<<Disclaimer: Verify this information before applying it to your situation.>>
Dear Celiac Friends:
Thanks to the many who responded to my post asking for feedback on the subject of bacterial overgrowth. The volume and thoroughness of the replies indicates that many of us suffer from this condition and that it warrants initiative as well as good medical advice in taking care of it.
Symptoms include: diarrhea sometimes violent off and on, especially at the end of the day; sometimes also constipation in the early part of the day; loss of energy; bloating; headache; general malaise. Part of what is so troubling is that the symptoms mimic those of gluten ingestion. I also have a history of persistent heartburn that has been helped with tablets of Betaine Hcl at meal times.
Diagnosis: I was diagnosed by a breath test for lactulose reaction. An endoscopy showed damage to the villi, similar to that caused by cd.
Prescription: Xifaxam (called Rifaximin in England): 200 mg twice daily for ten days.
(After two days on the antibiotic I feel improvement already.)
This antibiotic is apparently only recently available in the US. Previous treatment involved rotating different antibiotics until the offending bacteria were eliminated.
Insights from the responses:
1. A summary of [a good] article at. http://www.celiac.com/st_prod.html?p_prodid=1000 . The actual article: is Ameri. Journal of Gastroenterology, Vo. 98, No. 4, 2003.
2. a. search medline at www.medscape.com
b. Tursi A, Brandimarte G, Giorgetti G.; Department of Emergency, "L. Bonomo" Hospital, Andria (BA), Italy.
OBJECTIVE: Celiac disease is a gluten-sensitive enteropathy with a broad
spectrum of clinical manifestation, and most celiac patients respond to a
gluten-free diet (GFD). However, in some rare cases celiacs continue to
experience GI symptoms after GFD, despite optimal adherence to diet. The aim
of our study was to evaluate the causes of persistence of GI symptoms in a
series of consecutive celiac patients fully compliant to GFD. METHODS: We
studied 15 celiac patients (five men, 10 women, mean age 36.5 yr, range
24-59 yr) who continued to experience GI symptoms after at least 6-8 months
of GFD (even if of less severity). Antigliadin antibody (AGA) test,
antiendomysial antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as
well as esophagogastroduodenoscopy (EGD) with histological evaluation, were
performed before starting GFD. Bioptic samples were obtained from the second
duodenal portion during EGD, and histopathology was expressed according to
the Marsh classification. !
To
investigate the causes of persistence of GI symptoms in these patients, we
performed AGA and EMA tests, stool examination, EGD with histological
examination of small bowel mucosa, and sorbitol-, lactose-, and lactulose
H2-breath tests. RESULTS: Histology improved in all patients after 6-8
months of GFD; therefore, refractory celiac disease could be excluded. One
patient with Marsh II lesions was fully compliant to his diet but had
mistakenly taken an antibiotic containing gluten. Two patients showed
lactose malabsorption, one patient showed Giardia lamblia and one patient
Ascaris lumbricoides infestation, and 10 patients showed small intestinal
bacterial overgrowth (SIBO) by lactulose H2-BT. We prescribed a diet without
milk or fresh milk-derived foods to the patient with lactose malabsorption;
we treated the patients with parasite infestation with mebendazole 500
mg/day for 3 days for 2 consecutive wk; and we treated the patients with
SIBO with rifaximin 800 mg/day for 1 wk.!
The
patients were re-evaluated 1 month after the end of drug treatment (or
after starting lactose-free diet); at this visit all patients were
symptom-free. CONCLUSIONS: This study showed that SIBO affects most celiacs
with persistence of GI symptoms after gluten withdrawal.
PMID: 12738465 [PubMed]
c. Three more articles on the subject: http://www.nlm.nih.gov/medlineplus/ency/article/000222.htm
http://www.emedicine.com/med/topic198.htm
http://adam.about.com/encyclopedia/000222.htm
3. Contributors to the problem:
(1) Refined carbohydrates, especially GF baked goods, white rice, white potatoes, fresh milk.
(2) Low stomach acidity. Very common in celiacs.
(3) impaired immune system.
Solutions:
(1) Sugar free, lactose free, low starch diet loaded with veggies & meats.
No GF baked goods. No spaghetti, pasta, rice etc. Cook with almond flour.
(2) Stomach acid supplementation with each meal. (Best is Thorne Bio-Gest.)
(3) Fermented foods -- kefir (one or two cups a day), unsweetened yogurt, raw sauerkraut, raw pickles.
(4) Immune booster such as colostrum, echinasia, goldenseal, etc.
4. Might need to increased intake of Hcl. Try Thorne Bio-Gest (HCl w/ pepsin, ox bile and pancreatin). Read WHY STOMACH ACID IS GOOD FOR YOU, by Dr. Jonathan Wright MD. He explains in very plain English with TONS of research to back him up why & how heartburn is caused by low stomach acid.
Also use kefir on a daily basis...best (and cheapest) thing... Kefir plus Thorne Bio-Gest is what keeps me functional! There are some pricey commercial probiotics:One is Garden of Life's Primal Defense. It's $30 or $40 for a month supply.
5. A list mate last year told of his recovery from chronic diarrhea & dysbiosis after going on bovine colostrum..a $30 over the counter item. Schiff makes a product called Immune Assure,
It contains bovine colostrum and a couple of herbs that boost immune systems.
I understand that even though you avoid sugar like the plague you can still have bacterial overgrowth. I was on a totally sugar free diet yet I still suffered from an overgrowth of citrobacter, a nasty irritating bacteria. HCl plus kefir straightened it out... HCl alone only helped...
6. Dr. Cynthia Rudert of Atlanta recommends a probiotic for newly-diagnosed celiacs. This puts the "good" bacteria back into the system; the probiotic Culturelle is gluten-free.
7. I'm not a Celiac but was diagnosed with bacterial overgrowth about 5 years ago by an MD at Mayo in Scottsdale, AZ. 5 different antibiotics off and on for about a year cleared my diarrhea but made my bowel very irritable. I'm still dealing with it.
8.Many years ago we got a diagnosis of bacterial overgrowth based on the organic acid urine test from www.greatplainslaboratory.com (Dr. Shaw, who wrote Biological Treatments for Autism and PDD). The advice was to do probiotics, starting with Culturelle, the self-proclaimed "Cadillac brand". Dietary choices are important, too, just as with yeast. I have read that although gastroenterologists do try to treat bacterial overgrowth with antibiotics, it is not very successful, as it tends to recur - I believe that probiotics is the only way.
9. Suggested non-Rx Berberine as highly effective. Going to try PhytoPharmica Berberine Complex.
10. It is most commonly described in patients who are not using their stomach or
intestines, such as those on total IV feedings or on feeding tubes.
*Support summarization of posts, reply to the SENDER not the CELIAC List*
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