Those of you following my conversations here on the blog, or Defiant Health podcast, or my latest book, Super Gut, already know that I have been arguing that a huge number of Americans have small intestinal bacterial overgrowth, SIBO. This is based on the clinical studies that ask:

In condition __________, what proportion test positive for SIBO?

(With testing via H2-breath testing or endoscopic aspirate analysis.)

If we insert “obesity” into the blank, clinical studies have documented that around 50% of the 110 million obese Americans will test positive, or around 55-60 million people. If we insert “irritable bowel syndrome,” around 40% of the 60-70 million Americans with this condition will test positive, or 24-28 million. Of the 13 million Americans with fibromyalgia, 100% will test positive. Add up the numbers for restless leg syndrome, fat malabsorption, food intolerances of various types, type 2 diabetes, autoimmune conditions, neurodegenerative disorders, depression, anxiety, skin conditions such as psoriasis or rosacea, etc. and you can easily exceed 150 million Americans with infestation of the 24-feet of small intestine with fecal microbial species.

Take the same studies and look at the proportion of “healthy control” participants, i.e., participants enrolled with no overt symptoms or signs of SIBO–no bloating, diarrhea, abdominal discomfort, no gastrointestinal conditions, and none of the conditions listed above—and what proportion test positive for SIBO? It varies from study to study, depending on the population (age distribution, sex, geographic location,. socioeconomic status and other factors) and testing methods used, but it is common that 10 to 40% of the control population also test positive. In this study, for instance, looking at H2-breath positivity in participants with Parkinson’s disease vs. healthy controls, 54.5% of those with the disease tested positive while 20% of healthy controls tested positive. In other words, in this and similar studies, a substantial portion of people who appear healthy have SIBO, i.e., infestation of the 24-feet of small intestine with fecal microbial species.

Why is this important if the asymptomatic person has no diarrhea, bloating, or other bothersome symptoms? Well, let’s consider what can happen if SIBO is present but is not recognized and thereby not addressed. Among the consequences of having SIBO but failing to manage it include:

  • Weight gain—especially in abdominal visceral fat, the source of many health problems through insulin resistance and inflammation.
  • Insulin resistance–the process that leads to pre-diabetes, type 2 diabetes, coronary disease, cognitive decline and dementia, various cancers, and other conditions.
  • Diverticular disease—that leads to diverticulitis that can result in abdominal abscess formation, prolonged antibiotics, and partial surgical removal of the colon.
  • Colon cancer—It is becoming clear that colon cancer begins with a disrupted gastrointestinal microbiome with changes that include infestation by species such as Fusobacterium nucleatum, Prevotella copri, and others.
  • Non-alcoholic steatohepatitis—i.e., the more advanced form of fatty liver. It begins with liver de novo lipogenesis that converts dietary carbs to triglycerides that accumulate in the liver. Then the endotoxin that originates with SIBO species empties into the portal vein draining to the liver, triggering inflammation superimposed on the fat accumulation: steatohepatitis.
  • Mental health issues—that include depression unresponsive to conventional therapies, suicidal thoughts, anxiety, anger, hate, etc. You might say that SIBO brings out the worst in humans.
  • Sleep disruption—Insomnia, interrupted sleep, nightmares, restless leg syndrome. SIBO also worsens the phenomena associated with sleep apnea.
  • Autoimmune conditions—Likelihood of Hashimoto’s thyroiditis, Sjögren’s syndrome, rheumatoid arthritis, autoimmune gastritis, type 1 diabetes and other conditions is increased in the presence of SIBO.
  • Neurodegenerative conditions—Once a neurodegenerative condition such as Parkinson’s disease, Lou Gehrig’s disease, multiple sclerosis, or Alzheimer’s dementia appears, a lot of damage has already been done. Get to this point and even correcting the SIBO causing or worsening the condition will only be modestly helpful. Early intervention before neurological deterioration sets in is key.

There’s more, but I hope you get the point. In my view, everyone should be screened for SIBO using, for example, the AIRE device. Or the doctor should explore with a simple H2-breath test in a lab or clinic. Unfortunately, because it typically requires a generation for practicing physicians to catch up with the science, if you wait for your doctor to become educated, it will be 2040 or 2050 before your doctor takes appropriate action. (I even had a very busy and popular primary care physician tell me recently that “There is no such thing as SIBO,” clearly unaware of the hundreds, perhaps thousands, of research studies exploring this issue.)

Another pathway: Because my SIBO Yogurt has been so incredibly effective in normalizing breath H2, i.e., eradicating SIBO, as well as preventing recurrences when consumed chronically, I believe that it would be reasonable to simply restore the keystone microbes provided by the SIBO Yogurt: Lactobacillus reuteri, Lactobacillus gasseri, Bacillus coagulans. Recall that the SIBO Yogurt recipe is based on restoring lost keystone microbes that 1) colonize the small intestine, and 2) produce bacteriocins effective against the species of SIBO.

Don’t pay the price of your doctor’s ignorance or your fear of knowing the truth. If the solution can be as simple as something that looks and smells like yogurt (it’s not yogurt, of course), then you have the ability to take back control over a huge swath of health issues.