Michael Harrop
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Is SIBO real? SIBO vs dysbiosis? Debunking the SIBO hypothesis | Small Intestinal Bacterial Overgrowth Video
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What is he wrong about??
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Michael Harrop
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That is covered in the first post in this thread.
If SIBO isn’t real, then what is the explanation for people who report having SIBO and unwanted weight loss?
My understanding is that the creator of this site believes that SIBO doesn’t exist in the way the mainstream believes it does. Rather than being too much bacteria in the small intestine, there is simply dysbiosis in the small intestine.
Ok, even if that was true, could that still cause people to lose weight unwanted? People who say they have SIBO report having to eat more food to stop themselves from losing weight. Even I have experienced this…
This original explanation was that “too much” bacteria in the small intestine was eating the food our small intestine was suppose to be absorbing. Could the same thing be happening if it’s simply a dysbiosis?
My understanding is that the creator of this site believes that SIBO doesn’t exist in the way the mainstream believes it does. Rather than being too much bacteria in the small intestine, there is simply dysbiosis in the small intestine.
Ok, even if that was true, could that still cause people to lose weight unwanted? People who say they have SIBO report having to eat more food to stop themselves from losing weight. Even I have experienced this…
This original explanation was that “too much” bacteria in the small intestine was eating the food our small intestine was suppose to be absorbing. Could the same thing be happening if it’s simply a dysbiosis?
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Michael Harrop
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Of course. https://humanmicrobiome.info/obesity/
If you review the OP, you can see that there is no way to have or determine dysbiosis solely in the small intestine and not the large intestine.
This is nonsense, not backed by any science that I'm aware of.
Bile acid metabolism is a more likely major player: https://humanmicrobiome.info/bile/
Thank you so much! Didn’t know that about the bile acid connection with fat processing.
Also, do you think information in the small intestine from dysbiosis can also inhibit its ability to absorb properly? Maybe a contributing factor?
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Michael Harrop
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Definitely.
You basically answer this yourself in your next paragraph. It may be more a question of which bacteria are in the small intestine rather than how many. While people who test positive on hydrogen breath tests may indeed be more likely to have symptoms, what doesn't necessarily follow is that just randomly killing bacteria in the small intestine will alleviate the symptoms.
Now, for some it does, but certainly not everyone. If people like Mark Pimentel were completely correct, either they all should, or else those that don't would be presumed to have issues unrelated to gut bacteria. However, I'm the perfect example of a case where treatment with rifaximin did really nothing (there was a period on the treatment where I felt vaguely like something might be happening, but in the end I was no better off, neither with my diarrhea and food sensitivities nor with my neuropsychiatric symptoms), despite "correcting" the hydrogen breath test. However, I responded dramatically to a later FMT. And then, after this FMT, my subsequent re-treatment with rifaximin also produced rather dramatic but very short-lived improvements. However, additional re-treatments years later again did nothing.
And I agree with him or her about this. My experience suggests that at least for some people, treatment only works when there are enough of the right bacteria to fill the void when the "overgrowth" is killed off.
This was never the explanation, at least not of people like Mark Pimentel. And the symptoms of SIBO were never limited to just weight loss--they could just as easily be weight gain, diarrhea, constipation, food sensitivities, even depression in some cases.
Pimentel's idea (supported by test results of his own patients) was that excess hydrogen-producing bacteria in the small intestine cause diarrhea, and excess methane-producing archaea cause constipation. He did not claim definitively that it was the hydrogen and methane gases themselves causing these symptoms, rather than some other byproduct of the organisms (for example endotoxin/LPS). And in fact, while there is some data to indicate that hydrogen can act as an antioxidant, it's otherwise very inert, and so is methane. I never heard a theory that bacteria eating nutrients and starving the host was the mechanism. In fact, some science suggests that gut bacteria eating nutrients helps them get turned into fat, e.g. https://pubmed.ncbi.nlm.nih.gov/32214246/.
In my case, I had hydrogen-predominant "SIBO" prior to FMT, and combined hydrogen and methane "SIBO" post-FMT, before the retreatment that ended up being temporarily helpful. Pre-FMT I had constant diarrhea, and immediately post-FMT there was a change to firm stools tending toward constipation, so this would fit in terms of correlation, but again that doesn't mean that antibiotics that abolished the high hydrogen level pre-FMT eliminated the diarrhea the way the FMT did.
The way I see it, Pimentel's major advance was to recognize the importance of the microbiome in IBS patients. However, his focus on simple overabundance of bacteria (as opposed to dysbiosis) ultimately fell short. And in fact as his practice went on, Pimentel himself seems to have had to admit that there were patients he couldn't help just by antibiotics.