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Could a Leaky Gut Be Making You Fat?


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It’s no secret that obesity, diabetes, and metabolic disease are afflicting an incredible number of Americans; in fact, the prevalence of the metabolic syndrome in our country has reached an astonishing 34% and is continuing to rise. (1) This disease, characterized by long term low-grade inflammation, causes metabolic disturbances that lead to the development of complications such as nonalcoholic fatty liver disease, cardiovascular disease, and type 2 diabetes. This is a serious health problem for many Americans – one that isn’t going away any time soon – and determining the cause of these metabolic conditions is a top priority for obesity researchers across the country.

I’ve been writing about the connection between gut health and “diabesity” for quite some time now; I have an entire series on diabesity and metabolic syndrome on my website dedicated to the relationships between obesity, insulin resistance, metabolic syndrome and type 2 diabetes, and I believe that inflammation and leaky gut caused by gut dysbiosis are the key players in this metabolic epidemic. While the existence of leaky gut syndrome is still debated among doctors and scientists, it is clear to me that having healthy gut bacteria is crucial to maintaining a normal weight and functional metabolism.

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Recently, a group of researchers in Brazil published a new review exploring the idea that intestinal permeability is a contributing factor to obesity.

They identified three separate but related mechanisms: gut dysbiosis, an unhealthy dietary pattern, and specific nutrient deficiencies. These three risk factors likely interact to cause intestinal permeability and promote the development of the metabolic syndrome and obesity.

Gut Dysbiosis and Leaky Gut

It is well documented that those with obesity have significantly impaired gut function compared to the general population. Obese individuals are shown to have problems with effective digestion and absorption of food, gastrointestinal illness, unstable or pathological intestinal microbiota, poor immune status, and overall lower wellbeing, suggestion a lack of gut health. (2) This gut dysbiosis is thought to cause increased permeability in the small intestine, allowing the entry of toxins called lipopolysaccharides (LPS) into the blood and triggering systemic inflammation.

While it is uncertain whether the alterations in gut health are the cause or consequence of obesity, the association between dysbiosis and obesity is strong.

One theory is that the metabolic activity of gut microbiota contributes to weight gain by causing more calories to be extracted from the food passing through the gut. Small intestinal bacterial overgrowth (SIBO) may also play a role in intestinal permeability by increasing constipation, reducing pancreatic enzyme and gastric acid activity, and disturbing the microbiota and host immune system relationship.

Probiotic supplementation can help strengthen the tight junctions of the intestine, reducing overall permeability. Probiotics can have anti-inflammatory effects in the gut, regulating the production of inflammatory cytokines and reducing intestinal permeability. This demonstrates the benefits of a balanced microbiota in the gut to maintain the function of the intestinal barrier, particularly in obesity.

Dietary Effects on Leaky Gut

Besides just the composition of gut bacteria, nutritional factors play an important role in permeability as well. The authors of this study suggest that there are two major components of the diet that can affect intestinal permeability: fructose and fat. Fructose is thought to damage the liver directly by increasing blood levels of LPS toxins, causing fatty liver, inflammation, and hepatic insulin resistance. These effects explain why high fructose consumption has been implicated in the development of metabolic syndrome.

As far as fat goes, the authors of this study suggest that fat is more efficient than carbohydrates at transporting LPS toxins to the liver through the formation of chylomicrons, molecules that deliver dietary fats from digestion to the liver. An increase in liver toxins was demonstrated to induce obesity, diabetes, and insulin resistance in rats, demonstrating why a high fat diet could exacerbate metabolic disease. The type of fat matters though; oleate, a monounsaturated fat, promotes the delivery of toxins to the liver, while butyrate, a short chain saturated fat, does not form chylomicrons or increase LPS toxins in the liver. It has also been found that changes in bile secretion are associated with altered intestinal permeability, and a decrease in bile allows for greater bacterial growth in the small intestine and more LPS being produced.

It is important that future research determine the type of fatty acids that increase intestinal permeability of endotoxins, and whether or not there is an interaction with the type and amount of bacteria in the gut.

The authors of this review do suggest, however, that a combination of a high fructose and high fat diet can lead to an increase in toxin-related liver inflammation and weight gain, which is likely true. (Did someone say McDonald’s Value Meal?)

