Should you test for SIBO if you have IBS? 

In this episode of the Inside Knowledge for people with IBS I’ll share my thoughts on Small Intestine Bacterial Overgrowth and whether you should consider it a cause of your digestive symptoms - even if you have constipation predominant symptoms. 

SIBO occurs when more microbes than normal grow in the small intestine. These ferment your food, interfere with digestion and can cause the same symptoms as IBS such as bloating, gas, pain, diarrhoea and constipation.  

But how do you know if it is your issue? Let's find out.

🔍 Understanding SIBO: I break down how an overgrowth of bacteria in the small intestine can wreak havoc on your gut health.

🔍 IBS & SIBO: Discover the connection between IBS and SIBO, as we explore why many IBS sufferers may also have underlying SIBO.

🔍 Common Symptoms: Learn to identify the tell-tale signs of SIBO and its potential impact on IBS symptoms, from bloating and gas to irregular bowel movements.

Part 2 in Ep 12 on Risk factors for SIBO and Treatment

Links

Read more on my website - https://www.goodnessme-nutrition.com/sibo-nutritionist-small-intestine-bacterial-overgrowth/

Did

you test for SIBO if you've got IBS?

In this episode of the Inside Knowledge for People with IBS, I'll

share my thoughts on small intestine bacterial overgrowth, and whether you

should consider it a cause of your digestive symptoms, even if you don't.

if you've got constipation predominant symptoms.

SIBO occurs when more microbes than normal grow in your small intestine.

These ferment your food and interfere with your digestion, and can cause the

same symptoms as IBS, like bloating, gas, pain, diarrhoea, and constipation.

But how do you know if this is your issue?

That's what I'm going to cover in this episode, as well as...

How you can get tested.

Welcome

to episode 11 of the Inside Knowledge.

I'm Anna Mappson.

In this session, talking about SIBO, I've realized there's so much

to cover that I'm probably going to split it into two sections.

That's because I want to keep all the episodes under 20 minutes.

And there's just so much to say about small intestine bacterial overgrowth.

I can't get it all done in 20 minutes.

So I'm going to cover in this section, like what is it?

What are the symptoms and a little bit about the causes and how you get tested.

And then I'll do part two, which will cover some of the risk factors

for SIBO and also treatment.

So you might have to hang on till next week for part two.

If you haven't heard about SIBO before, you might find the concept

of having an overgrowth of microbes in the small intestine quite strange.

I'm going to cover a little bit about how that could start, like how

you would end up with a condition where you've got an overgrowth.

The reason I wanted to focus an episode of this podcast on SIBO is because

actually, whilst it is extremely difficult to get rid of SIBO, there is a plan, and

in a way it can be quite reassuring to know that's the cause of your symptoms.

So whilst I always hope people get a negative test result for SIBO, because

it's so tricky to manage, in a way at least you know what the problems

are and you can try to manage them.

Many of the main symptoms of SIBO are really similar to IBS, so you

might be getting, frequent bloating, excessive gas, either burping, a lot

of burping or farting, constipation or diarrhoea, um, abdominal pain can

be quite a constant through the people I see who have SIBO, But again, that

can be common to anyone who has IBS.

Often nausea, particularly with constipation predominant symptoms.

sometimes reflux as well, and that is due to increased gas in your small

intestine putting pressure within your torso that can then force open your

sphincters and cause a bit of reflux.

you've probably got some food intolerance and that's due to the way the bacteria are

interfering with our digestive enzymes.

And sometimes what people see is fatty stools, and again, it's just

an inability to break that down, so the term for that is steatorrhea.

So those are like the main symptoms, but clues that you might have SIBO

over another kind of IBS would be things like, if you feel worse when

you eat high prebiotic foods, or you take prebiotic supplements.

So these are things like foods containing inulin, or beans and pulses, onions

and garlic, but again, this doesn't always mean that you've got SIBO,

it's just these are potential clues.

Um, sugar alcohols as well, so things like xylitol, these might make your

symptoms worse,, maybe when you take Probiotics, you feel worse, and when

you take antibiotics, you feel better.

That is a big clue.

