“Bacterial overgrowth can cause an intolerance”

He bacterial overgrowth in the small intestine, known as sibois a little known and underdiagnosed disease whose prevalence affects up to 15% of the US population.

In Spain, more and more people discover that they have it when they find that it may be behind the cause of a intestinal dysbiosis, celiac disease, intolerance to fructose, lactose or Irritable Bowel Syndrome (YES).

Neither Social Security nor private insurers have enough specialists willing to detect a SIBO and do the pertinent analysis, although digestive and allergists are the ones who are most concerned.

Since most bacteria are in the colon and large intestine, having a SIBO in the small intestine (where digestion and nutrient absorption occurs) can lead to a host of disorders.

SIBO and food intolerances

He Dr. Blas Lopez Rueda, urologist, has been an expert in SIBO since his fructose intolerant daughter asked him to improve her health 6 years ago. He now runs several Facebook groups, a Youtube channel, and the Spanish Association of Patients with Food Intolerances. We talked to him about this health problem.

–What causes SIBO?
–SIBO occurs when bacteria from the colon proliferate into the small intestine, where they are not usually. The cause may be low acidity in the stomach or one low intestinal motility that prevents cleaning our intestine of food remains and bacteria so that they come out through the feces. And another cause may be the integrity of the ileocecal valve that separates the large intestine from the small one.

–Are many doctors still unaware of SIBO?
-Social Security does not contemplate this disease and people have to look for life. But thanks to the talks I give, more doctors are getting informed. We want to put the pathologies of food intolerances in Social Security; that’s why we support all arguments with scientific publications, even when we talk about herbal medicines.

–So there is no number of patients with SIBO?
–In Spain we put everyone under Irritable Bowel Syndrome, which we say affects 12-14% of the population. This would be about 5 million patients. But if we looked at these 40 different diseases, they would probably only be 1% of IBS sufferers. In this way, we are not diagnosing many other diseases.

How bacterial overgrowth is detected

–How is SIBO diagnosed?
–When we have many bacteria in the small intestine, they will ferment the food producing gases and substances that will give rise to bloating, bloating, diarrhea, nausea, vomiting, gas, reflux….

To assess whether a patient has SIBO, we do the lactulose or lactitol test. If there are bacteria in the small intestine, it will produce hydrogen or methane gases, or both. Based on this, we put the treatment.

Treatment for all three types of SIBO

–How do you combat the overgrowth of bacteria in the intestine?
-In hydrogen positive patients, would be the antibiotic Rifamycin or herbal mix perfectly studied in the US such as Fc-cidal and Disbiocide. You can also take only berberine (4 weeks 1,500 mg/day), a herbal antibiotic to combat candida, parasites, and regulate the microbiota. Or neem or ADP emulsified oregano oil in tablets.

But if the patient is very ill, all these botanicals are useful at the same time. There is a second type of SIBO, which is when the patient is methane positive. We will use berberine and allicin in high doses, herbaceous equivalent to the antibiotics Neomycin and Rifamicin. I also usually associate Atrantil with allicin, also for SIBO patients with hydrogen sulfide. And when there is SIBO of methane and candidiasis: Candibactin AR and Candibactin BR.

He third type of SIBO is that of hydrogen sulfide. Another thing is SIFO with candida at the level of the small intestine, which is addressed only with berberine, and LIBO, an increase in archaea in the large intestine.

–Can SIBO be improved with food?
–When I give drugs and herbs, I do not give prebiotics or probiotics. and put one FODMAP diet to reduce substances that can fermentespecially digestible and indigestible carbohydrates.

Another way to treat SIBO is with Elemental Dietwho does not use any medication but shakes with all the active ingredients, all the necessary macronutrients and micronutrients. They are already digested to be absorbed quickly, so as not to feed the bacteria and so that they die. But it does not work for candida.

