SIBO rosacea link

[thatguy]

I've been reading up on small intestinal bacterial overgrowth (SIBO) because it's linked to rosacea and IBS -- two conditions that I have.

I just found this, and want to share it with you guys:

https://www1.uegw.org/guest/ID90f7a8...iew?ABSID=3249

INTRODUCTION: Several pathogenetic factors have been implicated in the development of rosacea, but the role of intestinal bacteria has never been investigated.
AIMS & METHODS: We aimed at assessing the presence of small intestinal bacterial overgrowth (SIBO) in patients with rosacea and the clinical effectiveness of its eradication.We enrolled 60 consecutive rosacea patients (43 females, 17 males; mean age 52 ± 15) and 60 healthy controls, sex- and age-matched. All patients and controls underwent lactulose and glucose breath tests (BTs), in order to assess the presence of SIBO. Patients positive for SIBO were randomized to receive rifaximin 1200 mg/die for 10 days or placebo.Eradication was assessed with the same BTs after one month of the end of antibiotic therapy. Two independent dermatologists evaluated clinical features of rosacea before and after treatment on the basis of an objective scale.
RESULTS: We found an increased prevalence of SIBO in patients with rosacea compared to controls (40/60 vs 3/60, respectively, p<0.001). Oro-cecal transit time resulted significantly delayed in patients with SIBO than in controls (p<0.01). After SIBO eradication we obtained a complete recovery of cutaneous lesions in 17/20 (85%) and a relevant improvement in 2/20 (10%) patients, while those treated with placebo remained unchanged (14/16) or even worsened (2/16), (p<0,001). These latter patients were subsequently switched to rifaximin therapy with complete resolution of rosacea in 14/16 and significant improvement in the remaining 2 cases.
CONCLUSION: Our study shows the high prevalence of SIBO in patients with rosacea and emphasizes the clinical effectiveness of its eradication in inducing almost complete remission of cutaneous lesions.

Edit: If you're wondering where this is from, it's the United European Gastroenterology Week website.

[thatguy]

I found this interesting, too:

"The effect of red and black pepper on orocecal transit time"

http://www.jacn.org/cgi/content/abstract/11/2/228

Makes me wonder if taking red pepper capsules could help speed things up in our guts.

Also, take a look at all of these other conditions where people have prolonged orocecal transit times:

http://www.google.com/search?hl=en&s...t+time&spell=1

[Melissa W]

Hi Thatguy,

Thanks for all the interesting articles and thoughts regarding rosacea that you have been posting lately. I am reading everything you have been sharing with us with great interest. Thanks so much for all the thought provoking ideas!

BTW Are you any relation to That girl?
I was a big fan of her early tv show


Best wishes,
Melissa

[thatguy]

Hi Thatguy,

Thanks for all the interesting articles and thoughts regarding rosacea that you have been posting lately. I am reading everything you have been sharing with us with great interest. Thanks so much for all the thought provoking ideas!

Thanks, that's nice to hear.

I think everybody should take a look at this:

http://www.nlm.nih.gov/medlineplus/e...pages/1411.htm

This is a rash caused by Candidiasis. The erythema looks kind of like rosacea.

(Here's some more information on it: http://en.wikipedia.org/wiki/Candidiasis)

One of the other symptoms of Candidiasis is oral thrush, and I noticed that the back of my tongue looks like I have a mild case of it, so it piqued my interest.

Now look at this case of a 23-year-old whose facial rash went away after taking antibiotics, but then returned. Scroll down to read the article; linking to the original url doesn't work for some reason. I found it while searching for information on "demodicidosis."

http://www.medscape.com/content/2002....clar.fig1.jpg

Here's my theory: his rash went away because it killed off an overgrowth of bacteria in his small intestine. After he stopped it, the bacteria came back, and the symptoms returned. Why do they come back? Maybe not all of them were eradicated, and then they re-multiply and cause problems. Or maybe the gut transit time (GTT) is slowed down enough that the bacteria/candida/whatever you want to call them are given "too much" time to feed.

This might explain why people going on gluten/dairy free diets see relief from their symptoms: because the bacteria don't have anything to feed off of. Their gut motility, however, is still slow, which causes the symptoms to come back.

Alternatively, maybe the bacteria in the small intestine are causing malabsorption of minerals, which results in a damaged immune system that allows for demodex mites to grow.

Here's some information that backs up that theory:

"Rosacea-like demodicidosis associated with acquired immunodeficiency syndrome"

It seems likely that Demodex infestation does not manifest unless local or systemic immune function is altered, leading to the proliferation of the organism and subsequent disease.

Click here for the full study. The link expires in a week (sorry).

Either way, I think there's a very real link between digestion (particularly in the small intestine) and rosacea.

There's a book on treating IBS called "A New IBS Solution" by Dr. Mark Pimentel. I read it about a year ago, and he believes that IBS is caused by SIBO or small intestinal bacterial overgrowth. He treats it by making patients take high doses of an antibiotic used for travelers' diarrhea called rifaximin (the brand name is Xifaxan).

From the book's FAQ:

What about the gluten-free diet? Will this help my symptoms?

A gluten-free diet is used to treat a condition called celiac disease, which has symptoms similar to IBS. To a somewhat lesser degree, this diet is similar to the popular Atkins Diet in the sense that, in both diets, the person is reducing carbohydrates (sugars). In the case of a gluten-free diet, you are switching your carbohydrates more to potato starches and to rice, and therefore to more simple carbohydrates. The complex carbohydrates are the ones that come from grain cereals, and that’s where gluten, which is believed to be the protein that causes celiac disease, comes from.

