EP.400/ Three Ways SIBO Can Contribute to Endo Symptoms Outside of Endo Belly and IBS
So today marks the 400th This EndoLife episode, and I know people say in these circumstances “how did that happen?” But honestly, I know how that happened! Literally hundreds and hundreds of hours of researching, recording, and a lot of editing out my swearing.
I really hope that this podcast still continues to be helpful to you, to this day, what once started as interviews and my own personal journey, has evolved as my career has evolved, and I really hope that it’s still relevant to you to this day.
Anyway, the past few years I’ve been bridging the gap between endo, SIBO and co-conditions, and lately I’ve been sharing a lot about the impact of SIBO on the endo belly and common IBS symptoms us endo folk suffer with, and the way that SIBO may increase the risk of endometriosis development and growth.
But it occurred to me that my first full episode on SIBO was episode 90! So for some of you, you may wonder why it’s such a big deal in my mind for people with endo. So I wanted to share some of the ways that SIBO can affect our endo symptoms, outside of the usual endo belly issues. Now I have done some deeper dives into these topics individually, in the past, so this is more of a recap episode, but I’ve linked to the studies in the show notes if you want to do further reading.
Now, before we begin, I just want to remind you that a recent study found 91.9% of endo participants were positive for SIBO or IMO, with 49.4% being positive for both hydrogen and methane, and 34.8% being positive for hydrogen alone and 15.8% were positive for methane alone.
Additionally, a previous study found 80% of endo participants had SIBO,(2) and I would say that out of those I test, around 90% come back positive. I think I’ve only ever seen one or two negative test results!
So, how else could the presence of SIBO be affecting endo peeps?
1) Pelvic pain
The IBS symptoms such as pressure from bloating and abdominal cramping, can result in nerves being more sensitive and the nervous system being in a heightened state of stress, known as visceral hypersensitivity,(3) which can extend to the local pelvic area.(4) This heightened response, which as we explored in my episode with Christie Uipi, can actually turn up the volume on pain.
Additionally, localised inflammation resulting from the LPS that can escape through the gut barrier with SIBO, can also cause more inflammation in the pelvis and worsen pain.(6) I talk about this in another episode, so have linked to that in the show notes.
Finally, you know that improving the pelvic floor is a major part of my work when it comes to managing endo. The colon is part of the pelvic floor, so issues like chronic constipation, abdominal cramping and diarrhoea that come from SIBO, can all further contribute to pelvic floor dysfunction,(7) which impacts all the organs, nerves and muscles in the pelvis, including the bladder and vagina, contributing to pelvic pain and dysfunction like pain with sex.
So, for some people with SIBO and/or IBS, their endo symptoms won’t fully improve until IBS issues are minimised, because it allows the whole area to calm down, and in turn, for the nerves and nervous system to calm as well.
2) Systemic inflammatory symptoms
The gases, acids and LPS released from SIBO bacteria can cause full body pain, inflammation, brain fog, nerve sensitivity, anxiety and depression, (8) - common issues with endometriosis. This is especially true for hydrogen sulphide gas, which at elevated levels is a neurotoxin with far reaching effects on the body.(9)
3) Fatigue, brain fog and mental health
People with endo have a six-fold increased odds of having iron deficiency,(10) which can worsen fatigue, brain fog and mental health struggles, all of which we know are common in endo.(11) SIBO has been shown to cause nutrient deficiencies including iron.(12) This can be compounded if you also struggle with heavy bleeding each period, which depletes our iron levels.
And it’s worth noting that low iron can contribute to other symptoms too, such as dizziness, palpitations, breathlessness and exercise intolerance.
If you suspect you have low iron, I’ve linked to my episode on optimal levels, how to get tested, etc.
Okay, so that’s a whistle stop tour on how SIBO may be contributing to some of the symptoms we may think are solely down to endo, and after working with hundreds of students and clients on their SIBO, I can say that these symptoms do improve once the SIBO is eradicated or minimised, though remember that there are numerous reasons people can suffer with these symptoms when they have endo, and that’s why a full body, holistic approach is so important for managing this condition.
Now, if you’d like help with your endo belly, I am looking for 5-10 people who would like help with their endo belly and suspect SIBO (there are about four spaces left).
