Small intestinal bacterial overgrowth (SIBO) is gut condition in which there are abnormally large numbers of gut bacteria in the terminal ileum of the small intestine (the end of the small intestine, just before the colon). SIBO is one form of dysbiosis, or gut imbalance. Normally, the colon is where gut bacteria greatly increase in number, with the small intestine housing smaller numbers of bacteria. In SIBO, the high amount of gut bacteria in the small intestine leads to excess gas and discomfort. The condition is common in people with irritable bowel syndrome (IBS).

It has been known for a while that SIBO is more common in alcoholics, but a recent study is the first to look at the relationship of SIBO in people with moderate alcohol consumption. As it turns out, the researchers, from the Mayo Clinic and Dartmouth-Hitchcock Medical Center, found that moderate alcohol consumption—one drink per day in women and two per day in men—could lead to SIBO.

Dr. Gabbard, the lead researcher, stated, “While typical treatment for SIBO has been antibiotics, probiotics or a combination of the two, the question now becomes what is the exact association between moderate alcohol consumption and SIBO and whether alcohol cessation can be used as a treatment for this potentially harmful condition.”

Certainly, the things we consume—food, drink and medication—affect our gut. If you have been considering decreasing your alcohol intake (there are many good reasons to do so), it may just help improve your gut balance.

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Probiotic use for digestive conditions has seen a gradual increase in dosage over the past couple decades. Doses of 7 billion were thought to be very high just ten years ago, while average doses were about 250 million. Today, an average probiotic dose is around 1–5 billion with high-dose probiotics ranging from 30 to 450 billion or more. This increase comes with improvements in the development of probiotics and increased interest in studying high-dose probiotics, as is reflected in the literature.

The gut is home to about 100 trillion bacteria cells—10 times the amount of cells that make up the entire human body. For this reason, high-dose probiotic therapy may have a greater impact on the beneficial modulation of the gut flora, or microbiota. Here I’ll review a few studies on high-dose probiotics for gastrointestinal conditions.

In a randomized, double-blind, placebo-controlled study published in 2010 in the Journal of American Gastroenterology, 225 patients were randomized to one of three groups: two probiotic capsules per day providing 100 billion CFU (colony forming units) of live organisms, one probiotic capsule and one placebo capsule per day providing 50 billion CFU of live organisms, or two placebo capsules.¹ A dose-ranging effect was shown in which the group receiving the 100 billion CFUs had lower incidence of antibiotic-associated diarrhea (AAD) than the 50 billion group, and both probiotic groups had lower incidence versus placebo. In those patients who did acquire AAD, Clostridium difficile-associated diarrhea (CDAD) incidence was lower than the 500 billion CFU group, and both probiotic groups had lower CDAD incidence than placebo.

A previous dose-response study published in 1991 in the journal Microbial Ecology in Health and Disease investigated fecal recovery of the probiotic Lactobacillus casei strain GG (LGG).² In this study, healthy volunteers were assigned to six different groups: 1.5 million, 15 million, 150 million, 1.5 billion, 15 billion and 150 billion CFU per day of the probiotic. LGG could not be recovered from the feces of groups taking up to 150 million CFU per day. In the group taking 1.5 billion, LGG was occasionally recovered at low levels in two of the seven volunteers. In the group taking 15 billion CFU per day, all volunteers were colonized. LGG was recovered at the highest level with the highest dose—150 billion. This study showed a dose-response effect at higher dosage levels of 15 to 150 billion CFU per day required for fecal probiotic recovery.

A high-dose multistrain probiotic formula containing eight strains (three bifidobacteria, four lactobacilli and one Streptococcus) has also been shown to colonize the gut and maintain remission of ulcerative colitis (UC) in children and adults.^3-5 In children, 900 billion CFU per day of an eight-strain probiotic formula induced remission.³ In adults, 500 billion CFU per day of that same formula colonized the gut and maintained remission in UC patients.⁴ In another trial, a daily dose of 3.6 trillion CFU per day of the multistrain formula induced remission in adult patients not responding to conventional therapies.⁵

This same preparation (dosages ranging from 450 billion to 1.8 trillion CFU per day, based on weight of patient) was also found to induce and maintain remission of ulcerative colitis in children.⁶ In a randomized, double-blind, placebo-controlled trial of 29 children with UC, probiotics or placebo were added to standard treatment. In the probiotic group, 92.8 percent achieved remission compared to only 36.4 percent in the placebo group. Further, there were no biochemical or clinical adverse events related to the probiotic treatment in these children.

