The Healthy Gut Podcast Episode 9

The Healthy Gut Podcast, SIBO and Kids with Dr. Megan Taylor

the healthy gut podcast episode 9

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kids with sibo

Kids can often experience digestive pain and discomfort, or altered bowel movement with diarrhoea and constipation. Did you know this could be caused by Small Intestinal Bacterial Overgrowth?

In today’s episode of The Healthy Gut podcast, Rebecca chats to Dr. Megan Taylor, a naturopathic doctor who specialises in working with kids with SIBO and digestive complaints about how she treats young people with this often chronic and painful condition.

in today’s episode

In Episode 9 of The Healthy Gut Podcast, we discuss:

✓ How common SIBO is in kids and why other tests should be conducted first

✓ The types of symptoms children experience with SIBO

✓ The treatment options for SIBO in kids

✓ If there is an age restriction on kids taking the SIBO breath test, and what you can do to support them to be able to take a comprehensive test

✓ Why kids can often respond so well to treatment

✓ The emotional impact SIBO can have on kids and the techniques Megan utilises to support them

✓ Diet restrictions on kids with SIBO and finding a diet that is suitable for your child

✓  The role a parent’s anxiety and stress can play on a child’s health journey

resources mentioned in today’s podcast

connect with dr megan taylor

Dr Megan Taylor

Originally from Seattle, Washington, Dr Megan Taylor discovered natural medicine during a previous career in environmental planning, and went on to receive her degree in naturopathic medicine from the National University of Natural Medicine (previously National College of Natural Medicine).

During her time as a student and resident, she has had the good fortune of being mentored by Drs. Steven Sandberg-Lewis and Allison Siebecker, leaders in the fields of functional and naturopathic gastroenterology and small intestinal bacterial overgrowth (SIBO).

Dr. Taylor is currently completing a second-year residency with Dr. Sandberg-Lewis at 8 Hearts Health and Wellness in Portland, Oregon, where she sees children and adults with digestive concerns, autoimmune disease, and allergies.

More information about Dr. Taylor and her practice can be found at megantaylornd.com or 8Hearts.org.

The Healthy Gut Podcast Episode 9 with Dr. Megan Taylor

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about the host

Rebecca Coomes

rebecca coomes

Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.

Read more about Rebecca >>

podcast transcript

REBECCA: Welcome to the show Dr. Megan Taylor. It’s so wonderful to have you here today.

  1. MEGAN: Thank you Rebecca I’m excited to be here.

REBECCA: So today we are going to be talking all about kids with SIBO or Small intestinal bacterial overgrowth. And it is something that I get contacted about a lot by parents who are trying to find solutions and answers to their poor, sick kiddos who either have been diagnosed with SIBO or they suspect that they have SIBO and it’s such a pleasure to have you on this show because this is one of your areas that you specialize in working with kids and young people with SIBO. So, it’s so god to have you here.

  1. MEGAN: Thank you. Yeah, I am really excited to talk about this topic

REBECCA: Wonderful. I would love to know how you got started. Like why did you find yourself studying naturopathic medicine and becoming a naturopathic doctor and then to having a specialty in GI health and particularly with kids with SIBO?

[1:00] DR. MEGAN: Yeah, that’s a great question. So I actually started… before I even entered into the naturopathic medicine world, I was actually an environmental planner. I studied in school and I went off and I thought I was going to do awesome and amazing things. I actually really loved my job, a lot of it and how I realized that sitting in a cubicle day in, day out staring at a computer screen just really was not doing my health any favors and I really struggled and was lucky enough to be introduced to a naturopath and acupuncturist and really had my world blown apart. I had no idea that natural medicine was even a thing and was totally won over it and I remember going through a process and working with her about potentially doing something different with my life, something that would give me a little nourishment to feed my soul in all of the different ways than what I was getting out of my current profession and she said, “why don’t you do what I do? You love it and you are so excited about it? So do it”

And so I did and I dove right in, feet first probably without thinking about it, not quite realizing what i was signing up for. Medical school is a lot. It’s a big commitment but I am so grateful that I did. It’s funny. Sometimes things become in to school with. I came in; I had a lot of my own gastrointestinal issue coming into school and really shied away from specializing on this and focusing. I didn’t really want to be one of those clichéd folks out there who is treating what they have. But you really just can’t avoid it when you have the personal experience. You really know how to speak to people about it. You know what it is like to have gone through the treatments and what it’s like to have been sick in that way. So I had the pleasure of being in school about the same time that Doctor Samberg Lewis and Doctor Siebecker were really kind of discovering small intestine bacterial overgrowth. And it was just one of those right place, right time and right personality situations where I just totally jive with them. We got along great and I ended up getting to do a lot of mentorship with both of them and discovered just this whole area of functional and naturopathic gastroenterology that I absolutely love. It is so much fun.

And the kid’s piece kind of came later. I happen to be doing my internship in school and for whatever reason got assigned a lot of the pediatric cases and I loved working with children kind of in all aspects of my life. And happen to get these cases of these pediatric, these kiddos who are really suffering and really struggling and parents who felt they are at their wits end and I loved it. It was so inspiring to work with these kids. They are incredible. They are amazing responders. They are so resilient and I got so much pleasure out of working with them that I decide this is it. This is the population I want to work with. They made my days…seeing those patients really just made my days. So I am excited to be doing it and feel so lucky that I get to work with that patient population.

[4:10] REBECCA: That’s wonderful. I am sure the parents and the kids that you have worked are very happy that you have chosen that pathway. What are you seeing in your practice? Is this common for kids to have SIBO or to have GI issues? What is happening with our kiddos out there?

[4:31] DR. MEGAN: right. It’s such a good question. It’s really… yeah GI issues probably one of the leading reasons why parents bring their children into the doctor. You know chronic stomach aches, constipation. Even urinary accidents have been linked to chronic digestive disruption, discomfort. And so it’s a huge reason why parents bring their kids to the doctor. And skin rashes, allergies, things like that. All these things that are related to the gut and gut health. And so we see that a lot, all the time in naturopathic sort of medicine practice. That is one of the things we are trained in when we talk about pediatrics is how to treat… we treat everyone. We treat everyone’s gut but with pediatrics it is so important because their guts are still developing in a lot of ways and their immune systems are still developing. So it is a big focus for us.

