SIBO Explained

Dr. Whitney Baxter

SIBO is the accumulation of bacteria in the small intestine. There should be little to no bacteria present in this section of your digestive tract. With the help of stomach acid and digestive enzymes, this section of the digestive tract is where food is broken down and nutrients are absorbed.

In the case of SIBO, the food you eat is fermented by the bacteria, creating gas in the process and some or all of the following symptoms:

• Gas and bloating — including increased belching &/or flatulence

• Constipation, diarrhea or both (IBS)

• Pain and cramping

• Fatigue or brain fog

• Anxiety and other mood disturbances

• Joint pain

• Nutrient deficiencies causing fatigue, anxiety, brain fog, low weight or anemia (from poor absorption of B12, iron or ferritin)

These symptoms may have other causes. A thorough medical history and diagnostic testing by a naturopathic doctor will uncover the root cause & guide treatment.

What Causes SIBO?

SIBO is not the problem,
SIBO is the result of an underlying issue with the digestive process.

The most common risk factors and underlying causes of SIBO:

• Disruption of the normal protective functions that would otherwise kill the bacteria

  • Low HCL/ stomach acid production

  • Immune system dysfunction

  • Ileocecal valve dysfunction (the valve between the small and large intestine)

  • Decreased digestive enzyme and/or bile acids (normally released into the small intestine to breakdown proteins, carbohydrates and fats for absorption)

• Disruption of the normal cleansing function of the digestive tract (aka the MMC, explained more below)

• Structural adhesions from surgery or an underlying medical condition

• Food poisoning

• OTHER: depending on your medical history, there may be other underlying causes not discussed here

The Intestine Sweep!

A ‘sweep’ occurs in the digestive tract that is crucial to cleanse away any lingering bacteria or microbes into the colon (where your microbiome exists).

This is known as the migrating motor complex (MMC)

What you need to know about the MMC

• It ONLY occurs during fasting — it begins 90 minutes after eating and 3-4 times during sleep

• It is INHIBITED with eating — if you graze a lot during the day, this cleansing sweep is not happening

There are other things that can impact the normal functioning of the MMC that include structural and neurological causes. Your medical history will uncover these potential causes and can be discussed during your consultation.

Do Fruits & Veggies Make You Bloated?

This may be a sign of SIBO…

FODMAPS

AKA Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols (hence the acronym!!)

These foods are short chain carbohydrates that are fuel for bacteria. If you have an overgrowth of bacteria in the wrong location, aka SIBO, then these foods will feed the bacteria and create the symptoms listed above.

Here’s a checklist! Track your symptoms 1-3 hours after ingestion of the following (*not an exhaustive list):

• Onions & shallots

• Garlic

• Kombucha (and other fermented foods)

• Dairy

• Alcohol (especially beer)

• Beans (baked, snap peas, red kidney beans, lima and haricot beans)

• High fructose-containing fruit: avocado, apricots, banana, cherries, grapefruit, peaches (& more)

• Grains/wheats and other cereals

Avoiding FODMAPs is NOT the long term goal. It is a temporary solution to find relief. Instead, the goal is to heal the gut and kill the excess bacteria so you can eat these foods symptom-free.

SIBO Diagnosis & Treatment

TESTING

Testing is easy, you can do it from home and have the results back within 2 weeks. The gas produced by the microbes in the gut will be absorbed and released by your lungs. This is measured by a breath test.

TREATMENT

The basic principles of treatment involve killing off the bacteria, re-igniting that intestinal sweep/ the MMC (read above!) and supporting normal digestion to prevent re-growth. Once this phase is complete, the focus shifts to supporting regular digestive system function, including regulating the MMC, and slowly re-introducing foods.

FOR MORE INFORMATION, SPEAK WITH YOUR NATUROPATHIC DOCTOR

OR BOOK IN FOR A COMPLEMENTARY CALL WITH DR. BAXTER (BC RESIDENTS)

Ozone Therapy

Dr. Whitney Baxter

Ozone (O3) is a reactive molecule that is generated when oxygen (O2) is exposed to high energy, splits, and recombines into a triplet molecule[iii]. Ozone naturally exists in the earth’s atmosphere to protect us from harmful UV radiation and is formed during lightning storms. Do you remember the smell of a thunderstorm? That’s ozone!

