Hey all
I just had a call with my GP to ask for some tests for BAM and SIBO.
My GPs response to BAM was that they don’t test for it - anyone else had this issue?
For SIBO she said to try probiotics which they recommend for the treatment of it - anyone else had this too?
I’ve had all other tests, colonoscopy, bloods and cal pro tests but wanted to make sure everything was covered.
Thanks for any guidance!
Hi. I’ve suffered with diarrhoea for over 20 years and was told it was IBS. Anyway got diagnosed with non alcoholic fatty liver disease about 15 years ago and have high lipids (fats in blood like cholesterol and triglycerides) so on meds for all that. The diarrhoea still wasn’t linked. Fast forward another 10 years and my diarrhoea was worse and I was being sick. I kept a diary of everything, what I ate, times, toilet habits, eg the pain, smell, how long I was on toilet - sometimes 2 hours in middle of night being sick too. Got referred to gastro consultant who did a colonoscopy and a sehcat scan. Sehcat scan is the only way to diagnose bam. Are you in the uk? There are some countries like the US who don’t have sehcats. If you are in uk then push for test. Look at bad-uk.org website for info on this condition. If elsewhere ask if your doctor will prescribe cholestyramine or colesevelam which are bile binder meds. If they help then it’s pretty much a positive sign you have bam. If you do have bam you will need a check of your vitamins as most sufferers are very deficient in B12, D, iron, folic and I have to take potassium and omega. Good luck
Thank you! I’m based in U.K. so this might be one for my consultant rather than GP
Appreciate the info!
Your GP is wrong. There are tests for BAM:
gutscharity.org.uk/advice-a...
SIBO is a controversial subject. When I spoke to my gastro about it, he said that true SIBO cases are rare. Also the test is not 100% so you can get false positives and negatives. If you really do have SIBO which may not be the case, probiotics may not be the right thing to take since you'll be adding bacteria on top of bacteria. Unless you have one of the root causes of SIBO it is very unlikely you have it. I was presented with this handout which shows these root causes:
clinicaleducation.org/docum...
On the right hand side you will see the box containing the heading "Aetiology" which actually means 'a set of causes'. I went through this list with my gastroenterologist and I have added comments from my own health perspective.
He said that these areas would be covered by the Small Bowel MRI scan that I had:
• Stasis: dysmotility – not apparent
• Surgery (loops, vagotomy, bariatric) – not apparent
• Short Bowel Syndrome - not apparent
• I also added ileocecal valve (which sits between the small and large intestine) to this list, which my therapist kept going on about. She said that my ileocecal valve was stuck open allowing bacteria from my large intestine to wash back into my small bowel and I'd need to visit an osteopath who practices visceral (organ) manipulation to get them to close it for me (or you can do it yourself via a youtube video). I had to go to another city 1.5 hours away to visit such an osteopath who eventually said he didn't manipulate the ileocecal valve (although a phone call indicated he might), but I had a couple of sessions of him manipulating my intestines because they were stiff. My small bowel MRI showed there was nothing at all wrong with my ileocecal valve - it was closed and showed no inflammation or any abnormality that would cause SIBO.
And now for the rest:
• Achlorhydria – no stomach acid – he said this was highly unlikely and also considering I can experience acid reflux
. I also would have thought a fecal elastase test would show if you aren't breaking down proteins correctly (which require stomach acid for digestion) and mine came back OK.
• Hypochlohydria – low stomach acid – same answer as above – the only real test is a PH test directly into your stomach, but he said they didn't do this any more and home testing is inaccurate
• PPIs – my therapist said that I hadn't been on PPIs long enough to make a difference
• Malnutrition – no
• Collagen vascular disease – immune system inflammation e.g. arthritis – not in my case
• Immune deficiency - unlikely
• Advancing Age – no
• Chronic Pancreatitis – this causes constant abdominal pain/fatty stools - no
. It is interesting that another IBS Network member had responded to Rifaxamin but was also diagnosed with a compromised pancreas.
• Chronic ABX use – no
• IgA Deficiency – my tests show this is normal range
• Coeliac Disease – I had blood tests with the GP and these came back fine
• Crohn’s Disease – I had blood tests with the GP and these came back fine
and colonoscopy was OK
• NASH – non alcoholic fatty liver disease –looked at my records for this and this is normal
• Cirrhosis - no
• Fibromyalgia – widespread pain - no
• Rosacea – no
I don't know whether this list helps at all, but might be worth working through from your perspective. If you do have SIBO and the root cause isn't tackled, it will only keep coming back.
Also I'm wondering what help you have been getting with IBS, since there are many things worth a go to see if you can get on top of symptoms and maybe consider some of the others things as a follow up if standard approaches don't work. Here is some information about IBS that I have shared with others in this group that might be of assistance:
IBS can be due to a number or combination of factors - these can be stress (including stress from early life experiences) which impacts the communication between the brain and the digestive system. There are lots of free webinars online at the moment regarding mindfulness meditation which might help. Plus you can ask to be referred for CBT or something similar to reduce your anxiety - I would have thought online appointments are available. Exercise can play a major role in IBS in terms of reducing stress, helping your gut microbiome and regulating bowel movements.