The question about how come SIBO is in kids is a bigger one. We don’t have the research that we have with adults. We have more studies than we even want on how many adults have SIBO. And in kids it’s very very… the research is very very poor. There is a study out of Poland in 2015 that found in a population size only about 100 pediatric patients, that about 60% of them, these pediatric patients specifically with abdominal pain, about 60% of them had small intestinal bacterial overgrowth. But it’s interesting because that is you know about on par with our adults with IBS. Now this is just one study though. And then really what we need are a lot more studies to tell us whether what degree of SIBO is really present on the pediatric population.

[6:25] REBECCA: It’s interesting and let’s hope that there are studies coming at in the future that specifically look at kids with SIBO. Do kids suffer from the same types of symptoms as adults do when it comes to having SIBO?

[6:41] DR. MEGAN: Yeah. Absolutely. The symptoms are really similar if not the same. The trouble is that kids don’t describe them in the same way. Adults have this whole host of words and languages, descriptive language that we can use to describe our heart burn or our reflex or our bloating and out distention and we can get really clear exactly what is going on, exactly the symptoms that are present. But for kids it’s mostly like my stomach hurts or my bottom hurts when I go to the bathroom or I just don’t feel good. And so it takes a lot more observation on the part of both myself as physician and also parents. Parents come in reporting a lot. It’s really helpful to me. They notice that their kids belly gets really distended throughout the day for example. They notice that when they press in their belly, it’s quite harder or firmer. They even notice them when they press on their belly and they are doing abdominal massage. They feel some stools some hard stuff in there.

Parents are so helpful in that. They provide me a lot of information in terms of, is SIBO really on my radar? And that’s really what we are looking for. We are looking for that abdominal distention. That excess gas production due to those bacteria that are overgrown where they really shouldn’t be. That excess gas production that is contributing to abdominal pain, stomach aches and the kids. And then contributing to school changes whether that is a tendency to reduce stool and diarrhea or constipation. So we are looking… more often than not I hear stomach aches and constipation or diarrhea or the big ones that come in.

[8:15] REBECCA: And so for parents noticing that their child is gassy or having/suffering from distention or constipated or diarrhea or something between the tow, do you feel that they are the best signs for a parent to then think “Ok maybe I should go and see somebody about this?”

[8:31] A: Yeah absolutely. I think that anytime my kiddos complain especially of abdominal pain, you should have that worked out. Now is it SIBO? So that is what we mean hold another kind of topic. There are so many reasons why kids can be bloated, why kids can tend towards diarrhea or constipation which is think is an important thing to keep in mind because all these research is coming out about SIBO. A lot of parents themselves have been diagnosed with SIBO and aren’t just sure that these kiddos have it too. But in reality, and I know that we might talk about it later; kids don’t have as much life right. They haven’t lived as much life. So what often happens is we need to rule out all the other things that could be contributing to their symptoms first. It is sort of like how IBS was sort of the diagnosis of last resort and that diagnosis of exclusion that some people talk about it with.

SIBO we want to hold off on diagnosing kiddos with that until we have ruled out there is no food allergies, kids are really sensitive immunologically to certain foods. Dairy and wheat probably the biggest triggers for kids in terms of abdominal pain, stool changes and skin rashes for example. So we look there initially. We also make sure that really their digestive system is really up and functioning. We know that kids, when they are born don’t necessarily produce all the enzymes that they need in the amount. This shows up in all sorts of body systems. And so one of the reasons why infants can get jaundice or kind of that yellow appearance after birth. Kids don’t always have all their enzyme up and that include pancreatic enzymes output all up and running by the time they are in their toddlerhood and in their early 4,5,6. And so making sure their digestive functions on track is huge.

Digestive function, we can usually see a lot of these just from symptoms. For example pancreatic enzyme output. This is a really common one with kids with their pancreas might just not be up and running. Their digestive fire really isn’t going yet. And so we look for, is there undigested in the stool? That can probably the most common symptom of that abdominal bloating. That gas distention as well as abdominal pain can co-occur with that as well. So we look for symptoms.

And then they are also fantastic tests. In naturopathic medicine we do comprehensive stool test through various companies Genove, Diagnostics, Doctors data. There are wonderful companies out there that do these comprehensive stool panels that look at digestive enzymes specifically in the stools specifically things like fecal elastase or fecal chymotrypsin. These are measures of pancreatic output and we often, I see kids come back with low output in their stool test. So that tells us the need to support that digestive pathway.

[11:38] REBECCA: That is really interesting. And so it sounds like the process is really one of elimination whereby you start with looking if whether their digestive system is working well or optimally. You look at the types of foods that they are eating they may be reacting to. And then it sound like you would look at whether if the condition hasn’t resolved after looking at those things that you would then look elsewhere and one of those conditions might be SIBO.

[12:03] DR. MEGAN: Yeah it might be also fit in there before we got to SIBO is also how the kids are sort of constitutional. They tend to be a little bit more of an anxious kid, are they holding a lot of their nervousness and anxiety in there. That abdomen we talked about. Kids that we know the digestive system is really impacted by stress and impacted by excess worry. And I see a lot of kids who for whatever reason we may be their life circumstances. We may be particular people in their lives. It may just be them constitutionally tends towards being a little bit more of a worrier. But that can really impact digestive function. That is a sure fire way to shut off their digestive fire is to be worried and be anxious all the time. So I think I probably throw that up top in addition to making sure digestive system is online. Making sure we are not having any food sensitivities in the diet that may be contributing to symptoms looking at their nervous system balance.

[13:08] REBECCA: And how do you approach, let’s say you are looking at a kid, an anxious kid, that someone that is really holds internally their fears and anxieties and worries. How would you approach helping them to relax and release some of that anxiety that is impacting the digestive system?