Some people often feel that they might have celiac disease, even though all their tests for it came back negative, because they do feel somewhat better on a gluten-free diet. This makes sense because, when you eliminate gluten-containing foods, you are also eliminating complex carbohydrates, and carbohydrates, like sugar, are what bacteria thrive upon. If you starve bacteria of carbohydrates, they cannot sustain their large numbers, so the degree of bacterial overgrowth actually drops. We believe that explains why IBS symptoms are less pronounced, including bloating. Again, though, while a gluten-free diet may provide benefit for IBS patients, it rarely is enough for eliminating the bacterial overgrowth, which should be the primary aim of any IBS treatment program.

To some extent we have confirmed this concept. In a study we published recently, we were able to completely eradicate bacterial overgrowth and facilitate a dramatic improvement in IBS using a nutritional product from Novartis, called Vivonex™ (see Chapter 6 of the book for full details). Vivonex is an elemental diet, which means the food that it contains is already completely predigested.

Therefore, when a person consumes this product, the food is absorbed so readily into the blood that the food does not travel much beyond the first 2 feet of small intestine (the absorbing area of the gut; the full length of the gut is 15 feet). In the case of bacterial overgrowth where, in most cases, the bacteria are further into the small intestine than 2 feet, the patient’s eating this type of food starves them. The ability to get rid of bacterial overgrowth with this type of diet for two weeks is nearly 90%. The problem is that this diet is very difficult to tolerate even for brief periods of time.

I think people see some relief from using Pau d'Arco because it's killing off bacterial overgrowth. Enteric-coated peppermint oil has similar effects. Whether or not either is powerful to kill off all of the bacteria is another question. (Probiotics probably play a similar role.)

Dr. Pimentel wrote in his book that many people developed IBS after experiencing food poisoning. Patients get sick and then their bowels are basically never the same. The reason for this is that their small intestine has become infested with too much bacteria. So, how many of you have ever had food poisoning? I know that I've had 2-3 severe cases of it in my teens. And I do recall my acne/rosacea worsening during that period.

Finally, you can find out if you have SIBO by taking a hydrogen breath test. For more information on it, click here. You may want to take it before trying antibiotics, because rifaximin is absurdly expensive (I think it's something like $700 for the 14 day treatment that Dr. Pimentel recommends).

[thatguy]

Another interesting article:

http://medind.nic.in/ibo/t04/i2/ibot04i2p79.pdf

Here, Demodicidious is seen in patients with AIDS. Recall that people with AIDS have had their immune systems compromised. Maybe the same is true for people with SIBO.

On the otherhand, some authors suspect an unusual hypersensitivity against the mite itself.

So here's another thought:

1. Bacterial overgrowth leads to

2. Compromised immune system which

3. Can't fight off demodex mites

4. And some kind of genetic sensitivity to them results in a rash on our face?

The article mentions clearing it up with benzoyl peroxide. But I know from personal experience that it irritates my skin.

[thatguy]

Oh yeah, *one* more thing.

I think our rosacea could all be linked to SIBO, but brought about in different ways:

1. food poisoning which causes bacterial overgrowth which then leads to a sluggish gut transit time

2. low stomach acid production which causes a sluggish gut transit time

Maybe some of us got food poisoning, which led to a bacterial overgrowth that hasn't gone away. While others have low stomach acid, resulting in an unsterile environment that doesn't fully break down food and gives bacteria extra time to feed?

[thatguy]

SIBO is commonly seen in dogs.

http://www.vetmed.wsu.edu/courses_vm...rial_overg.htm

It causes a B12 deficiency.

http://www.provet.co.uk/health/diagnostics/cobalami.htm

Interestingly, I think people with fibromyalgia have to take B12 shots. I have a strong feeling that rosacea and fibromyalgia are both symptoms of a greater condition.

[thatguy]

This Wikipedia article on SIBO is fantastic:

http://en.wikipedia.org/wiki/Small_b...rowth_syndrome

Proton pump inhibitor medications that decrease acid in the stomach cause bacterial overgrowth by a similar mechanism, as they prevent the anti-bacterial effects of acid in the stomach.

Ding, ding, ding.

Low stomach acid -> SIBO -> rosacea

Here's another thing I want to mention:

I think I read somewhere that stress can reduce the production of stomach acid. So maybe this can explain why hypnotherapy, stress reduction techniques, etc. have helped some people. They've probably led to a return in a normal level of gastric acid, which ended the bacterial overgrowth?

Edit: It might also explain why people with IBS see relief when their stress goes away (it happened to me):

Stress -> low stomach acid -> SIBO -> IBS

[Brady Barrows]

Patients positive for SIBO were randomized to receive rifaximin 1200 mg/die for 10 days or placebo...These latter patients were subsequently switched to rifaximin therapy with complete resolution of rosacea in 14/16 and significant improvement in the remaining 2 cases.

Wikipedia says that Rifaximin is "a semisynthetic, rifamycin-based non-systemic antibiotic, meaning that the drug will not pass the gastrointestinal wall into the circulation as is common for other types of orally administered antibiotics....It is currently sold in the U.S. under the brand name Xifaxan by Salix Pharmaceuticals. It's also sold in Europe under the name Spiraxin and Zaxine.."
Source

I bet we hear more about Rifaximin and Xifaxan.

[thatguy]

Association between Hypothyroidism and Small Intestinal Bacterial Overgrowth

http://jcem.endojournals.org/cgi/con...act/92/11/4180