Nutritional Deficiencies and Leaky Gut

There are several micronutrient deficiencies that the authors found to be associated with gut barrier function, specifically vitamin A, magnesium, zinc, vitamin D, and calcium. Vitamin A, zinc, and magnesium all help maintain tight junctions in the intestine and regulate endothelial differentiation in the gut, while vitamin D stimulates intestinal lining renewal and resistance to damage by modulating the immune system. Vitamin D and calcium play a joint role in maintaining the intestinal barrier by supporting the ATP-dependent pumps in the intestinal cells. In obesity, intake of these micronutrients is typically low, so deficiencies could play a significant role in exacerbating leaky gut conditions, especially when combined with intestinal dysbiosis and poor dietary choices. Therefore, having good intake of these micronutrients could be protective against the development of leaky gut and the inflammation and eventual obesity it can cause.

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Obesity Caused by a Leaky Brain?

One more potential issue (not discussed by this particular review paper) is the possibility that systemic inflammation can actually cause leakiness in the blood-brain barrier as well. (3)

C-reactive protein (CRP), an inflammatory protein that is elevated in obesity, has been found to increase permeability of the blood-brain barrier, possibly leading to inflammation in the hypothalamus. This neuroinflammation can cause impairment of central nervous system (CNS) function, which has been associated with poor control of food intake, leptin resistance, and obesity.

Furthermore, LPS toxins, released into the blood by a leaky gut, can rapidly increase blood leptin concentrations; this increase is enhanced by the presence of CRP, which could explain why chronic inflammation is associated with a rise in both CRP and leptin in humans. In this way, a leaky gut and a leaky brain, both caused by systemic inflammation and exacerbated by gut dysbiosis, can increase the risk of developing obesity due to the disruption in CNS and leptin function.

Gaining Weight? Check Your Gut Health!

The take home message of this study is that the interplay of gut health and diet has a significant role in weight gain and risk of obesity and metabolic disease. If you are struggling to lose weight, you may be dealing with inflammation caused by leaky gut and dysbiosis. And remember, you don’t have to have gut symptoms to have a leaky gut! Weight gain alone could be your only symptom, but it’s an important one to consider.

There are many steps you can take to ensure a healthy gut. Using probiotics and prebiotics can change the quality of the microbiome in the gut, and there are certain dietary strategies that can help improve the strength of the tight junctions between intestinal cells. Other issues such as stress, antibiotic and other medication use, autoimmune disease, and dietary toxins can increase intestinal permeability, so these are gut health factors that must be addressed as well.

Just be sure that you take the necessary steps heal your gut if you’re struggling with weight loss despite making changes in your diet and lifestyle. It may be the last piece in the weight loss puzzle that you’re missing!

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Join the conversation

  1. Chris,
    Thank you so much for bringing the discussion back to gut health. Both theory and anecdote dovetail with the arguments against the widespread use of acid suppresssing drugs, which for a high proportion of the population perpetuates gut dysbiosis with knock on effects for physical and mental health. I look forward to a reiteration of your advice in the GERD series, which facilitates the move from no/low gastric acid to a repopulation with good bacteria, and an expansion on the pracical aspects of reinstating gut health for our entire population.

  2. Hi Chris,

    Are you saying here that SIBO causes hypochloridia and not the other way around?
    Does the GAPS diet treat SIBO?

    “Small intestinal bacterial overgrowth (SIBO) may also play a role in intestinal permeability by increasing constipation, reducing pancreatic enzyme and gastric acid activity, and disturbing the microbiota and host immune system relationship.”

  3. It is interesting article, but highly respected Chris knows that there already exists developed in detail program, which proved to be effective and give a long-lasting effect. It is GAPS protocol developed by doctor Natasha Campbell-McBride.

  4. I have this “gut’ feeling that leaky gut syndrome is directly related to the consumption of the Bt toxin, which exploes the stomachs of the insects that eat it. Is anyone else out htere making that connection?

    • jeannine, I was just going to ask Chris to comment on that and was planning on reading up on that some more myself. A recent “Fat Burning Man” podcast mentioned Bt GMO corn.

