Causes of SIBO-C (Methane)

Small Intestinal Bacterial Overgrowth (SIBO) is a gut dysbiosis. This means there's an imbalance of good-to-bad bacteria. When gut flora is unbalanced, there's always a reason, and the most common is years of eating a standard American diet that's heavy on chemical additives and processed grains and sugars and low in whole-food nutrients. Food toxins damage the intestine and make it "leaky" to gut bacteria and bacterial proteins. Malnutrition impairs the immune response and slows the healing of intestinal injuries. Add some type of "insult" to the gut, like food poisoning or a slew of antibiotic treatments that wipe out all the "good" bacteria, and you've got a perfect storm rising for SIBO to develop.

In SIBO, bacteria that are naturally occurring in the body but generally in the large intestine have migrated up to the small intestine, where they have less competition from "good bacteria" and are able to quickly over-colonize. Now that they're in the small intestine, they encounter our nutrients earlier in the digestive process and they're able to snap up essential nutrients like fats, iron and vitamin B-12. That's why people who have SIBO are almost always vitamin deficient.

The nutrient deficiencies caused by SIBO lead to leaky gut, so now the absorption of large protein molecules is possible, and this can cause an array of problems with the immune system and contribute to allergies, asthma and all types of autoimmune disorders, plus a general overall decline in health.

If you suspect you have SIBO, you'll be referred to a gastroenterologist. The gastro will want to run tests that usually include a colonoscopy, endoscopy and SIBO breath test. The colonoscopy and endoscopy, sometimes called an upper- and lower-GI, are to look for blockages and to take biopsies to rule out cancer and other infections. The breath test will measure the type and amount of gases your gut is producing. If you're a hydrogen producer, you have SIBO-D, the type of SIBO that causes diarrhea. If methane gas is found, you have SIBO-C, the constipation version.

Getting a SIBO diagnosis is one thing; tracking down the actual cause of your SIBO is even more complex.

Besides food toxins, other causes of leaky gut and SIBO can include use of prescription painkillers or other opiate drugs, birth control hormones or alcohol abuse.

Further causes that I seldom see discussed are:

• Parasympathetic nervous system disruption, which can be induced by stress
• Vagus nerve dysfunction, possibly from an injury to the head or spine
• A disruption in the Migrating Motor Complex, which cleans the gut during sleep, possibly from insomnia or other sleep dysfunction
• Nerve damage to the interstitial cells of Cajal (ICC)

If you're interested in learning the actual CAUSE of your SIBO, you'll need to find a functional medicine doctor, a type of doc who looks at disease systemically. The Institute for Functional Medicine has a doctor lookup by city.

My condition was likely the result of years of eating a low-carb diet, which leads to severe mucin-2 deficiency in the gut lining and finally to gastrointestinal disease. I also experienced several instances of food poisoning in the past ten years and that might have been a contributing factor.

In the book The Perfect Health Diet, author Paul Jaminet describes how low-carb diets lead to mucus deficiency and how that causes gastrointestinal diseases.

References:

SIBO: Methane or Hydrogen Dominant, What Is The Difference?

Physiology, injury and recovery of interstitial cells of Cajal: basic and clinical science

How Gut Disease Begins

33 Hidden Scientific Causes of IBS That Your Doctor Doesn’t Know About

SIBO-C Can Make You Gain Weight

One of the first symptoms of SIBO that sent me to my doctor two summers ago was weight gain, despite being on a restricted diet. I could tell he didn't believe me. I felt like Ingrid Bergman in the film noir classic Gaslight. (Hah, gas = methane = SIBO — hiyo!). Having SIBO-C and watching your weight can be similarly maddening.

In the film, Ingrid's husband Gregory is trying to make her seem crazy, so he can institutionalize her and claim her inheritance. One of Gregory's evil tactics is to flicker all the lights in the house which, thanks to eerie mood music, comes off a lot creepier in the movie than it sounds. Ingrid keeps telling her psychiatrist that her nerves are shattered living in that house because the lights flicker on and off all the time. But there's Gregory standing in the background, shaking his head no. And who does the psychiatrist believe? Yeah, it's like that.