Two more randomized, controlled trials evaluated the effects of this probiotic preparation in twenty-five patients with diarrhea-predominant irritable bowel syndrome (IBS-D). In the first study, patients were assigned to receive either the probiotic mixture (450 billion CFU per day) or placebo for eight weeks. The multistrain probiotic relieved abdominal bloating when compared to placebo. In the second study, 48 IBS patients were randomized, double-blind, to receive either the probiotic mixture (450 billion CFU per day) or placebo for 4 or 8 weeks. The multistrain probiotic mixture reduced flatulence and slowed colonic transit without altering bowel function in patients with IBS and bloating.

In another double-blind, placebo-controlled trial, sixty patients with functional bowel disorders—non-constipation IBS, functional diarrhea and functional bloating—received a probiotic mixture of two strains, Lactobacillus acidophilus and Bifidobacterium lactis, at 200 billion CFU daily for eight weeks.⁷ Abdominal bloating improved in the probiotics group at four and eight weeks when compared to placebo. A subgroup of patients with IBS was analyzed and also found to have reduced bloating when compared to placebo.

Studies evaluating high-dose probiotics are most common for inflammatory bowel diseases, though as we see from the studies cited above, other conditions are also benefitted from a high-potency probiotic therapy. The trend toward increasing dosage of probiotics is influenced and supported by studies using doses ranging from 50 billion up to 3.6 trillion or more.

References

1. Gao XW, et al., “Dose-response efficacy of a proprietary probiotic formula of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R for antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea prophylaxis in adult patients.” Am J Gastroenterol. 2010 Jul;105(7):1636-41.
2. Saxelin M, et al., “Dose-response colonization of faeces after oral administration of Lactobacillus casei strain GG.” MicroEcol Health Dis. 1991 Jan;4:209-14.
3. Miele E, et al., “Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis.” Am J Gastroenterol. 2009 Feb;104(2):437-43.
4. Ringel Y, et al., “Probiotic bacteria Lactobacillus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders—a double-blind study.” J Clin Gastroenterol. 2011 Jul;45(6):518-25.

1. Miele E, et al., “Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis.” Am J Gastroenterol. 2009 Feb;104(2):437-43.
2. Venturi A, et al., “Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis.” Aliment Pharmacol Ther. 1999 Aug;13(8):1103-8.
3. Bibiloni R, et al., “VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis.” Am J Gastroenterol. 2005 Jul;100(7):1539-46.

1. H.J. Kim, et al., “A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating.” Neurogastroenterol Motil. 2005 Oct;17(5):687-96.
2. H.J. Kim, et al., “A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome.” Aliment Pharmacol Ther. 2003 Apr 1;17(7):895-904.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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The gut-brain connection is fascinating. It involves an intimate communication between the gut and the brain, and it goes in both directions—from the brain to the gut, and from the gut to the brain. I mean, isn’t it cool that what happens in your gut can affect your brain?

Yet another study looking at the gut-brain connection has found that gut bacteria are associated with anxiety. The researchers used an animal model to study this link, as it is easier to work out the details of these connections in animal models. Researchers found that antibiotic treatment altered the normal gut bacterial count, producing a change in behavior—the mice became anxious. They also experienced an increase in brain derived neurotrophic factor (BDNF), linked to anxiety and depression. When the antibiotics were stopped, behavior returned to normal.

To take this one step further, the researchers added gut bacteria from mice genetically prone to be passive, to mice prone to be more active and exploratory, and vice versa. They found that by giving the mice a different set of bacteria, the mice began to behave as the mice from which the bacteria were originally isolated. One of the researchers stated, “these results lay the foundation for investigating the therapeutic potential of probiotic bacteria and their products in the treatment of behavioral disorders, particularly those associated with gastrointestinal conditions such as irritable bowel syndrome.”

Like I said, the gut-brain connection is fascinating.  Did you know your gut had so much power over your health?

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Renew You Challenge

Let’s start this week off right!

Weekly challenge (I mean, opportunity!) to help set you off on the right foot and in the right direction for bringing health to your week. You could even add it to your calendar. Join us!