      I think you may really be onto something there. I wouldn’t be surprised if a graph of BT corn consumption over laying the rise in metabolic syndrome would show a strong correlation.

      • An Underground Wellness podcast mentions this as well, that the BT toxin caused leaky gut. I think it’s one of the Real Food Summit Q&A podcasts.

        • From what little I understand so far, not only could there be direct damage from the toxin itself but there _may_ also be some gene transfer with some species of gut microbes as well.

          In effect we may end up with these little Bt toxin factories in our guts long after we stop eating GMO corn. Sounds far fetched I know, but it might explain a lot of things.. Like why some people never really get to feeling better until they clean things out with antibiotics and re-populate.

          OTOH, it could be radical environmentalists just throwing out FUD also – but either way it deserves some good research.

  5. One more thing, I have thought about taking prebiotics, but every time I start to try to find some to buy, I get confused and just give up. Do you have any brands to recommend? If you could list more than one, I would be grateful. I am often sensitive to supplement ingredients and have to read the labels very carefully.

  6. This is so frustrating to me. I do eat paleo but I need to lose weight. I never could stand probiotic powders or pills; within an hour of taking them I would get nauseous. But last year I started to make raw milk kefir. I loved it and kept it going each day. One day about three weeks ago, I awoke and had very loose stools. Was fine all day but it happened the next night again. I stopped drinking the kefir, and some days would basically fast, but if I ate anything that day, the next morning or night, I’d have this fun occurrence. After 5 days, I went to get blood and stool tests to find out what was wrong, and they found nothing. I threw away my kefir but its been three weeks, and while some days aren’t so bad, my stool never went back to normal. And it doesn’t seem to be affected by my meals. I can have a good, semi fasting, perfect primal day (no dairy even) and have diarrhea the next morning, and I can have a bad day (someone’s birthday at an Asian restaurant where I can’t control the sauces ) and nothing bad happens.

    I know our immune system is in our gut, and my gut is evidently messed up. While I have been chubby for years, this has never happened to me. I am not nauseous, there is no cramping. All my tests came back negative. I have no idea what is wrong or how to get my gut better.

    I take all the vitamins you mention except vitamin a. I am so frustrated. Yes, I am losing weight, but only because I often force myself not to eat so I can sleep better that night.

  7. I have heard it said that a leaky gut can cause leaky kidneys. What do you think about this, Chris? My n=1 is that I had a terrible time with recurrent calcium oxalate kidney stones for many years. Then, I started having horrible gut problems which eventually brought me to, what works best for me, the auto-immune moderate carb version of Paleo. Of course, I added probiotics and supplements as needed, too. My gut healed and I became increasingly healthier over three years. My diet was very limited because I am extremely sensitive to dairy, even to the point that I can’t tolerate ghee or butter oil and I had to be on a low oxalate diet to prevent kidney stones. The low oxalate diet worked like a charm. While my gut was still a mess, I still had no kidney stones because I was very strict with the low oxalate foods (no sweet potatoes, even!!!). I learned that if my urine flow just easily fell out of me that my dietary oxalates were fine. If I had a moderate oxalate food, like sweet potatoes or okra, my urine stream would become constrained and splattery within hours. So, it was nice that I discovered an early warning system that has worked perfectly for years (no more stones). By this last summer, my gut seemed to be completely healed and I started experimenting with adding medium oxalate foods back into my diet. Voila! No symptoms!! So, I’m eating sweet potatoes and okra, galore! 🙂 I haven’t had time to test high oxalate foods, yet. Careful food testing takes a while. I’m just wondering if this would be that after my gut was intact again, my body then turned to healing my kidneys? Just curious what your thoughts on this are. Thanks!

  8. Hi Chris,

    First of all great article, I recently wrote a similar piece for my Capstone paper to complete my undergrad. In doing my own research for this paper, and others I am wondering if you would not put gut health as secondary to immune system functioning. LPS is known to work through TLR4, which is part of our immune system. Also, LPS is known cause Macrophage accumulation in adipose tissue (http://www.ncbi.nlm.nih.gov/pubmed/22535377). You also talk a lot about the inflammatory nature of many of these diseases. So I am just wondering if, while it is important to have a healthy gut, given the fact that most of its effects work through the immune system, it is not more important to be supporting our immune system directly through nutritional and other interventions?