Because my weight gain was occurring along with symptoms like muscle cramps, joint pain, hair loss, dry skin, and feeling cold all the time, I suspected hypothyroid. My doctor at the time ran the standard blood and urine screens and my TSH level was within what's considered normal range. I had read at Stop the Thyroid Madness that the TSH test is not a good indicator, and I asked him if he could test my free T3, free T4 and reverse T3 levels and also look for thyroid antibodies. He handed me a lab sheet and said check off the tests you want and mail it back, but I'm telling you right now, I'm not prescribing thyroid medication to a patient whose TSH is in range.

Whoa! — who said anything about thyroid meds? I'd just asked to learn what my hormone levels are.

As a parting shot as he was walking me out, he said try a low-carb diet. But I was already on a low-carb diet. I'd eating low carb for most of the eight years I'd been his patient.  In fact, as I would soon come to find out, a low-carb diet for so many years may have been a causal factor in my gut dysbiosis.

Recovering from a shoulder injury that grounded me from my usual summer activities like biking and kayaking, I was concerned about weight gain, so I had been eating even fewer carbs than usual. I'd been watching my diet extra carefully and keeping an online food diary. What I was seeing was very strange. For most of my life when I was active I could eat 1800 calories a day and maintain my weight. When I needed to lose weight, reducing consumption to 1600 calories a day would result in about a two pound weight loss per week. But now here I was down to 1200 calories a day and steadily gaining weight.

I could tell he didn't believe me, so I exported my food diary into a PDF and sent it to him, but was met with stony silence. He wasn't the only one not listening. Even some of my closest friends were saying unhelpful things, like "a calorie is a calorie" and "there were no fat people in Auschwitz." And I couldn't blame them, as I'd spent a lifetime subscribing to the same "eat less, move more" philosophy.

If you have SIBO-C and think you're gaining weight even on a restricted diet, it's not all in your head. This paper by SIBO pioneer Dr. Mark Pimentel explains how methane gas production in SIBO-C leads to constipation, irritable bowel syndrome (IBS), and obesity.

In this Chris Kresser podcast, Dr. Pimentel further explains:

"... Methanogens, it turns out, based on the microbiome work that’s being done on that particular organism, are super important to help liberate calories from nondigestibles. So let’s say you have a high-fiber diet. Humans generally can’t eat fiber. Cows and ruminating animals have a lot of methanogens because the methanogens help facilitate digestion of fiber. So what does that mean? That means that you can get more calories from a meal if you’re a methane producer because you’re liberating calories from things that people who don’t have methane can’t get.

So where am I going with this? What I’m saying is if you take a population from Africa and immigrate them into the United States, and those folks, for genetic reasons or environmental reasons, have methanogens flourishing in their gut, which is an evolutionary advantage for getting and harvesting nutrients, it’s not an advantage when food is abundant and food is so processed and easily digested that you get more calories."

Hearing this from the world expert on SIBO didn't help cure my condition, but it did explain what was happening in my body. The bacteria colonizing my small intestine are extracting MORE calories from fiber foods that I eat.

I'm all for efficiency, but just once in my life I'd like to have the ailment that makes a person LOSE weight!

Optimizing Nutrients: Vitamins I'm Taking to Help Cure SIBO

I'd been a lifelong sceptic about supplements, until I was diagnosed with SIBO. When you have SIBO, bacteria that are normally located in the large intestine have migrated up to the small intestine, where they encounter your nutrients earlier in the digestive process and get to them before you do. SIBO patients are deficient in many vitamins, especially fat-soluble ones, and these vitamin deficiencies can actually mimic other very serious health issues. For example, a B12 deficiency can look amazingly alot like MS, ALS, Parkinson's or other incurable disease.

The PHD diet advises getting our nutrients from food wherever possible, but those of us with SIBO have malabsorption issues and are very likely deficient in Vitamin B12 and D3, among others. To heal the gut it's essential to optimize your nutrients as quickly as possible. This means asking your doctor for an extensive vitamin and mineral panel and researching the type of vitamin you need to take for best absorption. (Example: Methylcobalamin B12 is more bioavailable than the less expensive cyanocobalamin.)

