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Why SIBO Treatments Fail- (Part 2) Biofilms, Prokinetics, IC valve and More

Part 2 Why SIBO Treatments Fail for So Many People

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Hey everybody welcome back to part II of our video on 11 reasons why SIBO treatments fail.

Just as a reminder, this is part of my “Everything you want to know about SIBO video series” so if you are just tuning in, I want you to know that there is about 9 or 10 other videos in this series that are worth checking out. You can see them listed for you at the bottom of the page.

With that being said, You may remember in the first video we talked about the first 5 reasons- “Why you cant get rid of SIBO” Why its difficult to treat, why it relapses. Today we are going to talk about 6 more reasons why SIBO can be so challenging.

When you consider all of these things- it might seem daunting to tackle SIBO- and in some cases it can be. But, I promise you that your chances of success SIBO treatment drastically improves when you approach this with a plan, a road map and you are methodical about the process.

SIBO Requires An Understanding Of What I Call The “BIG PICTURE.”

If you do this, you will have the best chance of overcoming even the most challenging cases of SIBO. That I promise you! So in part II of today’s video we are going to dig a little bit deeper. If you missed part I you can go back and watch it here

Today I want to go over things like

  1. Biofilms,
  2. Probiotics and prebiotics,
  3. Vagal tone-Brain Gut Connection
  4. Ileocecal valve and its role in SIBO development
  5. Autoimmune disease.
  6. Unrealistic Expectations

If your IBS is the kind where you have either IBS-constipation or you have IBS-mixed or if you already had a breath test and you are methane dominant-if any of these are you- I want you to pay very close attention to the possibility of a biofilm.

A Biofilm is a collection of microbes (bacteria, yeast, archae) that stick to a surface, they wall themselves off with a very sticky protective coating called an EPS matrix.

The biofilm life cycle illustrated in three steps: initial attachment events, the growth of complex biofilms, and detachment events by clumps of bacteria or by a ‘swarming’ phenomenon within the interior of bacterial clusters, resulting in so-called ‘seeding dispersal.’

The purpose of the microbes forming this biofilm is to protect themselves from things like antibiotics, herbal antimicrobials and even our body’s immune system.

If you have undergone treatment and you don’t feel better or you have infections that you can’t shake and they keep coming back- I would consider biofilms.

If this topic of biofilms interests you, I dedicated an entire video on this topic where I review what a biofilm is, how to naturally break down biofilms, some of the mistakes people make when taking biofilms, some of the scenarios that make me think Biofilms are a problem and finally some of my favorite biofilm disruptors.

Biofilm Disruptors

  1. Interfase plus
  2. NAC
  3. Lumbrokinase
  4. Nattokinase

You can watch the video I did on SIBO and Biofilms 

When To Get tested for SIBO-10 Most Common Signs of SIBO (Small Intestinal Bacterial Overgrowth) 2

Reason #7 Why SIBO Treatments Fail- Your treatment plan is missing a Prokinetics or you haven’t found the right Prokinetic for you.

A prokinetic or prokinetic agents are substances that increase gastrointestinal motility or cleansing waves by stimulating the strength or the frequency of contractions in the small intestine.

Prokinetics can also can stimulate stomach contractions causing the emptying of the stomach contents.

Sometimes motility of the intestines can, for a number of reasons, go off-track; sometimes the muscle contractions don’t happen as frequently as they should, sometimes they aren’t strong enough or sometimes they just don’t last long enough.

This is where prokinetics can help. Now, there are natural prokinetics and there are drug based prokinetics.

Drug based or pharmacologic prokinetics are things like Low dose erythromycin, LDN or Zelnorm, there are few others but those are the big ones that are often prescribed.

There are many natural prokinetics some of my favorite include Motility Pro, Ginger,  5HTP, Cape Aloe, Ayur-Triphala, Artichoke Leaf Extract.

I find prokinetics super important for those patients with methane predominant SIBO as well as patients with Mixed IBS (Constipation and Diarrhea)

The big thing to take away about prokinetics is that they stimulate or reset the Cleansing waves, and this is one of the major pieces in conquering IBS/SIBO.

If you want more information on prokinetics and the ones I use in my office with good success, I will leave a link in the description of today’s video and you can go back and read more about my favorites.

