email my naturopath asking about this. Is there anything I should mention in particular?

But if she made a mistake, I don’t even know if she’d admit that she misinterpreted it? Can they even do that? I mean I’ve spent so much money...

[Michael569]

8 hours ago, Vision said:

But if she made a mistake, I don’t even know if she’d admit that she misinterpreted it? Can they even do that? I mean I’ve spent so much money...

From a personal experience, I'll tell you that working in holistic health can be sometimes incredibly challenging. For one, holistic practitioners cannot diagnose nor are we trained in diagnosis (unless you are a trained Naturopathic Doctor, which is only available in States for now). So you can often suspect but you cannot diagnose people. People have to be send to medical doctor for diagnosis but they will often look at something like SIBO and say "it's not a real thing" and so the person is stuck between the rock and the hard place. 

Secondly, you don't have a powerful governing legal body such as medicine does, you don't have a lobby in the government and most of all you don't have all the research done for you by pharmaceutical companies. Natural remedies have mostly shit quality of research and for SIBO, for example there is just 1 high quality randomized trial. One!!!! Compared to for example 100 trials using Rifaximin for treatment of IBS. Holistic practitioners cannot just prescribe whatever because our legal protection is not as strong as medical. If doctor messes you up with overprescription, they are fully protected by medical insurance , if a naturopath messes up, she loses her license so she will prefer to errr on the side of caution. This is another reason why so many holistic practitiners struggle, not because of lack of knowledge but because of fear of legal persecution. 

So as a holistic practitioner you often have to experiment, try to be creative and you often have to go easy on things that could change people's lives (e.g. variety of herbs) because you have to be careful not to get a backlash from medicine for doing something considered pseudoscientifical. 

So what I'm trying to say, don't blame your naturopath, she is doing her best with the training she got, it's just that sometimes there simply isn't enough resources and information for us to do the work 100%. On the other hand ofcourse, many practitioners in the industry do not invest in continuous education and get stuck with old ideas and theories brought over from school which can lead to all sorts of weird protocols and lack of results. 

[Leo Gura]

10 hours ago, Vision said:

But if she made a mistake

She probably just doesn't understand SIBO that well. I doubt she made some technical mistake.

[Hello from Russia]

These mainstream doctors don't understand anything, I am so frustrated with them

Even for common diseases, they just give you a bunch of antibiotics and other hardcore drugs which destroy your body. It's so fucking lazy. Why should I even go to these doctors for such an easy lazy solution?

I have no clue what these guys are doing for 8-10+ years in their medical schools. I've pretty much almost never had any really unique treatments, it is always just antibiotic + some kind of a painkiller, that's it

Edited May 20, 2021 by Hello from Russia

[Michael569]

1 hour ago, Hello from Russia said:

It's so fucking lazy. Why should I even go to these doctors for such an easy lazy solution?

modern medicine is brilliant for acute injuries, acute toxicity, cardiac arrest and getting you back to live once you are at the brink of dying. The amount of artistic work they can do if a 100 kilo brick falls on your leg is unbelievable. The Emergency medicine is a combination of art & science really.

You don't have time to piss around with herbs when you experience a heart attack, you need to be sent to hospital, injected with nitric oxide and have your chest opened if necessary but then once the person is stable, naturopaths should take over. But there is no holistic education in medicine which is why management of chronic disease is so poor. 

You also have to consider that most people WANT this sort of approach. 9/10 diabetics are not looking for a real cure, just to dump their responsibility somewhere else and to stop being in pain. That's it. Having to take metformin 3 times a day is less painful than having to lose 50 kilos and starting to exercise. 

If you are interested in real treatment and taking responsibility in your hands, you're better of doing your own studies or finding a holistic expert with a decent reputation. 

[Ora]

I had sibo for 3 years, didn't know what it was till last year. I just had God awful distended belly after eating, usually starting In the afternoon then lots of gas the rest of the day. Didn't know what it was until I learned about sibo. And it's prolific, like if you don't seriously do the protocols and just take some supplements here and there it's never gonna get better. It'll temporarily receed then just come back.

I don't think it's necessary to get a breath test. Hydrogen sulfide or methane, whatver because if your using herbs and stuff, the treatment is basically the same. Usually you need to do 2-3 rounds of the herbal antibiotics before it's completely gone. Basically you can usually only wipe out like 50% each time, so every round will weaken it and weaken it, until finally there's not enough to cause a problem. This is the case with chemical antibiotic and herbal. Usually sibo isn't a nuke the crap out of it and your good. You just slowly need to rebalance your population.

https://drruscio.com/ this guy has antibiotic herbal supplements and gut repairing powders. You can just learn the basics from his blog or book and decide what you need. His site makes it easy to get everything in one place. Personally i just got supplements from other places and built my own protocol because it's slightly cheaper. I rotated between apex energetics gi synergy and biotics research fc cidal + dysbiocide. I also added oregano oil and allicin. Took a gut mucosa healing powder also to reduce inflammation in the gut lining to help repair and rebalance flora. And took restor flora by microbiome labs as my probiotic. It's spore based specifically designed strains for sibo. I use https://www.maybeitsmercury.com/supplements this ladies referral thing to get some supplements at a good discount like the biotics research. 