  9. The biggest challange I have has been finding the time to prepare meals that match the dietary principles of this site. Its very hard to find the time to cook good meals from scratch. But last week I made a discovery, Three Stone Hearth in Berkeley, CA. For those people who live in the area, you can buy from them ready to eat meals. For those people who do live there, you can still get good recipe ideas from their site.

    • The crock pot is your friend! I make double batches and then freeze some. Or last night I ate leftover crockpot pork loin with some homemade BBQ sauce and had “pulled pork.”

      • I’ll second that.
        The crockpot has to be the next best thing to having someone else do the prep for you.
        Just throw it all in, add some salt, seasonings, tomato and Vegemite (yes that Australian stuff – absolutely unbeatable in meat dishes) and let it go.
        i also find that adding some white rice – i use the Italian “arborio” rice – makes a nice “gravy” without any effort.

        I never freeze the leftovers, just eat them the next day, they are the best leftovers for the least work.

        In winter, there is nothing quite like walking into your home to smell the crock pot.
        Plus, since you know a great, warm, healthy dinner is waiting for you, you are *never* tempted to cheat and buy some fast food on the way home.

  10. Hi Chris,

    I’ll be writing about gut flora and weight dysregulation on my blog syontix.com in the near future. I too am very suspicious of those blaming saturated fat intake for inflammation due to translocation of endotoxins. As I wrote in my latest post, “all transporters of blood fat or lipoproteins—chylomicrons, VLDL, LDL and HDL—bind to and inactivate toxic lipopolysaccharides from gram negative bacteria preventing the very inflammatory responses responsible for metabolic endotoxemia and allergic reactions.” But since the saturated fat-cholesterol-heart disease meme is alive and well even in the absence of scientific confirmation, I don’t expect a change in focus from researchers anytime soon.

    As far as I know, none of those examining metabolic endotoxemia are looking at how gluten opioids and gluten-derived adenosine negatively affect GI motility. As I wrote in my small intestinal bacterial overgrowth (SIBO) series, anything that compromises intestinal peristalsis will promote the migration of gram negative bacteria from the colon into the small intestine. Gluten is quite efficient at doing this.

    Gluten’s paralyzing effect on the pyloric sphincter is also the main reason for acid reflux and heartburn, which causes those suffering from these issues to pop antacids and proton-pump inhibitors like candy. Doing so compromises gastric barrier function and opens the door to colonization of the small intestine with dangerous oral pathogens that then translocate to systemic circulation. The consistent association between periodontal disease and heart disease is no coincidence.

    Inflammation also promotes SIBO and I can’t think of anything more inflammatory to the gut wall than gluten peptides. This is why I support a Paleo diet, but with the addition of adequate glucose from starchy tubers or safe grains like rice as recommended by Paul Jaminet to ensure proper GI mucous production and gut wall integrity.

    • Ray,
      That is exactly what happened to me. I was put on PPIs by my GI in 1994 who said if I didn’t take them religiously, I’d end up with Barrett’s Esophagus. I took those pills every day of my life (except when I didn’t have health insurance) until Jan 1, 2012. Since then, I lost 33 pounds, went off gluten, uncovered severe B12 and D deficiencies, and went through two courses of antibiotics for SIBO. During the last SIBO treatment, I read up on diet and realized I would have to change my eating even more so I went Paleo. I still eat white potatoes a few times a week. Is that enough to help the GI mucous production? I am taking 3500mg of L-Glutamine with DGL and aloe vera in a powder and drinking bone broth every day and this has helped my GI tract immensely. I also had a ESR of ZERO for the first time in 6 years. My CRP was still like .5 or something but that was before I went Paleo so here’s to hoping it’s gone the next time.