Ozone is generated in a clinical setting when oxygen is exposed to an electrical spark[i]. Clinical use of ozone has a rich history, dating back to 1902[ii]. It was shown to treat middle ear infections, and for the treatment of infectious diseases during the first world war[iii]. Clinical protocols have since been developed to target specific conditions, after more clinical studies emerged proving its safety and efficacy. 

The Mechanisms Of Ozone Can Be Broken Down Into Four Main Categories

• Stimulating the antioxidant defences of the body by creating mild oxidative stress [i,iii]

• Encouraging efficient oxygen utilization by the body tissues for the production of energy (in the form of the high energy molecule known as adenosine tri-phosphate, or ATP).

• Beginning the cascade of immune activation and tissue remodelling[iv],[v]

• Directing antimicrobial action[vi] through disruption of microbial cell walls (fungi and bacteria) and prevention of virus-to-cell contact.

Trauma (in the form of infection, chronic pain or damaged cells) sets off a cascade of inflammation, endothelial damage and decreased ability to utilize the oxygen necessary for activity, repair and growth[i]. Ozone supports the body in reversing these processes.

Clinical Uses Include (but are not limited to):

• Immune modulation: increased defense systems against infectious disease

  • Including: chronic hepatitis, Lyme disease[vii], Herpes 1 & 2, acute infections

• Cardiovascular disease[viii]

• Autoimmune conditions[i,ix]:

  • Has been shown to reduce chronic inflammatory processes in rheumatoid arthritis and Hashimoto’s thyroiditis[x].

• Allergies

• Chronic pain [i,iii]

• Macular degeneration[xi]

• Peripheral vascular disease[i]

• Fibromyalgia[xii]

• Topically for skin infections and atopic dermatitis or eczema (improves microbiome diversity)[xiii]

In order to maximize the effects on antioxidant systems, oxygen metabolism, and the immune system, ozone therapy should be used in conjunction with modalities that support these systems of the body. Examples include a diet rich in proper nutrients for detoxification, antioxidants, mitochondria support, exercise, and therapies that optimise liver and endocrine function. Your naturopathic doctor can customise a treatment plan including these important components for you.

Preparations for Ozone therapy

It is important to have an initial consult with your naturopathic doctor prior to ozone therapy as there are a number of important screening tests and some medical conditions that are contraindicated.

·  Vasovagal (fainting) episode:

• As with all IV and injection therapies, you may feel light headed and some people do faint.

• Naturopathic physicians are trained in emergency medicine and are prepared if this does occur.

• To prevent this from happening come to your appointment well hydrated (avoid coffee and black tea) and have something to eat prior to the visit.

· Avoid antioxidants like vitamin C , grapeseed extract , etc. for 5 hours before and after treatment.

Frequently Asked Questions

• Does it hurt?

  • Just a little pinch (if any) to insert the needle into the vein (or joint) and that’s it! The idea is to ensure you are comfortably seated or lying down if need be.

• Are there any side effects?

  • The most common side effect is bruising at the site of injection

• How long does it take?

  • 20-40 minutes depending on the practitioner’s ability to establish a viable vein for MAH.

Procedures and Mechanisms of Action

There are a number of different ways to administer ozone therapy and your naturopathic doctor will determine the best method depending on your symptoms. The most common ways are through major autohemotherapy (MAHT) and minor autohemotherapy.

• In MAHT, a small amount of blood is drawn, mixed with a specified ozone concentration indicated for your case, and infused back into your body. This produces an immune response that up-regulates cells such as antibodies and intermediates that function in antiviral, antimicrobial and tumour surveillance[xiv].

In minor autohemotherapy, a small amount of blood is withdrawn, mixed with ozone and injected intramuscularly. This procedure enhances our immune system’s first line of defence known as the cellular or innate immune response.

Ozone in Orthopedics: Prolozone

• This procedure involves ozone injections intraarticularly, intramuscularly and close to injured areas to promote tissue regeneration. This application is suitable for injuries and arthritis.

• Other applications of ozone therapy include vaginal or rectal insufflation, locally onto the skin for conditions such as ulcers and infections.

If you have more questions or would like to schedule an appointment for ozone therapy, click below for our online booking!

Written By: Dr. Whitney Baxter

References

[i] Shallenberger, G. (2011). Principles and Applications of Ozone Therapy; A Practical Guideline for Physicians

[ii] Elvis, A. M., & Ekta, J. S. (2011). Ozone therapy: A clinical review. Journal of natural science, biology, and medicine, 2(1), 66–70. https://doi.org/10.4103/0976-9668.82319

[iii] Rade, B. (2014). Ozone Therapy: An Effective Solution for Acute and Chronic Pain. Naturopathic Doctor News and Review. 

