Do any of these sound familiar to you? Painful bloating. Irregular bowel movements (constipation, diarrhea, or both). Excessive gas. Fatigue. Reflux. Abdominal cramping. In other words, does your overall digestion generally just suck?
For many, these types of symptoms result in a diagnosis of Irritable Bowel Syndrome (IBS). What is IBS? It is a condition affecting the large intestine, causing many of the symptoms previously listed. In many cases it acts as a catch-all diagnosis when other more definable problems, like Crohn’s or Ulcerative Colitis, have been ruled out. IBS often does not produce any damage to the intestines but certainly causes a host of unpleasant symptoms. Treatment is usually dietary modification and sometimes medications to ease the discomfort.
What we are now learning about IBS, however, is that there are a large portion of folks for which the large intestine is actually not the sole player. For some, it is actually the small intestine (SI) where the action is happening. In fact, researchers have uncovered a condition by which bacterial imbalances occurs in the SI, setting the stage for a whole host of symptoms that look just like IBS. They call this condition Small Intestinal Bacterial Overgrowth (SIBO). So what if… just what if, a large number of these “IBS” people don’t actually have IBS. What if it’s SIBO?
Well, that is exactly what is being reported. Currently it is estimated that about 20% of people in this country have IBS, and about 60% of those are actually caused by SIBO. That is certainly something to stop and think about. For many IBS sufferers, we are focusing on the wrong treatments.
So what exactly is SIBO and how to we treat it? Let’s talk a bit about normal digestion first so we can set the stage for what goes wrong in SIBO. Bear with me for this exciting trip down the digestive tract.
When we chew and swallow, there is an arsenal of acid in our stomach at the ready to start breaking down certain amino acids and killing unwanted bacteria that we consume. As food continues its journey through the system, it hits the small intestine (SI) where the acid is neutralized and digestive enzymes move in to start breaking down our meal, enabling the absorption of nutrients. Whatever is leftover, mainly fiber and other undigested material, is pushed into the colon and prepared for excretion. Although I’ve simplified this system greatly, it’s a pretty amazing process.
Guiding food through the system is a process call peristalsis. We have peristalsis in the colon, pushing stool to the colon for excretion, and we also have peristalsis in the small intestine, pushing food contents through to allow for nutrient absorption and the rest for eventual excretion. In the SI, one important peristaltic motion is coordinated by what we call the Migrating Motor Complex, or the MMC. The MMC, in the fasting state (ie 90 -120min after we eat), initiates a cleansing wave that helps push contents through and out of the SI. It also pushes unwanted bacteria out the door.
Also, between each part of the digestive tract we have valves that help keep food where it should be and, ideally, moving in a downward fashion. Between the esophagus and the stomach we have the esophageal sphincter, and between the SI and large intestine we have the ileocecal valve. Both are intended to prevent back flow from the previous organ.
When all aforementioned parts work as designed, we have healthy digestion. At any point in this delicate system, however, we can have malfunctions, then setting the stage for unwanted bacteria to take hold in the SI.
First, a person may lack adequate stomach acid. While this alone is usually not enough to cause SIBO, it certainly can contribute, especially when combined with other malfunctions. How many of us in America are on proton pump inhibitors? Or may have H Pylori? Low stomach acid equals impaired digestion and an increase in bacteria reaching the SI.
Also, there can be a breakdown in the function of the MMC, inhibiting the cleansing wave that is supposed to take that unwanted bacteria out and away. This is a definite contributor to SIBO. What can cause a breakdown in the MMC? Well, food poisoning for one. Food poisoning produces a toxin that damages the nerves of the SI, inhibiting the action of the MMC. Instead of pushing those critters out, they are allowed to stay and they set up shop. Getting them out can be a monumental task.
Another impairment leading to SIBO is dysfunction with the ileocecal valve. If that valve is faulty and allows back flow from the large intestine, bacteria can get into the SI which normally should not be there. This again sets the stage for SIBO to develop.
Other potential causes can be structural abnormalities in the SI that decrease the movement of contents, as well as adhesions that allow bacteria to find a foothold and stake a claim in the land of the SI. Such a complicated mess, isn’t it?
How does one know if they have SIBO? Well, I find that new onset of persistent gas and severe bloating is one clue. It certainly is not diagnostic, but it definitely perks my ears. Diet often affects this, and clients will note that certain foods make the condition better or worse.
Other hints are the IBS-like symptoms that we described earlier. Additionally there may be a host of vague symptoms that were initially attributed to other causes. These include reflux/GERD, fatigue, joint pain, headaches/migraines, brain fog, and weight changes, among others. Some of these are likely due to food sensitivity reactions brought on by the SIBO. Bacteria in the SI increases the risk for leaky gut, so often food sensitivities and SIBO go hand in hand. There can also be malabsorption due to the bacteria damaging the brush border of the SI where our enzymes are produced. Less digestive enzymes equals less absorption of nutrients. Seriously, what a gigantic mess.
So what do we do? Well, a good first step is getting tested. Yes, there are tests to see if you have these buggers in your system, thank goodness. If you do, there are specific prescription and herbal protocols that can be utilized. These options can be discussed with a knowledgeable MD or ND that can recommend the right course of action.
Diet interventions can also be extremely helpful and are a key part of the process. The thing is, those unwanted bacteria in the SI like to ferment specific carbohydrate substrates, so diets like FODMAPs, the Specific Carbohydrate Diet, GAPs and others can be useful. I specialize in using these diets with clients as a key part of SIBO management.
Additional lifestyle factors can help as well. These include meal spacing (let theMMC do it’s thing!), stress reduction, and food safety (reduce the risk for food poisoning!). These are helpful not only during treatment but are also a key part of prevention.
Clearly, SIBO is a critical consideration in cases of digestive complaints, especially those with IBS. In fact many IBS diagnoses are actually SIBO in disguise as the symptoms between the two often overlap. Hopefully SIBO knowledge will continue to spread, allowing millions of people in this country to get the appropriate treatment for a condition that is treatable but unfortunately not yet mainstream in the gastrointestinal community.
Not sure if your digestive issue might be SIBO? I would love to review your health history with you and see what we can uncover. I have a great group of MDs and NDs I refer to if testing and treatment looks like a good course of action, and of course we can discuss dietary protocols that can often get you feeling at least a little better within a week or less. Don’t let these issues fester and only worsen over time. Call asap!