Is your gut always out of whack? Are you suddenly having reactions to foods you’ve never had problems with before? And has your doctor recently diagnosed you with irritable bowel syndrome (IBS)? If so, there may be a hidden cause that’s often overlooked- SIBO. Here’s what you need to know about SIBO and what you can do to address it. I’ll also be splitting this post into three parts. We’ll be covering the basics of SIBO and getting diagnosed today, with the next posts covering the causes, treatment, and prevention. Sound good? Then let’s get started! (As always, I’m not treating or telling you what to do. This is all just general information that you can use to make the right decisions for your health!)

SIBO 101

SIBO is short for small intestinal bacterial overgrowth. As the name states, SIBO is a digestion-related condition where bacteria have overgrown in the small intestine. In doing so, they cause almost a laundry list of side effects. Side effects that can lead to more problems in other areas of the body, whether it’s with the endocrine system (causing hormone imbalances) or immune system (possibly triggering or worsening autoimmune disease). [1] As you may remember from some of my gut health posts, the bacteria in our body perform a variety of functions to keep us well. They not only assist with digestion, they fight off infections, produce vitamins, and help with detoxification. The problem is that we can get too much of a good thing. For one, most of our bacteria should be in the colon or large intestine. Very little should be in the small intestine. When they travel up there is when things start turning upside down. [2]

The excess bacteria in the small intestine could be anything from normal, healthy bacteria to not-so-friendly ones that either don’t belong in the gut at all or should only be in small numbers. Either way, the bacteria are very hungry and quick to ferment sugar, fiber, starch, and alcohol. As they start to break these foods down, they release different gases. These can be either one or a combination of hydrogen, hydrogen sulfide, and methane. Even worse is that one of these gases- hydrogen- feeds a species of organisms called archaea that produce methane gas. Here’s a quick recap- sugar, fiber, starch, and alcohol feed the overgrowth, which releases gas; if it’s hydrogen gas, then it may also feed archaea, which releases methane gas. [2] [3]

Signs and Symptoms of SIBO

How do you know you have SIBO? Keep an eye out for the following signs and symptoms:

• Bloating (increasing throughout the day; if you wake up with a flat stomach and go to bed looking pregnant, this is a strong sign)
• Gas (especially if it’s foul-smelling or painful)
• Diarrhea, constipation, or alternating between the two
• Floating stool (a sign of poor bile flow and enzyme release; not absorbing dietary fat)
• Extremely bad-smelling stool (not just “clear the room”- more like “did something die in here?”)
• Nutrient deficiencies (Vitamin A, B12, D, E, K2, iron, zinc)
• Sudden weight loss
• Fatigue
• Nausea or stomach pain (especially after eating)
• Feeling full even after a few bites of food; continuing throughout the day
• Incomplete stools (i.e., feeling like there’s “more” in there)
• Belching, burping, or hiccups
• Strange food intolerances, particularly to foods you usually could eat (fruit, grains, vegetables, etc.)
• Anxiety or depression (coming out of nowhere)
• Skin issues (acne, rosacea, eczema)

[4] [5]

According to SIBO-expert Dr. Allison Siebecker, ND, SIBO is either a cause or side-effect of many conditions, including:

• Anemia (iron deficiency)
• Celiac disease
• Chronic functional bloating
• Chronic intestinal pseudo-obstruction
• Anorexia
• Brain fog
• Dyspepsia
• Fructose malabsorption (i.e., not being able to tolerate most fruits)
• Crohn’s disease
• Ulcerative Colitis
• Fibromyalgia
• Gallstones
• Kidney stones
• Depression
• H. Pylori infection
• Lyme
• Diabetes
• Gastroparesis
• Ehlers-Danlos Syndrome
• Diverticular disease
• Intestinal permeability (leaky gut)
• Malabsorption syndrome
• Pancreatic insufficiency (not being able to produce or secrete enough digestive enzymes)
• Short bowel syndrome
• Parkinson’s
• Visceral fat
• Rheumatoid arthritis
• Restless leg syndrome
• Psoriasis
• Traveler’s diarrhea

[6]

SIBO- More Than IBS

The biggest tell-tale sign of SIBO is IBS (irritable bowel syndrome). Not only are many of its symptoms similar, but it may also downright be the cause of them. All of the gas and bloating may not be due to a nervous stomach but rather an overgrowth of bacteria that are over-fermenting food. If you’ve recently been diagnosed with IBS, consider asking for a referral to a GI or functional medicine doctor who can accurately test for SIBO. Most of the SIBO research out there is based on patients with IBS. [6] [7]

SIBO- Getting Tested

Some doctors will claim that there’s no reliable way to test for SIBO. You cannot do it with a colonoscopy since it only includes the large intestine (colon). Others say that they’re still trying to understand SIBO. Dr. Mark Pimentel from Cedars Sinai recommends breath testing. Though it’s not completely accurate, it’s, “… a simple, non-invasive approach to improve the clinician’s suspicion for SIBO… In summary, breath testing has come a long way since the 1980s, and the evolution of breath testing continues as new fermentation produces such as hydrogen sulfide are added and validated. The new data support that breath testing is an important part of the workup of patients with typical symptoms… Finally, a recent study now shows that breath testing predicts the response to treatment. This will help enrich and maximize the benefits of therapy. Given the recent validation of the breath test, this further diminishes the need for invasive, expensive testing such as endoscopically obtained duodenal aspirates” [8]

Like I mentioned earlier, get tested by either a functional medicine practitioner or GI-doctor (gastroenterologist) for a proper diagnosis. It also helps if they’re experienced with or have treated patients for SIBO. 

 The breath test itself will require you to fast and consume a small drink containing lactulose, which is a fermentable type of sugar. It’s unique because while we cannot digest it, our bacteria can. It’s what’s going to lure out any possible bacteria that may be growing in the small intestine. Once you’ve consumed the lactulose, you’ll be having your breath measured for any of the gases those bacteria may be producing (hydrogen, methane, hydrogen sulfide). The results will determine whether or not you have an overgrowth as well as the type of bacteria that need to be treated. [9]

The Takeaway

If you’ve been suffering from tons of gut-related symptoms and have been told you just have IBS, consider getting a second opinion and checking for SIBO. It’s often the root of many gut issues that can quickly be improved as soon as you’ve reached a diagnosis. Let me know if you’ve ever gotten SIBO and how you recovered. Until then, stay tuned for parts 2 and 3!

Sources:

[1] https://www.todaysdietitian.com/newarchives/021313p38.shtml
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/
[3] https://www.amymyersmd.com/2018/04/10-signs-small-intestinal-bacterial-overgrowth-sibo/
[4] http://edu.emersonecologics.com/2017/09/15/sibo-basics-understanding-a-complicated-condition/
[5] https://www.medicalnewstoday.com/articles/324475.php#signs-and-symptoms
[6] https://www.siboinfo.com/associated-diseases.html
[7] https://www.ncbi.nlm.nih.gov/pubmed?term=Normalization%20of%20lactulose%20breath%20testing%20correlates%20with%20symptom%20improvement%20in%20irritable%20bowel%20syndrome
[8] http://agaperspectives.gastro.org/breath-testing-prior-to-sibo-treatment-yes/#.XfkstS2ZP9A
[9] https://sibocenter.com/sibo-testing/