One other thing, if you haven’t see this video yet, I highly suggest you watch it because people who take prokinetics are doing it all wrong. I go over a few of the mistakes people make.

Reason #8 Why SIBO Treatments Fail- Autoimmune IBS

The next reason why SIBO can be so stubborn to shake and a huge challenge for some people (and this one is a more serious complication) this one is where you have Autoimmune IBS/SIBO.

10 years ago we didn’t think of IBS as being potentially an autoimmune disease- that is all changing!

If you suffer with Chronic Diarrhea, IBS-D, You may want to watch this video

It didn’t fit the criteria of other GI autoimmune diseases. After getting a colonoscopy and ruling out things like Celiac disease, Crohn’s and Ulcerative Colitis- if you didn’t have any of these- your doctor diagnosed you with IBS and said have a nice life- Eat more fiber, take your Metamucil, take your Imodium AD, and that was it- come back and see me in a year for another colonoscopy.

So for years you lived and suffered with the diagnosis of IBS- which is really a diagnosis of exclusion- you don’t have and inflammatory bowel disease- and your GI doctor can’t find anything wrong structurally so you must have IBS.

But, recent research is showing that some patients who have IBS or SIBO have immune mechanism that has gone haywire.

You have autoimmune IBS – this is in part thanks to the work done by Dr Mark Pimantel.

To determine if your SIBO/IBS has an autoimmune piece you need a special test that is looking for antibodies against Vinculin which is a cytoskeleton protein and you also need a test that looks at a toxin called Cdt-B.

This toxin is made primarily by E.coli, Salmonella, Shigella or Campylobacter. All of these bacteria produce a common toxin which can be measured.

These toxins have a major role in causing a breakdown in the tight junction- this is you leaky gut if you have ever heard of this- but these toxins also weaken the epithelial cell lining.

The overwhelming majority of people who are diagnosed with IBS are people who developed IBS after an episode of gastro-enteritis with the bacteria that I just mentioned.

So if you can recall a bout of food poisoning and your bowel movements were never the same after that infection, then it is possible that your IBS has an autoimmune component. I find this test especially helpful for patients who have already been diagnosed with IBS-D or IBS-M.

The studies that have been done so far show that this test not only confirms post-infectious IBS-D and IBS-M but that it has a 90% specificity.

What that means for you is that 9 out of 10 times if this test comes back positive- you can also bet that part of your problem was due to a post infectious event.

Here’s what happens in Everyday terms..

Lets say you go to a friend’s house for a dinner party, and some of the meat you just ate was contaminated with bacteria- Salmonella, E.coli, Shigella, Camphylobacter- you go home and you spend the next day or two on the toilet having things come out of you that you never knew lived there!-

Maybe you go to the doctor, maybe you don’t- if you don’t, lets say (because you are feeling better), life goes on and within a few days you are back to your usual routine and the daily stressors and grind.

Months later, you develop symptoms of IBS. Well….. those same bacteria (Salmonella, Shigella, E.coli, and Camphylobacter) will produce toxins (cytolethal distending toxins) is one of those toxins. – Your body naturally produce antibodies against these Cytolethal Distending Toxins- We can measure these!

Now……Because they toxins are very similar to the tight junctions or proteins in the mucosal lining of your intestines, which is what you see here in this illustration your immune system begins to attack the proteins of your body and begin to attack your gut barrier leading to a leaky gut.

But the story doesn’t end here…….. this is not why you end up with soft, mushy loose stools. These antibodies can cross react with another protein- one that regulates the activity of the Migrating Motor Complex- this protein is called Vinculin.

When the immune system attacks this protein, it shuts down the migrating motor complex or the MMC for short.

I talked about these cleansing waves in the video titled “Getting relief from Diarrhea” but these waves are absolutely critical in maintaining a clean small intestinal environment.

Vinculin is the connection between the MMC (migrating motor complex) and bacterial overgrowth.

If you test positive for antibodies against vinculin- this is one of the reasons why you have bacterial overgrowth.

Reason #Why SIBO Treatments Fail is Low Ileocecal valve pressure.

You have probably heard of a leaky gut, but have you heard of a leaky ileocecal valve.

