COLUMN: Can treating for SIBO relieve my IBS?
By Dr Amanda Chay ND
What is SIBO?
SIBO (Small Intestinal Bacterial Overgrowth) happens when bacteria that normally populates the large intestine moves back and colonizes the small intestine. When this happens, food that is typically fermented in the large intestine starts being fermented in the small intestine, causing symptoms of bloating (sometimes so bad you feel like you are 9 months pregnant!), gas, chronic diarrhea and/or constipation, and abdominal cramping and pain.
How do I know if my Irritable Bowel Syndrome (IBS) is caused by SIBO?
SIBO causes many of the same symptoms as IBS (gas, bloating, pain, constipation and/or diarrhea), however patients who have SIBO also generally have some of the following symptoms:
· Digestive symptoms (especially bloating) are worse with raw foods and fiber
· Digestive symptoms (especially bloating) are worse with grains
· Digestive symptoms (especially bloating) are worse with probiotics that contain pre-biotics (eg. inulin, FOS) and fermented foods
· Symptoms are better after taking antibiotics
· Your symptoms have not completely resolved after eliminating your food intolerances
What causes SIBO?
SIBO is caused by a problem with your migrating motor complex (MMC). The migrating motor complex is responsible for peristalsis (intestinal contractions) that keeps the bacteria in the small intestine relatively low (this is why an overgrowth in the small intestines causes problems). This peristalsis cleans the intestines between meals and during sleep. Common disruptors of the MMC include GI surgery, GI infection (typically from food poisoning or traveling), chronic disease, low stomach acid, and chronic stress.
What other conditions are associated with SIBO?
SIBO can cause intestinal permeability (see the next section below) and also inhibit the absorption of certain vitamins and minerals. SIBO is commonly associated with other conditions and symptoms listed below:
· Anemia/chronic low ferritin (our storage form of iron—this is what they look for on blood work to see if you have an iron deficiency)
· Chronic low B12 on lab work: Both B12 & ferritin play a huge role in energy! If you are having IBS symptoms and low energy, ask your ND about testing for SIBO
· Acne rosacea
· GERD (heartburn) and/or nausea
· Restless legs
· Fibromyalgia
· Unexplained bloating
· Chronic constipation (ie. not having a daily bowel movement)
· Many others
How does SIBO contribute to overall inflammation?
SIBO can cause damage to the intestines that leads to intestinal permeability (aka. leaky gut). Very simply, intestinal permeability is caused by damage to the lining of the intestine that causes gaps between the cells of the intestine. When you have these gaps, proteins from your food you are eating leak out into the bloodstream before they are completely broken down. Because the particles are too large, your body sees them as a foreign invader and causes an immune response. Our immune response triggers inflammation (our body’s natural response to heal), however this chronic inflammation can cause symptoms such as joint pain, low energy, headaches, foggy brain, weight loss resistance, hormone imbalance, GERD/acid reflux, and rashes, among many others. We also now know that chronic inflammation is the underlying cause of many of the chronic diseases we have in North America, such as autoimmune disease, cancer, diabetes, cardiovascular disease, dementia and Alzheimer’s, fibromyalgia, and Inflammatory Bowel Disease (IBD).
How do I test for SIBO?
We test for SIBO using a breath test that involves drinking a sugar solution and collecting breath samples over 3 hours. This measures how much and what type of gas the bacteria is producing, and gives us a clear idea of how to treat for your specific case. Currently this test is only available through Naturopathic and Functional Medicine doctors.
How do I treat SIBO?
I treat SIBO in three steps:
1. Preparation phase
a. This step involves preparing your liver for the elimination of the bacteria.
2. Eradication phase
a. I offer patients a few options for this step, depending on what they are most comfortable with. The options are antibiotics, a combination of antibiotics and herbs, or purely herbal.
3. Recovery phase
a. As long as the SIBO was completely removed in the Eradication phase, we move onto the 3rd phase that focuses on diet, healing the intestines, and stimulating the migrating motor complex.
Thank you for reading through this article. If any of these symptoms speak to you, I encourage you to talk to your ND. Most patients feel a huge sense of relief within the first 2 weeks after having symptoms for several years!
