As everyone knows, IBS stands for “Irritable Bowel Syndrome”.

Irritable = upset, cranky, agitated.
Bowel = intestines, colon.
Syndrome = a set of signs and symptoms.

So, "IBS" is a label given to a set of symptoms, meaning, IBS does not actually explain WHY the problem is occurring.

Say it with me, "IBS does not explain the cause".

So when I hear "I have IBS" from a patient, I immediately think about how I can solve their root cause. So they can get rid of their IBS for good.

If a person is lucky, their IBS symptoms may be a simple case of a food intolerance such as gluten or dairy. If they avoid the trigger, their digestion is 100%.

However, most cases are not that simple. In fact, the #1 cause of IBS is something called SIBO [SEE-bow] which stands for Small Intestinal Bacterial Overgrowth.

Multiple studies have consistently shown that subjects diagnosed with IBS have disruption in gut bacteria. SIBO is surprisingly common and is the ROOT CAUSE of irritable bowel syndrome in up to 84% of cases.

So what is SIBO?

SIBO is a condition marked by an accumulation of bacteria in the small intestine. Keep in mind, this overgrowth consists of bacteria that normally live in the gastrointestinal tract but they have just accumulated in a location not meant for so many bacteria. So, it's not that these bacteria are bad, they are just in the wrong spot. Having lots of bacteria where there shouldn't be leads to a variety of symptoms as outlined below.

SIGNS AND SYMPTOMS of SIBO:

Some people with SIBO have many of these symptoms while others may only have 1 or 2. It should also be noted that for some patients with SIBO, symptoms will seem to come and go (flares and remissions).

• Bloating: usually worse by the end of the day or after every time you eat.
• Gas
• Constipation and/or diarrhea (though some have normal stools).                                        *In cases of chronic constipation (IBS-C), SIBO is often the cause.            
• Bowel urgency
• Abdominal pain and/or discomfort
• Reflux
• Nausea
• Sensation of fullness and slow digestion
• Issues with certain foods: garlic/onions, foods high in fibre, raw fruit/veg, dairy.

Most patients with SIBO notice that certain foods bother them. They may also become frustrated because certain foods will only seem to bother them some of the time, so it can become difficult to know what to eat.

ASSOCIATED CONDITIONS:

• IBS
• Hypothyroidism
• B12 and iron deficiency
• Intestinal permeability ('leaky gut')
• Food sensitivities
• Rosacea
• Eczema
• Fibromyalgia
• Interstitial cystitis
• NAFLD (non-alcoholic fatty liver disease)

CAUSES AND MITIGATING FACTORS: 

• History of gastroenteritis such as: food poisoning or traveller's diarrhea
• History of a parasitic infection 
• History of abdominal or bowel surgery
• History of a traumatic brain injury 
• Slower gut motility (hypothyroidism)
• Low stomach acid
• Use of antacids such as Tecta, Losec, Nexium, Pantaloc etc.

How do I know if I have SIBO?

We provide lactulose breath testing kits at our clinic. This is a take-home test that involves collecting breath samples over a 3 hour period. Contact us for details.

What happens if I test positive for SIBO?

I use specific protocols based on my clinical experience and the training that I have received from my mentors. To date, I have treated over 150 people with this condition and these patients are well-supported throughout the process. Though it's not always an easy road, SIBO is a condition that can be cured so that you can carry on with life in a symptom-free manner. 

What's the ultimate goal of SIBO treatment?

The goal of SIBO is to successfully reduce the bacterial load in the small intestine, thereby reducing symptoms. SIBO can lead to intestinal permeability (leaky gut) so we want to prevent that or fix it. On a more tangible level, I also like to see the patient enjoy a wider variety of foods so that they no longer have to second guess everything they eat.

So please remember, you do not have to settle for a diagnosis of IBS. My goal is to help people heal their gut so that they can have a normal relationship with food again.

Intestinal comfort for the win!

-Dr. Kerri

References

Augustyn M et al. Small intestinal bacterial overgrowth and nonalcoholic fatty liver disease. Clin Exp Hepatol. 2019 Mar;5 (1):1-10. 

Chen B et al. Prevalence and predictors of small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis. J Gastroenterol. 2018 Jul; 53(7):807-818.

Francesco Drago et al. The role of small intestinal bacterial overgrowth in rosacea; a 3 year follow up. JAAD. 2016 Sept; 75 (3): 113–115.

Lin, HC. Small Intestine Bacterial Overgrowth: a framework for understanding irritable bowel syndrome. JAMA. 2004 Aug; 292 (7) 852-8.

Luisa Leite Barros et al. Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: prevalence, diagnosis and treatment. World J Gastroenterol. 2019 Aug; 25 (31): 4414-4426.

Patil AD. Link between hypothyroidism and small intestinal bacterial overgrowth. Indian J Endocrinol Metab. 2014 May;18(3):307-9.

Pimentel M et al.  A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing. Ann Rheum Dis. 2004 Apr; 63(4):450-2.

Reddymascu SC et al. Small intestine bacterial overgrowth in irritable bowel syndrome: are there any predictors? BMC Gastroenterol. 2010 Feb;10 (23) 1186-1471.

Simenova D et al. Recognizing the Leaky Gut as a Trans-diagnostic Target for Neuroimmune Disorders Using Clinical Chemistry and Molecular Immunology Assays. Curr Top Med Chem. 2018;18(19):1641-1655