–Anything that you recommend not to be left out?
-I use a lot 5HTP (a serotonin precursor, in patients with digestive disorders) and low dose naltrexoma (4.5 mg at night) as a prokinetic to encourage movement and boost the immune system.

Support for people with intolerances

–What mission do your Facebook groups have?
–Help to seek diagnosis or find the disease that produces your intolerances. Because when a doctor tells you that you are intolerant, they are not telling you anything at all. Fructose intolerance is not a disease, but a symptom of something that is causing your intolerance. And there are 40 diseases that can produce it.

–What diseases or factors can cause fructose intolerance?
–Many, such as fibromyalgia and interstitial cystitis; Therefore, they should be treated differently. It can also be produced by a SIBO, celiacparasites, methylation disorders, inflammatory bowel diseases, heavy metals…

One important thing that we know today is that everyone who is intolerant to fructose (between 5-6% in Spain) in turn has a microbiota disorder, an intestinal dysbiosis sometimes very important. So much so that if we cure the parasites and the damage, that patient improves.

An underdiagnosed problem

– Is it easy to find these diseases?
-It is not. You have to think about them. Doctors do not do things well and I say this very clearly. Many digestives do not know or believe that SIBO exists, just like the parasites, as present today as they were 40 years ago, although they are no longer endemic.

The Social Security tests give 70% false negatives, but in the new diagnostic techniques such as those of determination of antigens and PCRwe see that parasites are six times more frequent.

Thus they have become chronic, causing many problems such as fructose intolerancebecause they affect the intestinal microvilli, which is where the mechanisms of digestion and absorption of food occur.

Errors in the diagnosis of celiac disease

–Could there also be another pathology behind celiac disease?
–With celiac disease, very serious mistakes are being made, despite the fact that Health published a protocol for doctors in 2018. But they are not interested in it and many patients with food intolerance are also told that their symptoms have a psychological origin. The gastroenterologists at my own hospital also sent my daughter to the psychologist. In four months she lost 21 kilos; that’s why I had to learn.

– What is going wrong with celiac disease?
–The first thing is to rule it out as soon as the negative antibodies come out instead of following the protocol, which is to do a genetic test. Many patients are directly removed from gluten when there are other diseases that cause similar damage. But these protocol techniques are not established in Social Security hospitals.

–Furthermore, food intolerances are on the rise…
–We eat processed products with lots of harmful chemicals, pesticides, phosphates… We are not eating healthy, or seasonal, and we do not eat a spoon or eat the authentic Mediterranean diet. Some generations don’t even know it.

Where are SIBO tests performed?

–Are there enough laboratories in Spain to carry out these tests?
–We have the Institute of Microecology and Teletest for the microbiota; Calderón and Isomed for lactulose in SIBO; Calderón and Teletest for parasites. In the Valencian Community there is one of the best teams to detect parasites, but they have not even started it up.

The ideal would be to do massive sequencing in stool to analyze all the bacterial strains of the microbiota, but while in the US it costs $350, in Spain we only do PCR looking for the DNA of a certain number of bacteria. He nutrigenetics test and zonulin (to measure intestinal permeability) are made in Spain.

–How serious is the parasite problem?
–They are a very serious problem, just like Lyme disease, but good specialists are lacking. That is why I recommend that people put pressure on their doctors and demand that their hospital apply the protocols.

Theoretically there are two parasites that would be mandatory declaration according to the latest BOE: the giardia and clistoporidium. But the communities do not do it and they skip it to the bullfighter. In addition, each community has its budget so we would even have to fight to introduce these diagnoses in each community.

Food and water parasites

–And are some of these parasites related to cancer?
-They are related to chronic intestinal diseases but not all with cancer, although there are some who seem to. Parasitologists should put pressure on the authorities and denounce that they are missing methods to filter water and avoid infections. The filters have to have a certain caliber, because the parasites are not killed by the chlorine in the water.

In addition, we receive and eat fresh food from many countries where parasites are endemic and hygienic measures are not what they are in Spain, such as Morocco.