SIBO With a Negative Result on the Hydrogen Breath Test

SIBO (small intestine bacterial overgrowth) is a frequent cause of IBS. This idea was developed by Dr. Pimentel of Cedars-Sinai.

https://www.cedars-sinai.edu/Research/Research-Labs/Pimentel-Lab/

There is a hydrogen breath test that has been developed to determine whether a person has bacteria in the small intestine that produce hydrogen. Methane is often also tested.

However, I recently learned that if someone is negative on this test, that does not mean that they do not have SIBO! Apparently there are other bacteria that can be involved that don't produce hydrogen or methane. So just because a patient has a negative SIBO test, this does not mean that they do not have SIBO or IBS.

High blood B-12 levels and high folate levels are an indication that there is bacteria in the small intestine that are producing these vitamins, or at least B-12 analogues in the terminal ileum of the small intestine, according to Dr. William Sandborn and NP Elizabeth Evans, of UC San Diego Health System.

Dr. Sandborn also stated that Crohn's is a disease of dysbiosis, and that most Crohn's patients have SIBO.

EnteraGam is a Powerful Product!

EnteraGam is a medical food treatment that I read about in an article about IBS in Prevention magazine.

http://enteragam.com/

EnteraGam contains immunoglobulins that can boost immunity in your gut and has clinical trials that show that it has positive effects on IBS and IBD. It is a natural product, a food, and not a drug and has no drug side effects. Sounds great, yeah? Well,...

There is a definite ick factor, however. This product is actually made from raw cow blood. I had quite a few questions for the company that I needed answered before I would ever consider using this product! Below is a consolidation of an email exchange that took place with Tim Bradshaw of EnterGam. My questions are in bold.

Thank you for your excellent questions regarding EnteraGam. I’ll try to answer to the extent possible and hope this information helps you. You may also want to visit our website at: www.enteragam.com

Is EnteraGam a raw product or is it sanitized?
EnteraGam is not a raw product; it is manufactured in a GMP facility from USDA edible grade plasma collected under rigorous controls from cattle. It undergoes extensive safety analysis, including tests looking for pathogenic bacteria, before packaging. Because it is taken orally it does not need to be sterilized.

Why does it need to be supervised by a physician?
The FDA requires that all Medical Foods are used under medical supervision.

Does this product cause any negative reactions?
While the safety of EnteraGam is well-documented, like any other substance introduced into the body, whether it be a drug or foods that one eats, side effects can sometimes occur. The side effects most frequently reported for EnteraGam include abdominal cramps, constipation, diarrhea, headache, and nausea. When these occur they are typical mild to moderate in intensity.

Can EnteraGam cause detoxification symptoms from healing the gut?
To the knowledge, we have not received reports of detoxification symptoms appearing in patients using EnteraGam.

Does this product make people feel a little worse before they feel better?
We have had some patients in the first week feel a bit worse. It seems to be transient and if they stick with the product, they feel much better the week after.

Is the product heated above 165 degrees F? Or is it just checked for pathogens? I understand that this product is made from blood, and all kinds of things can be present in that. I'm trying to understand how safe it is.
EnteraGam is an exceptionally safe product – in fact it has what is called GRAS (generally recognized as safe) status with the FDA. In addition to the testing of the final product, there are numerous steps in the manufacturing process that ensure no pathogens are present. You cannot heat sterilize a protein product as that would destroy the structure, and thus, activity of the immunoglobulins that are present. Over 3 million doses of EnteraGam have been taken by patients so its track record for safety is well established.

What specific aspects will the doctor be supervising? Is there something dangerous about the product that doctors need to watch for?
Medical supervision is required for all medical foods and your physician should always be monitoring your health status. Also, if you were to experience some mild constipation, you would want to contact him / her for a possible reduction in dose.

Does this product boost the immune system or directly kill bacteria or cause the body to respond to pathogenic bacteria in the gut?
EnteraGam does not kill bacteria – that would make it an antibiotic. While not really an “immune modulator” it does support the immune system by binding to breakdown products from bacteria and viruses in the GI tract that, left unchecked, can cross the epithelial lining of the intestine and cause inflammation and other problems.

Does this product act like bovine colostrum in that is has immunoglobulins?It is similar to bovine colostrum but more potent due to the higher concentration of immunoglobulins present.

Please tell me if EnteraGam is filtered to remove viruses and any other type of pathogen. If possible, please explain or send me a link to information about the filtration technique used, so I can understand how safe this product is. I will appreciate detailed, technical information.
Pathogen removal is achieved by a variety of steps in the manufacturing process, but not by filtration as that would also remove the protein, and thus, immunoglobulin content. The product is then tested for viruses and microbes before packaging. I’m afraid that our manufacturing process is proprietary so I cannot provide a link where you can find details.

