I have been arguing that, based on the existing evidence, more than 150 million Americans, or around 50% of the population, have small intestinal bacterial overgrowth, SIBO. Take, for instance, the 100 million Americans with fatty liver. Studies have demonstrated that 50% of people with fatty liver test positive for SIBO–that’s 50 million people right there. How about the 60-70 million people with irritable bowel syndrome? Studies vary, but approximately 40% test positive for SIBO, adding another 24+ million people to the list. Add up the number of people who test positive for SIBO who are type 2 diabetics, obese, have an autoimmune condition, food intolerances, restless leg syndrome, psoriasis, rosacea, a neurodegenerative condition, etc.—you can see we are talking about huge numbers of people.

In SIBO, with trillions of microbes living and dying every few hours in all 24-feet of small intestine, a large quantity of their cellular components are released upon microbial death, especially a toxic compound called endotoxin. Because the small intestine is, by design, very permeable, since that is where amino acids, fatty acids, vitamins, and minerals are absorbed, endotoxin flooding the small intestine is able to penetrate the small intestinal wall and enter the blood stream: endotoxemia.

Endotoxemia is responsible for a breathtaking amount of health problems across numerous diseases. Recognize this phenomenon, however, and you have been given the ticket to impressive power over your health.

So what can you expect when you correct this situation of SIBO and endotoxemia? This long list includes:

• Reduced blood pressure
• Reduced insulin resistance and thereby reduced risk for coronary disease, fatty liver, high triglycerides, low HDL, small LDL, cognitive impairment, breast cancer
• Weight loss, especially from abdominal visceral fat
• Reduced depression, suicidal thoughts
• Reduced potential for heart rhythm disorders
• Reduced severity of congestive heart failure
• Reduced arthritis pain
• Reduced risk for diverticular disease and colon cancer
• Reduced risk for Crohn’s disease and ulcerative colitis
• Reduced risk for irritable bowel syndrome
• Reduced risk for restless leg syndrome
• Reduced potential for food intolerances to FODMAPs, nightshades, fructose, histamine-containing foods, legumes, nuts
• Reduced risk for neurodegenerative conditions
• Slowing of many of the phenomena of aging

Those are among the most common benefits—there are more.

Where do you start in order to reduce or minimize the effects of endotoxemia? Start by correcting SIBO. My recipe for SIBO Yogurt would be an excellent starting place, as this has so far outperformed every other strategy in the last 50 people who have consumed the “yogurt” for a minimum of 4 weeks. Omega-3 fatty acids and vitamin D of my basic programs contribute to a reduction in endotoxemia. Here are some other strategies that, once SIBO eradication is underway, stack the odds further in your favor by both inhibiting proliferation of fecal microbes in the small intestine and fortifying the intestinal barrier against endotoxin:

• Continue intermittent consumption of the SIBO Yogurt-–since L. reuteri and L. gasseri, in particular, are keystone species that colonize the small intestine and, via bacteriocins, inhibit re-ascendence of fecal microbes into the small intestine. Even better, continue intake of Bacillus coagulans, also, as it expands the range of microbes inhibited.
• Frequent consumption of fermented foods—Kefirs, kombucha, kimchi, other fermented veggies, etc., “cross-feed” beneficial species via metabolites such as acetate and lactate.
• Consumption of prebiotic fibers and other microbiota-accessible carbohydrates: inulin from onions and other root vegetables, galactooligosaccharides from legumes, hyaluronic acid, others.
• Clove Green Tea (recipe in Super Gut, page 246)—The eugenol of clove thickens intestinal mucus, green tea catechins cross-link mucin proteins in mucus that convert it from a semi-liquid to a semi-gel, while the inulin/FOS blooms Faecalibacterium and Akkermansia that also support a healthy intestinal barrier. Clove Green Tea is especially helpful early in your SIBO management/eradication efforts.
• Dietary components—Factors originating in whole foods, such as polyphenols, resveratrol, and capsaicin (a component of hot peppers) add modestly to these effects.
• Probiotics—The only probiotic I would recommend for this effect is BiotiQuest Sugar Shift. Here is one study demonstrating reduction in endotoxemia.

And, of course, avoid factors that increase entry of endotoxin into the bloodstream or encourage growth of fecal microbes: emulsifying agents, preservatives, chlorinated drinking water, polyethylene glycol (bowel prep for colonoscopy), N-acetyl cysteine, the gliadin protein of wheat and grains, herbicide and pesticide residues in food, food genetically-modified to be resistant to glyphosate (corn, soy), non-steroidal anti-inflammatory drugs, stomach acid-blocking drugs. Sadly, take this conversation to John Q. Primary Care and you will receive blank stares, indifference, or the “Did you consult Dr. Google again?” comment. In the majority of cases, you cannot rely on your doctor to tackle this enormously important aspect of health—it is up to YOU.

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