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Erika’s Story – SIBO

by Kirsten Jackson Specialist Dietitian Leave a Comment

SIBO is becoming more of a common issue and often masks itself as IBS.

In this post, I am going to share my client’s story on how we helped solve her SIBO. Please note, I would never normally share information like this but she has kindly agreed.

Stage 1 – Client History

Before starting the VIP Program with myself, Erika had already done the full Take Control Group Program.

During the program she had followed all the advice and had some relief. But found that when she reintroduced FODMAPs, she reacted to nearly all of them, having very little tolerance.

Although there is no cure for IBS, it sends alarm bells ringing to me that someone would follow all my advice for their ‘IBS’ and then have zero tolerance to FODMAPs. Very strange.

So I started my assessment.

Symptom questionnaire from initial assessment

Firstly, I reviewed Erika’s medical tests – she had, had all the tests required for an IBS diagnosis as per NICE guidelines. You can read about this here.

She had also had some IgG testing but I explained how this was not accurate.

I then looked at the onset of her symptoms. This is important as IBS symptoms tend to start with things like stress, antibiotics or a stomach bug. Instead, Erika’s started around the same time she was put on proton-pump inhibitor medications. This is for acid reflux.

We then looked at other supplements and medications. Erika had been taking some chinese medications. We were unable to find the exact content of these.

There was nothing really substantial in her diet to be concerned over. She was pretty much following a low FODMAP diet, ate regularly, potentially a slightly high fibre intake, no caffeine and no alcohol. Again, very strange to still get symptoms.

The same thing was apparent in her social life. She exercised regularly, slept pretty well and had regular stress levels.

So given this history I immediately thought she must have SIBO as she didn’t have a typical IBS history and had been on long term PPIs which can cause SIBO.

Plan;

  • Breath test for SIBO – to discuss with GP
  • Probiotics and meditation – to optimise own gut health further
  • To track fibre content – if it is too high then can aggravate symptoms

Weekly Email Reviews

As part of the VIP package, clients get weekly email reviews. In this, they send across a food and symptom diary. This also details mood, sleep and exercise.

Over the coming weeks Erika explained that due to Corona Virus she was unable to get a SIBO breath test.

Despite the inability to get a test, it was still important to optimise Erika’s gut. Failure to do this would only result in any SIBO coming back when it was finally treated.

We therefore continued to optimise gut health and found that her optimal fibre intake was around 25g a day.

Second Consultation

I knew Erika had been unable to get the SIBO testing due to circumstances, but this wasn’t a huge deal.

I explained that whilst the breath test is best test we currently have, it isn’t actually that accurate. Many doctors will therefore treat SIBO based on clinical history, with a diagnosis coming from the patient’s condition improving on antibiotics.

Other than the above, we had found that 25g of fibre a day seemed to improve stool consistency and also bloating slightly.

Plan

  1. Continue with around 25g a day of fibre
  2. Continue with lifestyle measures and probiotics
  3. Discontinue Chinese herbs (we were unable to find out what these contained).
  4. Discuss antibiotics with GP.

Weekly Email Reviews

Following the second consultation, Erika was able to arrange a course of antibiotics through a phone consultation with her GP.

Erikas symptoms did improve on this antibiotic but the symptoms then came back. This is very classic of SIBO which often takes several courses to kill off.

Erika’s GP (happy that her symptoms responded to the antibiotics), then prescribed a longer, more specific antibiotic.

Final Consultation

At the final consultation, Erika’s symptoms had almost all resolved and she was happy with the outcome.

  • Symptom Questionnaire From Final Consultation

Plan;

  1. To organise a referral to a GI surgeon to discuss a Nissen Fundoplication (a permanent solution for her acid reflux).
  2. Continue with around 25g fibre / day.
  3. Continue with probiotics.
  4. Continue with lifestyle gut optimisation – looking at sleep, movement and stress.
  5. Continue with PPIs as per the doctor recommendations (this may sound crazy because they are still the lesser of the 2 ‘evils’ in comparison to recurring acid reflux which can result in a lot of inflammation and potentially cancer).
  6. To trial reintroductions of FODMAPs again (as these would have been reacting to the SIBO originally).

Summary

Erika is a classic case of SIBO caused by PPIs.

When treating SIBO we need to take a holistic approach and consider both the treatment (antibiotics), optimising gut health and then preventing to from coming back.

Without this approach it is likely that SIBO will keep coming back or may not even go away in the first place.

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Filed Under: IBS Dietary Advice Tagged With: how to treat SIBO, SIBO patient story

About Kirsten Jackson Specialist Dietitian

Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.

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🙋‍♀️ Coffee contains the active ingredient caffeine. Although we think of caffeine as an everyday thing, it is a drug and does have an impact on our body. In IBS, this impact may be negative in the form of over stimulating bowels. It can also worsen anxiety and prevent good quality sleep, both of these aspects then have a knock on impact on your IBS. 

🤔Instead of blindly avoiding all coffee (which may not be needed). Here are some top tips from the Take Control Membership:
1️⃣ Never exceed 400mg caffeine a day (this is the general guidelines for a healthy intake and is lower for those pregnant and breast feeding) 
2️⃣ Reduce intake gradually to avoid headaches. 
3️⃣ Avoid coffee after mid-day (it's long 1/2 life means it may still be in your system when trying to sleep otherwise). 
4️⃣ Track your bowel habits and mood against intake to see if it is causing an issue.
5️⃣ Coffee isn't all bad for IBS - if you have IBS-C,  you may find that it helps you go! 

‼️ Have you downloaded my free 'morning guide' yet? (the link is in my bio).⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀
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SAVE THIS POST - FOR REFERENCE. 🤷‍♀️Have SAVE THIS POST - FOR REFERENCE.