Irritable bowel syndrome (IBS) is a common gut disorder characterized by abdominal pain and discomfort, and altered bowel habits—constipation, diarrhea, or usually, alternating between both. People with IBS have a decreased health-related quality of life. Often, they also experience such conditions as fibromyalgia, depression, or even colon cancer.

It is known that women with IBS are less physically active than healthy women, and that women with IBS who do participate in regular physical exercise experience less fatigue or bowel complaints. A study published in the American Journal of Gastroenterology takes this association one step further by testing whether increased physical activity decreases IBS symptoms, and whether it increases quality of life.

As it turns out, regular exercise—20 to 60 minutes of moderate-to-vigorous physical activity 3 to 5 days per week—improved gastrointestinal symptoms and quality of life in people with IBS. The researchers recommend that physical activity be used as a primary treatment modality for IBS. 

I recommend exercise a lot because I believe it should be a part of everyone’s routine. It helps improve gut function, yes, but it also helps improve just about every area of health. So this week, if you or someone you know has IBS and you aren’t getting enough physical exercise, get moving. Find some form of exercise that makes you feel good, and just do it.

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I’m really excited about a couple of new studies on gluten sensitivity. I have been talking about this condition for so long, knowing that it contributes to many different health conditions in the body. The science is only beginning to scratch the surface of what clinicians have been seeing for years in patients who suddenly feel better after removing gluten from the diet.

A new study published in the American Journal of Gastroenterology (yes, you heard me—gluten sensitivity is hitting the “big time” folks) has validated the fact that gluten sensitivity is not just “all in their heads.” This double-blind randomized placebo-controlled trial recruited people with irritable bowel syndrome (IBS) whose symptoms improved after following a gluten free diet. These patients, in whom celiac disease was ruled out, were then put into two groups: one group was re-challenged with foods containing gluten and the other group was given “placebo” foods that did not contain gluten.

The results? In the group receiving the gluten-containing foods there was a significant increase in bloating, abdominal pain, altered bowel pattern and fatigue. Surprise, surprise! This is something that I have seen in people for years, and that the natural health community has known for a long time. But to see it published in this prestigious journal gives me hope that we will be taken more seriously with regard to the knowledge we are spreading about the damage that gluten can cause in many people.

This study is only the beginning, and will surely trigger many new studies that seek to discover just what is occurring in gluten sensitivity and why. The study helps to not only put gluten sensitivity on the map, so to speak, but also to explain one of the triggers to the ever-elusive IBS. We have known that gut infections can trigger IBS, and now we know that gluten sensitivity may also be a trigger. Again, this is something that I have been saying for many years.

And that’s not all! Another study reported in the Wall Street Journal and published in BMC Medicine has determined that gluten sensitivity and celiac disease involve two different branches of the immune system. Gluten sensitivity involves the innate immune system, which is responsible for the initial inflammatory response that occurs when the body encounters a “foreign” invader—in this case, gluten. Celiac disease, on the other hand, was found to involve the adaptive immune system, which involves a more complex secondary immune response that identifies the foreign invaders so that they will be recognized each time they are subsequently encountered.

Very interesting is that the difference between these two conditions was related to intestinal permeability—leaky gut. Those people with celiac disease were more likely to have leaky gut, while those with gluten sensitivity had not developed leaky gut—YET! What I think they will find is that gluten sensitivity is the first, milder reaction that worsens, increases leaky gut, and becomes full blown celiac disease. It’s a progression, and if you don’t take control of it early, it can lead to many different health conditions.

If you think you are gluten sensitive, try a gluten-free diet (no cheating—I’m not kidding!) for at least six weeks (even up to 6 months or more depending on your condition) to see if you begin to feel better. Today, there are many gluten-free options. Be sure to include plenty of fruits and vegetables, lean proteins, good fats, and whole, gluten-free grains. You’ll be on your way to wellness.

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There is still a general belief with medical doctors and the public as well that Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are mostly stress-related psychological disorders. I have personally had many patients who were reluctant to discuss their bowel problems for fear of being labeled a “psych” case. Many practitioners still aren’t aware there can be legitimate causes of disease that come from both mind and body.

