You’re in luck, because in addition to this one overhead, here are two statistics that at least 10% of the American population might appreciate:
#1: Roughly 30 million Americans and millions more worldwide struggle with irritable bowel syndrome (IBS), a chronic gastrointestinal condition that can significantly reduce one’s quality of life
#2: More than 80% of people with IBS are estimated to have small intestinal bacterial overgrowth (SIBO), a major contributor to IBS
SIBO occurs when excessive amounts of bacteria end up in the small intestine, where they don't belong, and treating SIBO may be your key to improving your IBS symptoms.
Not too long I ago I was asked to provide information about SIBO and it’s possible connection to IBS.
1. What is SIBO - Small Intestinal Bacterial Overgrowth?
SIBO occurs when excessive amounts of bacteria end up in the small intestine, where it doesn’t belong. In most cases, the bacteria migrates from the colon (aka the large bowel) which houses trillions of bacteria.
2. What are the symptoms?
The classic symptoms of SIBO include intestinal gas, abdominal distension or bloating, and irregular bowel movements. However, SIBO can contribute to a variety of other gastrointestinal (GI) symptoms, such as heartburn, abdominal pain, intestinal rumbling or mucus in the stool, as well as non-gastrointestinal complaints, like joint pain, headaches, weight loss, nutrient deficiencies or fatigue.
3. How is someone diagnosed with SIBO
The most common and least invasive way to diagnose SIBO is through a breath test that measures both hydrogen and methane. Patients are asked to drink a fermentable solution and then provide a breath sample every 20 minutes for approximately two hours. If the bacteria are present then they should feed on the solution and produce gas, which is then exhaled through the lungs. Elevated hydrogen or methane production within a given period of time is used to diagnose SIBO.
4. What makes a person susceptible to SIBO? And what causes it?
We don’t know exactly what causes SIBO, but we suspect that at least one of the following conditions has to exist in order for SIBO to occur:
- Disordered GI motility
- Food poisoning, IBS, intestinal scar tissue secondary to inflammation or surgery, stress, history of radiation therapy, and hypothyroidism are just some of the conditions that can contribute to disordered GI motility.
- Low stomach acid
- Low stomach acid can happen for a variety of reasons, including age and acid suppressing medication, like proton pump inhibitors.
- Poor digestion
- Pancreatic insufficiency, Crohn’s disease and poor diet can result in poor digestion.
Most if not all autoimmune diseases have been linked to SIBO, but more research is needed to connect the dots.
5. Can dietary changes fix or manage SIBO?
Lots of bacteria feed on carbohydrates so the most common dietary recommendations for SIBO include limiting or avoiding certain types of carbs.
In my experience, the most popular diets for SIBO include the low FODMAP diet, the Specific Carbohydrate diet, and a low fiber diet. All three of these approaches are aimed at starving the bacteria in the small bowel in order to minimize symptoms and possibly eradicate the bacteria.
Whatever approach you choose, it’s important to eat a wide variety of whole foods and to limit or avoid added sugars and highly processed foods.
6. What is the connection between IBS and SIBO?
SIBO appears to be a major contributing factor to IBS. In fact, studies have shown drastic improvement of IBS symptoms after successful treatment of SIBO. Both conditions involve a disturbance in the gut microbiota, and both have been shown to respond to antibiotics that work on the bacteria in the small intestine. I believe that everyone who is given a diagnosis of IBS should be worked up for SIBO.
7. Is SIBO chronic? What is the relapse rate?
Without knowing exactly what causes SIBO, we can’t treat the underlying issue. Therefore, SIBO tends to be a chronic issue for many individuals, with an estimated 60% relapse rate.
Limiting added sugar, highly processed foods and alcohol, managing stress, waiting a few hours in between eating, not smoking, sleeping and promoting regular and complete bowel movements can help minimize the risk of recurrence.
8.What creates “bad” or “harmful” bacteria within the microbiome? Do certain good intestinal bacteria become corrupt?
All of us have a combination of “good”, “bad” and “neutral” bacteria in our intestines. As long as the “good” bacteria outweigh the “bad” then we’re in balance.
However, our stressful lives, overuse of antibiotics and acid suppressing medications (e.g. Proton Pump Inhibitors), and the standard American diet put that balance at risk creating a condition called dysbiosis or microbial imbalance.
Dysbiosis is suspected to play a role in the development of a number of chronic diseases.
9. Are there specific supplements that can help?
Different supplements can help for different reasons. For example, herbal supplements can sometimes be used as an alternative to antibiotics thanks to their antimicrobial properties.
Plant-based digestive enzymes might be recommended to help facilitate digestion so that less undigested food is available to feed bacteria. These can significantly help with gas and bloating.
To promote better GI motility and regular bowel movements, I often suggest a well-absorbed liquid magnesium supplement.