🤷‍♀️Have you heard of SIBO before? Comment below ⬇️

🙋‍♀️SIBO (small intestinal bacterial overgrowth) is a condition caused by..you guessed it...an overgrowth of bacteria in the small bowel. It is unclear what causes SIBO but it does seem to be linked with PPI medications, low immunity and poor gut motility.

🤓The management of SIBO is difficult. Because the best diagnostic tools we currently have are not very accurate and the current treatments for SIBO are mostly antibiotics. We often see in practise that SIBO tends to return after antibiotic treatment, likely due the underlying cause not being treated.
 
🤓SIBO management;
✅Antibiotics
✅Addressing motility (avoiding constipation)
✅Optimising good gut bacteria (so it can thrive and compete with bad bacteria)
✅Elemental diet - some limited research to support this use as a treatment.
❓Low FODMAP diet - no evidence but the theory is that these FODMAPs will feed the bad bacteria so avoidance of them whilst taking antibiotics may allow the antibiotics to work better. 
❌Herbs - no placebo controlled trials to support this or any logical theory.

🤓Ultimately we have very limited research in this area. I tend to work with gastroenterologists on this one to first have the condition diagnosed and then get the individuals gut in a place where the antibiotics are mostly likely to work.

‼️ If you haven't already, do not forget to sign up to my free Veganuary IBS Guide (the link is in my bio).⠀⠀⠀⠀⠀⠀ 

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🤷‍♀️How often do you get outside each week? For how long? Comment below ⬇️⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️When I discuss movement with my clients, I often find that either they rely on the gym / computer or simply do not do any exercise. And before you say, it is because of the weather, even my clients in warmer climates have a similar pattern. Failure to go outside in the day can be disruptive to your circadian rhythm (sleep cycle) and we know this is connected to you gut. Outside exercise can also beneficial to your gut microbiota.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤷‍♀️Which emotion are you today? Comment below ⬇️⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️when you have IBS, it is a whirlwind of emotion. One minute, everything is going well and then suddenly you have a flare up of symptoms. Or perhaps you are anxious about what your bowels may do. This whirlwind is due to having a limited understanding of your triggers and so you simply can not avoid them. Instead of this, opt for the low FODMAP process which will guide you step by step to pinpointing your trigger foods.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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⏩⏩Have you downloaded my latest free guide? “Veganuary for IBS.”⠀⠀⠀⠀⠀⠀⠀⠀⠀
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COMMENT 'VIP' BELOW IF YOU WANT THIS OUTCOME ⬇️(I will direct message you)⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️Who would say their quality of life is negatively impacted by their gut health?.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤓Research shows that IBS is directly linked to poor gut health, so it is not surprising that this was the main outcome for this client.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️If you would like information about the VIP programme...working with myself over 3 months to get to the bottom of your gut health then comment VIP below or DM me so we can have a chat.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤷‍♀️Do you have any symptoms of IBD? Comment below ⬇️⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️I always advise my clients that they MUST get an accurate IBS diagnosis, this includes ruling out IBD.⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤓IBD stands for inflammatory bowel disease. Although many symptoms are similar, the condition is not. IBD is an autoimmune disease which causes inflammation in the GI tract. So, make sure you have the correct testing done (a fecal calprotectin test).⠀⠀⠀⠀⠀⠀⠀⠀⠀
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⏩⏩Do not forget to grab your FREE download on IBS and Veganuary (link in my bio).⠀⠀⠀⠀⠀⠀⠀⠀⠀
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#bloating #diarrhoea #constipation #tummypain #bloatingremedy #irritablebowelsyndrome #ibs #ibsdiet #foodanxiety #chronichealthcondition #chronicallyunwell #bodyimage #celebratingwomen #foodbaby #ibstriggers #lowFODMAPdiet #fodmapfree #lowFODMAP theibsdietitian #autoimmunedisease #bloodinstool #gastroenterologist #immunesystem #inflammatorybowelsyndrome #chronsdisease #ulcerativecolitis #IBD #IBDfighter
ARE YOU GUILTY OF STAYING UP Late? ⠀⠀⠀⠀⠀ ARE YOU GUILTY OF STAYING UP Late?
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🤷‍♀️ Give me a 😅 below if this is you? Comment below ⬇️⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙋‍♀️ Sleep is such an important factor in our general health as well as gut health.. Yet we seem to put it at the bottom of the list after fitness and nutrition.. Why? Whilst chatting to @drsalihaafridi recently she summed it up.. We evented electricity! .⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🤓Poor quality and or quantity of sleep will reduce your mental wellbeing and negatively impact your gut. It also impacts your food choices. 

👍We cover sleep hygiene in my Take Control Programme (available for joining at the end of this month). In the meantime, here are some easy tips. 
✳️ Use @off_the_grid_app (to block your phone overnight!) 
✳️ Read before bed
✳️ Have a hot shower before bed to relax your muscles
✳️ Go to bed and get up at the same time each day
✳️ Use an eye mask⠀⠀⠀⠀⠀⠀⠀⠀⠀
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⏩⏩ If you would like to know more about my Take Control Programme then please DM me so I see if you are suitable and also give you some details 😊. 
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#bloating #diarrhoea #constipation #tummypain #bloatingremedy #irritablebowelsyndrome #ibs #ibsdiet #foodanxiety #chronichealthcondition #chronicallyunwell #bodyimage #celebratingwomen #foodbaby #bodyimage #ibstriggers #lowFODMAPdiet #fodmapfree #lowFODMAP #ibsdietian ##sleepaid #sleep #whywesleep #restandrecovery #randr #sleephygiene #sleeper
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