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10 signs of SIBO

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10 signs SIBO & difference between IBS and SIBO. The FODMAP diet and why it’s not for everybody. Most digestive problems like IBS are formed by lifestyle; our nutrition & our daily stress. Digestive complaints — constipation, diarrhoea, heartburn and bloating are very common.

The IBS diet

Most digestive problems like IBS and SIBO are formed by lifestyle; our nutrition and our daily stress. Digestive complaints — constipation, diarrhoea, heartburn and bloating are very common. SIBO can leave us feeling tired all the time. SIBO or IBS? (read on)…

We shouldn’t have to live with them though.


SIBO is Small Intestinal Bacterial Overgrowth. It’s often confused with IBS (Irritable Bowl Syndrome).
Dysbiosis is a microbial imbalance on or inside the body. 10 Signs of SIBO — read on…

FODMAP, GAPS paleolithic diet, pegan diet, sirtfoods, sugar free. What’s our take on these?

London Nutrition expert Susannah at The Bulgari Hotel, Knightsbridge and The Chelsea Private Clinic uses a functional approach. This can help identify between SIBO and IBS.

Digestive issues affect gut healthLondon naturopath and osteopath Susannah looks at total body wellness. Her gut health assessment links dysfunction to skin issues, stubborn belly fat, tiredness, low immunity, musculoskeletal pain, etc…
— How can you actually use this? —

SIBO test

SIBO test

10 signs of SIBO

1. Gas 2. Bloating 3. Diarrhoea 4. Abdominal pain or abdominal cramping 5. Constipation (much less common than diarrhoea) 6. Diagnosis of IBS or IBD irritable bowel syndrome or inflammatory bowel disease
7. Food intolerances such as
and more
Can we get rid of food intolerance for good? Drop us a line. How can we help answer your food intolerance questions?
8. Chronic illnesses such as: fibromyalgia : chronic fatigue syndrome : diabetes : neuromuscular disorders
autoimmune disorders
9.  Nutrient deficiencies and their associated symptoms: Vitamin B12, A, D, E, iron, other B vitamins, fat, protein and carbohydrate malabsorption.
Carbohydrate intolerance-symptoms se.g. bloating or pain or gas or fatigue after eating.
Fat malabsorption.
10. Joint pain

SIBO test

SIBO Breath Test This is the gold standard. However, it’s quite cumbersome. Individuals must fast for 12 hours, breathe into a small balloon, ingest a precise amount of sugar and repeat breath samples every 15 minutes for 3 or more hours. Abnormal breath tests also can signify pancreatic insufficiency and celiac disease.

Organix Dysbiosis Test or Urine Organic Acid Test This functional medicine lab test the urine for by-products of yeast or bacteria in the small intestine. If your small intestine is housing a yeast or bacterial overgrowth, byproducts will appear in your urine, indicating their presence. This test is much easier for patients and only requires one single urine specimen. This is the test I use most often in my clinic.

Comprehensive Stool Test This is also a functional medicine lab test looking at the flora of the large intestines.

History By listening to our patient’s history and symptoms oftentimes, this can reveal far more than any test. The question is, can we make a diagnosis of SIBO in order to effectively treat it?

SIBO diet

The goals of treatment for SIBO and IBS are In The Four Phases.

PHASE 1) correct underlying cause PHASE 2) provide the 2 PHASE plan: nutrition support to target the cause 3) Nutritional support to treat side-effects of malabsorption 4) treat bacterial overgrowth

The standard treatment for SIBO is an antibiotic called Xifaxan or Rifaximin. You may be prescribed this by a prescribing physician as part of our clinic team. Because Xifaxan isn’t well absorbed throughout the body, it mostly stays in the gut. So, it’s effective against SIBO. The antibiotic – probiotic combination is carefully considered @ Susannah Makram Clinics. The right amount of probiotic is incorporated into your FOUR PHASE treatment.

Nutrient supplementation is only effective to target your primary health concern when administered in this supervised manner.



Sibo Treatment

So now you know the 10 signs of SIBO. Generally, it’s advised to adopt a long-term diet low in carbohydrates. Specifically, refined carbohydrates. HOWEVER, Candida overgrowth is more common in those susceptible to SIBO. So we may set ourselves up for more issues with low carbohydrate diets thus.

EAT DRINK TAKE MAKE for SIBO and IBS. What it is. Personalised nutrition in the 4) phases. What it’s not: a generic FODMAP Diet or the GAPS Diet – in fact it’s not a diet at all! Functional Nutrition with Susannah is designed to be effective by its practical nature that fits into your lifestyle as well as the specially designed methodical approach it takes to heal your gut.

Key Thyroid Symptoms

Thyroid Symptoms

THYROID PROBLEMS – overactive thyroid symptoms or underactive thyroid can be overlooked or mismanaged.

TSH IS A HORMONE secreted from the anterior pituitary gland to control THYROID FUNCTION.
Symptoms of thyroid problems are manageable when working with the medical community – at Susannah Makram Clinics .
Optimal THYROID FUNCTION or functional health impacts lifestyle quality.