[13:26] DR. MEGAN: It is a really interesting thing to approach kids with because as adults we often get a lot of… we have that capacity to sort of see that the insight into – “Oh yeah I am feeling anxious.” Or, “I am feeling…” and this might be why, kids don’t have that developed as much often as adults. That being said, I think I have probably seen some of the mist insightful comments coming from kids about how they are feeling in their bodies. So I don’t put it past them. They are really quite capable. And I approach it form many directions. It really depends on the family and what they are interested in doing. One of the easiest skills especially if their age you know 3,4,5,6 and older you can really take some direction and do some exercises are visualization exercises that visualize.. . I had a great one were they are constipated kiddo. When we visualized, she was really into dragons, dragons like magical dragons that fairies rode on. And so she would imagine this dragon sort of kind of heading through her large intestines, sort of helping her stool move through. And it seems kind of funny to us but it was so helpful for her to lay there, breathing and doing that visualization.

So I find whatever works for the kids and we develop a mindfulness practice for that. And it might be just learning who to do deep belly breathing. It might be practicing how to really recognize how they are feeling in their bodies. Taking a moment when you are feeling upset. For example some of the kiddos with more behavioral components in to their sort of stories. We might start changing language around when they are getting really worked up, having a temper tantrum for example. Really starting to coach parents to ask kids to tune in to how their bodies are feeling. Like really start building that mind body awareness. That can work wonders. Even that in itself can be really wonderful for kids. And if that doesn’t t work or if doesn’t really fit for the family to do that kind of thing, we might look at using, don’t have a lot of results with diffusing essential oils in our room so kiddos, especially kiddos who have more challenge… let’s say sleeping at night, we know how a healthy sleep is so important for kids for their growth and development. And so we might diffuse lavender essential oil throughout the room or the one that they really enjoy that helps them relax.

Sometimes I will use supplementation, things like L-thiamine and other kind of like amino acids support that is really specific to the kiddo though. For sure it definitely requires…I usually like doing some testing before I actually treat that. And I think the last thing that is probably the most powerful that I used is homeopathy. That is a whole other conversation and a lot of opinions about the effectiveness of homeopathy. But I see amazing result sin kids. They are often very vital and responsive and a well prescribed homeopathic remedy can really change the sort of nervous system balance that that kid comes in to the office for.

[16:51] REBECCA: Listening to you talk, and I know we are talking about kids today but gosh there is so much that you can take away even as an adult that is experiencing any kind of digestive disorder. All of these is so useful and relevant to even us older people. And I think…

[17:09] DR. MEGAN: Absolutely. It’s huge and we learn so much.

REBECCA: Exactly. And when I was a kid, I remember clearly being sick and saying to my mom, “Mom I feel sick.” And she would say, “What do you feel sick with?” and I would say, “I don’t know, I just feel sick.” And I quite often felt this kind of low level nausea. I just never went to the toilet. I was chronically constipated from day 1 really it seemed. But I couldn’t really explain it and she would take me to the doctors and the doctor would say, “What’s wrong with you?” and I would say, “I don’t know, I just feel sick.” And so it makes me smile in a sense that they are the kind of words that you are hearing from the kids that are coming through and seeing you.

Back when I was a kid, I knew I felt sick that could have meant….

I would like to know whether there is an age where you see SIBO developing in kids or whether it can appear in any age in a child?

[18:14] DR. MEGAN: yeah, it is interesting I kind of alluded to in the beginning. Kids, they have lived less life right? So they have experienced less interventions. They have experienced fewer sort of the medical interventions that many adults have experienced that then result to them developing SIBO. So for example, one thing that we work with in adult population a lot is long term medication use that changes motility for example. It can be a huge risk factor. Having had surgeries especially abdominal and pelvic surgeries creating adhesions. Another huge risk factor. And then gastroenteritis or food poisoning, travelers’ diarrhea. Any of these gut infections are huge risk factors for developing SIBO.

Kids, they have lived less years. So they basically have less exposure and less likely they have experienced some of these thing. With that being said, I have worked with kids who at 6 months old they had a terrible food poisoning or stomach flu and that’s when everything started. So it’s not to say that it cannot happen but we are usually looking for kids especially the really young ones who are coming in in that 2, 3, 45 age range that are having a lot of these symptoms. We are often looking at things that are more congenital. Things that are coming into this world with that are predisposing them to either poor motility or some sort of impact to their protective barriers. We see that is reflected to research a lot. Kids with immunodeficiency for example, things like selective IgA deficiency which is basically when our bodies don’t produce a type of immunoglobulin that helps protects us against infection. That can predispose kids to developing SIBO.

Conditions like cystic fibrosis or muscular dystrophy absolutely impact motility and cause the development… and can contribute to the development of SIBO. We see this lot too in kids on the autistic spectrum or kids with chromosomal abnormalities. These kids are at great risk for mitochondrial dysfunction which we know mitochondria, the little powerhouses, little batteries of our cells. We need those for good healthy gastrointestinal motility and if those are impacted in some way, we see that reflected in the development of SIBO. And these kids often suffer from hypothyroidism. We actually know that congenital hypothyroidism. So hypothyroidism that a kid either experience in the womb or soon after work is actually on the rise which is a little terrifying and we know that hypothyroidism in adults, we see that as a risk factor for SIBO and that is the same thing for kids.

So it’s interesting when you look at the research, it is very much these sort of specific diseases have been associated with SIBO. And less about like the life factors, the life living that has happened.

[21:24] REBECCA: that is very true. As you say, they just haven’t been on this planet long enough to have experienced some of those life factors that us adults have experienced.

[21:36] DR. MEGAN: I do say though that…. (I’m sorry Rebecca). I would say that one of the things that are interesting is that, one of the things that we should always recognize and think about s use of proton pump inhibitors or acid blocking medications. That’s one thing that I almost slipped my memory but it’s so important to address that’s actually, those are being prescribed frequently for children. Frequently for infants in children. Infants often for spit up like chronic reflex and spit up are prescribed proton pump inhibitors. Kids with abdominal pain prescribed with proton pump inhibitors and that is huge risk factor. We know that blocking the acid production in our stomach doesn’t allow us to practically protect ourselves against bacteria overgrowing in the stomach and then in the intestines. And so that is something to always be considering to if your child has been prescribed a proton pump inhibitor because you whipped your gastroenteritis and said, “They have pain!” Or something that that could be contributed into the development of SIBO.