      • Tara,

        I’m glad you’re on the road to recovery. Going Paleo is a great way to avoid SIBO but not because you’re limiting carbs or insulin release, but because you eliminate the most toxic foods: gluten grains, ill-prepared legumes, refined sugar and vegetable oils. Personally, I wouldn’t consider eating anything less than 100 carb grams a day derived from safe starches and rice. I always feel better including a starch or rice in my daily breakfast and dinner, but that’s me. If you do any amount of exercise that figure will need to go up, or you risk a glucose deficiency. Please visit Paul Jaminet’s blog at http://perfecthealthdiet.com/ for more on this. So no, I think you would feel better adding more starches and rice to your diet.

        The only issue I have with potatoes is that as a member of the nightshade family, it may irritate your GI tract. I love them and tomatoes, but they don’t love me. That doesn’t mean I don’t eat them, I just don’t eat as much of them at one sitting as I used to. As I wrote in my insomnia series, leaky gut increases cortisol production which disrupts sleep. When I eat too many nightshades for dinner, it always interferes with my sleep, and I suspect this is the reason why.

        Obviously, I recommend probiotics and prebiotics for reasons detailed in my blog which I won’t get into here. You may also want to add in a digestive enzyme with every meal, especially if colonic gas is an issue. Many people are not digesting their food properly because of dysbiosis so it ends up in the colon where bacteria ferment it causing loads of gas. Moreover, I’ll be blogging on how gut dysbiosis interferes with gut hormone production including production of cholecystokinin (CCK) which is necessary for proper gall bladder release of bile and pancreatic release of digestive enzymes.

        Everything else you’re doing sounds spot on as I too once took L-Glutamine with DGL and aloe vera when I had my gut dysbiosis. Bone broths are fantastic, and I look forward to having some Vietnamese pho for dinner tonight.

    • I will check out your series on SIBO, and maybe you talk about it in there, but would you recommend giving up coffee as well. I know Chris has mentioned here on his site somewhere the possible cross reaction to coffee due to the molecular signature of coffee being similar to that of gluten. Coffee is one thing I have not given up. Maybe that is why I am so distended and maybe that why I am so hungry all the time. When I have accidentally consumed gluten (last time was in July) I felt ravenous.

      • Kristina, I have a pretty strong reaction to gluten, but manage coffee okay, so it will depend on your personal tolerances. I didn’t drink coffee at all until five years ago, and now only drink one cup per day, so it’s not a big part of my diet, and I think that’s important when it comes to food sensitivities – we tend to react to the things we consume most often. Also, you might be interested to know that I associate ravenous hunger with iron deficiency. Pica is a well documented symptom of iron deficiency, and while it could manifest as eating ice or strange non-foods, it makes sense that it could show up simply as hunger. It’s a pretty reliable indicator in me (and tends to turn up along with a cluster of other symptoms). Iron deficiency seems to be the tip of the nutritional deficiency iceberg in that it often shows up first. If eating gluten is damaging the gut, then I reckon iron deficiency will turn up sooner or later. Pauline

        • Hi Pauline,

          Thank you for the reply. I don’t actually notice a reaction to the coffee, but I still have so many symptoms, it’s kind of hard to tell. It’s also not like I drink coffee and then feel hungry, I sort of feel hungry all day long, sometimes more so after a meal. It’s part of the reason I suspect SIBO and/or H. Pylori.

          As for iron, mine was elevated for the longest time and is now finally in the normal range, but I am still in the mid to upper level most of the time.


      • Coffee indeed can be a cross reactor with gluten, and worsen poor intestinal health, bad bacteria overgrowth, leaky gut, and hypothyroid, especially if you’re prone to Hashimoto’s auto-immune low thyroid disease. Coffee can also interfere with blood sugar levels and increase hunger in some people, so that could be contributing to your constant hunger. Have you tried having a colonic and avoiding eggs (which can cross react also)? I am in the process of getting my Cyrex labs gluten cross reactor foods results, and can’t wait to report!

    • Ray, you’re the first person I’ve come across to comment on gluten and gut motility. Do you have any references on that? I don’t get GERD, but my gut quite literally stops every time I eat gluten – I don’t eat it now on purpose, of course. I’m not overweight, if it matters, in fact, I’ve lost 14 lb since I went gluten free about 15 months ago, and I don’t have any more spare weight to lose.

      • Pauline,
        I get the same issue. I do get GERD, even off gluten, but if I eat gluten, everything stops. It’s really the only noticeable symptom I do get.

