Do I have IBS or could it be SIBO?
Do I have IBS or could it be SIBO?
IBS- Irritable bowel syndrome effects approx. 11% of the World’s population. It is the most common gastrointestinal disorder, with increasing numbers of people either believing or thinking that they have the condition.
But in the past 10–15 years there has been growing recognition and research of another “condition” known as SIBO, and it is now considered to cause IBS in two-thirds of sufferers.
But what is SIBO? Why isn’t it recognised by most general practitioners? Would you know if you were experiencing SIBO?
In this article, I’ll provide you with a simple overview of SIBO and why it gets confused with IBS too. In Part 2 next week, I will discuss how you can detect SIBO and the different methods to help alleviate the symptoms.
What is IBS
IBS is officially diagnosed when you have the following symptoms for three or more months: abdominal pain and/or discomfort, bloating, gas, diarrhoea, constipation, or alternating diarrhoea/constipation.
What is SIBO?
SIBO stands for Small Intestinal Bacterial Overgrowth. Very simply, this is gut bacteria in the wrong place. There should be very little bacteria in the small intestines, but for an increasing number of individuals there is an abnormal overgrowth of the wrong type of bacteria that choose to reside in the very place where food should be digested and absorbed.
For those who have SIBO the symptoms can vary from discomfort to excruciatingly painful. Common symptoms are bloating and distension of the abdomen (from 2 minutes to 3 hours after eating); increased wind; abdominal discomfort and pain; pain under the sternum; burping; nausea; diarrhoea and /or constipation.
It’s all about Gut Bacteria
Bacteria are an essential component of the human gut microbiome. There are trillions of microbes that reside in the large intestines – also known as the colon. In fact, there are ten times the quantity of microbes as there are cells in the body. Very few bacteria should live in the small intestines.
In SIBO, microbes have built up a residency in your small intestines – the area between the stomach and the colon. This is a very long, winding tube where food is digested, and most nutrients are absorbed into the bloodstream.
Some microbes have found a way to shift from the colon and into the small intestines. Others have lingered on their journey to the colon and decided to take a hold.
What about IBS?
You may be thinking, “but aren’t these “SIBO” digestive symptoms just IBS”? Well yes and no and this is where it can become confusing.
Put very simply, SIBO (microbes in the wrong place) can be a cause of IBS symptoms (hence the overlap between the two). But not everyone with IBS has SIBO.
Current research (2023) suggests that two thirds of IBS is due to SIBO.
Why does bacteria cause such awful symptoms?
The bacteria that are linked to SIBO are predominantly hydrogen, hydrogen sulphide bacteria and methane gas producers. These are not gut species that we want present anywhere in the gut, and certainly not where we should be digesting food.
These bacteria love to feed off certain carbohydrates and in doing so create gas and a perfect breeding ground for more bacteria to grow.
If there is gas in the stomach, you can burp. If there is gas in the colon, you have wind. But if gas is trapped in the small intestines, it has no-where to go. It’s a truly unhealthy gut environment. Hence, the typical symptoms of bloating, pain and discomfort and altered bowel movements either diarrhoea or constipation. Even a combination of the two.
How does bacteria end up as SIBO?
We constantly swallow bacteria and pathogens with our food. Most pathogens should be killed with the strong acidic environment of the stomach and the presence of bile in the small intestines. Those that survive should be swept along through the small intestines and down to the colon with strong and regular sweeping brush like movements that clear away food debris and bacteria.
But this only happens several hours after eating when we are in a fasting state. And especially at night when we are fasting for 12 hours or more.
Too often, people end up with very poor motility and movement through the small intestines after food has left the stomach. This allows the bacteria to linger and build up an unwanted presence in the small intestines.
The Western style snacking culture is considered to be the main contributor to the huge increase in SIBO – and therefore IBS.
Do you have a history of food poisoning? It is a complex mechanism, but this appears to switch off the ability for the “sweeping/clearing” action to occur after eating.
The Good News
Whilst SIBO can be complex, we do now know there are several factors that can lead to slow motility. If we can understand the cause(s) it helps determine the route to resolution.
As part of my in-depth case history taking with clients I will always be looking for signs of chronic stress, use of stomach acid reducing medications, long-term use of other medications, traveller’s diarrhoea, food poisoning, use of antibiotics, abdominal surgery, frequent snacking/eating and of course food choices.
In Part 2 I will explain how to help determine if SIBO is part of the “IBS” problem and the methods I use towards its resolution.
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