[22:38] REBECCA: that’s a very important point that you are making there. What about the, and I have read quite a bit around the impact around cesarean births and breastfeeding or lack thereof and the impact that that can have one developing a healthy gut microbiome. Are you seeing any correlation between babies that have been born via cesarean and potentially also not breastfed with SIBO developing later?

[23:06] DR. MEGAN: Absolutely. We see that. We know that breastfeeds status is a huge sort of predictor of the development of small intestine bacterial overgrowth. We know that as children are breastfed, they receiving so many things via breasts milk that help mature the immune system in the gut and that is the same true for the flora that you receive via vaginal birth versus a cesarean or birth in the hospital. Without that healthy microbiome via the birth canal and breastfeeding, kiddos do not have the immune system that is in the enteric immune system that is in the gastrointestinal tract where a vast majority of immune system lives and reside. Because that is where we come in contact with the outside world with the most part. That does not have the adequate time to develop and not the adequate inputs to develop and so we end up seeing kids at greater risks for not only small intestinal bacterial overgrowth especially that later in life. But also increase in food allergies or food sensitivities or just more of an immune reactivity in general. That’s the allergic triad – emphysema, asthma, and hay fever can we see that a lot in a kid that is breastfed.

So it’s really important to really establish the healthy microbiome. It also helps to heal up all those….kid are born with naturally leaky guts as infants. The whole point of the gastrointestinal tract as infants is supposed to be quite leaky so that we can absorb all the immune proteins that our mothers milk provides. And so that being breastfed and that healthy microbiome inherited in the vaginal birth are supposed to help stitch that up over time so that we end up having a good barrier between us and the outside world.

[25:16] REBECCA: that’s fascinating and myself I was born premature. I was born vaginally but my poor mum was pretty sick. So she couldn’t breastfeed me. So I was put straight into formula and pumped with antibiotics.

[25:34] DR. MEGAN: A rough start and we hear that so much not only with our pediatric patients but also of course with our adults patients. There’s a huge sort of unanswered question that I think research is only going to continue to provide us great information about what it means when we don’t inherit that ancestral microbiome. We are not dealing with multigenerational lack of inherited microbiome where maybe mom was born via cesarean section and maybe grandchild is born via cesarean section or not breastfed for whatever reason. So we see that kind of happen over generations kind of the compounded effect of that.

[26:15] REBECCA: what can people do if… what can mothers do if they have had to have a cesarean or they haven’t been able to breastfeed unfortunately not everyone can. There are situations that prevent that from occurring. Is there anything that a mother can do to help support her baby’s microbiome?

[26:34] DR. MEGAN: That is a really great question. I feel like I am not probably the best person who could answer that. I know a lot of people who specialize directly on infant care. And it is something, it’s funny. It’s a question that Dr. Samberg Lewis and I have been, we have talked about recently. We should come up with a protocol for that because we see so much of it after the fact. You know 2 or 3 or 5 or 20 years after the fact. And so it’s best probably answered by somebody’s pediatrician or a functional sort of OB Gyne who can give a lot of feedback there. I know frequently people will introduce probiotics quite early as a way to help the enteric immune system really develop in the right way.

[27:22] REBECCA: that sounds like a topic for another podcast.

  1. MEGAN: yes, that could be a whole another podcast. Exactly.

REBECCA: So let’s move on to the actual diagnosis of SIBO with kids. We assumed that a parent and their physician with a child have gone through a variety of pre-tests. Rule out other conditions and it’s still looking like it might be SIBO. How did you go about testing children? Because in adults we would do the breath test but can that be done with young kids.

[27:58] DR. MEGAN: Absolutely can. And it really is dependent on that kid. I had no problem getting kids as young as 4 to complete their breath test. Allison has told me a couple of kids as young as 3 that she has kind of helped coach the family through getting their breath test. And really it’s just a matter of whether that they can sort of blow on command. It’s like that we know from having done the breath test that it requires drinking lactulose solution or taking pre-lactulose sample. Drinking your sugar solution and then blowing every 20 minutes until all the vials…

A lot of kids can do this actually and you can do a lot of coaching leading up to their breath test whether that be blowing through straw or blowing through a… like blowing up balloons or anything that kind of helps them learn how to blow and kids can be really successful at it. In fact some of the best breath test I get back are done with parents and kids who are doing them. The other key piece of course is making sure that the kid will actually drink the sugar solution. It’s sort of funny you think kids would be all about drinking the sugar drink but I have had several occasion were parents said, “They got to it and they just didn’t want to do it. They didn’t like it. It was too sweet.” It’s just funny.

And so again kind of preparing them for that. Kids do amazing when they are able to practice and prepare for what is coming up and not to have things sort of sprung on them or to have them be unexpected. So those are some tips they give. You know picking out their favorite straw and cup and they want to drink their sugar solution through. And then practicing the blowing beforehand and then the last thing I would say is if doing a breath test is deemed feasible for the kid is that doing an in-house breath test if that is available in your community can be really helpful because then whoever is collecting the samples can just test them right there off the back. They know if they are a good sample or not and if they are not they can recollect.

So it doesn’t waste the… run the risk of having “bad test” I guess. If breath tests are not possible that is always the question that I get in parents and I just say, “No way, that’s not going to be doable that’s too hard for our family.”

We can do something called a urine test. There is a particular compound found in urine, a urinary acid that is excreted that is called 4-hydroxypehnyl acidic acid. It’s long. Long name. It’s tested by a lot of panels. The one I use primarily is Genova’s organics with an X-dysbiosis profile. It measures this urinary acid in the urine and this can give us a pretty darn good reflection. When this is being produced, we have a pretty good idea that there is something going on in the small intestine. There is some sort of small intestine dysibiosis or small intestinal overgrowth validated in the studies.