Many studies have been done looking at the connection between low Ileocecal valve pressure and its connection to SIBO.
The research is pretty clear that a problem with the ileocecal valve contributes to SIBO-

There are several structural causes of SIBO and Ileocecal Valve Dysfunction falls under the category of a structural problems.

So what is the ileocecal valve and why is it so important- I want you to look at this picture, the Ileocecal Valve separates the small intestines from the large intestines. The main job of this valve is to prevent backflow of material from large intestine back up into the small intestine.

In a healthy bowel, this valve is closed the majority of the time and it opens when pressure is applied by the contents in the small intestine.

When there is low pressure- the valve stays open and allows bacteria in the large intestines to migrate up into the small intestine- (which is the very definition of SIBO) Remember we don’t want bacteria from the large intestines coming up into the small intestines.


ileocecal Valve and Its Connection To SIBO 1

Things go down and out, not up. If a person tests positive for a Hydrogen Breath Test the bacteria that produce hydrogen will keep the valve open, allowing the bacteria to migrate upwards.

This is why frequent bloating will also cause bacterial overgrowth due to the effects of the valve remaining open.

So how do you know if you have a problem with the ileocecal valve?

You can get a colonoscopy or you can swallow a wireless motility capsule (WMC) to confirm this, but there are a couple of symptoms that most likely indicate it as well.

Learn more about the Ileocecal valve and its relationship to SIBO/SIFO

Three scenarios that could indicate you have a problem with the ileocecal valve.

1. Do you feel pressure under your ribs, or pain to the right of your belly button and angled about 45 degrees-
2. Do you have back pain or pain that wraps around the right side of your back?
3. Do you have right shoulder pain while this could also be a gall bladder problem it may be the ileocecal valve.

If you answered yes to any of these- go watch my video on, “How to release the ileocecal valve” through a self-massage technique.

This is something you can have someone in your home help you with and if your not comfortable with doing this yourself or if doubt the skills of a friend or loved one- you can always call around to the local massage therapists, PT, acupuncturist, Osteopath, or Chiropractic office and ask if they have experience with this. Very simple!

Reason #10 Why SIBO Treatments Fail- Poor Vagal tone


















Physical stress, chemical stress and emotional stress can affect vagal tone- and the Vagus nerve is one of the most important parasympathetic nerves involved in GI motility.

Nerves carry signal back and forth from the brain to the organs of the body. The tone of this nerve sets the stage for inflammatory condition, high blood pressure, depression and all kinds of digestive problems.

A very common problem interfering with vagal tone are Past and present emotional stressors. Poor adaption to stress causing a condition called HPA axis dysregulation.

Ultimately, when you go into a fight or flight state-or a sympathetic dominant state you can’t sleep, you can’t think straight, you have brain fog, you are easily irritated, you find yourself jumpy at every little thing, the slightest noise startles you and after a period of time, if not corrected you find yourself drained and exhausted in life.

This Fight or Flight state- is not the state you want to be in if you have SIBO, or any other GI problems. You can’t digest food in a state like this.

Stress effects GI function in so many ways. If this is you, it is super important to work with a Functional Medicine Doctor evaluate your HPA axis through a saliva test and see what can be done to reset and balance your Nerve system.

Some things you can do that will help improve vagal tone include chiropractic care, acupuncture, Slow, Deep, Belly breathing, gargling, singing, meditation, Alternate nostril breathing, (plug up one nostril and breath through the other, then repeat on the other), humming and Increasing Heart Rate Variability through exercise.

Some studies are already showing the link between inflammation in the gut and brain inflammation like what we would see with patients who have Alzheimer’s disease, Parkinsons, Depression and dementia.

So this can be an important area that often gets overlooked in patients with SIBO. Balance between the sympathetic and parasympathetic nerve system.

Reason #11 Why SIBO Treatments Fail- Expectations.

Your expectations of healing SIBO must be realistic. I truly believe that the power of our mind influences how we heal so it’s important to not only to be positive and surround ourselves with positive people but along with maintaining a healthy mind set, we also need to have realistic expectations.

Eradicating SIBO can take a few weeks, but correcting “Why” the SIBO is there in the first place or why it keeps coming back can easily take 6, 12, 18 months. That why you need to look at the BIG picture.

It’s also not something that you treat one time with one round of antibacterial and you are done.

