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Why SIBO Treatments Fail So Many People (Part I)-Co-infections, Cortisol, Blood Sugar and More

(SIBO) Small Intestinal Bacterial Overgrowth

SIBO (small intestinal bacterial overgrowth) is an imbalance of the microorganisms in your gut that maintain healthy digestion. When too many bacteria, or the wrong kind, populate the small intestine, it can lead to uncomfortable symptoms such as gas and diarrhea. It can also inhibit your ability to digest and absorb nutrients from food.

Part 1 WHY SIBO Treatments Fail

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Part I
11 Reasons You Can’t Rid of  SIBO-(reasons 1-5)

Hi I’m Dr Hagmeyer and I want to welcome you my website or my YouTube video channel depending on where you are watching this.

Today’s video is part of my “Everything you want to know about SIBO video series” this is a two part video within the series.

Several weeks ago, I was asked If I could put together a video on the most common reasons Why SIBO Treatment Fail.

So this is it. If you have SIBO- you might be realizing at this point that there is much more to SIBO than what you once thought.

The reason why SIBO is so difficult to get rid of is that there is a long list of causes behind SIBO including medications as well as certain health problems.

SIBO is just the tip of the Iceberg- Whats Causing SIBO?

If SIBO is just the tip of the iceberg- then we need to ask ourselves, “What else is going on under the water’s surface?”, “What are some of the root causes” that doctors who work with patients who have SIBO need to consider, for the successful treatment of SIBO?

So in today’s video, I want to share with some of the most common reasons why people who have SIBO- why they relapse, why treatment fails, and what are some of things that might make the difference for you.

So let’s jump into reason #1

1. You have a co-infection

SIBO is often found in conjunction with many other kinds of infections- When you start testing for these infections it is no surprise when we find them- it is also not uncommon to have more than one co-infection at the same time.
One of the most common SIBO co-infections is something called SIFO (small intestinal fungal overgrowth), another common co-infection-would be things like H. Pylori, Epstein Barr Virus, Klebsiella, Cytomegalovirus and sometimes even parasites like hookworm, pinworm, giardia, C.Diff etc Sometimes a person all has a history of Lyme Disease.

So if you tried SIBO Antimicrobials, rifaximin, or xifaxan and it didn’t work, it could be that you have other infections going on as well and the medication or the co-infection is not sensitive to the therapeutic intervention.

Not that long ago, a patient consulted my office with SIBO, when we ran some additional testing on her, it turned out that she had several of these co-infections present.

Once we identified these co-infections, we were able to target them very effectively and her SIBO improved very quickly. So moral of the story here is that If you have parasites or other pathogens and you don’t address them. Trying to solve SIBO, may be very slow going.

The name of the game is to figure out which co-infections you need to tackle first and why. I like to use this test for detected parasites, and many of the co-infections

2. You have Insulin Dependent Diabetes/Prediabetes/Syndrome X, Metabolic Syndrome and Don’t know it.

1 in 3 people have a blood sugar problem in the Unites States. Now you might be thinking why blood sugar is important if my problem is in my gut. This can be related to cortisol which I will talk about in just a minute, but both acute and chronic (high sugar blood sugar) can lead to GI complications.

70% of diabetic have and complain of GI problems. That’s a huge number.

Diabetes and Prediabetes (Insulin resistance) is a systemic disease that means they affect many organs, tissues and systems in your body, the GI tract is no exception.

The longer you have blood sugar problems or dysglycemia, the greater and more severe GI problems you will suffer with.

Many GI complications of diabetes and Insulin resistance seem to be related to problems with nerves supplying the gut. Just as the nerves in the feet can be affected in peripheral neuropathy (tingling, shock like sensation, numbness, clumsiness in the feet), involvement of the intestinal nerves may lead to enteric or GI neuropathy.

Different nerve fibers can either stimulate or inhibit intestinal motility and function, and if you have damage to these nerves, affecting motility- it may be one of the reasons bacterial overgrowth has developed.

The other thing to realize is that excess sugar in the blood or poor utilization of sugar as in the case of pre-diabetes- does two things-

#1 Sugar feeds bacteria and yeast giving rise to SIFO (small intestinal Fungal Overgrowth) and
#2 sugar suppresses the immune system.