There is also not absorbing certain types of carbohydrates called FODMAPs very well, the residue ending up in the colon and bacteria feeding off them causing symptoms. Ordinarily feeding gut bacteria is a really good thing - when you feed good gut bacteria these produce by-products that have great health effects in the gut and throughout the body. However, in some people with IBS bad bugs might have the upper hand over good - these bad bugs may cause symptoms such as pain or disordered bowel movements. There is an interesting infographic on this here:
gutmicrobiotaforhealth.com/....
This is why it’s worth trying probiotics such as Alflorex (which has been scientifically studied for IBS) or Symprove to crowd out the bad bugs and make their numbers die down. If that doesn't work you can try the FODMAP elimination and reintroduction diet. This is normally under the guidance of a nutritionist via GP referral - this may not be possible at the moment so you can read about it online. If you download the Monash University FODMAP app it will tell you which foods contain FODMAPs and in what quantities. You can eliminate all FODMAPs for 2 weeks and then introduce each type of FODMAP one at a time starting in small quantities, increasing over a 3 day period and wait up to 4 days for symptoms. I go much slower than this - only introducing a small amount (1/4 to 1/3 of a normal portion size) of the same food for 3 days and then increase if tolerable or no symptoms and cut back to the previous amount if symptoms for longer and then try to increment again . I've read your microbiome can adapt to handling a new food if introduced very slowly and your bad bugs are under control with a good probiotic. Ideally you want to eat as many FODMAPs as you can since they are good for your health. Many people with IBS don't have diverse gut bacteria - it has been found that people who lack a diverse microbiome are more prone to diseases in general. In the long run, if you can get your symptoms under control, the ideal situation is to have a very varied diet - lots of different coloured fruits and vegetables, a variety of protein and carbohydrate sources including cereal fibres. This may seem a long way off, but with the right treatment all of this is possible. Last year all I could consume to control my IBS was white rice, protein and limited low fodmap veg. Using the approach above (particularly introducing Alflorex) I am now able to consume far more foods - more than I've ever dreamed of including wholewheat bread which is unheard of for me.
If you are also suffering from pain, you may be suffering from visceral hypersensitivity (functional abdominal pain) - there is info about it here:
iffgd.org/lower-gi-disorder...
It is where the brain interprets the normal activity of the bowel as pain - this is due to a wearing down of neurons in pain control centres of the brain which can be caused by PTSD, neglect or abuse in childhood, extreme stressful events etc. The first line treatment is nerve pain agents such as low dose amitriptyline. There is a theory that being on something like amitriptyline for 6-12 months can help the pain control centre neurons to regenerate. Note that amitriptyline can cause constipation, but this can be helpful in people who are diarrhea dominant. Unfortunately I couldn't tolerate these. Linaclotide (for IBS-C only) & Alflorex have helped me with this intestinal pain.
You may also find assistance with anti-spasmodic medication such as mebeverine (Colofac) or enteric coated peppermint.
You can find some info on self management here:
Thank you so much for all that info!
I’m pleased your tests came back ok and it looks like you’ve had it thoroughly checked out.
It’s so interesting with SIBO as I found conflicting arguments about it - some recognise it and others don’t.
Very grateful for everyone’s guidance - after many years I think I’m getting somewhere from having come across this network.
I’ve spoken to my consultant today who’s booked me in to be tested for BAM. I’m finding the more targeted questions I ask the more they are exploring.
I’m also getting a general Health check for cholesterol / sugar etc so should help understand my general health.
My bloods to date have been fine- couple of high cal pro tests and a colonoscopy 2 years ago showed ulcers and erosions - so I’ve had crohns as a possibility but not confirmed.
Also had a call with a dietician today too - I actually ordered a book called “eat yourself healthy” that I’ve been following this week- and the dietician said to keep following that, and she will guide me through FODMAP.... so far this week I’ve only had one episode of D - which up until this week was daily. The stomach cramps continue but I’m managing those and I’m finding I can handle a lot more than just shakes and bland chicken and rice.
Also have a therapist to support with psychological aspects, I do have PTSD and anxiety which I need to address. I’m doing lots of yoga - I was very active until about 3 months ago when the flare got quite bad. But working back up to resistance training again.
I’ve also started on Alflorex, I switched from optibac so I’m hoping these will have a positive effect too. So far all positive! I really didn’t like mebeverine - found I went from one extreme to another so try only take when I really need to.
Has your intestinal pain eased?
That is so great that you are doing so much for your health to get you on track and also asking all the right questions. Unfortunately sometimes you need to do your own research and push for what you think you need.
My intestinal pain is so much better (touch wood :-)) A combination of the Alflorex and Linaclotide worked for me. The pain generally comes back for a short while whilst I am doing new food challenges but I manage this by only consuming increments of small quantities over a long time period so my body can adapt.
Good luck with all your treatments.
That’s really good to Hear!
Alforex does seem to be doing well atm! Lots of people seem to be having great success with it 😊
Thank you so much for your help!
Hey Lauray! I did, I have mild BAM and have adjusted my diet - no more pills thankfully as I’ve been able to manage with diet alone
Thank you, and of course...mainly it was diarrhoea, stomach cramps, fatigue and significant weight loss. If you’re experiencing any symptoms I’d really recommend pushing your GP for some tests- mine didn’t know what BAM was and said she couldn’t refer me to tests, I ended up going private but you can get a sehcat on NHS
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