First steps you must take to help your SIBO/IBS symptoms
First steps you must take to help your SIBO/IBS symptoms
Last week, I explained why SIBO- Small Intestinal Bacterial Overgrowth – is now considered to be the leading cause of IBS symptoms.
This is a situation where unwelcome pathogenic strains of bacteria thrive and grow in the small intestines, feeding and fermenting food (that has not had a chance to be digested yet) creating bloating, distension, discomfort and pain. The key strains of bacteria lead to either loose diarrhoea type stools, harder constipation bowel movements or a mixture of the two.
It’s amazing to think this SIBO phenomenon was unheard of twenty years ago and has only really become more recognised by IBS sufferers in recent years. Yet considering the vast numbers of people who suffer with IBS, most doctors are still unaware of it.
So how do you know if it is SIBO, and what steps can you take to help your symptoms?
You think you have SIBO?
The most common symptoms are bloating and distension of the abdomen (from 2 minutes to 3 hours after eating); abdominal discomfort and pain; diarrhoea and /or constipation.
But not all IBS is SIBO. So how can you assess for SIBO?
Can you test?
Yes you can, but there is no single test that has been validated as a gold standard for an accurate SIBO diagnosis. In my opinion, the best stand-alone test currently available (in the UK) is a lactulose breath test which can assess for hydrogen and methane gas (the SIBO bacteria ferment food and create these gases).
This is a non-invasive test using a lactulose sugar solution and assessing the rise in certain gases (methane and/or hydrogen) over the following 100 minutes. If bacteria is present in the small intestines, it feeds off (ferments) the sugar and gives off one of the two gases which is passed out via the lungs. Hence, it can be collected through a breath sample.
The downside to the test is that we now know there are other bacteria creating hydrogen sulphide gas. But we don’t yet have a test in the UK to measure this. They can use up the hydrogen gas (in a two-step process) produced by hydrogen SIBO bacteria. Be aware, if no hydrogen gas is detected, it may be a false negative result. You may have hydrogen and hydrogen sulphide bacteria! The test is good at detecting methane gas and bacteria, though.
I don’t recommend glucose breath testing in my practice as glucose is absorbed high up in the small intestines so if the bacteria reside lower down, they cannot ferment the sugar and create the gas – another potential false negative result.
I mostly use in-depth stool testing that can also detect these bacteria – including hydrogen sulphide bacteria- and through my clinical experience and case history questioning it helps me determine what may really be going on in the gut.
The test I find most accurate is a comprehensive stool test using PCR DNA technology (not cultured). And I use only one test for this: Invivo’s GI EcologiX.
I think it’s SIBO- What next?
Don’t go rushing in with really strong anti-microbial products. I’m afraid this may do more harm than good. Just like antibiotics, strong herbal antimicrobials also destroy the friendly good bacteria that we need to protect.
Gentle antimicrobials known to have a negative impact on each type of bacterial strain detected is important, but for short spells, not long-term. Common herbs are berberine, allicin and oregano.
As a practitioner, I include motility type supplements and prebiotic fibres. These must be chosen carefully. Working with an experienced practitioner is advised to put in place a protocol that is right for you.
What about diet?
It is important to remove the food that feeds these SIBO bacteria, but only for short spells at a time. A FODMAP diet can be helpful, but if it’s followed for too long it also removes the fuel for the good bacteria, and we really don’t want that to happen! We need to protect these beneficial bacteria. Therefore, don’t continue this for more than 6–8 weeks at a time.
SIBO is associated with the inhibition of the “MMC” cleaning/sweeping action that clears debris and bacteria that may be stuck to the walls of the small intestines. This action only occurs 4–5 hours since the last meal. Meal size is not important, any small snack will inhibit this important action.
Therefore, it is essential to stop snacking. This is hard, and hunger between meals can be a sign that your meals are not “balanced” to provide sustenance to keep you going.
As a minimum, aim to have a 12-hour break from any food overnight. No late night snacking!
Can I beat SIBO?
Yes, you can, but I won’t pretend it is easy. It really is best to work with an experienced practitioner who understands the different testing techniques; and who also has an excellent understanding of the gastrointestinal system and digestive function. In the right hands there are a number of supplements, dietary approaches and protocols that can be extremely helpful to alleviate symptoms.
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