So good luck trying to overcome an infection- if you are supplying it with a steady stream of food. The important point here, is that you don’t have to be a full blown diabetic to have SIBO.

I have many patients who are pre-diabetic who have SIBO as well. And when you correct one, you see improvement in the other. I have even seen improvement in Insulin requirements.

If you are a person who gets irritable if you don’t eat, you feel fatigued after you eat, you have increased thirst, you experience frequent fatigue, you have brain fog- even if your diet is “clean”

I suggest you track your fasting blood sugar levels with a glucometer- these can be picked up in any pharmacy. You want a morning fasting levels less than 100.

Any level greater than 100 and you are moving towards insulin resistance and you should then follow up with more specific testing to evaluate a potential blood sugar problem.

If you have these symptoms that I just mentioned- you should follow up with a doctor who can run the kinds of tests that will flush out any sugar problems as potential SIBO contributors.

#3. Reason why your SIBO is difficult to overcome- comes down to cortisol dysregulation-

Cortisol is released in times of stress. That stress may be from an Infection, inflammation or from fluctuating blood sugar.

It might be caused by a stressful work environment or stressful home life. Concerning the link between stress and gastrointestinal diseases, I think many people are becoming increasingly aware of the fact that the Brain and the gut are intimately connected.

It is well known that exposure to not only acute stress but also prolonged stress will lead to many different symptoms within the gastrointestinal tract…. things like bloating, constipation, diarrhea or abdominal pain.

Various studies show that stress can affect the gut in many ways. If you look here at this illustration you can see the different parts of the GI system most easily influenced.

1- Stress can lead to problems with Gut motility, Secretion of digestive enzymes, visceral sensitivity or heightened awareness to pain, stress can change the blood flow to the mucosal tissues (where the immune system is housed)
2- Stress will changes the kinds of bacteria in the gut and studies done at Cornell and Harvard show that people under acute or prolonged stress will have more C.diff in their gut to decease in certain beneficial bacteria.

3. Finally stress causes a leaky gut. And this should all makes sense when you think about right? When you sit down to eat- you don’t want to be in a sympathetic Fight/Flight state- this is not good for digestion.

You want to be in a Parasympathetic state- Your Digestive system is most active when the parasympathetic nerve system is dominating. Another-words- The nerves in your gut, do their best job when under the parasympathetic state.

Earlier, I said blood sugar stability is connected to adrenal glands here’s why- fluctuating blood sugar levels as in the case of diabetes, pre-diabetes is a major stressor on your body and any time we stress the body-we are activating our Sympathetic Fight/Flight state– the more stress we have, the more we slow down digestion.

So if you are inflamed, infected or have fluctuating blood sugar, you need to get these under control and yes there are tests that show if you have any of these things.

I prefer to use salivary cortisol testing to understand the interaction between the adrenal glands and the gut.

Moving along to the 4th reason why your SIBO is difficult Shake is that it could be your thyroid replacement.

Many people with SIBO have a thyroid problem. In fact if you have SIBO, I highly suggest you get a full thyroid panel done and don’t settle for only the TSH and T4 test.

A study came out in World Journal of Gastroenterology back in Feb of 2017- this study showed that levothyroxine therapy is strong contributor to SIBO- we know that Thyroid problem can be exacerbated by gut problems.

But this was the first study that I came across linking the medication as a cause of SIBO. So if you have fatigue, depression, weight gain, anxiety, feeling cold all the time you may have an undiagnosed thyroid problem and if you have already been diagnosed with a thyroid problem and you are taking thyroid replacement (Thyroxine) your medication could be causing SIBO

I did a video a while back on SIBO and its connection to Hypothyroidism I suggest you go back and watch that if its of interest. I also did a video talking about the Medications that cause SIBO, Leaky Gut and gut Disbiosis.

You can watch that as well if interested. I don’t know which came first- the GI/IBS/SIBO problem or the Thyroid problem- but one thing I can tell you is that- when you improve or fix one area, the other area also often improves.