After the success of using probiotics for SIBO in endo clients these past nine months, and the recent practitioner training I ran on endo and SIBO, where I presented the latest research and my experience with endo+SIBO clients over the past several years, I would LOVE to now take this further to a larger group of endo peeps to begin gathering more data on the impact of SIBO on endo, and how addressing it affects IBS symptoms, endo symptoms and endo belly.
I am particularly keen to work with anyone interested in trying the probiotic protocols I’ve been testing, as this is where we have the least data and yet are seeing good success rates, BUT I’m also happy to work with anyone who would like to explore other avenues i.e. elemental diet, herbs, etc.
To keep this affordable and also to help manage my caseload, the programme will consist of three one to one sessions, delivered over six months (nine months if needed, some cases require longer), with email support in between (in contrast to my usual coaching, which is 12 sessions). SIBO is tough to treat, so there will of course be room for extension if required.
Prior to starting, we’ll order you a SIBO test and go over your symptom history to help me identify any SIBO co-conditions or root causes we need to address.
Then we will meet for two initial sessions to get started, covering:
Test results
Protocol options and creating a plan (including retesting)
Dietary options
Die off preparation and management
Symptom management
You’ll then be able to move forward with the protocol, with email check ins and support from me.
The third session will cover prevention of relapse and microbiome rebuilding, or chronic SIBO management if you have a root cause that causes continual relapse i.e. hEDS. It’ll be booked in based on when you’re near completion of the protocol.
In return for the discounted price (which I’ll share in just a moment), I’d love to use your experience to gather information on which protocols were most helpful, which management strategies you responded best to, SIBO success rates, impact on endo, etc. I won’t be sharing any personal information like names, etc. It’ll simply be quantitative data (maybe some qualitative if there’s any quotes that you’re happy to share).
My hope is that I can use this info to learn more about the endo + SIBO connection, develop better and more effective protocols and eventually present all of this in an accessible course or book, that’s budget friendly for everyone.
Because this is a condensed version of my usual work, we won’t be directly targeting/discussing endo, but I will take into account your endo history and symptoms, and this will all be considered in the SIBO protocols, and they will be tailored to support your endo symptoms i.e. certain prokinetics for SIBO can also treat endo pain, certain SIBO dietary changes have also been shown to help endo symptoms, etc. If you’d like one or more targeted endo sessions, they can be booked in, in addition.
Whilst I would love this to be free, I can’t work with that many people on two such tough conditions for no fee - it would simply take up so much time, I wouldn’t have enough spare time to earn a living! But the programme is significantly cheaper than my typical year long 1:1 coaching programme, at £600, with the option of 3-6 month payment plans if needed in £100 or £200 instalments.
If you’d like to learn more, email me on hello@thisendolife.com
References
(1) https://pubmed.ncbi.nlm.nih.gov/39959963/
3) https://pmc.ncbi.nlm.nih.gov/articles/PMC5056566/
6) https://www.theendobellycoach.com/podcast/lipopolysaccharides-endo-pain-growth
7) https://pubmed.ncbi.nlm.nih.gov/20087090/, https://pmc.ncbi.nlm.nih.gov/articles/PMC6326213/, https://pubmed.ncbi.nlm.nih.gov/33973308/
8) https://www.sciencedirect.com/science/article/pii/S0031938421000391, https://pubmed.ncbi.nlm.nih.gov/18422970/, https://journals.lww.com/ajg/fulltext/2020/02000/acg_clinical_guideline__small_intestinal_bacterial.9.aspx, https://pmc.ncbi.nlm.nih.gov/articles/PMC3607857/, https://journals.lww.com/ctg/fulltext/2018/06000/Brain_fogginess,_gas_and_bloating__a_link_between.6.aspx?ref=podcastdisclosed.com
9)https://youtu.be/daNnGb-dnmM?si=S0ofly2WWYjSZZm0
10) https://pubmed.ncbi.nlm.nih.gov/39990556/
11)https://www.thelancet.com/journals/lanogw/article/PIIS3050-5038(25)00111-6/abstract, https://pmc.ncbi.nlm.nih.gov/articles/PMC7203274/, https://pmc.ncbi.nlm.nih.gov/articles/PMC5440042/
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