      • Pauline,

        Yes, the references I cite are in part five and six of my SIBO series. Funny enough I’ll be posting on constipation today. However, keep in mind that no one has spent any time actually studying this in humans which frustrates me to no end. But given the resolution of GERD and constipation from people who have read my blog and contact me personally to tell me this, I’m pretty certain it’s what causes the vast majority of non-drug induced motility problems.

        Another issue causing GERD and constipation is eating too much indigestible fiber. I also cover this in both those posts.

        • I tried to reintroduce coffee in July and had this reaction! After a few days of increased motility, all went “dead”. It must be the gluten/coffee cross-reaction! Very interesting! I finally figured out the coffee thing and quit again, but I didn’t know that this was a common reaction to gluten. I used to have it all the time, back when I ate gluten. Thanks for your posts in this thread. I’m checking out your blog.

            • I know. 🙁 But, I am working on a replacement: a coconut oil cocoa. I’m still working on the right proportions of everything, but the testing is delicious! 🙂

              • I make chocolate from cocoa butter, coconut oil, cocoa powder, and stevia, but wouldn’t the cocoa butter and cocoa powder be problems as well? I think you can cross react to them also. I could be wrong but I think chocolate was among the list.

                • From what I read, it is the dairy in chocolate that people cross-react with; pure cocoa is fine. I did research it before I started having a hot cocoa every morning. I’m not sure about cocoa butter. I’ve never used it. But, I think it is dairy free and fine. I found that stevia is too bitter paired with cocoa. I am using a small amount of honey and am going to try xylitol (from birch, not from corn) sometime.

  11. Nice to see a sort of recommendation for products, since most reading your articles would like to know where to zero in on the myriad of pre/probiotics, etc. One problem regular folks have in this search for true health, is knowing where to turn. All recommendations are hugely useful.

  12. Hey Chris,

    I think the idea with dietary fat isn’t that it increases gut permeability (as in lower tight junction integrity), it’s that LPS sneaks into the circulation on chylomicrons because it’s hydrophobic enough.

  13. Chris, I am hoping that you would soon develop “heal your gut” program, similar to your paleo code.

  14. Very interesting. I can’t wait to see what develops from all this research. My CRP levels have been over 30 and normal is <1. Developed gluten intolerance and metabolic syndrome and Hashimoto's and a severe B12 deficiency. It hasn't been fun but going off gluten and switching to a more wapf diet has helped a lot!

  15. Chris, I have an idea, maybe someday you could create a program “High Weight Action Plan”, similar to the program “High Cholesterol Action Plan”.

    • Definitely on my list. I’m collaborating with a couple other people you probably know on something like this. Stay tuned.

  16. Hi Chris,

    Great article…thank you. I have read that probiotics are not recommended if a person has SIBO. It seems you are of the opposite opinion?

    Thank you,

    • It depends on the type of probiotics. With SIBO, I think it’s best to avoid D-lactate forming species like L. acidophilus, because SIBO often involves an overgrowth of these species. CustomProbiotics.com makes a good D-Lactate free probiotic.

      • Interesting…thank you for the reply. I actually have a d-lactate free probiotic (Supernatant), but I thought bifido bacteria could overgrow in the small intestine as well. What is your thought on taking s. boulardii?

        • I would be interested in the answer to this as well. I did not take probiotics after finishing my last round of Xifaxin for SIBO. Instead, I went Paleo and started taking L-Glutamine/DGL powder in addition to my liquid vitamin D and B-complex and B12 shots. I think that giving up dairy is essential to preventing SIBO recurrence. I feel great. I am stalled on weight loss though.

          • Hi Tara,

            How long did you take Xifaxan and what dose? I am on it right now. Getting pretty extreme die off from it (550 mg twice a day). I am “afraid” to take probiotics and also afraid not to take them. I considered doing them rectally only but if overgrowth in the SI comes from bacteria in the LI I guess that is no good either.

            As for diet, between FODMAPs, low ox, and low carb, I may as well go back to zero carb.