The downside to it… so it is going to be really helpful just to say, “Yup this is what is going on.” The downside into it is unlike breath test, it is a little harder to determine based on levels, how long and with which kind of protocol should we treat. We know that with breath test we can see is there hydrogen gas? Is there methane gas? Ok maybe both of those gases are present. How high do they peak? What is their peak in the small intestine? Ok, now we know kind of how many rounds that this person will need to be treated with before we are safe to assume we’ve gotten back to sort of a normal breath test.

So without that breath test curve, it is a little harder. That being said, kids are, like I said so many times kids are amazing responders and sometimes a single round of treatment is really all they need and they do fantastically on that. So if we can’t do a breath test then I move on to this dysbiosis profile, this urinary profile. And that is pretty easy to collec.t we do have some folks say, “I can’t even collect urine on my kid.” So we just have them like, “really early in the morning. Sit them in the toilet and just with a little… there’s a urine collection devices and just wait because they will urinate at some point.”

[32:26] REBECCA: They will. And how do you approach the actual treatment with kids? Is it the same with what you would do for adults?

[32:34] DR. MEGAN: I would say, the antimicrobial treatment can be similar. We have our antibiotic or pharmaceutical antibiotic options. We have our herbal options. I do definitely don’t go anywhere near an elemental diet with kids unless the kid is actually on a feeding tube and the feeding tube is where they get their primary nutrients. Sometimes we do recommend different types of formula. If they are using a peptamine or something like that, we might use an elemental diet formula instead as a way of decreasing symptoms. But usually that is kind of off the table because kids are growing and they need lots of good healthy nourishing foods to grow strong bodies. So we typically stay in the herbal antibiotic route. There have been a few studies, not enough; it’s my ongoing theme about using antibiotics in kids to treat SIBO. There is a couple; they use usually smaller doses than what is given to adults. So potentially even close have the dose to what is given to adults. Most studies show of the rifaximin.

New studies have been used. Neomycin has been used. Again we use a smaller often half the dose for kids depending on their size. And we really have not used Metronidazole. These are the three sort of most common antibiotics that a lot of the SIBO community might be familiar with. We really haven’t used metronidazole in our pediatric population. There are some studies that show potential cancer promoting effects of these things, of that medication. And so we just really stay away from it in our child population.

I think more frequently, I use herbs with kids.

[34:27] REBECCA: Sure. And I was going to ask, do you favor one over the other which you just answered for me? And would you ever use…..

  1. MEGAN: Yeah and it is really…. Absolutely yeah. And I think that it really depends on the family. As a doctor, my main job is to educate about alternatives and then I go with whatever the parents are leaning towards. And a lot of parents are really uncomfortable about the idea of using antibiotics in their kids. Now that being said, I have had great luck using rifaximin with children. In fact I will often use Rifaximin in combination with herbs. Sort of like a combo treatment. Or we just go the herb route. We use similar herbs to what we use in adults. We often use allicin, the garlic extract if methane is present. We use burburin, although that is a harder one, harder cell because kids again they are swallowing capsules. There is a liquid version of allicin that makes it really a lot easier to give to kiddos. We use less oregano. It’s quite hot herb. So typically don’t go there. Cinnamon again quite a hot herb. Kids don’t usually need more heat in their gastrointestinal tract. So we don’t typically go there.

We’ve used a little bit of neem in some kiddos. And I think the one that would probably have the most experience, maybe not the most, but is really well tolerated by kids is the biocidin combination by Biobotanical research. That one is, most kids don’t mind the taste. It’s kind of on the sweet side and we have been able to use that quite a bit because it’s liquid and it is quite a low dose. Maximum maybe taking 5 drops three times a day.

[36:11] REBECCA: So what are the implications of not treating SIBO in kids if you just leave it?

  1. MEGAN: That is a really good question. And I think it’s one that is probably talked about in… I think we don’t know is actually probably the most honest answer. It’s likely that kids have had SIBO, has small intestine issues for as long as we can remember. People have always been getting food poisoning. They have always experienced these things. Now, maybe not to a degree we are experiencing were we have food poisoning on top of not being breastfed, on top of the cesarean birth, on top of maybe some mitochondrial dysfunction that kind of layered issue. It makes it little harder for kids to really bounce back and be resilient. But we know that this happened before and we haven’t always been actively going after SIBO. That being said, I also know that there are… when we talk about adults with SIBO, we know that bacterial overgrowth can contribute to the development of increased gut permeability or leaky gut and we think long term that leaky gut can contribute to the development of immune system dysfunction.

So if we are thinking sort of theoretically about kids, we might also think that increase gut permeability in children contributing to allergies, autoimmune disease, eczema, hay fever, asthma. Those things maybe later in life… and again that is entirely sort of theoretical. From my perspective we don’t have a lot of evidence to support that but it sort of makes sense theoretically. It makes sense from that sort of that aspect of naturopathic medicine that I love so much which is really about prevention. Really preventing those things from occurring. So really helping to support healthy digestion in whatever way that is. Whether or not it is treating SIBO in the way that I described it may be supporting healthy digestion and in another way could help prevent those diseases from developing later in life.

[38:37] REBECCA: And if we look at the study of one which is Rebecca Coomes and that being two months premature, not breastfed although vaginally born. Significant amounts of antibiotics throughout my childhood because I got sick constantly. I got every single thing going and I always got the worst case of it. I got chicken pox to such an extreme case that the doctor was talking about photographing me for medical journals.

Then off intolerances. So I started off, was never great with dairy and then as i got older, I became less tolerant to other foods. And by my mid-twenties I have been diagnosed with endometriosis and then around the time that I was diagnosed with SIBO I also got diagnosed with hemochromatosis which is a condition where my body thinks that I dint have enough iron which is generally opposite for women. They normally don’t have enough iron. My iron saturation levels were just increasing steadily.

But interestingly since treating my SIBO and working on trying to improve my leaky gut and bringing down the inflammation in my body, the hemochromatosis is not so active and my iron saturation has dropped back to a normal range and my endometriosis is almost non-existence. I really don’t feel it anymore and I am able to eat a broader range of foods again. So it has been really interesting in this little personal experiment of myself to see how I have actually been able to improve some of my conditions which I had suffered from for many years. And the really awesome thing for me is that I used to spend every single winter in bed for at least 4 weeks over the course of winter and I would get sick throughout the year but winter was particularly rough for me.