With IBS and IBD, as with most discussions, there is often an element of truth on both sides or there would be no controversy. First, let’s look at the validity of the stress factors. People with genetic short serotonin transporter systems react negatively to stress-related increases in cortisol (a stress hormone) than people with normal serotonin transport systems.1 Second, ALL people react to significant stress, which can produce damage to the gut epithelial lining. However, people with a history of IBD generally show more gut lining damage than those without IBD. The damage includes: increased levels of stress hormones, activation and degranulation of mast cells, mitochondrial damage in epithelial cells, and mucosal protein oxidation which can create multiple problems with permeability (leaky gut) and immunity.2 Again, this happens to everyone under stress, but is worse with IBS and IBD because stress can trigger a relapse of either condition.

On the other hand, there are many reports that suggest anywhere from 20 to 60 percent of IBS and IBD patients have had a serious gastrointestinal infection days or weeks before they began having symptoms of chronic bloating, abdominal pain, diarrhea or constipation (or both diarrhea and constipation) that may have lasted years. A study was done on 111 patients with IBS using the lactulose breath test (measures hydrogen and methane gas produced by too many of the wrong bacteria) and 84 percent of patients were positive, which indicates small intestinal bacterial overgrowth (SIBO). Those who were treated with a non-absorbable antibiotic, Neomycin, had a statistically significant improvement both in symptoms, and normalization of the breath test.3 A more recent study4 showed that patients with IBS, but without constipation, treated with rifaximin (a broad spectrum non-absorbable antibiotic) for two weeks provided significant relief of IBS symptoms including: bloating, abdominal pain, and loose or watery stools.

Both of these studies strongly suggest that bacterial overgrowth, which creates a low-grade infection, is a major part of IBS, and can be treated with antibiotics. In addition, I think the standard of care today strongly suggests using probiotics while on antibiotics. This has been shown to lower the incidence of antibiotic associated diarrhea (AAD), and especially Clostridium difficle diarrhea, which can lead to total removal of the colon or even death.

Probiotics alone have been shown to significantly help with IBS. More specifically, probiotics enhance gut barrier function, inhibit pathogen binding and modulate gut inflammatory response. They reduce visceral hypersensitivity associated with both inflammation and psychological stress. More importantly, probiotics can alter colonic fermentation and stabilize the colonic microbiota, show that dietary exposure to pathogens maybe less likely to create another relapse of symptoms.5

Once again we can see that the use of high fiber, essential oils (omegas), probiotics and digestive enzymes (Brenda Watson’s HOPE Formula) can be beneficial in preventing or treating intestinal inflammation—be it IBS or IBD.

1. Way BM. “The Serotonin Transporter Promoter Polymorphism Is Associated with Cortisol Response to Psychosocial Stress.” Biol Psychiat. 2010 Mar 1;67(5):487-92.
2. Farhadi A, et al. “Heightened Responses to Stressors in Patients with Inflammatory Bowel Disease.” Am J Gastro. 2005;100:1796–1804.
3. Pimentel M., et al. “Normalization of Lactulose Breath Testing Correlates With Symptom Improvement in Irritable Bowel Syndrome: A Double-Blind, Randomized, Placebo-Controlled Study.” Am J Gastro. 2003;98:412-19.
4. Pimentel M., et al. “Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation.” N Engl J Med. 2011 Jan;364:22-32.
5. Spiller, R. “Review article: probiotics and prebiotics in irritable bowel syndrome.” Aliment Pharmacog Ther. 2008 Jun;28(4):385-96.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Ok folks, my weekly challenge involves a very interesting study from Boston University that I came across the other day that I want to share with you. The study looked at a technique known as expressive writing, which involves writing one’s thoughts and feelings about a certain issue. In this study, participants with irritable bowel syndrome (IBS) expressed their thoughts and feelings about having IBS. They wrote for 30 minutes on four consecutive days.

Expressive writing was found to improve IBS severity and cognition in participants with longer-term duration of IBS. More studies are needed to confirm the potential for using this method in IBS treatment, but these preliminary results are hopeful.

It turns out that expressive writing has been found to be beneficial for a number of health conditions, like depression, rheumatoid arthritis, high blood pressure, chronic pain, chronic infection, and even length of hospital stay. How cool!