If you've had to take antibiotics for, I don't know, an infection in your skin,

for example, and your stomach miraculously cured up whilst you were taking the

Antibiotics., that could be an indication that you've got an overgrowth of...

bacteria or microbes that are contributing to your digestive discomfort.

Also, if you've had an episode of food poisoning that seemed to kick

start your symptoms, that is another sign that you could have a problem

with your migrating motor complex.

If you want more information on that, go back and listen to episode

10, because that is all about post infectious IBS, and that is one of the...

triggers for SIBO.

So when I talk about microbes in your small intestine, obviously there are

hundreds of different types of microbes that could be living and growing there.

And there are different types of gases that these microbes produce.

The main three types that we know about that can affect your digestion

and your gut motility are hydrogen, methane, and hydrogen sulfide.

These gases are not naturally produced by...

And I'll talk about testing in a minute, because that is important, the

fact that humans don't create a lot of this gas, and yet the microbes do.

And if you're wondering how these gas producing microbes get into your small

intestine, there are a couple of ways.

It's generally either that you have reduced defences, so you are not

killing them off, or You're allowing microbes to overgrow through a

slowing down of your digestion.

Those are the main reasons.

So with a bit more detail behind what that might look like is changes

in your migrating motor complex.

So go back and listen to episode 10, all about post infectious IBS, because that

shows how a previous stomach bug could damage your migrating motor complex.

which can then slow down the cleaning process for your small intestine,

which allows more bacteria to grow.

You might also have, ileocecal valve dysfunction, which is the valve in

between your small and large intestine.

If that starts to get loose and bacteria can migrate from the large

intestine into the small intestine, maybe there's a structural blockage

in your small intestine that is allowing bacteria to overgrow.

This could be for things like small intestine diverticular pockets, so these

are like little bulges in your small intestine where food can grow and bacteria

can just grow and they're not cleaned out by that migrating motor complex.

Maybe you've got adhesions where your small intestine is sticking to

the sides of another organ and just slowing down the process of digestion,

slowing down the food moving through.

Similar with endometriosis, this can also happen.

where you're just slowing down the progress of food.

So that's like the motility, the slowing down of digestion.

But the other thing is, you might have reduced defences, so you've got more

microbes coming in, or they're not being killed in your stomach or small intestine.

And this can be down to a lack of stomach acid.

So maybe you've been on proton pump inhibitors, like PPIs, blocking your

stomach acid for reflux management.

Maybe you're not producing enough digestive enzymes, enough bile, you're not

producing immune, factors like secretory IgA, or you've got lowered immunity.

These are things that are allowing the bacteria to go in there where our natural

defenses would normally kill them off.

And this can happen over a long period of time.

It might not just be one instance that really, solidifies, the risk for.

It could just be that you've got a lot of these small things building up over time.

If you think SIBO could be the cause of your symptoms, you might

want to get checked out and know for sure if you have got it.

So there are different ways you can get tested and there's quite a lot of issues

with the testing procedures for SIBO.

It's a new ish field in terms of gastroenterology.

And not all doctors are that on board with it, I will say, um, so in the UK, across

the NHS, it's very patchy as to whether you can get a SIBO test on the NHS.

Some places will.

You can order a private test and, I can talk to you a little bit more about that.

But your two main options for getting tested for SIBO include breath testing and

a small bowel biopsy, aspirate, where they go in through your mouth and go down with

a small, device and take a little sample of your small intestine juices and see

what bacteria and microbes are in there.

This is invasive, it's not a Pleasant procedure and it's also costly.

It has to be done in a hospital setting by doctors And it's only going to

measure the top of your small intestine.

Your small intestine is up to eight meters long There's no way you're going to get a

sense of what microbes are at the bottom of the small intestine This is a process

that's sometimes called the gold standard for SIBO testing However, because it's

so invasive a lot of people have this as an option, even under their doctor.

The other option that is not invasive and you can do at home or in a

hospital setting is a breath test.

Now, as I mentioned, the microbes are breathing out

or no, they're not breathing.

They are, um.

emitting hydrogen or methane or hydrogen sulfide.

In the UK, we have the ability to test for hydrogen and methane only.

In the US, and some maybe in Australia as well, there are tests for hydrogen

sulfide, which is the third type of gas.