If you feel researching all the products is too time consuming and want to just jump into the protocol, I'd just go with Dr ruscios stuff. It's just slightly more expensive. He recommends his elemental diet where you eat these low fodmap carb drinks for 5 days or so. Personally because I didn't want to spend the money, I just fasted for 5 days. Well, I did a liver detox thing where I drank half cup olive oil and half cup grapefruit juice twice a day 12 hrs apart, and an enema twice a day 1hr before taking the potion. The point of his elemental diet or my detox is to ingest NO fiber that feeds the bacteria. You starve down BOTH bad and good bacteria. Then you start taking the antibacterial supps, while eating lowfodmap. This way instead firing into huge legions of enemies, you starve them all down, reduce their numbers, then start "attacking."

This method worked best for me. I tried just taking all the supps and I tried fasting and then taking the supps. It's a huge difference in effectiveness. The first method works, but be prepared to spend more money because you gotta treatment longer.

[Ora]

5 hours ago, Michael569 said:

You also have to consider that most people WANT this sort of approach. 9/10 diabetics are not looking for a real cure, just to dump their responsibility somewhere else and to stop being in pain. That's it. Having to take metformin 3 times a day is less painful than having to lose 50 kilos and starting to exercise. 

Crazy isn't it? Especially when they found like 3 weeks of intermittent fasting could cure 70% of longstanding type 2 diabetics. And a couple more weeks for the other 30.

[Ora]

@Vision either you don't have sibo... or you do. In the book healthy gut healthy you, the guy talks about how tests aren't 100% accurate, maybe like 60% only. It also matters the sugar they give you. I forget if he says lactose was the more accurate one or if it was the other glucose or something. I feel like I remember glucose was more accurate because it's transit is slower or something. 

I think your test means the lactose didn't trigger fermentation and gas in your small intestine (sibo is small intestinal bacterial overgrowth) but fermented in your colon instead, which is normal because that's where your probiotics live. So according to your test you dont have sibo, but again testing for sibo is very hit or miss since it depends on many factors like the sugars they use, and like your test says "unless small intestine transit is abnormally slow"

[Vision]

@Ora

I took glucose first, then lactulose. I was in the clinic for about 5-6 hours. 

[Michael569]

On 19/05/2021 at 9:34 AM, Vision said:

@Michael569

These are my Lactulose results.

@Vision ok so I did a little bit of digging on this. There are 2 fairly reliable statements at the moment. One is coming from the Association of Gastrointestinal Physiologists (AGIP) the other from North American Consensus.

This is what they both say: 

• First of all, the order of testing (according to AGIP) should have been Lactulose first, Glucose second. Did your lab do it this way? If not, you may have got false positive/false negative. 
• Secondly, "the recent North American Consensus document on breath testing (2) suggests that a rise above the baseline hydrogen level of >=20ppm of hydrogen within the first 90 minutes following ingestion of the provocation dose (lactulose or glucose) is normally considered positive for assessment of SIBO". -> this is positive on your test 
• Thirdly, AGIP says -> "methane level >=10ppm at baseline or at any point during the test should be considered positive for methanogenesis. As methane may affect transit times it is difficult to say with certainty whether the methanogenic organisms are in the small bowel or colon so no comment on SIBO should be made in the absence of a concomitant rise in hydrogen" -> In your test, methane (yellow line) is above 10 at the baseline pretty much straight away + you have rise in hydrogen. So this point applies
• Fourth, AGIP Says: "The time from ingestion to the rise in breath levels associated with large bowel fermentation should not be used as a diagnostic tool for estimating small bowel transit." - This is what your testing company did. Dump it all as "colonic fermentation". This does not seem to be right. 
• Finally, AGIP says "Ledochowski cut off values of a rise of >=10ppm within 60-minutes as positive for SIBO (6) which is a more conservative value but conversely increases the risk of a false-negative result. Therefore clinical judgement by an experienced Clinician and / or discussion within a multidisciplinary team should be used with borderline positive results (i.e. a rise seen between 60-90 minutes) and a glucose HMBT could be undertaken to provide more confidence in a SIBO positive diagnosis" -> This is the point that takes away the certainty. We cannot tell whether the increase behind 90 minutes is due to colonic fermentation or small intestinal fermentation. I think you should get a second opinion

SUMMARY
You should take these results and show them to a medical gastroenterologist. There is too much vagueness in SIBO diagnosis at the moment and you may need to get a test called jejunum culture aspirate which is currently considered to be a gold standard test. This is more invasive however and includes sticking a tube down your throat, this is the best we have so far. 

Good luck on your next step. 

 

[Vision]

On 5/21/2021 at 11:32 PM, Michael569 said:

First of all, the order of testing (according to AGIP) should have been Lactulose first, Glucose second. Did your lab do it this way? If not, you may have got false positive/false negative. 

No. It was Glucose first, then Lactulose. 
 

On 5/21/2021 at 11:32 PM, Michael569 said:

This is the point that takes away the certainty. We cannot tell whether the increase behind 90 minutes is due to colonic fermentation or small intestinal fermentation. I think you should get a second opinion

But even with a second opinion how will I know which one it is?

On 5/21/2021 at 11:32 PM, Michael569 said:

You should take these results and show them to a medical gastroenterologist. There is too much vagueness in SIBO diagnosis at the moment and you may need to get a test called jejunum culture aspirate which is currently considered to be a gold standard test. This is more invasive however and includes sticking a tube down your throat, this is the best we have so far. 

 

What does the jejenum culture aspirate do? What information does it give?

I just want to know exactly what to do. I’ll do whatever it takes. 

[Vision]

@Michael569 Have you heard of Gojiman? What are your thoughts on him?