Do you meet the criteria for irritable bowel syndrome (IBS) and can’t find relief? Do you look pregnant thanks to a bloated belly? Are chronic diarrhea or constipation your constant companions? If so, you may be a victim of stubborn gut bacteria, also known as small intestinal bacterial overgrowth (SIBO).
While a long list of symptoms accompany SIBO, its trademark symptoms are a chronically bloated, distended belly; gas, which can cause flatulence, belching, or both; and a tendency toward chronic diarrhea, constipation, or both.
Any of these symptoms may be due to a condition called SIBO, or small intestinal bacterial overgrowth. SIBO happens when bacteria that normally belong in the large intestine travel backwards to colonize the small intestine. The small intestine is where we absorb the majority of our nutrients. Because SIBO inflames and damages the small intestine, this prevents these vital nutrients from being absorbed.
Symptoms of IBS and SIBO
For most people, the symptoms of IBS and SIBO are straightforward. One of the most common symptoms is bloating after eating, particularly after eating grains, bread, pasta, desserts, or other starchy foods. Other SIBO symptoms include gas, belching, indigestion, heartburn, nausea, abdominal pain and cramping, and either constipation, diarrhea, or both.
Doctors often misdiagnose SIBO as irritable bowel syndrome (IBS), as the symptoms are so similar. In fact, SIBO has been found in more than 80% of patients diagnosed with IBS.
• Excess gas, flatulence, belching
• Abdominal bloating from gas and distension
• Abdominal pain and cramping
• Constipation, diarrhea, or both
• Nausea, heartburn or acid reflux
• Irritable bowel syndrome
• Multiple food sensitivities
• Leaky gut
• Joint Pain
• Malabsorption symptoms (anemia or fatty stools)
• Rosacea and acne
• Neurologic and muscular diseases
• Pancreatic insufficiency
• Restless Leg Syndrome
Here are 6 additional signs that your IBS may likely be caused by SIBO:
1. You notice that fiber worsens your constipation
2. You notice an improvement in IBS symptoms when taking antibiotics
3. You feel more gas and bloating when you take probiotics that contain prebiotics
4. You have celiac or are gluten intolerant and do not have 100% resolution of symptoms on a gluten-free diet
5. You develop chronic symptoms of gas, bloating, constipation or diarrhea after taking pain medications, like opiates.
6. Your blood work shows chronically low iron or ferritin with no known cause
How SIBO causes bloating, gas, constipation, and diarrhea
The entire gastrointestinal (GI) tract contains bacteria, both good and bad. The small intestine contains bacteria different from that of the large intestine. In the case of SIBO, the small intestine contains too much bacteria, and these bacteria more closely resemble the bacteria of the colon. These bacteria consume sugars and carbohydrates, producing large amounts of gas. Not only does this gas cause bloating, belching, and flatulence, it is also behind chronic cases of constipation and diarrhea (depending on the type of gas produced).
SIBO Causes Leaky Gut
In addition to producing gas, the bacteria create byproducts that irritate and damage the lining of the GI tract. This damage causes intestinal permeability, or “leaky gut,” a condition in which the lining of the intestine becomes damaged and overly porous, allowing undigested foods, infectious bacteria, and other pathogens into the bloodstream. This creates inflammation in the GI tract and throughout the body. And because the bacteria digest foods normally meant for the intestine to absorb, nutrient deficiencies and malabsorption are common side effects with SIBO.
SIBO Causes Nutrient Deficiencies
Bacteria overgrowth in the small intestine can lead to malnutrition, one of the biggest concerns with SIBO. Essential nutrients, protein, carbohydrates and fats aren’t properly absorbed, causing deficiencies, including iron deficiency, vitamin B12 deficiency, calcium deficiency and deficiencies in the fat-soluble vitamins — Vitamin D, A, E and K.
These deficiencies can lead to symptoms, including weakness, fatigue, confusion and damage to the central nervous symptom
Vitamin B12 deficiency is more common than most people believe. There are a number of factors that can lead to deficiency, besides SIBO. Vegetarians and vegans are at particular risk, as are individuals who have inadequate stomach acid or take medications that suppress stomach acid — proton pump inhibitors, H2 blockers and other antacids.
Risk Factors For SIBO
• Low stomach acid
• Irritable bowel syndrome
• Celiac disease (long-standing)
• Undiagnosed gluten sensitivity
• Pancreatic insufficiency
• Use of opiate or opiate like drugs
• Crohn’s disease
• Prior bowel surgery
• Diabetes mellitus (type I and type II)
• Multiple courses of antibiotics
• History of a gastrointestinal infection such as traveller’s diarrhea, food poisoning, or viral gastroenteritis (stomach flu)
• Alcohol use
• Oral hormonal contraceptives pills
How To Manage SIBO
The first step is getting proper testing. Unfortunately, the standard medical community does not recognize SIBO as a cause of digestive and health issues, nor do they have access to lab tests that measure for SIBO.
However, Naturopathic Doctors are trained in the assessment and treatment of SIBO. Diagnosing SIBO involves a breath test, which has the patient ingesting a sugar solution and collecting breath samples over a period of several hours. Once the results are analyzed and interpreted, a treatment plan can be initiated.
Treatment often takes several months and involves a therapeutic diet such as the FODMAPs or Specific Carbohydrate Diet, antibiotic therapy, botanical antimicrobial therapy, and digestive system rebuilding and repair.
The goals of SIBO treatment are three-fold:
1. Reduce and eradicate the bacteria using a combination of diet, antibiotics, and botanical antimicrobials.
2. Heal the lining of the digestive tract
3. Prevent reoccurrence
Until you get to the underlying root cause of your digestive issues, relief from medications will be temporary ~ Dr Chelsea
For more information about IBS and SIBO, please visit www.siboinfo.org
If you are interested in discussing whether testing for SIBO and comprehensive digestive restoration might be an indicated for you, please contact my office or schedule a complimentary 15 min Discovery Session.