Hormone Panel

Hormone Panel

The thyroid gland is a vitally important hormonal gland. It plays a major role in:- our metabolism, growth and maturation of our bodies.
WHY DO WE NEED TO KNOW  exactly what’s going on? Because the hormones released affect our body’s overall ability to function. The gland reacts to our environment. Hormones secreted affect how we use the MACRONUTRIENT and MICRONUTRIENTS impacting how we feel, our weight, our energy levels etc.

Thyroid Functional Health

We might be on a seemingly great diet. We’re taking the right supplements and doing everything to take ownership and feel better. However, we’re still not really making any progress. How frustrating if all it took was making small change.

Hypothyroidism – Disorder

Fatigue is a common symptom of an underactive thyroid but it is also a symptom of many other associated conditions. These include adrenal fatigue, food sensitivities and various nutrient deficiencies.
Underactivity in adults often develops gradually. This is why people might not notice symptoms for a while. Possible symptoms can include the following.

General loss of energy and power; Difficulties concentrating or mental slowness
Slowed metabolism; Tiredness; Being overweight
Sensitivity to cold; Slow pulse
Waxy skin thickening and swelling (myxedema)
Dry skin
Deep, hoarse voice
Brittle, dry hair
Loss of sexual desire or potency problems; Sometimes even depression

Hashimoto’s Thyroiditis

A condition called Hashimoto’s thyroiditis is a chronic inflammation of the thyroid. It can also lead to underactivity.
Often people with Hashimoto’s will be started on thyroid hormones but continue to feel tired.

Overactivity of the gland is also called hyperthyroidism. It produces too many hormones. This speeds up energy metabolism. The following symptoms can occur.

Hot flashes; Sweating; Trembling
Weight loss
Hair loss
Nervousness, Hyperactivity; Emotional instability and irritability or fatigue
Insomnia and restlessness
Potency problems
Racing heart

Top Thyroid tests

Top Thyroid tests

Top 6 Thyroid Tests

Here is a comprehensive list to take to your doctor.

  1. TSH (Thyroid Stimulating Hormone)
  2. Thyroid peroxidase antibodies (TPO Antibodies) 
  3. Thyroglobulin Antibodies (TG Antibodies)
  4. Thyroid Ultrasound 
  5. Free T3 
  6. Free T41 or Free T4

You can ask for tests for Hashimoto’s and hypothyroidism. Request a copy of your thyroid labs. Then you can see them and ensure they are interpreted correctly.

TSH is a pituitary hormone. TSH responds to low/high amounts of circulating thyroid hormone. This is in advanced cases of Hashimoto’s and primary hypothyroidism. In the case of Graves’ disease the TSH will be low. People with Hashimoto’s and central hypothyroidism may have a normal reading on this test.

Thyroid peroxidase antibodies (TPO Antibodies) and Thyroglobulin Antibodies (TG Antibodies)
Most people with Hashimoto’s will have an elevation of one or both of these antibodies. These antibodies are often elevated for decades before a change in TSH is seen. People with Graves’ disease and thyroid cancer may also have an elevation in thyroid antibodies including TPO & TG, as well as TSH receptor antibodies.

Thyroid Ultrasound-
A small percentage of people may have Hashimoto’s. However, they may not have thyroid antibodies detectible in the blood. Doing a thyroid ultrasound will help your physician determine a diagnosis.

Free T3 & Free T4
These tests measure the levels of active thyroid hormone circulating in the body. When TSH is informal range but free T3 and T4 levels are low, this may lead your doctor might suspect central hypothyroidism (a rare type of hypothyroidism).

The Best Probiotics – 10 Check List

What is probiotics

We TAKE Probiotics for gut health so does what we EAT DRINK TAKE MAKE count towards our gut health? Our digestive problems or overall digestive health alone requires personalised nutrition. Here’s why…

best probiotic

best probiotic

FAQ: which is the best probiotic to take? How, when and even why we eat = nutrition and lifestyle habits = information. This feeds our or nourishes or bodies and informs our gut health and wellbeing. So let’s make choices that count towards OUR health.
Probiotics and Prescript Assist probiotics and antibiotics and probiotics and prebiotics – find out about them here

We have all that friend. They’re super healthy. They eat whole foods, they workout. Yet, they’re catching bugs or unwell. A lot. They look and feel tired all the time.

So this super healthy friend, eating seasonal whole foods – nutrient rich… outside their body. Inside? Useless.
Is this why we’re all taking Probiotics? Well, probiotics do far more than improve digestive function and our ability to stay ‘regular.’ Possibly, Probiotics are the best natural solution for eliminating bloating and puffiness. Probiotics are the safest way to get a healthier, flatter stomach. However, not all probiotics are created equal.

