Is it IBS or SIBO?
If you struggle with chronic constipation, chronic diarrhea, abdominal bloating, and foul smelling gas it could be more than just IBS.
You could have SIBO.
In fact up to 85% of IBS cases are actually caused by SIBO.
If you have been struggling to manage your IBS symptoms, you could be one of those cases. This begs the question, “How do I know if my symptoms are caused by SIBO or something else?”
The truth is, you won’t know for sure until you’re able to consult a doctor. But, hopefully this article can bring more awareness about what SIBO is, what causes it, symptoms you’ll want to look out for, and what to do next if you think you may have SIBO.
What is SIBO?
SIBO stands for Small Intestine Bacterial Overgrowth. If someone suffers from SIBO, that means an abnormal/excessive amount of bacteria or archaea (a single celled organism that is even older than bacteria) has set up camp in their small intestine.
Here’s why this is bad…
The small intestine is intended to digest your food and then absorb its nutrients into the bloodstream, but if you have an overgrowth of bacteria living there, it will continually interfere with this process.
The bacteria, or archaea, will absorb the nutrients from your food before your body gets the chance to, causing the food to ferment instead of being properly digested. During the fermentation process, the bacteria releases hydrogen and the archaea releases methane, which are gasses that cause your tummy to bloat. From there, depending on what type of SIBO you have, you’ll either experience diarrhea, constipation, or alternating periods of both.
Less than ideal, right?
Now that you have an idea of what SIBO is, let’s delve into the different types that can manifest in the body.
SIBO sufferers will fall into one of three categories: diarrhea dominant (SIBO-D), constipation-dominant (SIBO-C), or a combination of both.
SIBO-D: Hydrogen-Producing Bacteria is present
This is the more common form of SIBO, and is a result of an overgrowth of carbohydrate-fermenting bacteria that produces hydrogen gas in the small intestine. This production of hydrogen is what causes abdominal bloating and chronic diarrhea.
SIBO-C: Methane-Producing Archaea is present
This type of SIBO is a result of an overgrowth of single-celled organisms called archaea as well as hydrogen-producing bacteria. When the bacteria ferments carbohydrates and produces hydrogen, the archaea will feed off that hydrogen and produce methane, which also causes abdominal bloating. The production of methane also slows down the transit time of your food leading to constipation. Not only is this uncomfortable, but it also allows even more bacteria to grow in the small intestine, leading to more methane production and more constipation.
It’s a vicious cycle that can be hard to break. Killing archaea’s food source (aka, the hydrogen-producing bacteria) with antibiotics and antimicrobials often isn’t enough because they can survive for quite some time without hydrogen. So, this type of SIBO is much harder to eliminate than SIBO-D.
The third type…
This type is a result of Sulphate-reducing bacteria (SRB) residing in the small intestine alongside archaea and hydrogen-producing bacteria. This overgrowth of SRB creates hydrogen Sulphide, which is a highly toxic gas (known for its rotten-egg smell) that can damage the cells of the intestinal wall that are responsible for absorbing nutrients into the bloodstream. Like archaea, it also feeds on hydrogen, so if you kill one, it can result in the overgrowth of the other.
What causes SIBO?
The body has a number of mechanisms in place to prevent your small intestine from having an overgrowth of bacteria, but if one or more of these mechanisms are no longer functioning properly, SIBO can occur.
Let’s talk about each mechanism in depth…
Stomach acid secretion - The stomach will create acid that kills off bad bacteria so it won’t enter the small intestine. So, if the stomach stops secreting acid for whatever reason, this can lead to that bacteria migrating to the small intestine and setting up camp.
Bile secretion - The liver produces bile (an agent that fights off bad bacteria) which is stored in the gallbladder and then released into the small intestine. If this process is interfered with, bile doesn’t get to the small intestine and bad bacteria can grow and thrive.
Migrating motor complex (MMC) - The wall of the small intestine will create waves of movement every 90-120 minutes (usually between meals) to move waste and unwanted bacteria into the large intestine and then the colon. If MMC is inhibited or unable to function, any bacteria in the small intestine will get stuck there.
Immune system - the fluid that resides in the small intestine contains antibodies called immunoglobulins that fight bacteria and other pathogens. If something is off with the body’s immune system, the small intestine may not have the antibodies it needs to fight off bacteria that passes through.
Ileocecal valve - this is a one way valve that allows the contents of the small intestine to enter the large intestine without the contents of the large intestine flowing back up. If this valve fails, the millions of bacteria that live in the large intestine (this is where they’re supposed to live) can make their way into the small intestine.
These functions of the body can be interrupted due to a myriad of reasons, including:
Gastroenteritis, caused by a parasite, bacteria, yeast, etc (aka, food poisoning)
Lyme disease
Clostridium difficile
Inflammatory bowel disease
Scleroderma
Diabetes
Ehlers-Danlos syndrome
Hypothyroidism
Medications such as opiates or the recurrent use of antibiotics
Surgery or injury resulting in muscle or nerve damage
Autonomic nervous system dysfunction resulting in sympathetic dominance
Adhesions or obstructions from abdominal surgery or nonsurgical causes such as trauma
Inflammatory bowel disease stricture
Ileocecal valve removal or impairment
Volvulus
Cancer
Superior mesenteric artery syndrome
Non-draining pockets
Hypochlorhydria
Altered bile flow and enzyme production
Medications such as proton pump inhibitors
Immunodeficiency
Leaky gut
This is why it’s important to talk to your doctor about your medical history so you can get to the root of what’s causing your SIBO.
I say this because if you eliminate the bacteria overgrowth in the small intestine without also addressing what caused it to happen in the first place, it will come back.
Symptoms to look out for…
The most common symptoms of SIBO are:
Bloating within 1 hour after eating
Chronic diarrhea, chronic constipation, or alternating constipation and diarrhea
Burping after meals
Experience acid reflux after meals
Gas that smells extremely foul (more so than normal)
Stomach discomfort or cramping
Secondary symptoms that can occur:
Restless legs during sleep
Joint pain
Changes in mood
Multiple food sensitivities
Respiratory symptoms, like asthma
Acne or skin rashes
Memory issues or brain fog
Chronic iron and/or B12 deficiency
Weight gain or weight loss
Poor quality sleep
Other clues that it could be SIBO:
Your digestive symptoms temporarily improve during the use of antibiotics.
Upping your fiber intake, or using fibre supplements like Metamucil, makes things worse.
Taking pre-biotics and probiotics actually makes you feel worse, not better.
The longterm effects SIBO can have on your health
Aside from the frustrating and sometimes embarrassing symptoms of bloating, diarrhea, constipation, and foul gas…SIBO leads to chronic malnutrition which is bad for your overall health in the long run.
This happens in two different ways:
Damage to the wall of the small intestine - the overgrowth of bacteria (whichever ones are present) and the various gasses they emit can damage the lining of the intestinal wall, preventing the absorption of nutrients and leading to a leaky gut.
The bacteria absorbs nutrients before your own cells - As I mentioned before, any overgrowth of bacteria in the small intestine will consume essential nutrients that your body needs before your own cells can. Ones like, vitamin B12, magnesium, iron, calcium, and amino acids found in protein (which are the building blocks for growth and repair in the body).
What to do if you think you might have SIBO…
SIBO is poorly understood by western medicine and will often go undiagnosed. However, there are many naturopathic physicians that are able to provide insight on this condition and help patients find relief.
The best way to know for sure is to be tested for it, which is something I am more than happy to help with. Schedule a free consultation call with me if you’d like to discuss your symptoms, and from there I can recommend the best strategy for treatment.
