Is it common for you to wake up in the morning with a flat belly, and as the day goes on you get more bloated and gassy to the point where your clothes feel tight or you are uncomfortable? Maybe it’s worse soon after eating but you can’t put your finger on what foods aggravate it, or it seems no matter what you eat it happens anyway? Have you seen your doctor for this and ended up with a diagnosis of IBS (Irritable Bowel Syndrome)? If so, you may have Small Intestine Bacterial Overgrowth or SIBO.
People who have been diagnosed with IBS often wind up with more questions than answers. This is because an IBS diagnosis often tells us what isn't causing our chronic digestive symptoms instead of pointing to causes that can be treated. SIBO may be one of these causes, and there are straightforward tests to discover if you have it as well as targeted treatment approaches to address it appropriately.
What is SIBO?
Our digestive tract is home to a large ecosystem of bacteria, viruses and fungi that live with us in a symbiotic relationship and have a profound positive effect on our health. We call this the gut microbiome, and it totals several pounds of microorganisms. The vast majority of these reside in the large intestine, while small amounts can normally be found in the small intestine and other organs of our digestive tract. SIBO occurs when additional bacteria migrate from the large intestine to the small intestine and “overgrow” there, a place they are not ordinarily supposed to be. Because our gut bacteria have a role in digesting and processing the foods we ingest, their actions can cause recurrent gas, bloating, abdominal pain and diarrhea.
Because these are very common IBS symptoms, discovering if SIBO is the cause of ongoing problems can lead to targeted and effective solutions.
SIBO isn’t just a problem of discomfort and gas. It is a serious condition that can affect the integrity of the gut walls which increases the risk of leaky gut and low grade inflammation, and it can interfere with proper digestion and absorption of our food. SIBO is often linked or can lead to other chronic conditions not only affecting our digestion but the whole body as well.
How can I find out if I have SIBO?
Fortunately, SIBO is easy to diagnose with noninvasive testing which can be done at home. When bacteria interact with the food we eat, they produce gas, mainly hydrogen and methane. While this is normal in the large intestine, it is not so in the small intestine and may even be worse there as we may still be digesting and absorbing our food. Thus, we test for SIBO with breath tests that measure the presence of elevated levels of hydrogen and methane that peak earlier in the digestive process than they would if this were happening in the large intestine.
There is a 24-hour preparation period before taking the test; the first 12 hours require a specific diet, and the last 12 hours require a complete fasting period; however, you may brush your teeth. When ready, one ingests a substrate packet and then produces breath samples every 20 minutes over a 3 hour period, which are submitted to the lab for testing. The lab measures these gases and produces a graph showing when their levels rise, thus determining if SIBO is present.
How is SIBO treated?
It appears easy on first glance. If the small intestine has bacteria that shouldn’t be there, why not just treat with antibiotics and wipe them out? Unfortunately it’s not so simple. Many of the patients I see at SFNM have been previously diagnosed with SIBO, did one or several courses of antibiotics (most commonly Xifaxan, an expensive antibiotic that doesn’t absorb well thus stays in the GI tract) which gave some relief only to notice symptoms gradually returning. Further, use of antibiotics can upset the balance of the normal microbiome of the large intestine, thus creating symptoms of gas, diarrhea and others.
To effectively treat SIBO and prevent recurrences, one must address the underlying causes.
A comprehensive approach to addressing SIBO
Antibiotics have their place, but as noted above can be ineffective by themselves and sometimes create new gut symptoms. To address SIBO effectively and decrease the possibility of recurrence, one must address underlying causes and factors that caused SIBO to occur in the first place. These causes are often specific to each of us, and may include inadequate stomach acid or enzymes, issues with gut motility, constipation, and dietary factors. In my practice, I carefully assess each of these possible causes for clues as to how to individualize and create a treatment plan specific for you. I have also found that use of gentler herbal antimicrobial compounds can work as well as antibiotic therapy without some of the more dramatic side-effects.
In naturopathic medicine we have a saying “It’s not the germ, it’s the soil.” By addressing causal or predisposing factors and individualizing treatment to the person, we have a better chance of treating SIBO effectively and solving chronic digestive issues.
If you have been diagnosed with IBS or suffer from unexplained chronic digestive issues, are wondering if you have SIBO, or have been diagnosed with SIBO but your treatment doesn’t appear to be effective, we can help. You can contact San Francisco Natural Medicine at 415-643-6600 to make an appointment or set up a free, 15-minute phone consult to determine if my approach is right for you.