Correcting The Underlying Root Cause Of SIBO Can Take Time to Heal

My experience is that people with SIBO often need several rounds of treatment.

If you are one of those patients who has Thyroid disease, or PCOS, endometriosis, Lupus, Diabetes, Crohn’s, Depression, Fibromyalgia and you have a history of taking medications that are known to cause SIBO Medications like antibiotics, birth control pills, Thyroid medication, acid reflux blockers, antidepressants, steroids, pain pills, immune system modulators as in the case of RA, Crohns, all of these take a toll on your gut microbiome and so the longer you have been taking these medications, the longer your journey is going to be.

Focus on getting to the Root Cause of SIBO

So again be realistic and don’t compare your progress to your Facebook friends, or next door neighbor. What I find in many cases like this, is that rather than focuses on killing the SIBO and co-infections where some people with SIBO may first start treatment – You and your doctor many need to put an emphasis on gut healing, dietary changes, emotional stress in your life, detoxification and making some headway in repairing the gut lining.

It’s important to understand that SIBO doesn’t always responds to the Nukem mindset that is so pervasive in our culture.

Sometimes, we need heal and repair before we start killing. Another thing to keep in mind is that no two SIBO cases are alike.

Some cases of SIBO are harder to treat that others-

  • If you were tested for SIBO did you have a positive test for Hydrogen or were you positive for Methane?
  • Methane dominant SIBO, is more difficult to treat than Hydrogen.
  • What were your levels?
  • Did you get retested?
  • Did the levels come down from the initial test?

When you read about the person in you Facebook group that has SIBO and all they needed to do in order to get better was take some HCL, probiotics and follow a low FODMAP and you did all that but it didn’t work- don’t beat yourself up over this.

It’s easy to see how one can get depressed and frustrated and give up and then sinks lower physically and emotionally. This is a marathon race and the only one you are competing against is yourself. So hang in there!

I showed this article in our last video, but it’s worth mentioning again here. as I bring this video to a close. I want you to see what This medical journal says about the treatment of SIBO.

It sums up the treatment philosophy of SIBO fairly well- “Therapy for SIBO must be complex, addressing all causes, symptoms and complications and fully individualized”

Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO I couldn’t agree more.

What led to SIBO- Again whats the root cause?

I hope you enjoyed today’s video, I hope you found this information helpful. Please share it with your friends and loved ones or someone who might also be struggling with their health problems.
If you found this helpful encouraging and helpful comment below and be to subscribe to our channel. Until our next video, I’m Dr Hagmeyer take care. !

Our Personal SIBO Recovery Program is a GREAT place to start

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The Missing Piece in Treating SIBO- Prokinetics 1

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People Who Viewed and Watched Today Video Also Watched

  1. 10 warning signs you have SIBO & When To Get Tested
  2. Breath Kind Of testing for SIBO 
  3. Eradicate SIBO by incorporating Biofilm Disruptors
  4. SIBO and Prokinetics- The Missing Piece In Treating SIBO 
  5. Why SIBO Treatments Fail Most Of The Time-Part I
  6. Part 2 Why SIBO Treatments Fail Most Of The Time-Part II
  7. 4 Common Mistakes Made On Low FODMAP and SIBO Diet
  8. Feeling Worse After Taking Probiotics ? Learn Why
  9. Best Probiotics To take When You Have SIBO and When To Introduce Them 
  10. How Food Poisoning Triggers Autoimmune IBS-D
  11. What You Need To Know Before Getting Tested For SIBO
  12. 5 Food Additives You Should Avoid, If You Have SIBO
  13. Ileocecal Valve Release- Self Massage-How, When And Where To Massage Your Ileocecal Valve
  14. Why The Ileocecal Valve Holds The Key to IBS and SIBO- What It Is and Why It’s Important 
  15. Vicious cycle of Nutritional Deficiencies Associated With Low FODMAP and SIBO Diet
  16. SIBO/IBS And The Connection To Thyroid Disease
  17. Why Antibiotics May Not Be The Best Approach for SIBO
  18. Medications That Cause IBS, SIBO and Leaky Gut
  19. Studies Now Connect Fibromyalgia and Chronic Pain to Bacterial Overgrowth (SIBO)
  20. Dr Hagmeyer Explains Some of The Overlooked Areas or Causes of Diarrhea

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