I read that Enteragam is not absorbed until the large intestine. I have Crohn's disease of the small intestine. Can Enteragam have any effect on the small intestine? After it is absorbed in the large intestine, does it have systemic affects that could possibly help with my small intestine problems?
The immunoglobulins in EnteraGam are not absorbed intact into the bloodstream; they are first digested into much smaller peptides and individual amino acids. Our studies support others demonstrating that a significant amount (40-50%, if I recall correctly) survives past the stomach before entering the small intestine. Over the last several years we’ve collected significant data on the efficacy of EnteraGam in Crohn’s disease. If you run an internet search on “serum-derived bovine immunoglobulin” and IBD, you’ll find a number of articles discussing this efficacy.

In the end, I decided to go ahead and try EnteraGam. Since I am notoriously sensitive to treatments that are capable of causing die-off reactions, I tried 1/4 teaspoon for several weeks, and I could not handle the diarrhea, nausea, headache and other typical die-off symptoms. I then tried less, but have not found a dose that I can tolerate yet.

My feeling is that this is a powerful product that might actually help me if I could actually take it. But it will be impossible or very hard for me to do so. So it is a fail for me.

The IBD-AID Diet

I just recently discovered a new evolution in the SCD diet trend - the IBD-AID Diet.

http://www.umassmed.edu/nutrition/ibd/ibdaid/

This diet is like the Specific Carbohydrate Diet, (SCD), but with more attention toward building up your gut biome, the importance of which recent research has brought out.

After people started talking about how important it is to build up your good gut flora, I became concerned that GAPS Diet, the SCD diet and others that eliminate food for bacteria, might be harmful to your gut flora.

Apparently, diversity and health in your gut flora is associated with less Crohn's disease.

After so many years on the GAPS Diet, and the SCD, I was concerned that I was starving the bugs that might help me.

The IBD-AID Diet seems to address this issue. It even allows a grain! Oats are allowed on the diet, with the evidence that oats selectively feed good flora.

Apparently the diet has tested well in clinical trials, with some people going into remission or able to eliminate some of their drugs.

D-Mannose - Not Just for Bladders Anymore

A recent Dr. Mercola article mentioned that d-mannose, a monosaccharide sugar, can not only remove bad bacteria from the bladder, but also from the digestive tract!

http://products.mercola.com/d-mannose-health-benefits/

He writes:

Could D-Mannose Benefit Your Gastrointestinal Health? 

*With D-mannose, many people first think of urinary tract health. However, this unique sugar may offer other potential benefits as well. 

 

Some studies suggest that D-mannose may be useful as a “prebiotic.” Prebiotics are substances that promote the growth of beneficial bacteria in your gut. The proper balance between “good” and “bad” bacteria is a prerequisite for both gut and overall health, so D-mannose may support your health by helping to raise levels of good bacteria.* 

Similar to how D-mannose works in your urinary tract, pathogenic bacteria are attracted to D-mannose on tissue cell membranes in your gut. D-mannose naturally occurs in the cells that line the walls of your urinary tract. 

There is also evidence that D-mannose may help protect against lectins in your gastrointestinal tract. Lectins are proteins found in beans, seeds, grains, and even some vegetables and fruits. They present a challenge to digestion because they are not broken down by stomach acid or digestive enzymes. 

Studies show that D-mannose may help bind and block lectins, and prevent them from reacting with and damaging your intestinal wall.*

So, if I am understanding this, it sounds like the d-mannose is removing the bacteria, and not killing it. This sounds like it would not cause the die-off that so many products cause. This sounds like some kind of miracle cure! 

In the past I have used d-mannose daily for months on end, and I have not seen an improvement in my symptoms from it. However, it does seem to work for bladder health, and can get rid of, and treat bladder infections for me.

So, the question is, what would be the appropriate dose that could make a difference in IBS or SIBO? This is not something I could find on the internet in any definitive form. But, one article said,  "In some lab studies and studies in mice, D-mannose components were shown to increase the growth of "good" bacteria. This suggests D-mannose may have some use for people with dysbiosis, an imbalance in good and bad bacteria."

Has d-mannose ever worked for you for intestinal health? What dosage did you use?

Histamine Intolerance

Histamine Intolerance occurs with many people with Crohn's disease because of the intestinal dysbiosis going in the gut. This article from Natural News describes symptoms describes Histamine Intolerance and says that people with IBS and Crohn's disease have it more commonly.

http://www.naturalnews.com/047470_DAO_enzymes_histamine_intolerance_immune_system.html

This article also talks about histamine intolerance.

http://naturimedica.com/histamine-intolerance-causes-treatment/

Sadly, many of these articles talk about avoiding kefir, sauerkraut, bone broth, and even probiotic supplements. All of these of course are foundational to the GAPS diet, which many people are trying to follow for their Crohn's disease.