[iv] Smith, N. L., Wilson, A. L., Gandhi, J., Vatsia, S., & Khan, S. A. (2017). Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility. Medical gas research, 7(3), 212–219. https://doi.org/10.4103/2045-9912.215752

[v] Bocci V, Luzzi E, et al. (1994). Studies on the Biological Effects of Ozone: 5 Biotherapy. 7;83-90

[vi] Gulmen S, Kurtoglu T, Meteoglu I, Kaya S, Okutan H. (2013). Ozone therapy as an adjunct to vancomycin enhances bacterial elimination in methicillin resistant Staphylococcus aureus mediastinitis. J Surg Res. 185:64–69.

[vii] Rowen R. J. (2018). Ozone therapy as a primary and sole treatment for acute bacterial infection: case report. Medical gas research, 8(3), 121–124. https://doi.org/10.4103/2045-9912.241078

[viii] Idriss NK, et al. (2008). J AM Coll Card. Volume 52, Issue 12, 9. 971–978

[ix]. (2004). Guidelines for the Use of Ozone in Medicine. German Medical Association of Ozone Application in Prevention and Therapy

[x] Hernandez-Rosales, F. and Picrin-Duany, Y. (2019). Hashimoto’s Chronic Thyroiditis Treated with Systemic Ozone Therapy. Journal of Ozone Therapy. Accessed from: https://dialnet.unirioja.es/servlet/articulo?codigo=7222593

[xi] Borrelli, E. et al. (2012). Effects of Major Ozonated Autohemotherapy in the Treatment of Dry Age Related Macular Degeneration: A Randomized Controlled Clinical Study. International Journal of Opthalmology. Volume 5, Number 6.

[xii] Moreno-Fernández A1, Macías-García L1, Valverde-Moreno R1, Ortiz T1, Fernández-Rodríguez A1, Moliní-Estrada A2, De-Miguel M1. (2019). Autohemotherapy with ozone as a possible effective treatment for Fibromyalgia. Academic Rheumatology Portal.

[xiii] Zeng, J. et al. (2019). Topical Ozone Therapy Restores Microbiome Diversity in Atopic Dermatitis. Department of Dermatology, The Third Xiangya Hospital. International Immunopharmacology. Volume 80.

[xiv] Tau, G., & Rothman, P. (1999). Biologic functions of the IFN-gamma receptors. Allergy, 54(12), 1233–1251. https://doi.org/10.1034/j.1398-9995.1999.00099.x

SHOULD YOU TAKE VITAMIN D?

Vitamin D, aka the sunshine vitamin, is important for bone health, immune function, mood and a healthy pregnancy. It is a very common vitamin deficiency for those of us living in the northern hemispheres - one-third of Canadians were found to be deficient!

If you’re wondering if you should start supplementing or how to choose the correct dose, there are a few things to keep in mind. Below is an overview of of why testing and knowing your levels is key for proper dosing and maintenance of the important functions listed above.

FUNCTIONS OF VITAMIN D

• Bone Health: its best known action is the absorption of calcium from the digestive tract and the regulation of calcium and phosphorus required for healthy bones, teeth and muscles.

• Immune function: many immune cells not only express vitamin D receptors (VDR), but can also synthesize vitamin D. Deficiency has been associated with an increased incidence of autoimmune disease and susceptibility to infections.

• Mood and mental wellness: studies have linked depression (especially in the winter months) with vitamin D deficiency. In addition to vitamin D, there are many nutrients, hormones and neurotransmitters involved that work together to support mood.

• PMS: those who experience PMS (depression and/or anxiety, cramping, breast tenderness) were found to have lower vitamin D levels than control groups. Vitamin D has been shown to reduce levels of inflammation that can worsen PMS symptoms.

• Pregnancy: vitamin D is essential for the developing baby’s bone and teeth. It also supports estrogen production required for a healthy pregnancy. Low vitamin D levels have been associated with infertility, gestational diabetes and asthma in infants.

ARE YOU GETTING ENOUGH VITAMIN D?

Vitamin D is a unique vitamin that can be produced by the body when the skin is exposed to sunlight. It can also be taken orally (as a supplement or food). Your liver and kidneys are important for converting vitamin D into its final active form known as vitamin D3 or cholecalciferol.