#5- Dietary Mistakes.

4 Mistakes People Make on a Low FODMAP diet-

This is a huge area for discussion, so I am only going to hit the 3 or 4 major areas that I often see problems in-
#1 You are not eating Low FODMAP diet at the right time during your SIBO protocol
#2 Your Low FODMAP diet needs to be tweaked based on your individual food sensitivities- You need to be tested here- following a Low FODMAP list is not enough.
#3 You lack consistency with the Low FODMAP diet or you have food sensitivities above and beyond low FODMAP
#4- Relying on low FODMAP diet to correct the problem- A low FODMAP diet is only 1 piece of the SIBO puzzle
People often think that just because they have SIBO, they just have to follow a low FODMAP diet that they downloaded off the internet and call it day.

Here again- diet is only the tip of the ice berg- a person with SIBO may also have histamine intolerance, they may have a gluten sensitivity, you may even be sensitive to food that are very similar to gluten- we call this Gluten Cross Reactivity

You may have a leaky gut, You may have a problems with fermented foods and Lectins and many other food additives  that are sometimes permissible on a low FODMAP diet.


You could be that perfect patient following a low FODMAP diet to the T- but many times you are reacting to those Low FODMAP foods- this is why food sensitivity and sometimes food allergy testing is needed.

Another words, just because on paper it says you can eat those foods, does not mean that you immune system is not reacting to those foods on the inside.

This is something I wish more doctors and patients understood. So consider that if a LOW FODMAP diet just isn’t working out as well as you had hoped you should consider these things that I just mentioned.

Don’t be discouraged by this- just understand that when it comes to food, there are many possible scenarios that you or your doctor could be missing. This is where you should work with a doctor and functional nutritionist who understands these finer points.

One more thing I want you to be aware of when it comes to SIBO and diet is that you could be eating Low FODMAP at the wrong time and what I mean by eating them at the wrong time is this.

If you are eating a low FODMAP diet when you are trying to kill the SIBO bacteria, it might be counterproductive- The rationale behind this is that you want the bacteria to be active and present, so that the antimicrobial or anti-fungal/ anti yeast protocol can work.

Eating foods that are high in FODMAPS is like throwing a party for the bacteria…. you are coaxing them out and inviting them to lunch and then POW you are hitting them with your Antimicrobial/Anti-fungal/Antibacterial protocol.

So again these are some of the finer points- These are some of the strategies I use and I think these are some of the reasons we have the success that we do.

So that’s going to wrap up todays video I want to leave just a couple last thoughts reminders

#1 Remember SIBO is not an infection like strep throat- if all you think you can do is a take an antibiotics, or some antimicrobials, go on a low FODMAP diet and take probiotics- chances are you are going to be in for a major disappointment.

#2 Cortisol levels, fluctuating blood sugar levels all take a toll on the GI tract as does stress from work, home and school.

#3- SIBO is a challenging disorder for many reasons and it’s important that whoever you work with, that they understand the BIG picture when it comes to treating your SIBO and they can identify the finer points of a treatment plan that need attention.
#4 This medical journal sums up the treatment philosophy of SIBO fairly well- Therapy for SIBO must be complex, addressing all causes, symptoms and complications and be fully individualized.
Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO

Unfortunately, for the patient- the patient fails to receive the proper treatment, proper testing and the proper management….. which in the long run leads to a more difficult/resistant case of SIBO.
I hope that is not happening to you.

I hope you learned a few new things, if you liked today’s video, be sure to share it with your friends and loved ones who might be having a difficult time with their SIBO and one last thing- In part II of this video series we will review 6 more reasons, you can’t shake SIBO and what you can do to improve your outcome. Be sure to check out some of the other videos in this- Until next time, Take care.

Our Personal SIBO Recovery Program is a Great place to start

The Personal Program IBS/SIBO/SIFO Recovery Program is a Natural Treatment for IBS and other GI related problems.
Our office implements Advanced Functional lab Testing, Natural Medicine/supplements as well as nutritional counseling tailored specifically to you.

We’re here to listen and help you through this frustrating and confusing time.

The Missing Piece in Treating SIBO- Prokinetics 1

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