A new approach to IBS treatment: addressing small intestine bacterial overgrowth (SIBO)

Do you suffer from Irritable Bowel Syndrome – a common health condition that impacts one in eight people at any time? Here, we’ll share the signs and symptoms of IBS, the causes, and what to do if Small Intestine Bacterial Overgrowth (SIBO) is the culprit behind your gut health issues.

Signs and symptoms of IBS

Here are the common symptoms of IBS.

  • Abdominal pain, cramping and bloating
  • Irregular bowel movements
  • Loose stools with occasional diarrhoea (IBS-D)
  • Frequent constipation (IBS-C)
  • Fluctuating between diarrhoea and constipation (IBS-M)

Causes of IBS

IBS is a chronic disorder, with symptoms that can disappear and reappear over years. Whilst conventional doctors aren’t sure what causes IBS, the following problems are seen to play a part.

Causes of IBS include:

  • Bacterial infections in your digestive tract
  • Gastroenteritis (stomach flu) leading to post-infectious IBS (PI-IBS)
  • Food poisoning leading to gastroenteritis and in turn to PI-IBS
  • Food intolerances or sensitivities, such as to wheat or gluten. Around 4% of IBS sufferers are confirmed to have severe gluten intolerance called Celiac Disease based on a meta-analysis of 14 studies. The same study found people who suffer from IBS are around four times more likely to have Celiac Disease than people without IBS.
  • Small intestinal bacterial overgrowth (SIBO), a chronic bacterial infection of the small intestine. A study published in 2000 in the Journal of Gastroenterologyreported that 80 percent of those suffering with IBS symptoms of bloating, stomach pain, diarrhoea or constipation were found to have SIBO.

While IBS is considered one of the hardest-to-treat conditions, don’t lose hope. Our naturopaths are all experienced with treating gut health issues – be it related to food intolerances, bacterial imbalances, and more.

How to diagnose and treat SIBO

Given the significant link between IBS and SIBO, it is worthwhile testing to see if SIBO is the cause of your gut issues. This can be easily identified through a simple breath test and effectively treated with a natural treatment protocol.

The SIBO breath test involves drinking a lactulose solution and then breathing into a collection tube every 20 minutes for at least 2 hours. The tubes are then sent to a lab to be assessed. If you have SIBO, the bacteria will ferment the lactulose solution into hydrogen or methane.

Here are two cases – one related to constipation and the other to diarrhoea – where we were able to identify and treat SIBO, naturally.

Real case 1: Mike and IBS-C

Mike gave up his corporate life to become an athlete and coach. He was used to being fit and competing in iron man races with record-breaking swims. When his performance began to drop significantly due to painful abdominal bloating and constipation, he was distraught. He experienced debilitating muscle pain after training and became increasingly tired and moody. He also found his weight would fluctuate from 77kg up to 83kg every couple of days, not due to dietary changes.

Given his symptoms I suggested Mike take the SIBO breath test. His report showed a significant amount of methane gas in his system, confirming he had SIBO.

The green line indicates high levels of Methane – a by-product of the digestive process produced by Archaea, the hardest infection to eliminate with conventional antibiotics.

Given Mike’s challenges, he was also keen to do a stool test to gather all necessary data on his gut infection, including virus, bacteria, Candida, and parasites. The G.I.MAP test also finds any intestinal inflammation, “leaky gut”, gluten intolerance and digestive enzyme deficiencies.

Based on Mike’s clinical symptoms, the SIBO breath test, and stool test results, I prepared a personalised treatment plan for him. Depending on a client’s symptoms and results, herbal treatment might include multiple natural antimicrobial agents, antibiotics and anti-biofilm agents such as thyme oil, oregano oil and garlic oil.

After six weeks of herbal treatment, Mike’s weight returned to within 1-2 kilograms of his optimal goal, his muscle pains disappeared and his mood significantly improved.. Mike’s performance returned to form and training was a pleasure again.

Real case 2: Michelle and IBS-D

For over five years, Michelle, an advertising executive, suffered from a simpler and more common case of IBS. Her symptoms included bloating that, she said, made her look pregnant, and diarrhoea that would have her running to the bathroom after a meal.

Michelle’s SIBO test results showed high hydrogen gas production; an easier-to-treat form of bacterial infection in her gut. If you have diarrhoea related SIBO, you are very likely suffering from an overgrowth of hydrogen-producing bacteria in your small intestine, as we saw in Michelle’s case.

Within just three weeks of taking the prescribed herbal anti-microbial treatments and probiotics, Michelle’s symptoms had disappeared and she shared she looked and felt great.

With appropriate testing in functional medicine and treatment in naturopathic medicine, we can be confident of tackling the causes – usually the infections – at the root of your IBS. Once the infection has been cured and the good gut flora replaced, many symptoms and food intolerances disappear and most people find their overall health rebounds.

If you’d like to test for and treat SIBO, please reach out. You can schedule an in-person, phone or video appointment with me by calling +852 2523 7121 or connecting here.

[1]. Mönnikes H. Quality of life in patients with irritable bowel syndrome. J Clin Gastroenterol. 2011;45 Suppl:S98–S101. [PubMed]

[2]. Agarwal N, Spiegel BM. The effect of irritable bowel syndrome on health-related quality of life and health care expenditures. Gastroenterol Clin NorthAm. 2011;40:11–19. [PubMed] [2] Reddymasu SC, Sostarich S, McCallum RW. Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors? BMC Gastroenterol. 2010;10:23. [PubMed]

[3] Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95:3503–3506. [PubMed]

[4] Ragavan ND et al. PLoS One. 2015 Sep 16;10(9): Blastocystis sp. in Irritable Bowel Syndrome (IBS)- – Detection in Stool Aspirates during Colonoscopy. PMID: 26375823]

[5] Ford AC et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis.Arch Intern Med. 2009 Apr 13;169(7):651-8. doi: 10.1001/archinternmed.2009.22

[6] Almeida JA, Kim R, Stoita A, McIver CJ, Kurtovic J, Riordan SM. Lactose malabsorption in the elderly: role of small intestinal bacterial overgrowth. Scand J Gastroenterol. 2008;43(2):146-154.

[7] Pimentel M. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome. Dig Dis Sci. 2012;57(5):1321-1329. also see Bures J. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978-2990.

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