So, the question is are you getting enough from sunlight? Here are some things that can impact the body’s ability to make it from the sun:

• Living in the northern hemispheres

• Darker winter months

• How much skin is exposed to the sunlight (are you out in your bathing suit or is just your face exposed?)

• Wearing sunscreen (still important to do!)

• Increasing age: for example, 70-year-olds were found to make 25% of the vitamin D from sun exposure than those who were 25, on average

Other factors that are involved in whether you are making enough active vitamin D are your gastrointestinal health (are you absorbing enough?) and your liver and kidney function (is what you are taking in being converted into the active form?). These factors and understanding your levels throughout the year is best done through testing, read more below!

TEST DON’T GUESS

It is safe to take 1000-2000 IU/day without needing to test. However, testing may be indicated depending on your case (do you have low moods, especially in the winter? are you pregnant or planning to be? are you concerned about your bone health?). As always, speak with your medical or naturopathic doctor for more guidance.

Here are guidelines and things to know about vitamin D’s safety.

A blood draw is done to show your vitamin D level, and dosing is based on this.

CANADIAN GUIDELINES

A blood draw is done to show your vitamin D level, and dosing is based on this.

Currently, vitamin D testing in Canada is only indicated (and therefore covered) for those who are at high risk for vitamin D deficiency such as those with malabsorption syndromes of the gut, renal failure, unexplained bone pain, unusual fractures, or other evidence of metabolic bone disorders.

However, because so many Canadians were found to be deficient, testing vitamin D levels is beneficial to catch a deficiency before the onset of the above conditions.

HIGH DOSES CAN BE UNSAFE

Vitamin D is fat-soluble, meaning it can be stored in the body. Higher levels are associated with health risks, mostly due to its role in calcium absorption and high calcium levels can be harmful.

HOW TO TEST

A requisition can be filled out by your medical or naturopathic doctor and taken to the lab for a blood draw. Results should come back within a week and dosing is based on this level.

FOR MORE QUESTIONS ABOUT TESTING & DEFICIENCY, BOOK IN FOR A FREE 15 MIN DISCOVERY CALL - CLICK HERE

About the author

Dr. Whitney Baxter is a licensed naturopathic physician practicing in Victoria, BC. She graduated from Boucher Institute of Naturopathic Medicine, holds a BSc in Kinesiology and is a Certified Exercise Physiologist (ACSM). She is an avid runner and loves everything to do with mountain life on Vancouver Island, BC.

REFERENCES

PMS & Vitamin D: Heidari, H., Amani, R., Feizi, A. et al. Vitamin D Supplementation for Premenstrual Syndrome-Related inflammation and antioxidant markers in students with vitamin D deficient: a randomized clinical trial. Sci Rep 9, 14939 (2019). https://doi.org/10.1038/s41598-019-51498-x

British Columbia, Canada Guidelines and Statistics: Janz, T. and Pearson, C. (2015). Vitamin D blood levels of Canadians. Statistics Canada Catalogue no. 82-624-X

Polish Review: Rusińska, A., et al. (Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland-Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies-2018 Update. Frontiers in endocrinology, 9, 246. https://doi.org/10.3389/fendo.2018.00246. 2018).

WOMEN AND HEART DISEASE

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in North America. Five times as many women die from heart disease as they do from breast cancer[1]. However, women are often unaware of their risks and how CVD can differ from men in both symptom presentation and location of disease in the heart vessels. In addition, women are under-represented in the research that is used for the development of diagnostic and clinical management guidelines[2]. These factors have led to delays in obtaining accurate diagnosis and appropriate care for women presenting with symptoms of heart disease.

Understanding these differences is key to empowering women to understand their risks and when to seek medical attention.

SIGNS AND SYMPTOMS OF A HEART ATTACK IN WOMEN 

Many of us are aware of the signs and symptoms of a heart attack (also known as a myocardial infarction or MI). These include chest pain (described as squeezing pressure or heaviness) that can radiate to the jaw, arms, abdomen or back. Symptoms can also include shortness of breath and/or heart palpitations.

Though women often do present with chest pain, many women describe this experience differently than these classic symptoms, such as dullness, discomfort or burning rather than overt pain. Women can also present with symptoms that may seem vague and don’t necessarily point to a cardiovascular origin.