I have not spent a day in bed since I have commenced my SIBO treatment which is almost two years ago and that is amazing. And I am not sick. It is just, it’s like a new life. It’s really incredible. It’s good for people listening that you can actually… things can reverse and who knows what my ultimate life journey will be with my ultimate medical health history. Let’s hope I still got many years of life left ahead of me. But it’s really nice to see some conditions turning around.

[41:08] DR. MEGAN: Absolutely. It’s huge. So it’s a story that we hear so often as people address their gut health. We really see this shift in a big way.

[41:17] REBECCA: Let’s talk about food because food is something we do every day. We all eat and it can often be such a point of stress and anxiety for parents and kids alike. What do you do when it comes to foods with kids that are experiencing SIBO?

[41:38] DR. MEGAN: I think it is such an important topic. I would love to just talk about, have a whole podcast to talk about food and all these diets that we keep putting ourselves on. I think with kids we just have to be really cautious. Kids like I mentioned earlier are growing. They are so active and constantly kind of on the move burning calories. They need so much more nutrition than we as adults do. So I really shy away from restrictive diets with kids even in the interim because I have seen it impact their growth curves. I have seen it impact their ability to gain weight and gain height. And so I really am hesitant to restrict.

That being said, there are some kids who just have legitimate food sensitivities. They just cannot do dairy. They cannot do wheat without developing… getting all snotty and having rashes and maybe their behavior gets all over the place. So there are those things that we can recognize that we can eat a really healthy balanced diet without maybe those foods. So there is that.

And then in my SIBO kids, we do have a long conversation because I know that they are going to go home, parents are going to go home, they are going to research. They are going to find these diets online and they are going to be like, “Why didn’t you tell me about this? Why didn’t you tell me that I shouldn’t eat these high FODMAPS foods or these, all these different diets?” so we have a long conversation about who we can use especially like low FODMAP resources as a resource for what foods might be making your kid more symptomatic, giving your kid stomach aches for example. I think a really good example case that I had. Really early with a little girl that had chronic constipation, skin rashes, bloating with a big gassy belly. And she had been told by a lot of MD that she had seen previously that the best thing for constipation in kids is to feed them stewed prunes. It’s like what grandmothers did. right? Stewed prunes to kids get them to eat them somehow and they won’t be constipated. And the family came in and they talked to me and they said, “It doesn’t seem to be working. We just don’t understand. In fact it seems to be making her worst. Like we give her this and she won’t go for three days.” It turns out right? Stewed prunes and they were also figs and some other dried fruits, they can be a little higher in these polyols, these high FODMAPS foods and these FODMAP containing foods and they were making her bloating worst and her constipation worst. And so doing that kind of education with parents actually these foods probably aren’t going to be great for your kid. Let’s focus on all these other healthy foods that we can do. So we focus a lot on really encouraging whole foods diet as best as we can, you know good sources of proteins, eggs, meat, lactose free dairy. Really shying away from drinking milk and really focusing on those lactose free dairy sources, and really healthy sources of greens. And we might suggest things… it typically don’t modify their green consumption. But we sometimes will talk about especially if we think gluten is a sensitivity or wheat resistant sensitivity. We might talk about a wheat free or gluten free approach to greens. But really my goal behind diet is to keep it as broad as we can because most kids are coming in only they wanting to eat pied things anyway. So really we don’t really limit them anymore than they already kind of have limited themselves.

[45:19] REBECCA: and that was going to be on the next question. How do you work with kids and parents who have kids who are particularly fuzzy eaters because there are kids out there that just don’t want to eat many items? Eat a few and that’s it. And what if those items are actually the things that are triggering some these symptoms? How do you work with them to overcome that situation?

[45:42] DR. MEGAN: It’s such a hard one and I really feel for parents when they come in and talk about it because it can just make people want to pull their hair out. It’s so frustrating and really what I find even in my pickiest eaters, I am able to find alternatives. So they love dairy and just really want to eat dairy and I don’t think it’s necessarily causing. I don’t think they have sensitivity to it. Ok, dairy is great we are just going to do only lactose free dairy. You are not going to have a big glass of milk in the morning. Maybe we do lactose free milk, we do lactid and add some lactese enzyme to it to make it more lactose free.

We focus… you know those kind of like the beige food diet which a lot of kids really really gravitates towards. It doesn’t mean they can’t get helpful calories in there right? And it doesn’t mean that they necessarily are going to be worsening their symptoms. So we really work on in an individual basis, what tis your kid eating and how can we get them to make sure… I see a lot with kids who are, picky eaters, fast eaters, also are a little underweight or low weight side. And so we talk about how do we get their calories up and what are they really like and what can we do?

I do not shy away from hiding things in kid’s food. I see recipes online all the time about vegetables and spinach and brownies or black beans and brownies. Things like hat. Or smoothies. Smoothies are like one of my go tos for that. Really trying to get more nutrition and add a very… for some of our kids that are really picky eaters, we sometimes will do supplemental nutrition as well. You know multivitamins or things like that to really help make sure that they are getting balance nutrition. But I suggest for a lot of those families that they work either with myself or somebody like a nutritionist who can really help them navigate getting more foods and more diverse foods into their diet. But it is a challenge. It’s a never ending challenge with parents and it just doesn’t go away this problem of fuzzy eaters.

[47:45] REBECCA: and is there a way that you test for food sensitivities or intolerances. Like if the kid is kid is kind of reacting to a whole range of foods, how do you have that and identify which of the foods that are problematic?

[48:02] DR. MEGAN: yeah I think what most frequently… there’s kind of two ways to do it. one is just to observe. You know the kid has a time they eat. You know dairies, their favorite food, and they eat a ton of it and you can do what is called and elimination trial where you take it out and then you see what happens. This works better with adults because usually adults have a broader… you know they are able to eat all alternatives. Kids are less likely to eat alternatives. So often what I turn to is not necessarily the most scientific method but is food sensitivity testing where you are testing for anti0body levels, IgG or IgE to certain foods. There are a couple of many many different companies that run these kinds of food sensitivity panels. They all have to be taken just a little bit of grain of salt.