But at the moment, we have to make some judgment.

over whether we think it's hydrogen sulfide, and I can explain a

bit about that in a minute.

Coming back to the hydrogen

and the microbes make them in your small intestine.

That gas is absorbed through your small intestine into your bloodstream.

It travels to your lungs and we breathe it out.

So our body is getting rid of the hydrogen, getting rid

of the methane in our breath.

The process for Testing whether the gas is present in your body is that you

do 12 hours on a very low fermentable diet, as in there's nothing fermentable.

So you just eat protein like meat and fish, white rice,

no sugar, no milk, nothing.

So nothing that could potentially be fermenting for 12 hours.

Then you want to fast for 12 hours.

And then you drink a little sugary solution that the kit includes and then

you breathe out every 20 minutes into some small bags that the test kit provide.

So every 20 minutes you just do a deep breath and breathe out and then

these bags are sent off and analysed to see how much hydrogen, how much

methane is available in your breath.

There is a little bit of controversy over the test, not controversy,

but, um, discussion, I should say, about how to interpret the test

and also how to kick the test off.

So, you know, I mentioned where you drink a sugary solution.

There is some discussion across the world and in different, uh,

nutrition bodies and different SIBO practitioners about what is the best.

Sugary solution to use.

There are various tests you can get using lactulose, which is not

digested at all and travels through your small intestine, but doesn't

always pick up all the microbes.

Or you can do a glucose or a fructose test.

And these, glucose and fructose could be absorbed, which means that they might not

get to the end of your small intestine.

So your bacteria, and you could, your body could absorb it, and then you would never

know, near the large intestine, whether.

that sugary solution is driving methane or hydrogen production in

the lower part of your intestine.

So there's a bit of controversy or discussion, I should say, about

what type of solution to use.

And you can find All three tests available, um, then also there's some

discussion about what is the cutoff point?

So, for example, with hydrogen, we're normally looking for a rise of 10 parts

per million within the first 60 minutes.

And that is like the European guidelines.

But in America, they look for a rise of 20 parts per million within 90 minutes.

So they're looking for a bigger rise.

in a longer time period.

In Europe, we're looking for a smaller rise within the first 60 minutes.

With methane, it's a little bit more complicated.

We're basically looking for a rise of over 12 parts per million

or, a score of over three.

This is because with methane, the more you have, The more your constipation

will be increased, in most cases.

And then also we look at the combined gases, like within the first 60

or 90 minutes as well, because the combined gases can be important.

Where you've got hydrogen sulfide gas, generally we tend to see a flat

lining of the results, so you don't see any rise as the gas hits your

large intestine, and that is partly because it's often used up by the other.

I like using a SIBO breath test at home because it's non invasive,

you can do it in your own time.

It is a hassle to do.

The PrEP diet is a hassle and it's a hassle to sit there for 3 hours

every 20 minutes blowing into a bag.

But, it doesn't involve having, something to shove down your throat

all the way into your small intestine.

And it doesn't involve even taking any blood, so it's useful for people who

really don't like invasive procedures.

And it is probably the best thing that we've got at the moment.

In an ideal world, you would do all three tests, so fructose,

glucose, and lactulose.

In the UK, the tests are around 170, so it is not cheap, and I don't

recommend doing all three of them.

And, unless you have available funds to do so, because that's really costly.

I don't always do a test with everyone, not everyone, who I suspect SIBO in

can afford the test, and there are things you can do anyway, making some

assumptions based on your symptoms, based on your reactions to food, and

it's not always going to be about...

Taking a supplement or excluding certain foods, often lifestyle factors are a

really big part of SIBO management.

So in summary, there are multiple causes of SIBO.

Symptoms are very similar to IBS, and there are some problems in terms of

the way you test for it, but it can help direct our treatment to a more

specific, supplement or a specific action or things that you need to do.

The, the thing I would love you to take from this episode is

that it can take a lot of time to reduce SIBO, but there is hope.

And particularly if we have a clear indication of what your levels are,

it might help us tune your nutrition plan in order to help you resolve.

So that's it for part one.

Part two coming up, which we'll talk more about specific risk factors for SIBO, but

also I'm sure what you want to find out as well is what you can actually do about it.

Okay, that's it for now.

See you next time.