Women’s symptoms of an MI can include:

• Extreme fatigue

• Shortness of breath with, or with without, chest pain

• Light-headedness

• Cold-sweats

• Nausea and vomiting

• Indigestion and/or heartburn

Recognizing these symptoms is important so women can seek appropriate medical treatment and receive timely care.

WHY THESE DIFFERENCES OCCUR

Women are more likely to have disease in the smaller vessels of the heart, as opposed to the larger coronary arteries more often seen in men. This different location leads to the different symptoms outline above. It also poses challenges for physicians in terms of where to look for disease and decide on the correct imaging or other diagnostic tests.

Another physiological difference between men and women is the hormonal changes throughout life. Though not necessarily a reason for the differences in symptom presentation, hormonal changes dictate when the risk of CVD increase in women. Estradiol (one of the 3 forms of estrogen) has cardiovascular-protective effects by a number of mechanisms including protecting the vessels against oxidative damage. The decline in estrogen during menopause increases the risk of cardiovascular disease. Women are encouraged to speak with their health care provider about the safety and options for hormone replacement therapy, including herbal medicine or bio-identical hormones.

THE ROLE OF NATUROPATHIC MEDICINE IN CARDIOVASCULAR HEALTHCARE

PREVENTION OF RISK FACTORS

Naturopathic doctors are a valuable addition to a healthcare team when it comes to the prevention and management of cardiovascular health. Our goal is to help women understand and manage their risk factors for CVD which include:

• Hypertension (high blood pressure)

• High blood sugar or diabetes

• Physical inactivity

• High cholesterol levels

• Smoking

• Healthy weight management

• Mental health including depression and anxiety

The following lifestyle factors help build a resilient foundation for the prevention and management of CVD:

• Dietary guidance

• Nutritional supplements when higher dosing of specific nutrients is indicated

• Exercise prescription

• Quality sleep support

• Stress management

• Smoking and other substance cessation

At Fairfield Health and Wellness clinic, the naturopathic doctors are also trained in herbal medicine, IV and ozone therapy that can further support the cardiovascular system as a whole.

An individualized approach with the patient’s medical care team can help target and support these areas. This approach can also ensure women are aware of the signs and symptoms of heart disease and feel empowered to seek proper medical care.

About the author

Dr. Whitney Baxter is a licensed naturopathic physician practicing in Victoria, BC. She graduated from Boucher Institute of Naturopathic Medicine, holds a BSc in Kinesiology and is a Certified Exercise Physiologist (ACSM). She is an avid runner and loves everything to do with mountain life on Vancouver Island, BC.

References

[1] (2020), Heart and Stroke Foundation of Canada.

[2] Chrysohoou, C., et al. (2020). Cardiovascular Disease in Women: Executive Summary of the Expert Panel Statement of Women in Cardiology of the Hellenic Cardiological Society. Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese, S1109-9666(20)30215-3. Advance online publication.

3. Brewer, L. C., Svatikova, A., & Mulvagh, S. L. (2015). The Challenges of Prevention, Diagnosis and Treatment of Ischemic Heart Disease in Women. Cardiovascular drugs and therapy, 29(4), 355–368.

4. Saw, J., et al.(2019). Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. European heart journal, 40(15), 1188–1197.

5. Taqueti V. R. (2018). Sex Differences in the Coronary System. Advances in experimental medicine and biology, 1065, 257–278. https://doi.org/10.1007/978-3-319-77932-4_17

6. Mehta, P. K., Bess, C., Elias-Smale, S., Vaccarino, V., Quyyumi, A., Pepine, C. J., & Bairey Merz, C. N. (2019). Gender in Cardiovascular Medicine: Chest Pain and Coronary Artery Disease. European Heart Journal. 0, 1–8. doi:10.1093

7. McMaster University. (2019). Simple cardiac risk score can predict problems with blood flow in the brain. ScienceDaily; Anand, S. et al. (2019). Cardiovascular risk scoring and magnetic resonance imaging detected subclinical cerebrovascular disease. European Heart Journal.

8. (2015). Angina in Women Can Be Different Than Men. American Heart Association.

9 (2020). A Fighting Chance, 2020 Spotlight on Women. Heart and Stroke Foundation of Canada.

10. Iorga, A., Cunningham, C.M., Moazeni, S. et al. (2017). The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biol Sex Differ 8, 33. https://doi.org/10.1186/s13293-017-0152-8