We see for example eggs come up on them almost constantly with kids. It doesn’t mean that every kid is allergic to eggs. And maybe that there is just sort of ongoing reaction or this test is particularly sensitive at picking that up. So they need to be interpreted with a grain of salt. And really when we get those results then we will do the elimination and we’ll see – ok they may be sensitive to X, Y, and Z foods. Let’s eliminate those. Let’s see how they do. That process requires a lot of communication back and forth with the parents and myself to find healthy alternatives and then we kind of move forward from there knowing that those foods because they came up from a food sensitivity test, different from a food allergy test. It’s not like a peanut allergy where they have anaphylaxis and swelling and trouble breathing and all those things. They likely and many kids grow out of these sensitivities. So it is something to know if they come back positive on a test. It is not a life sentence for the kid.

[49:47] REBECCA: And do you then work with the parent and the child to reintroduce foods that are… for some time to see if they can tolerate them again?

  1. MEGAN: exactly. The same thing that so many of us have probably done elimination diets, food being retreated. SIBO would have gone back to eating a broader diet is really being cautious about that trial elimination period, that trial reintroduction period. You know introducing new foods maybe once every three days and really being conscious of the fact that the body reacts different to cheddar that has been aged for 3 months versus this yoghurt that you picked up in the grocery store versus the milk at the shelf. There is a whole way that our body will react differently to different forms of particular foods. So we talk a lot about that and try to do it as cautiously and scientifically as we can.

[50:39] REBECCA: now we talked a little bit earlier about the association between other conditions and SIBO and I am just wondering whether those conditions, those maybe primary conditions are seen to improve or decrease when SIBO is treated. Is there a correlation between healing the gut and then perhaps seeing an improvement in a primary condition that the child has.

[51:07] DR. MEGAN: yeah. Absolutely and clinically we see that time and time again. I would say that there is a whole host of research out there necessarily supported just yet. But we see it often and that if we can address that health, a lot of these other conditions can really be improved everything from sort of an immune system dysfunction, allergies, skin rashes, asthma to more mood based symptoms. Maybe behavioral disorders, things like that. Kiddos in the autism spectrum tend to really struggle with digestive health and we are able to get them with kind of a healthy functioning gut as best we can. They often do, we notice a lot of their particular behaviors whatever is unique to that child. Really move in the right direction.

So we see that a lot and I guess I can just point to the GAPS, Gut and Psychology Syndrome. A good book by Natasha Campbell McBride that really shows that so many parents have had incredible results with treating the gut and really seeing that reflected in their children’s health.

[52:16] REBECCA: And what would be your approach of treating other illnesses and it might even be a simple cold and flu when you are also treating SIBO. I know from an adult perspective often people become very very reluctant to use any other antibiotics or forms of treatment if they get sick because they are worried that it might undo the work they have done for their SIBO. What is the approach that you take for supporting kids with other illnesses and also dealing with SIBO?

[52:45] DR. MEGAN: it’s a really good question. I feel like we get that all the time not only in kids but adults as well. You did all these really good work and you don’t want to screw it up. And also the first thing I do is really try to help people reduce their fear around medications. One round of antibiotics is not likely to set you back in a huge way. That being said there a whole lot of ways that we can address conditions and more importantly improve immunity. So one of the things that often work on with kids especially kids that are chronically ill and parents are like, “Ok we could start the SIBO treatment but they are going to need antibiotics again in a couple of months when winter hits and they get their ear infection that they always get.

We will talk about prevention. Are our vitamin D levels sufficient? Do they have good sources of vitamin Do we need to make sure that their immune system is functioning appropriately? Have we decreased the amount of antigenicity that those food sensitivities that they have. That can trigger inflammation. It can be incredible at preventing. We make sure that they have the right vitamins and minerals on board. A lot of kids especially our kids with digestive disorders, really do need a little extra support in terms of multivitamins and multi minerals to make sure that their immune systems are functioning. And then there are so many other things. Elder berries, my hands down favorite. Just tiny little amounts can be incredibly helpful in preventing colds and flus. Let me move in to fruits in seasons and kids love it. So we can go there as well.

[54:25] REBECCA: I have never hear of elder berries syrup. So that is really interesting.

  1. MEGAN: You haven’t? You must look at it.

REBECCA: I will.

  1. MEGAN: It’s quite amazing. It’s delicious and very effective.

[54:42] REBECCA: And how does it work? How does it boost the immune system?

  1. MEGAN: That is a very good question and I don’t think I know the answer to that from an immunologic standpoint. I know that there have been several studies in it helping to prove that flu… but I don’t think I know the answer about how it is actually stimulating the immune system.

[55:05] REBECCA: there you go. There are some research for me to go and do. I can tell my community more about it. And I can look at this.

  1. MEGAN: Yes I know. I am going to do it too. Pop on the internet yes. Absolutely.

REBECCA: Now another really important component is the emotional side of dealing with a condition like SIBO. Emotionally, both for the kid and for the parent, do you have some kind of coping strategies that you work with your parents and kids alike on how to just survive and deal with the a condition like SIBO. because it can be really isolating and I think if the kids out there, especially if they are dealing with food sensitivities or they ate foods and it makes them feel sick, they probably going to feel different to their friends which is the worst thing when you are kid. You don’t want to be different from anybody. You want to be exactly the same with friends. You don’t want to turn up to parties and not be able to eat the food. So how do you work with parents and kids around these very important piece of life with SIBO?

[56:07] DR. MEGAN: It is such an important part of working with the whole person which is absolutely what we want to do when we are addressing SIBO or any health condition. And I think the thing that I probably spend the most time doing is just education. Really helping the parents and children understand that the things that they are doing are to have a healthy and strong body. And it’s amazing what that can do with kids if they really understand like – I am doing this. I don’t eat dairy because when I eat dairy I get sick. When they are empowered with that information they will tell their friends and it’s kind of amazing.

