SIBO (small intestinal bacterial overgrowth) is something that is strongly linked with IBS and is often overlooked. I support many clients struggling with gut issues, and SIBO can be the missing part of the puzzle for them. Here is the low down on what SIBO is, how to test and manage it:
What is SIBO?
SIBO occurs when bacteria multiply excessively in the small intestine, causing a range of digestive symptoms. These bacteria ferment undigested food, producing gas that can lead to bloating, abdominal discomfort, and irregular bowel movements. Additionally, these bacteria consume nutrients like iron and B12, which can lead to nutrient deficiencies, fatigue, and even anaemia. SIBO can also damage the lining of the small intestine, a condition known as “leaky gut,” allowing partially digested food particles and bacteria to enter the bloodstream and triggering immune responses.
Common Symptoms of SIBO:
Bloating and abdominal gas
Belching and flatulence
Abdominal pain or cramping
Constipation, diarrhoea, or both
Heartburn, nausea
Malabsorption issues (e.g., iron, vitamins A, D, E, B12)
Fatigue, joint pain, skin conditions
Inability to lose weight despite dietary efforts
How Prevalent is SIBO?
SIBO is more common than many realise, especially in those with existing digestive conditions. Studies suggest that up to 60% (if not more) of people with Irritable Bowel Syndrome (IBS) also have SIBO. This overlap has led researchers and healthcare providers to explore SIBO as an underlying factor in IBS, particularly when IBS symptoms improve with certain treatments that address bacterial overgrowth.
The Link Between SIBO and IBS
The symptoms of SIBO and IBS are similar, with both conditions causing bloating, abdominal discomfort, and altered bowel habits. Because of these overlaps, SIBO often goes undiagnosed or is mistaken for IBS. However, there are signs that SIBO might be contributing to IBS-like symptoms, including:
Symptoms appearing after a bout of food poisoning or gastroenteritis
Symptom relief following antibiotic treatment
Worsening of IBS symptoms after using probiotics with “prebiotics” like FOS or inulin
Increased symptoms with higher fibre intake
Persistent low ferritin or iron levels without clear cause
Since SIBO involves excess bacterial activity, its presence in IBS patients can further irritate the small intestine, leading to the characteristic symptoms of IBS. Addressing SIBO may significantly relieve or even resolve IBS symptoms, especially when other treatments have proven ineffective.
Causes and Risk Factors for SIBO
Several factors can contribute to SIBO by altering the gut’s bacterial balance or slowing digestive motility. Common causes include:
High Blood Sugar Levels: Elevated glucose provides a favourable environment for bacterial growth.
Slow Digestion and Gut Motility Issues: When food takes too long to move through the intestine, it provides fuel for bacteria, leading to overgrowth.
Low Immune Defense: A weak immune system allows harmful bacteria to thrive and multiply.
Low Stomach Acid and Digestive Enzymes: Without sufficient gastric juices, foods aren’t fully digested, promoting bacterial overgrowth.
Lifestyle Factors: High alcohol intake, over-training, and stress can strain the digestive system, increasing SIBO risk.
Structural Issues: Gut structural changes, certain medications (e.g., recurrent antibiotics, proton pump inhibitors), and advanced age may also disrupt the gut's bacterial balance.
How is SIBO Diagnosed?
The primary diagnostic tool for SIBO is a breath test that measures hydrogen and methane gases produced by bacteria in the small intestine. Here’s a look at how it works:
Preparation: Patients fast for 12 hours before the test and avoid antibiotics, probiotics, and certain vitamins.
Breath Sample Collection: After a baseline sample, patients drink a lactulose solution that prompts bacterial fermentation. Every 20 minutes over 2–3 hours, patients provide breath samples.
Gas Measurement: The test detects hydrogen and methane gases, which signal bacterial activity. High gas levels confirm SIBO and help identify whether it’s hydrogen-dominant or methane-dominant, as this distinction affects treatment options.
This non-invasive test is easy to complete at home, with results available within a week.
Treating SIBO: Steps and Options
Treating SIBO typically involves a multi-step approach to restore balance to the small intestine:
Testing and Diagnosis: Confirming SIBO and identifying the gas type guides the treatment.
Dietary Adjustments: Patients receive a “SIBO-friendly” eating plan, usually low in fermentable carbohydrates, to reduce bacterial fuel.
Antimicrobial Therapy: Natural antimicrobials or targeted antibiotics are used for 4–6 weeks to reduce bacterial overgrowth.
Gut Healing: Addressing “leaky gut” by supporting the intestinal lining, which can take up to three months.
Probiotic Support: Reintroducing beneficial bacteria with high-strength probiotics to maintain a healthy gut balance.
Retesting: After three months, patients retake the breath test to confirm SIBO resolution.
Summary
For those with IBS, exploring SIBO as an underlying cause can be crucial for effective treatment. With a strong connection between the two, many IBS patients experience significant relief after addressing SIBO. Identifying and treating SIBO early can improve nutrient absorption, ease digestive symptoms, and support long-term gut health. If you think this is something that may be affecting you, do book a complimentary call to find out more about how I can help you.
Comments