          • I forgot…did you gain weight on the Xifaxan? I don’t weigh myself but since starting it all my jeans have gotten tighter and I am more distended as well. Two of my worst symptoms, whether I am on Xifaxan or not, are abdominal distention (I look pregnant) and constant hunger (no matter how much or what I eat).

            • Kristina,
              I got no “die off” symptoms at all. I think I was on the same dose as you. Are you still eating gluten and dairy? If so, I highly suggest trying to give it up. Get a copy of this book: http://www.amazon.com/New-IBS-Solution-Bacteria-The-ebook/dp/B007Z5SVRC/ref=sr_1_2?ie=UTF8&qid=1352484674&sr=8-2&keywords=a+new+ibs+solution “A New IBS Solution” and read it. All I add to it is that you have to stop feeding the bacteria and they like sugar and lactose. Dr. Pimental’s book talks about Probiotics with SIBO. I stopped eating added sugar, soy, gluten and all dairy except butter and I feel much better. No IBS at all.
              I too suffered from severe hunger before changing my diet. I have always looked pregnant and I have a distended belly. It is worse at night. At the end of my Xifaxin, I had lost 2 inches off my nightime belly size. I did not gain weight on Xifaxin.

              • Hi Tara,

                I don’t eat any grains at all so no gluten. I buy “one ingredient” foods – no cans, packages, etc. I have been on a Paleo diet since 2003 and my daily distention started in 2008. I always had a flat stomach. Now I don’t and I have love handles, too. I read Dr. Pimentel’s book last year, was going to re-read it since I am on Xifaxan right now, but cannot seem to find it. Anyway, I eat grass-fed/pastured meats and chicken, wild caught salmon, coconut oil, animal fats, sometimes raw butter or ghee, and low starch veggies. That’s it. I do drink coffee but am about to give it up.

                • Wow, so you’ve already done all your homework. Hmm. Did you have a breath test to confirm the SIBO?

                • I did but that was January 2011. The reason my doctor put me on Xifaxan is because a stool test showed overgrowth of Klebsiella, two strains of streptococcus, and taxoplasma. I am just so tired of the distention because it has been daily for 4+ years and it doesn’t matter what I eat. I even went zero carb for a long time and was just as distended. It’s very, very uncomfortable and the constant hunger feels unbearable. If I try to eat t hunger it never happens and I just feel more and more uncomfortable from the increasing distention.

                  I also have chronic lyme and babesia, h. pylori, and other stuff going on so there’s a lot happening. Just torn about taking probees or not. Can’t say I feel better or worse when I take them. Really no difference except that I may be even more hungry with them which I chalked off to die off.

      • Chris,

        I have to disagree with avoiding beneficial D-lactate bacterial strains when treating SIBO. Both L. acidophilus and L. plantarum are natural and essential constituents of the small intestinal gut flora ensuring through their production of lactic acid an inhospitable environment to pathogens. While it is true that SIBO caused by gastric barrier dysfunction is “usually” due to gram-positive pathogens and these bacteria are of this type, it does not follow that they are the main reason for the problem. According to one research paper:

        “When the gastric acid barrier fails, contaminating bacteria are mainly composed of upper respiratory tract flora, such as viridans Streptococci, coagulase-negative Staphilococci, Haemophilus sp., Diphtheroids, Moraxella sp., Lactobacilli and other streptococci, most of which are Gram-positive bacteria.”

        If anything, the lactobacillus present in the aspirate and therefore included in the above list is due to the fact that this is their normal environment and their populations should be encouraged to displace these other pathogens.

        I also want to mention that the number one reason for SIBO is overgrowth of gram-negative bacteria migrating from the colon due to impaired peristalsis. As the highly inflammatory cell wall remnants of these pathogens (LPS) is likely the proximate cause of metabolic syndrome, anything we can do to displace them, including supplementing with gram-positive lactobacillus should be encouraged. Otherwise, as yogurt and kefir are rich in D-lactate commensals, this would result in the bizarre recommendation to avoid these fermented foods when battling gut dysbiosis.

    • Chris, I’m involved in a research study because of an over growth of bacteria – I’m having all the complications you have described and seem to be getting worse after the antibiotic series for ten days – I really need your help on who I can see to help me with this debilitating illness