10 Tips For Choosing A High Quality Probiotic

1) Different Probiotics work in different ways. You should discuss what you want to achieve by taking probiotics safely.
2) It is important to Know The Strain. The most common strains you will find are bifidobacterium and lactobacillus. Medications that decrease the immune system (Immunosuppressants) interact with lactobacillus strains. Lactobacillus acidophilus is thought to help with the digestion and absorption of lactose by producing lactase. This may be helpful for those with Lactose intolerance – usually the result of a lactase deficiency.

Probiotics means ‘for life’

They are defined by the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO) of the United Nations as ‘live microorganisms which, when administered in adequate amounts as part of food, confer a beneficial health effect by producing gut microflora on the host’.

Probiotics often are not that effective at re-populating the gut flora – Prebiotics are more effective for that. The health benefits of probiotics go beyond gut health. 

Vegan Probiotics

If you are vegan it can be challenging to find a vegan probiotic. Some brands use milk in the manufacturing process, or have gelatin-derived capsules, or use bee products. It is not impossible, however, to find a vegan-friendly probiotic formula. It should be all of the following: (i) dairy free probiotic (ii) casein free probiotic (iii) gelatin free probiotic (iv) bee product free probiotic

If you are sensitive to dairy you can find dairy-free probiotics and increase your food intake of probiotics with these foods that are also vegan diet friendly: Ten Dairy Free Probiotic Foods

If you are taking antibiotics it is good to start a Saccharomyces boulardii or S. boulardii probiotic. Take these while still taking the antibiotic as this is a yeast strain (antibiotics cannot kill it). Taking these rather than bacteria and can help prepare the internal environment to welcome new “good” bacteria back into the body. This happens once the antibiotic has done its job of clearing bacteria from the body. There are quite a few randomised, placebo-controlled trials for e.g. here and here that have demonstrated the effectiveness of probiotic use during a course of antibiotics. This is specific for reducing side effects and preventing gut infection. Prebiotics are an important part of any regimen to protect or rebuild a healthy microbiome during and after antibiotic use.

The Best Probiotics - 10 Check List

The Best Probiotics – 10 Check List

3) Demonstrated safety in vivo and In Vitro Studies SBO probiotics have risen in recognition recently as clinical evidence grows to support their traditonally-derived approach. Species from the Bacillus genus, a gut-adapted spore-forming bacteria is found in certain probiotic products. It has been demonstrated to be safe and effective in in vitro and in vivo studies. 4) Clinical Trials – Many probiotic products have not been validated by peer-reviewed, clinical studies. The best products are those that have been studied in the scientific literature.

5) Shelf Stability – Probiotics should be shelf-stable i.e. do not require refrigeration. Many probiotics require refrigeration and lose their potency if not stored within a very narrow range of temperature and this is inconvenient in today’s modern, mobile world. A shelf-stable probiotic is easier to take consistently because you can take it with you wherever you go.

6) Strength – A superior delivery can more than compensate for a product with a lower CFU count i.e. Colony Forming Units. That said, a true probiotic effect involves a significant number of CFU (preferably 10 billion CFU or more per serving). This serving produces significant quantities of lactic acid within our intestinal tract. One of the roles of stomach acid is to prevent harmful bacteria from entering our bodies. However, stomach acid will also kill good bacteria that we swallow in the form of probiotics—unless the bacteria is protected from that acid in our stomachs. Delivery does not only mean making the probiotic go through the stomach alive. The best delivery systems keep the probiotics together in a protective gel as they move deep into the intestinal tract. The more pristine this gel state can be kept, in terms of allowing only probiotics to grow, the better. 7) Time Of Manufacture – always read the label. A time of manufacture guarantee declares the amount of CFUs in a probiotic at the time of production

The Best Probiotics - 10 Check List

The Best Probiotics – 10 Check List

8) Too Many Strains? The most effective probiotics contain several different strains of bacteria that work together synergistically to mimic the natural flora found in the human gut. A broad spectrum of bacterial chains is generally advised. This is unless specifications in point 2) apply e.g.of  broad spectrum is 29 strains of beneficial microflora
9) Viability. To repeat point 6) the good delivery system is required. This is for the probiotic product to remain viable on the shelf. Also, through the harsh acidic environment of the stomach —  delivering active, therapeutic levels at the time they reach the lower GI tract.
10) Value & Gluten Free & Dairy Free. Always read the label.

In the last ten years, studies of the human microbiome, have propelled our appreciation for studies into probiotics. The microbiome is defined as the collective genetic identity of the microbes. These microbes are composed of bacteria, bacteriophage, fungi, protozoa and viruses. They live inside and on the human body and provided us with much data. These bacteria help to balance pH and maintain immunity. They aid in absorption and synthesis of nutrients, to neutralise harmful compounds and produce short chain fatty acids. Short chain fatty acids play a role in the digestive process as well.

In summary, the health benefits of probiotic therapy depend on choice factors. The type of bacterium dosing regimen, delivery method and other underlying host factors. For e.g. the age and diet of the host. Really we cannot summarise this topic just yet: points 3) and 4) call for regular updates. This is an important part of delivering the best personalised nutritional plan for you.

Safe, clinical, practical and effective.

Call  020 7060 3181