Multivitamins aren't a good option. They'll never have the right proportion of each vitamin that you need. Why? Because some vitamins like C and magnesium are so big that to put all that into a single multivitamin would not be swallowable. In addition, you don't need to take all vitamins daily — just those you're deficient in or ones critical to correcting a health condition. To bring my nutrition up to speed I take this panel recommended by the Perfect Health Diet:

Daily
* D3 — to go weekly, after serum 25OHD of 40 ng/ml is achieved
* B12 500 mcg — to go weekly after deficiency is addressed
* B-5 500 mg
* C 1 g
* K2 100 mcg
* Magnesium 200 mg (when not taking Natural Calm)
* Iodine 225 mcg

Weekly
* B vitamins:
    * 50 to 100 mg each of B1, B2, and B6
    * 5 mg biotin
* Boron 3 mg
* Zinc 50 to 100 mg

And when not eating 1/4 lb of liver per week:
* Copper 50 mg
* Vitamin A from cod liver oil, 50,000 IU/week

And when not eating brazil nuts::
* Selenium 200 mcg

Additionally
I start my morning with a tsp of virgin cod liver oil — that's right, our grandmas knew a thing or two that we've forgotten. The omega-3s in cod liver oil balance out the omega-6s I get in olive oil. The only other oils I cook with are grassfed butter and coconut oil.

Next, I mix a 1/2 tsp of glycine powder in a glass and drink it down with 1 NAC capsule. Both are healing to the gut lining, and NAC helps get neurotransmitters back on track, which can help with the sleep disruption that throws the migrating motor complex off, slowing up digestion.

I fast until noon, when I eat my first meal — usually eggs in some type of veggie frittata. While I'm eating I gulp down two Atrantil capsules. Atrantil is a botanical antimicrobial that tamp down my "bad" gut bacteria population. About a half hour later, I pop a soil-based probiotic (usually Prescript Assist).

I mix a 1/4 tsp of vitamin c powder in a 1-liter travel bottle and take it with me to work. When I've finished it, I fill it up again. I try to drink two of these during the day before it's time to commute home.

After dinner I take all of the above supplements, and I'm done for the day, unless constipation symptoms have raised their ugly head. When that happens, I take mix two teaspoons of Natural Calm magnesium drink into a mug of warm water and drink it down before bed.

Could Vagus Nerve Dysfunction Be the Cause of SIBO?

The vagus nerve is the longest of the 12 cranial nerves, running from brainstem to gut and touching multiple organs along the way, including the brain, heart, esophagus, and lungs. It forms part of the parasympathetic nervous system that supports unconscious body processes, such as breathing, heart rate, body temperature and — yes, digestion — by managing communication between organs and the brain via neurotransmitters. While we're accustomed to hearing the media talk about serotonin as a "feel-good chemical in the brain," there are far more serotonin receptors in the gut than anywhere else in the body. That's why so many people with gut issues also deal with symptoms of depression, anxiety and even agoraphobia.

Interacting with the brain, the vagus helps manage anxiety and depression. Interacting with the gut, it controls neurotransmitters and enzymes responsible for the production of stomach acid, digestion, and motility, so having poor vagal tone increases risk of SIBO-C. By releasing intrinsic factor, the vagus nerve also helps with B12 absorption — and that's important because most SIBO-C sufferers are B12 deficient.

People with gut problems are very likely to have vagus nerve dysfunction. The vagus nerve can be damaged by any gut insult, such as food poisoning, antibiotics, chronic infection or illness. Luckily, there are many ways to stimulate the vagus nerve and most are easy and inexpensive. Here are the ones I've worked into my protocol so far:

• Yoga — I'm a beginner and practice a very gentle himalayan yoga with a lot of focus on the breath and relaxation
• 4/8 breathing at random times during the day — a four-counts inhale, eight-count exhale almost immediately calms all systems of the body
• Gargling two days a week — I gargle with warm salt water because it has the added benefit of breaking up biofilms in the mouth and sinuses
• Singing/humming while I drive to work
• Laughter — I've begun actively following comedian podcasts and watching comedy shows and movies

Other things I've learned that may help are coffee enemas and herbal medications that stimulate the postganglionic portion of the vagus nerve, like Parasym Plus.  I haven't been brave enough to try the former,and I'm not ready to add more medicines to my already aggressive daily regimen of supplements right now, but I've made a mental note of these.