So, this week, if you are suffering from a chronic illness (especially IBS) take 30 minutes out of four days in a row to record your thoughts and feelings about it. Here is an excerpt from the instructions used in the study:

“…Feel free to really let go and explore your very deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends, or relatives, to your past, your present, your future, or to who you have been, who you would like to be, or who you are now…”

So get out a pen and paper (or your laptop) and let it all out. It may just make you feel better in the long run.

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If you’re reading this blog, chances are good you’ve heard of probiotics. Probiotics are beneficial bacteria that are known for supporting digestive and immune health. From my perspective, probiotics are as important as a daily multivitamin and have many healing properties. I have seen so many people get well while taking probiotics.

When people think of probiotics, the first thing that comes to mind is usually yogurt. It’s true that all yogurt is cultured with probiotics, but not all yogurt contains live cultures in the finished product. This is because yogurt must be pasteurized, or heated, to kill off potentially pathogenic bacteria. Unfortunately, this also kills off the beneficial bacteria the yogurt was cultured with. Some yogurts do contain live cultures that are added back in after pasteurization. Next time you buy yogurt, be sure to look for the “live cultures” label.

The limitation of yogurt, however, is the amount of probiotics in yogurt—it’s low. It may not be enough, especially if your gut is out of balance. Unless you want to eat a gallon of yogurt each day, a probiotic supplement is best.

A recent study found that a high-potency (450 billion), multi-strain probiotic was able to ease irritable bowel syndrome (IBS) symptoms in children and adolescents who took the supplement for six weeks. This is a very high dose, but it can take that much (even in children) in certain conditions to rebalance the gut.

On the other hand, a lower dose (even that found in yogurt) can be beneficial for certain health concerns. Another recent study found that a particular probiotic yogurt containing Lactobacillus acidophilus and Bifidobacterium lactis decreased cholesterol and increased HDL (“good”) cholesterol in women when eaten for six weeks.

It’s a fact: Bacteria are everywhere. It’s just a matter of striking the right balance. Yet another study found that household dust even contains up to 1,000 different microbe species per gram! (No wonder no one likes to dust!) We can only do so much to reduce our daily exposure to harmful toxins and pathogens, but we can do a lot to improve our health by choosing the right foods and nutrients to optimize the body’s functions.

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Irritable Bowel? Diarrhea? Painful gas and bloating? This might come as a surprise, but as many as one in every five Americans suffers from IBS or some other intestinal disorder—and just like you they’re searching for relief. But conventional medicine may not always be the answer, especially if doctors aren’t looking deeply enough to get to the root of the problem!

Tomorrow on the Poop Scoop I’ll be talking with leading gastroenterologist and nutrition expert Dr. Leonard Smith to learn more about irritable bowel syndrome and other digestive conditions. Learn why IBS is what some physicians call a “catch-all” diagnosis and what that means for you, and join us as we take a look at the many causes of digestive distress (some might surprise you!) and the natural solutions that can help you get your insides back on track.

Log on and listen to Brenda’s Poop Scoop LIVE every Wednesday from 4-5 pm (EST) right from your computer. Missed an episode? Visit the Episode Directory on my website and listen to past shows from the archive!

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We all know how uncomfortable constipation can be, so imagine what it must feel like for little kids…ugh! That’s why a recent study published in the American Journal of Gastroenterology caught my eye.

The study suggests that a combination of two things may be involved in higher incidences of constipation in children: 1. introducing gluten in the first year of life, and 2. an allergy to cow’s milk.

This is not surprising when you consider that the digestive tracts of infants are still very sensitive, especially in the first months of life. Not only that, but their immune systems are weaker, which means they are more susceptible to pretty much everything.

So the bottom line? When it comes to little tummies, it’s better to wait on the gluten and cow’s milk until they are more ready to handle it. And yes, some children may eat it and be fine (or appear fine), but I say better safe than sorry! There are plenty of substitutes for gluten and cow’s milk these days, even for infants.

All this is important because childhood constipation has been linked to irritable bowel syndrome (IBS) in adults, so if your child has chronic constipation, be sure to take a look at his or her diet. Other dietary factors to think about are fiber intake (since fiber helps promote regular bowel movements) and intestinal balance. In babies who are not breast fed, who were delivered by cesarean section, or who have been treated with antibiotics, there is a greater risk for an altered intestinal flora balance, so a daily probiotic supplement may be helpful in these situations.

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