ibs could be sibo

New hope for those with IBS? You may actually have SIBO!

Do you often feel gasey and bloated? Maybe you have loose stools or suffer from constipation, possibly some stomach pain, nausea, heartburn and/or excess burping? Does it seem like you have some or all of these symptoms regardless of the foods you eat? Or you are eating healthier than ever before but your digestion is much worse? Do you have these symptoms along with fatigue or skin concerns like rosacea, acne or eczema? Have you been told you have Irritable Bowel Syndrome (IBS)? It could be that you actually have Small Intestinal Bacterial Overgrowth (SIBO).

This article will tell you more about SIBO and what you can do about it.

What is Irritable Bowel Syndrome (IBS)? What are the symptoms?

Irritable Bowel Syndrome is a fairly common condition in North America. The estimates are that 10-20% of Americans have been diagnosed with IBS. Broadly speaking IBS is defined as a gastrointestinal disorder for which no known physiologic or anatomical cause has been identified. It is a diagnosis of exclusion based on non-specific symptoms that include recurrent abdominal pain on average at least one day per week in the past 3 months, along with two or more of the following: (1) the pain is related to defecation; (2) the pain is associated with a change in frequency of stool and/or; (3) the pain is associated with a change in the form of stool.

Many medical professionals have touted stress as the root cause of IBS but what we are actually seeing is that development of chronic IBS is highly correlated with a prior incidence of acute bacterial stomach infections (ex. Travelers diarrhea or food poisoning).

Conventional treatment options are minimal and directed toward symptom relief, such as the low FODMAPS diet.  Which brings us to SIBO – a new root cause and novel treatment for those with IBS symptoms.

What is Small Intestinal Bacterial Overgrowth (SIBO)? What are the symptoms?

We are seeing that as many as 84% of those with IBS actually have something called Small Intestinal Bacterial Overgrowth, also known as SIBO.  SIBO is defined as an excess of problematic bacteria in the lower part of the small intestine. This overgrowth of bacteria leads to some or all of the following symptoms:

  1. Dyspepsia Symptoms
  • Abdominal bloating/distension after meals
  • Abdominal discomfort/pain after meals
  • Excessive burping
  • Excessive flatulence (passing gas)
  • Nausea
  • Heartburn
  • Sensation of fullness
  1. Bowel Movement Signs & Symptoms
  • Chronic loose stool
  • Chronic constipation
  • Alternating bouts of loose stool and constipation
  • Bowel movement urgency
  1. Other potential findings
  • Rosacea, eczema, acne
  • Chronic fatigue
  • Joint pains
  • Brain fog

Typically, someone with SIBO will have some stool changes and some dyspepsia (gas induced) symptoms. Some will also have skin concerns and fatigue. The degree of symptom severity correlates with the bacteria overgrowth levels, so higher levels equals more severe symptoms often.

Conditions Associated with SIBO

Here is a list of conditions that have been associated with SIBO:

  • Iron and Vitamin B12 Deficiency Anemia
  • Intestinal Permeability
  • Non-Alcoholic Fatty Liver Disease (NAFLD)
  • Interstitial Cystitis
  • Hypothyroidism
  • Restless Leg Syndrome
  • Histamine Intolerance

SIBO Lab Testing
There is a relatively new non-invasive test to determine if someone has SIBO.  Currently the gold standard for SIBO testing, the a lactulose breath test that measures hydrogen and methane levels produced the bacteria in the small intestine.  Overgrown bacteria in the small intestine produce elevated levels of hydrogen and/or methane gas which can be measured through breathing into tubes over three hours. Elevated levels of one or both of these gases is a positive test result for SIBO.

The lactulose hydrogen/ methane test is a given as a home breath test kit and requires the patient to follow specific low fibre/ low sugar food intake during the 24 hours before the test.  The bacteria ferment fibre and sugar fuel sources which then results in hydrogen and/or methane and/or hydrogen sulfide gases.

The test kit is available through your Naturopath. It is a specialized test not covered by OHIP so it is not offered through your family doctor or specialist. It can be covered though by extended health benefits.

SIBO Treatment

Treatment for SIBO is depended on which gas(es) are positive on the lab test. Typically, treatment will start with 2-4 weeks of high dose herbal antimicrobials along with biofilm disruptor capsules. In some refractory cases, specific anti-biotics are used but typically high dose herbal antibiotics work very well.  Once eradicated, your Naturopath will work on healing your gut. Often there are higher levels of intestinal permeability when someone has SIBO, and also stomach acid secretion can be low.  It is important to repair the gut after SIBO and put some preventative measures in place so that it doesn’t recur.  This gut healing phase may last about 8 weeks.

The approach to treating SIBO includes the following 4 steps:

  1. Inhibit & Disrupt the Bacteria’s Biofilm
    • Bacteria produce biofilm to protect itself from antibiotic/ antimicrobial agents.
    • Treating SIBO involves giving specific biofilm disrupting agents to crack open the biofilm and allow for the full eradication of the bacteria.
  2. Upregulate Liver Detoxification Pathways
    • Many SIBO patients need liver support in advance of SIBO eradication, especially those with fatty liver disease. There is a risk of having a more significant die off reaction during eradication if liver detox pathways are not optimal.
  3. Eradicate SIBO
    • Eradicate the single or multiple forms of SIBO. Options here include herbal or pharmaceutical treatments or the elemental diet.
    • Herbal antibiotic treatments will depend on the type of SIBO but can include the following:
      1. Berberine
      2. Thyme
      3. Myrrh
      4. Goldenseal
      5. Emulsified Oregano Oil
      6. High dose Allicin Extract
      7. Silver Hydradol Liquid
      8. Grapefruit Seed Extract
      9. Uva Ursi
  1. Heal the Gut & Prevent Recurrence
    • Prokinetic therapy – natural or pharmaceutical
    • Support and improve gastric acid production and/or bile production and flow
    • Gut healing

Some advocate a specific diet to effectively starve the overgrown bacteria. There are a number of variations on this, including the Biphasic Diet, the Specific Carbohydrate Diet, the Gut and Psychology Syndrome Diet and the low Fodmap Diet.  However, there is only one diet that has been shown to eradicate SIBO and that is the Elemental Diet. The other diets will reduce gas and bloating symptoms but not eradicate SIBO.  The Elemental Diet is effective but very hard to implement since it requires the patient to only consume a specific liquid shake for 2-3 weeks. This approach will starve the bacteria but weight loss, compliance and cost is a significant barrier.

Repair your gut! See a Naturopath.

A Naturopath will do a thorough assessment of your IBS and other gastrointestinal symptoms and review previous lab testing before determining whether you might benefit from doing the SIBO test.  Then if the test is possible for SIBO, your Naturopath will give you a comprehensive treatment plan designed to address SIBO and prevent its recurrence.

To find out more about how a Naturopath treats gastrointestinal concerns including IBS, book a FREE 15 min Meet the Naturopath consultation with Dr. Tara Andresen today at one her NDcare Naturopathic Clinics in Toronto.