 Okay, what the heck is all this to do about small intestinal bacterial overgrowth? SIBO. Everywhere you go it's trending. I have SIBO. I've seen my functional medicine doctor and I have SIBO and that's what's wrong with me and I'm getting treated for SIBO. Just this past week I had a patient come in with telling me that they were diagnosed with SIBO because they walked into their GI doctor's office and the GI doctor said, here blow in this tube and within a couple of seconds the doctor proclaimed that I have SIBO because he measured hydrogen and methane on my breath therefore I have SIBO. Not. Now why do I say that? Let me give you a little history of the human microbiome. Remember that we really did not know anything about the human microbiome and how important it was, how diverse it was, how many species there were until the human microbiome project which started in 2006 and finished in 2016. For years we did not believe that there were any bacteria that lived in the stomach for example because stomach acid would kill any bacteria that you happen to swallow and so it would be impossible for bacteria to exist in that acidic environment. Well lo and behold when H. pylori was discovered as a bacteria that not only thrived in the stomach but could be a cause of gastric ulcers that we began to say oops I guess we were wrong that bacteria don't exist in the stomach. Now similarly the colon we knew bacteria lived in the colon why because we could culture a few bacteria and we knew that there were bacteria that could live with oxygen which are called aerobic bacteria and we knew that there were bacteria who couldn't live around oxygen and those were anaerobic bacteria and until we learned that we didn't know the existence that anaerobic bacteria existed because we kept putting them out in plates that were surrounded by oxygen and they wouldn't grow so we wouldn't know they were there. I'm old enough to remember the huge advent in taking blood cultures and culturing bacteria from blood and people we thought were in septic shock and the advent of both aerobic and anaerobic blood cultures opened up a whole new world to us that we didn't even know existed because we couldn't grow those bacteria. So now we know there's bacteria in the stomach now we know there's tens of thousand different bacterial species that live in the colon but what about the small bowel that's the largest surface area you have in your gut and for years we assumed that most of the small bowel like the stomach was sterile. Why? Because before I was a heart surgeon I was a general surgeon and quite frankly we operated on the small bowel all the time and we didn't have to be very careful about contamination from the small bowel. On the other hand if we were operating on the colon we had to be really careful about getting an infection from colon contents so we pretty much felt pretty good that there wasn't a whole lot growing in the small bowel. Now there's such a thing called the acid gradient in the small bowel and the acid gradient says that bacteria particularly colonic bacteria don't particularly like acidic environments and they don't grow very well so that the acid from the stomach as it makes its way down past the duodenum and mixes with bile and pancreatic juices which are alkaline in nature the acid from the stomach gets neutralized and by the time it gets down to the colon it's pretty much all the acid is neutralized. The colon bacteria we thought wouldn't come up into the small bowel because it wasn't a really great place for them to live and the acid gradient kept them down there. Now some of that is true we know that people who take acid reducing drugs chew a lot of toms bind up that acid neutralize the acid and so there is a possibility that colonic bacteria could migrate up into the small bowel. Now when we started looking at post biotic gas production, gasotransmitters and I've written an entire book about that the energy paradox, none of us really knew that normal gut bacteria should be producing a variety of gases that are a language system that our gut bacteria talk to us, talk to our mitochondria, talk to our brain. Those gases include hydrogen gas, methane, carbon dioxide, hydrogen sulfide, nitric oxide and I could go on and on. We now know that these gasotransmitters are essential for a healthy life, are essential for brain health and little did we know that we did not know that bacteria that are capable of producing these gases live in our small bowel and our normal flora for our small bowel. Now why didn't we know that? Well quite frankly it's almost impossible to measure the bacterial contents in our small bowel. We could use a colonoscope and get into the bottom part of our small bowel the ilium but those samples are often contaminated by the fact that we went through the bowel to get there. A scope coming from what we swallow can only get into the duodenum and we just can't get into the small bowel. We can do capsules that people swallow and hope to take a sample but quite frankly we just didn't know those guys were there. Now the original tests looking for SIBO small intestinal bacterial overgrowth relied on having you swallow a sugar like mannose or even simple sugars and looking at when you would start to produce hydrogen gas or methane gas those are the two most popular and if you produce them fairly quickly after you swallowed these sugar molecules then it had to have been coming from your small bowel and everybody knows the small bowel is pretty much sterile so if you're making hydrogen gas or methane gas or if you walk into the room and breathe into a tube and these can now be bought on the internet you must have small intestinal bacterial overgrowth as a cause of that. Nope that's not correct. This is a normal part of what you and your gut bacteria should produce. Why is it so important? Well there are now 1200 separate studies looking at the importance of hydrogen gas that your intestinal bacteria produce in among other things protecting your brain from Parkinson's disease and Alzheimer's disease and people who don't have bacteria that produce hydrogen in their intestines actually have an increased rate of memory impairment in Parkinson's and amazingly if you give these people hydrogen water that is water that's had hydrogen gas dissolved in it their memory and their Parkinson's improved. My point if you're diagnosed with SIBO you are prescribed antibiotics to kill off these bacteria which quite frankly are essential for your well-being. I'll say that again these bacteria and the gases they produce are essential for your well-being but you might say but I'm very uncomfortable. I have gas and bloating so that must be coming from these bacteria in my small bowel. Yeah they probably are. So what's your option? Well you could go on the FODMAP diet. The FODMAP diet takes away all fermentable sugars from your diet and it's very popular and quite frankly it's remarkably effective for most people in reducing gas and bloating. Why? Because you aren't giving these normal flora of your gut the foods they need to ferment to keep them alive but the downside is you will not get the benefit of all these gasotransmitters that we now know are essential for both your short term and your long-term health and your long-term brain health. So yeah you might feel better but in fact it's a bad choice of things to do. One of my biggest critics is a physician by the name of Michael Greger nutritionfacts.org and quite frankly he and I absolutely agree on this subject and he thinks that SIBO doesn't exist. Do I think it exists? Yes but certainly not the epidemic that everyone thinks it is and these breath tests have been shown to be very inaccurate time and time again and quite frankly the last thing you want to do is take antibiotics that kill off gas producing bacteria in your gut. That's the last thing you want to do. There are really good studies looking at people who have been told they have SIBO put on a sham placebo treatment and believe it or not the placebo group did just as well as the treatment group which goes to show that the gas and bloating probably had nothing to do with small intestinal bacterial overgrowth. So I see this all the time in my clinics and I have never given anyone an antibiotic treat this. We put them on my program which involves removing gluten and grains, removing beans and legumes or pressure cooking them and in some cases removing all American dairy and eggs and we see remarkable turnarounds and we didn't have to kill any bacteria to accomplish it. So if you really are worried about SIBO, gas and bloating, you've been told you make hydrogen or methane gas and take it as good news you're going to be protecting your brain but the complaints of irritable bowel of celiac, we can eliminate that by just following the plant paradox program and in the new book Gut Check you'll learn all the new ways that I've learned since the plant paradox to really improve your gut health. More amazing episodes just like this one. Watch now. Studies have shown that adding an avocado a day to human volunteers improve weight loss as opposed to not having that avocado. Just remember eating fat does not make you fat.