One cause of IBS: SIBO (Small intestinal bacterial overgrowth)
All about SIBO
You may be happy to hear that there are a small group of medical doctors out there who don’t brush off IBS as a psychological condition.
In fact, they believe they’ve found the cause of IBS and the cure. Their theory is that IBS is caused by an overgrowth of bad bacteria in the small intestine. This condition is known as SIBO or small intestinal bacterial overgrowth.
The doctor leading the SIBO theory is Dr. Mark Pimentel. He wrote this book about it.
In the book, he addresses not only SIBO but also the relationship between female hormones, menstruation and IBS symptoms (it’s progesterone related) and why removing lactose can make your symptoms better.
He also discusses the relationship between IBS and symptoms of fibromyalgia and discusses related SIBO symptoms like depression, fatigue, yeast infections and interstitial cystitis.
So what exactly is SIBO?
A SIBO diagnosis means you have an overgrowth of bad bacteria in your small intestine. The problem is that most of the bacteria in your gut should be in the colon or large intestines, not in the small intestine. The primary job of the small intestine is to absorb nutrients and minerals from food.
A bacterial overgrowth in the small intestine causes the same issues as IBS (gas, bloating, gut pain, diarrhea or constipation). But it can also cause nausea, heartburn, brain fog, head aches, food allergies and body aches.
SIBO can be diagnosed with a breath test. The best test is a hydrogen/methane breath test. Before the test you drink a lactulose solution to determine if your are a hydrogen or methane gas producer.
You can also test for fructose, lactose or sorbitol sensitivity by drinking each substances before another breath test. SIBO expert and naturopath, Dr. Allison Siebecker, has more information about testing on her website.
Treatments for SIBO
This is where it gets a bit controversial. One of the common ways that SIBO is treated by doctors is with an antibiotic called Rifaximin or Neomycin. These particular antibiotics are used because they don’t absorb into the bloodstream and stay locally in the small intestine.
Studies show that these antibiotics have had great results in eradicating SIBO and improving symptoms. But you’re probably wondering, wasn’t it antibiotics that caused the problem in the first place?
Because many people are gun shy about taking antibiotics as a treatment, SIBO can also be treated with herbal antibiotics like oregano oil, garlic capsules, or goldenseal.
While antibiotics kill bad bacteria directly, diet is also used to starve the bad bacteria, which feed mostly on sugar and carbs.
There are two diets used for SIBO. The elemental diet is a two week long, predigested diet. Predigested food is broken down into powdered form and mixed with water so the body can skip the digestion step and easily absorb the nutrients.
The second way to starve the bad bugs is to choose a grain and sugar-free diet like the Specific Carbohydrate, GAPS or Paleo diet. I write all about these diets here.
Diet alone can be effective at healing SIBO but can be slow and take a long time.
It should take about a month on one of these diets to feel symptom relief but people typically stay on the diet for a year or two, depending on the case. Sometimes people can feel worse on this diet as bacterial die off occurs. That can feel like the worsening of IBS symptoms or flu-like symptoms.
Cautions about SIBO
Because SIBO is thought to prevent people from absorbing and processing fructose and vegetables with insoluble fiber, the diets above should be modified to address these issues. Fruit and veggies with insoluble fiber need to be taken out and reintroduced very slowly.
Beans and nuts are also foods that are known to cause digestive flare ups.
One of the best ways to prevent SIBO from recurring is to keep digestive fire strong. That means having sufficient hydrochloric acid in the stomach and sufficient enzymes to help break down the food so no undigested particles remain.
Things that keep digestion and absorption strong are taking probiotics, enzymes, or bitters before a meal. Or diluting a bit of apple cider vinegar in water and drinking it before a meal.
Dr. Pimentel also recommends fasting 3 to 5 hours between meals to give the small intestine the opportunity to sweep bad bacteria out.
Lastly, constipation-dominant SIBO is much harder to teat because it indicates a higher level of bacteria and methane gas, according to Dr.Siebecker.
I believe there can be many causes of IBS, and SIBO is just one of them. I will talk about more underlying causes for IBS in future blog posts.