They have opted… once they hit their pre-teen years it’s a whole other story. But often in their younger years they are quite up front and able to really describe what is going on with them and not necessarily feel worried. I think I actually deal more with parents an parents worry about their kids being isolated or feeling different or feeling weird and again that education around is just a normal thing. There are plenty of other families out there who are struggling with this that are having to eat this way or avoid these certain foods or use kinds of treatments and that can really go a long way. Because one of the… I don’t want to say the worst things… but one thing that can really impact little children’s health is their parents worry. If a parent is hyper vigilant, constantly looking out if did they eat this right foods or did they have a little bit of symptoms? Do they have bloating or how was their stool today? All these things like the anxiety that that brings in can really impact the kid without the kid even telling you. They don’t need to be aware of it. Their nervous systems are aware of that ongoing anxiety.

So try to make this not about a disease conversation. Not something that your kid is going to be dealing forever. This is not a scary diagnosis. This is really common and what we do is we learn how to live with it in a lot of ways. I am not saying we don’t treat it. We absolutely do. we also learn that there are things that his particular body right is… whoever you are, this body might just need to be a little bit more aware of you know whether it be food or stress or getting enough water or having the right position when you’re sleeping. All of these things. They are just things that we be a little bit more aware of. And I think that only builds healthy relationships for kids around really knowing their bodies and understanding their bodies.

[58:56] REBECCA: Yeah I think its great advice for parents who are listening to the podcast that are being mindful of their own anxiety and the effect that might have on their kids. And that is so natural as a parent to be worried about your precious little baby. The little bundle of joy that you brought into the world. They are not doing as well as you had hoped that they would. I totally understand the really stressful things parents have to go through.

[59:24] DR. MEGAN: very scary, very freaking for a lot of families that just want their kids to be healthy and well.

REBECCA: Do you see a correlation in families if like one kid has SIBO, do you often find that a parent might have or a sibling might have it?

[59:39] DR. MEGAN: I do see a fair amount of correlation whether it is actually SIBO or just digestive sort of issues. I see that happen but not always. Not in the same way and I think part of that is because again leaning back to that less life years, less interventions happen, less exposures happen. So maybe all the family at some point gets gastroenteritis or food poisoning and then two of the family members come down with SIBO. I have seen that. I have seen that happen but the other two don’t. Because the other two, for whatever reason, are more resilient against that particular infection. So I sort of see it and I don’t. I see it a plenty of times it comes in families and other times where it absolutely….

This one kid that has this…. We don’t necessarily know why. We can’t necessarily pin point it for one reason.

REBECCA: I look at my own family and there are definitely some digestive issues going on in our household, and I seem to be the only one doing anything about it.

  1. MEGAN: As so often happens. A lot of people live with this, that’s the whole IBS conversation, people are diagnosed with IBS and you just live with it or don’t want to talk about it.

REBECCA: My final thing to talk about it as I went through my own journey through reclaim my health and get so much better than I had been for years. I realized I had to address the key areas and I would love to just briefly touch on them in terms of, in relevance to kids. We have talked about some of them. But I what I realized I had to do was I had to focus on my awareness. I am reconnecting with my body and my surroundings and my mind and all the rest. I had to think about my nutrition and really focus on what was good nutrition for my body to help me get well. There was the movement component because I have been pretty sluggish. I haven’t moved well. I haven’t been moving a lot. In fact I have sat in front of a computer for many many years. My mindset was an enormous piece of the puzzle that I had to work on that really only when I started to work on that did my health really start to improve. And then the 5th piece that I realized to have to work on was my lifestyle. So putting supportive measures in place. Things like stress reduction, improving the quality and quantity of my sleep, looking at my relationships and friendships and all of those types of things that gave me the support or the foundations to continue to work towards health.

How important do you think that those 5 key pillars are when it comes to kids that are dealing with a condition like SIBO?

[1:2:31] Dr. Megan: I love those pillars. I think they are so perfect for anyone with any health condition. I think they are absolutely imperative for kids. Just as they are for adults in getting well. I think about especially movement. It just popped into my mind. We talked about so many of these bits and pieces for our conversation but movement we really haven’t talked to and I would say that I have had amazing results just getting kids moving. Especially my more constipated kiddos. We might not even go down the SIBO rabbit hole as I sometimes call it. We might just work on…a kiddo that tends to be a little more scholarly. They like to read and they like to kind of sit around and don’t really like to move. Just getting that out and moving their bodies can be exactly what they need to get their bowels really going.

I think mindset… we have talked a lot about that, that mindset of really shifting. Maybe it is more applicable to parents than kids about really moving away from the worry and really moving towards the hope that your kids is going to be well, that your kid is resilient and vital as best you can so that you can really hold that for them. Those things are really essential and important.

 

[1:04:00] Rebecca: Yeah they are and it has made a huge difference to my life and other people that i have worked with.

Dr. Megan Taylor, it has been an absolute pleasure to have you on the healthy gut Podcast today and I have learned so much around just kids with SIBO and I know that this episode will be so informative and helpful for those parents out there that are dealing with a sick kiddo who has got SIBO and they are wanting to learn some more information about it. Or perhaps they are wondering if their kid has SIBO and we have given them a lot of info of with they can do and how they can approach it. So thank you so much for joining us on the show today.

[1:04:42] Dr. Megan: You are very welcome. I really enjoyed it.

Rebecca: Now if people would like to connect with you or lean more about what you do, what is the best place that they can go to to connect with you?

Dr. Megan: Yeah. Probably the easiest way is via my website. Megan Taylor ND.com and I am there. There are links to setting up. I do Skype consults for patients who are out of state or out of country. And then I also see patients privately and in person in Portland, Oregon where I am located. So there are kind of links to all the various places to see me as well as some information and good helpful resources on the site as well.

Rebecca: That’s wonderful. Thanks very much. Thanks for coming on the show.

The Healthy Gut Podcast, SIBO and Kids with Dr. Megan Taylor

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