Culprit behind the chronically bloated – SIBO and IBS

Do you currently suffer from the following digestive complaints?

  • Pain
  • Constipation
  • Diarrhoea
  • Alternating constipation and diarrhoea
  • Food sensitivities
  • Fatigue
  • Reflux/ burping
  • Abdominal cramping
  • Bloating and/or wind

It is highly likely that you could have a condition called Small Intestinal Bacterial Overgrowth (SIBO).

What is SIBO and how does it relate to Irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is an extremely common functional digestive disorder that is notoriously difficult to treat due to its functional nature. Although IBS is a widely diagnosed condition, it is often misunderstood, which is not ideal, as it is a condition that affects a huge chunk of the population, with some estimates as high as 28 percent. It is the most common functional digestive disorder worldwide and it is the second most common cause of missed work after the common cold. IBS is characterized by abdominal pain, flatulence, bloating, gas, abdominal discomfort, and changes in bowel habits (constipation/diarrhoea) and is diagnosed when other conditions with structural diagnostic criteria (such as IBD or celiac disease) have been ruled out. In other words, IBS is a “diagnosis of exclusion.”

Because the mainstream medical community currently has not defined the cause of IBS, standard treatment is based primarily on symptom suppression, rather than treating the underlying cause. This may include antidiarrheal medications, anticholinergic or antispasmodic medications, laxatives, SSRIs, or 5-HT3 antagonists. These drugs primarily target intestinal motility (increase of decrease) and pain relief as a way to address a patient’s symptoms. Furthermore, many of these drugs can cause unwanted and problematic side effects, which are sometimes similar to IBS, such as gas and bloating.

Fortunately, the research literature is starting to show strong evidence around the potential causes of IBS, allowing us to develop safer and more targeted treatments for IBS.

As mentioned above, IBS has been considered a “functional” gastrointestinal disorder and is used as a diagnosis when infectious (e.g. parastites) and structural abnormalities in the gut are ruled out. This means that it is caused by abnormal function of the GI tract, rather than structural or biochemical abnormalities. However, while this may be true in some cases, in most cases it is not. This is because it is thought that one of the main drivers behind IBS is small intestinal bacterial overgrowth (SIBO), which is a biochemical abnormality. Diagnosis of SIBO has increased in recent years, particularly due to its very close association with irritable bowel syndrome (IBS).

Simply put , SIBO is an overgrowth of bacteria in the small intestine when there shouldn’t be.

While microbes are present throughout the gastrointestinal tract, a healthy small intestine contains relatively few microbes, especially compared to the large intestine. SIBO occurs when there is an excessive amount of bacteria in the small intestine and the bacterial population resembles that of the large intestine. This means there is an overgrowth of commensal bacteria in the small intestine. SIBO is defined as bacterial populations exceeding 10^5 – 10^6 organisms/ml. Usually there is less than 10^3 organisms in the small intestine. Most are gram positive bacteria, however SIBO involves the overgrowth of gram negative species. Typical species that overgrow in the small intestine are Klibsiella pnemonae, E.coli, Strep spp., Staph spp., Proteus spp., Bacterioides spp., Clostridium spp., Micrococcus, and Enterroccocus spp. These overgrown species produce various inflammatory cytokines as well as LPS (lipo-polysaccharride), which in turn further activates inflammatory mediators like NFk-B.

This creates inflammation in the small intestine mucosa, which decreases brush border enzyme production (digestion) and decreases nutrient absorption. This results in undigested food staying in the small intestine and also moving into the large intestine where it is excessively fermented by bacteria to produce gas, which is responsible for the symptoms of IBS such as bloating, reflux, stool issues, food intolerances/allergies (e.g. lactose, FODMAP, fructose) and abdominal discomfort/pain. It also leads to nutrient deficiencies such as calcium, iron, magnesium, protein, zinc and vitamins A, D, E, K and B12, which can create their own health issues such as anemia, peripheral neuropathy and osteoporosis.

Stay tuned for another blog post on why we don’t think removing FODMAPS from the diet is the answer. The FODMAP diet simply provides symptomatic relief and doesn’t address the underlying causes. The FODMAP diet should never be a long term treatment, rather can be used short term and during the treatment of SIBO under supervised practitioner care.

We are writing a book

Alon Blumgart and Karly Fisher, two university qualified Naturopaths have come together with a shared passion for treating gastrointestinal conditions and SIBO in particular, to create a highly researched and informative resource for health professionals and their clients. This book will contains up-to-date research on SIBO with lots of information about the condition along with treatment suggestions using herbal medicine, nutritional medicine and lifestyle changes along with options for an integrated approach and how Naturopaths and Nutritionists can work alongside specialists and general practitioners to increase patient outcomes.

Want to work with a Naturopath to address your current gut symptoms and get to the root cause?

For professional advice on management of SIBO or any gut related conditions click here to book an appointment with naturopath, Karly Fisher.

Content written by Karly Fisher (Naturopath) and Alon Blumgart (Naturopath)