This is the story of how my client, Louise, got from here:
to here:
This case study shows how much the gut contributes to skin problems. Acne (including rosacea) are common symptoms of SIBO (small intestinal bacterial overgrowth).
The case study also shows that sometimes healing and recovery can be a long and winding road, but once the root causes have been uncovered and addressed, you can achieve results and get better.
Louise's timeline
Initial treatment
When Louise first consulted me, she had endured gut problems for the previous two years. Her main symptoms were:
Persistent acne
Severe bloating
Chronic constipation
Iron deficiency
The antimicrobial treatment phase of Louise's treatment lasted 12 weeks, including two 6-week courses using two different herbal formulations.
We then focused on repair and restoration, which included:
continuing to heal the gut
supporting motility
building the microbiome
gradually diversifying diet
This phase lasted for 8 weeks.
In total, this programme of treatment was completed in 20 weeks.
After this, Louise continued to feel better. She went on to a maintenance phase where we cut back her supplements to a core group of supporting products and continued gradually to get her back to a normal diet.
The hiccup
Louise felt well for about three months after she had completed treatment. She experienced occasional off days where milder symptoms returned, but this is a normal pattern during recovery.
She then travelled to a new state and started a demanding uni course. Her symptoms came back and she sought my help again.
We decided to do a functional stool test to get a proper picture of what was going on in the large intestine and with digestive function. We used the Comprehensive Digestive Stool Analysis, which is a very simple test done at home.
The results showed low digestive enzyme output. We determined that this was mostly due to stress, as a result of the big life changes she had been through. Dysregulated production of the stress hormone, cortisol, can effectively inhibit gut function, especially digestion and motility. It can also cause leaky gut and imbalances in gut flora.
Louise worked on her stress management. She took Metagenics Calm X to help balance her nervous system and support the adrenals, and also supplemented with digestive enzymes.
She did two more rounds of antimicrobial treatment, followed by a repair and restoration phase, as before.
In total, this took about 4 months. Louise felt much better and we gradually got her back to a healthy diverse diet.
Her SIBO has not returned and she uses fermented foods, a prokinetic to support motility, and plenty of plant foods to keep herself on track. She also continues to prioritise daily stress management practices. The main driver of Louise's condition was stress and so it is very important to continue looking after her nervous system to prevent relapse.
Testing
Normally, I would organise a SIBO breath test for my clients. However, in Louise's case, we decided to go ahead with treatment regardless, as she had a limited budget for treatment.
It is always preferable to be properly tested as this can guide treatment, since the test reveals the type of SIBO the client has (methane-dominant, hydrogen-dominant or hydrogen sulfide), as well as the severity.
Even though Louise was not able to do the test, it was still possible to treat her SIBO using broad-spectrum antimicrobials that work well for both methane-dominant and hydrogen-dominant SIBO. It was then quite easy to tweak Louise's protocol as we went along, based on how well she was responding to treatment.
What we used
Please note, supplements in italics are practitioner-only. You will need to email us a picture or copy of a practitioner prescription or contact Carmela for a free consult before ordering.
Metagenics Calm X | |
Amazonia Raw Protein Collagen Plus | |
Bioceuticals Ultra Biotic 45 | |
Wonderfoods PHGG | Designs for Health Zymegest |
Natural antimicrobial treatment
We used Biomedica Phytaxil to kill the bacterial overgrowth in her gut. This is a broad-spectrum natural antimicrobial that contains:
Allisure garlic (this type doesn't provoke symptoms, unlike other garlic supplements)
Oregano
Berberine
Thyme
Myrrh
I find this practitioner-only supplement very effective for both methane-dominant and hydrogen-dominant SIBO sufferers.
Gut healing
We used L-glutamine powder to support gut healing, essential for SIBO treatment or any other gut issue as leaky gut is almost always an accompanying issue. This is because of factors such as:
local inflammation
damage done by unwanted bacteria and other micro-organisms
increased cortisol production when you have a gut infection (bacteria, viruses, yeasts and parasites)
higher histamine levels
Collagen is also a great gut healer. It also provides nourishing amino acids, making it a great addition to a SIBO protocol. We used Raw Amazonia Protein Collagen Plus in Louise's case.
Liver support
With any skin issue, my go-to product is Naturobest Detox & Liver. This is one of my favourite supplements as I always get fantastic results for anyone who has skin problems alongside their gut issues.
Liver support is essential when treating a gut condition, such as SIBO, as it helps your body to process dead and dying bacteria during treatment. It also promotes healthy bile production. Bile has many important functions in relation to gut health, including:
killing unwanted bacteria
triggering motility (vital for overcoming chronic constipation)
supporting healthy digestion
Prokinetic
Chronic constipation is a sure sign of poor motility. Prokinetic products help stimulate muscular contractions in the digestive system.
Poor motility causes food to stagnate in the gut as it is not being moved through quickly enough and this can create bacterial overgrowths. Prokinetic action supports digestion and also works between meals to sweep unwanted bacteria through the gut, preventing them for taking hold and proliferating.
You can use strong ginger supplements, such as Henry Blooms Ginger Calm, or Iberogast, which I find particularly helpful as it helps to support the liver and reduce symptoms of indigestion, as well as boosting motility.
As well using Iberogast, Louisa made ginger teas and drank them between meals to help improve motility further.
Microbiome support
Your microbiome is the cornerstone of good gut health and so it is always essential to do whatever you can to keep it healthy. Most probiotics are not recommended if you have SIBO as they sometimes activate the bacteria and make symptoms worse.
Similarly, most fibre products will exacerbate symptoms.
I use spore-based probiotics as these are not activated until they reach the large intestine and so do not trigger SIBO symptoms. PHGG is a fibre that is well tolerated and is very effective at feeding healthy gut flora and helping to heal a leaky gut.
I often use Wonder Foods PHGG Plus which combines PHGG with spore-based probiotics.
Eating right
No matter how good your supplement plan is or how strong your antibiotics are, you are unlikely to fully recover without paying attention to diet. Louise followed the specific SIBO diet, developed by Dr Nirala Jacobi of SIBOtest.com. It is a modification of a low Fodmap diet and is extremely effective.
Louise followed this diet while on antimicrobial treatment, and then systematically added foods back into her diet once her symptoms had reduced by about 75%.
Moving forward
Once we had treated Louise's SIBO and she became more tolerant to foods and probiotics, we were then able to work on preventing SIBO from returning so that she could be free of it forever. The three main elements of this were:
building a healthy microbiome
supporting motility
managing stress
Because Louise had done the comprehensive stool test, we were able to use the results to guide our approach to balancing her gut flora.
Summary of treatment
The graphic below shows Louise's journey to recovery. I have only included gut-related work for simplicity. We also worked on building her general health, for example supplementing with iron and B vitamins. We also worked on bringing down inflammation, clearly seen in the redness of Louise's skin. We did this using fish oil supplementation and by adding turmeric to her diet.
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