SIBO: The Culprit Behind the Chronically Bloated

Bloating and gas are the most common digestive complaints that I come across in my practice.  For some, these symptoms can easily be addressed with the introduction of probiotic rich foods or supplements, removing food sensitivities or increasing digestive fire.  There are, however, many people that have tried these and still feel just as bloated, if not worse, and that even drinking water makes them bloated.

 I feel a great affinity to helping these people.  Those with the chronic gut problems who feel they have tried everything.   Those who have been given a diagnosis of Irritable Bowel Syndrome, handed a prescription, and told there isn’t a chance of recovery.  Having been in that situation myself, I understand exactly how frustrating, overwhelming and hopeless one can feel.  Fear not, my bloated friends!  There may be one very important factor in what is causing your symptoms.

 Small Intestine Bacteria Overgrowth.

I was diagnosed and went through treatment for SIBO a few years ago. Unfortunately, it is not a well-known condition in the medical community. Because it is not well known, I spent a lot of time doing my own research to ensure that I could execute the most effective treatment plan possible. Effective treatment takes a very individualized and multifaceted approach and the knowledge I gained was indispensable.

One thing that really stood out to me during my research, is that people, whether they have been diagnosed with SIBO or suspect they have it, feel very lost and overwhelmed with testing, treatment and especially diet.  This is understandable considering that SIBO is fairly new to the medical community and many doctors are not familiar with the protocol for treating it.  Dr. Allison Siebecker of the SIBO Center for Digestive Health at NCNM Clinic in Portland, OR and Dr. Mark Pimentel of the Cedars Sinai Medical Center in Los Angeles, CA are at the forefront of SIBO research and if you have not done so, I urge you visit their websites (links provided at the end).  They are the SIBO experts and much of the information I am laying out here has come from them.

So, after reading countless stories of frustration from those looking for answers, I wanted to put together as much information on the issue as I could muster and my own experiences with it.

First, an overview on what exactly is SIBO: 

What is it?

Small Intestinal Bacterial Overgrowth (SIBO for short) is a bacterial infection of the small intestine.  In a healthy digestive tract, the bacteria numbers in the small intestine are almost non-existent as most bacteria should colonize in the large intestine.  In a compromised digestive system, bacteria flourish in the small intestine and produce gases that affect the motility of the gut.  These bacteria are classified as either hydrogen gas producing or methane gas producing.  They are, quite literally, fart bugs.

Dr. Mark Pimental’s research on SIBO has shown that it is often the cause or main symptom of Irritable Bowel Syndrome (IBS).  His research has shown that successful eradication of SIBO can diminish symptoms of IBS completely.  If you’ve ever had the disheartening diagnosis of IBS and have been told there is no cure, this research is life changing!

 What happens?

As mentioned above, the bacteria produce hydrogen or methane gases that affect gut motility and can cause pain, cramping and distension, among other symptoms.  These gases are the metabolic product of fermentation of carbohydrates by the bacteria and cannot be produced by the body (without the bacteria).  In addition to expelling gas into the intestines, the bacteria affect our digestion and absorption process, often leading to vitamin/mineral deficiencies (B12 in particular).  SIBO often results in damage to the micro villi of the small intestine, leading to inflammation and, and in about 50% of SIBO cases, leaky gut.

What does it feel like?

There are many, many possible symptoms associated with SIBO but here are the most common:

• Bloating
• Abdominal distension
• Abdominal pain, cramping
• Constipation, diarrhea, or a combination of both
• Heartburn
• Nausea
• Malabsorption
• Headache
• Joint pain
• Muscle pain
• Fatigue
• Skin problems
• Food sensitivities
• Mood symptoms
• Hydrogen producers generally have diarrhea as their main symptom while methane producers will experience constipation as their main symptom.  It is common for SIBO’ers to experience alternating constipation and diarrhea.

 There are a few good indications that SIBO is present:

Gas or bloating increases when you take probiotics that also contain prebiotics, often labelled as FOS or inulin

Constipation worsens with fiber increase

You develop chronic symptoms of gas, bloating, constipation or diarrhea after taking pain medications, like opiates

You have a gluten allergy or intolerance and your symptoms do not improve on a gluten free diet

Your symptoms improve after taking antibiotics

Your symptoms do not improve after following a candida protocol (many people are quick to assume gastrointestinal symptoms and mood symptoms as candida)

Intolerance to carbohydrates (meaning your symptoms worsen greatly)

How it’s Diagnosed

SIBO is tested for through a breath test that can be done at home or at a medical clinic.  After providing an initial breath sample into a test tube, you then drink a solution of lactulose and provide further breath samples over the course of about two hours.  If SIBO is present, the lactulose will cause a rise in the hydrogen or methane gases which will then be measured by the lab.

I know that if you’re reading this, there is a very good chance you are using Dr. Google to diagnose and treat what you suspect is a case of SIBO (oh, how many times I’ve been there…).  I will tell you from experience that it is absolutely essential to have this test done before executing a treatment plan.  In order to effectively eradicate it, you must know if you are dealing with methane or hydrogen as the treatment differs for both.  Also, it is important to know exactly how high your levels are so that you and your practitioner can know how long of a treatment you can expect.  High levels require more than one round of treatment and you must know where you started so you can judge the effectiveness of the treatment.  For me personally, this test was never offered nor mentioned by my GI Specialist, even after many other diagnostic tests came back negative.  I chose to pay for it through my Naturopath in order to speed things up and it was ordered through Genova Diagnostics.

Some manufacturers of the breath test use a glucose solution in place of the lactulose, but since glucose is absorbed quite rapidly it may not provide a complete picture of the bacteria present throughout the small intestine.

Stool testing will not give an indication of SIBO but is a fantastic test to couple with the breath test to get a complete picture of your digestive system.  Quite often there is more than one culprit behind digestive symptoms.

What Causes It?

In short, any disruption to the natural wave of the intestines, the Migrating Motor Complex (MMC), can result in SIBO.  When there is a disruption in the MMC, bacteria are allowed to travel back up the digestive tract, allowing them to colonize where they shouldn’t.

There are a few conditions that affect intestinal motility that can predispose you to SIBO: 

• Diabetes
• Hypothyroidism
• Diverticulitis
• Surgical bowel resection
• Insufficient pancreatic enzymes and low hydrochloric acid
• Bowel obstruction
• Food poisoning
• Opiate use
• Ileocecal valce malfunction
• Chronic stress

Are you feeling at this point that SIBO is likely an issue for you?  When I first learned about this condition it was the (long-awaited) final piece in my health puzzle and I felt a huge sense of relief.  Finally, an answer!  Even though I knew I had quite the battle ahead of me, having the test done and getting a complete picture of my digestive system was invaluable.  If you’ve been feeling frustrated with failed attempts at controlling your own symptoms, I encourage you to seek out a practitioner that can provide a breath test and see if SIBO is present.  Letting it go on can lead to nutrient deficiencies and can be detrimental to your health.

Treatment of SIBO is incredibly detailed and requires diet and lifestyle modification in addition to herbal or prescription antibiotics.   I will be covering the topic of treatment in a separate post and will include what did and didn’t work for me.

Dr. Allison Siebecker’s website is www.siboinfo.com

Dr. Mark Pimentel’s website is www.anewibssolution.com