Gas, bloating, abdominal pain, diarrhea, constipation – present to your medical doctor with any of these symptoms and you’ll likely get a diagnosis of IBS – irritable bowel syndrome. But what if it’s more than that? What if rather than having a cranky digestive tract you actually have a bacterial imbalance in your small intestines? What if you have SIBO?
What is SIBO?
SIBO stands for small intestine bacterial overgrowth, a condition where abnormally large numbers of bacteria (both the good and bad kind) are present in the small intestine. SIBO is a very common cause of IBS-like symptoms – studies have shown SIBO to be involved in between 50-84% of IBS cases. More importantly, when treated for SIBO, a 75% reduction in IBS symptoms has been found. For people who have been suffering for years (or decades!) with IBS symptoms, a proper diagnosis of SIBO can be life-changing.
While most people who experience digestive issues are given a diagnosis of IBS, the symptoms of SIBO are so similar that I recommend every patient who has been told they have IBS be tested for SIBO. Symptoms of IBS include:
- Gas and bloating (often causing visible distention of the abdomen)
- Flatulence (farting) and belching (burping)
- Abdominal pain, cramping or general discomfort
- Constipation or diarrhea (or both!)
- Nutrient deficiencies (due to malabsorption – vitamin D, B12, K)
The bacterial overgrowth in SIBO can cause significant gas and bloating – if you are experiencing severe gas or bloating, SIBO testing should be considered. With healthy normal bacteria levels, a single ounce of milk will cause about 50cc of gas to be created. With SIBO, that same amount of milk will cause up to 5000cc of gas to be created! And that gas has to go somewhere – filling the intestines and causing pain, or being released as gas and burping.
Many conditions may also be associated with SIBO, with the additional symptoms of those conditions being present. Some of those conditions include:
- Crohn’s disease and inflammatory bowel disease
- Lactose intolerance
- Diverticulitis/ diverticulosis
- Chronic pancreatitis
- Lactose intolerance
- Celiac disease
- Restless leg syndrome
What Causes SIBO?
In our bodies we support a population of around 300 trillion bacteria. Living mostly on our skin and in our large intestine, these bacteria are powerful supporters of healthy human function. Producing vitamins like vitamin K and B12, producing neurotransmitters like serotonin, and regulating the function of our immune system – these bacteria are essential for optimal health.
SIBO occurs when the bacteria that should be in our large intestine migrate upwards into our small intestine. There they produce gases and disrupt nutrient absorption, leading the symptoms often attributed to IBS.
There are some specific triggers that can lead to this movement of bacteria into the small intestine. Some of those triggers include:
- A stomach flu or food poisoning
- Low stomach acid (or use of antacids)
- Prior bowel surgery
- Use of antibiotics (especially multiple courses)
- Moderate or high alcohol consumption (greater than one drink per day for women or two drinks per day for men)
- Use of birth control pills
One of the organisms involved in SIBO, Methanobrevivacter smithii has been linked to obesity in humans
Clues to SIBO
There are some clues that your IBS may in fact be SIBO. If you answer “yes” to any of these questions, you should invest in SIBO testing now.
- Did your digestive symptoms start, or become worse, after a bout of the stomach flu?
- Have you experienced short term improvement in your symptoms after taking an antibiotic?
- Do your symptoms get worse when taking a probiotic or prebiotic supplement?
- Does eating a high fiber diet worsen constipation or IBS symptoms?
- Do you have celiac disease that has not sufficiently improved following a gluten-free diet?
- Have you been diagnosed with an iron deficiency, despite having an iron rich diet?
- Do you have IBS symptoms and take antacids more than once per month (including Tums, Rolaids, Nexxium or Prilosec)?
- Do you experience gas that has a strong “rotten-egg” odour?
The overgrowth of bacteria seen in SIBO can be identified through a breath test. The bacteria produce high amounts of hydrogen, hydrogen sulfide, or methane gas. These gases are not produced by human cells, but only through the action of bacteria on carbohydrates in our intestines.
The most common (and effective) test for SIBO is a combined hydrogen/methane breath test. This test is readily available from your Naturopathic Doctor. This is the only test for SIBO – stool tests will not help to diagnose SIBO.
If you suspect you may have SIBO, you should see your Naturopath for appropriate testing. Once a diagnosis has been made you can embark on a treatment plan that may finally resolve your symptoms and get you back on the path to optimal health.
The treatment of SIBO is multifaceted and individualized for each person. Some of the key areas we focus on are supporting small intestine motility, optimizing digestive acids and enzymes, healing the lining of the digestive tract, eradicating biofilm and promoting healthy bacterial balance in the large intestine. Addressing the lifestyle and diet for long term prevention of recurrence is also important. Discontinuing medications, like antacids and proton pump inhibitors that encourage SIBO must also be considered.
You don’t have to continue to suffer. Digestive health is essential for optimal health. Get yourself tested, and get on the path to wellness today.
The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.