I’ll be the first to admit. I’m a bit amazed at the number of patients I see here in the San Jose area and the Silicon Valley who have been unable to get satisfactory testing and treatment for IBS and SIBO from their doctors.
After all, it is the mecca of all things tech.
I would expect that the medical community would be aggressively cutting edge about testing and treating SIBO, which is small intestinal bacterial overgrowth.
My clinic is in Los Gatos, in the Silicon Valley. I still hear too often from patients that local doctors can be dismissive of SIBO. Or they may not really know about it. Or don’t know how to test for SIBO.
Often people simply end up being treated with the usual IBS medications. But their symptoms continue. Gas, bloating, belching, acid reflux, cramping, constipation or diarrhea, or both.
Why would we suspect SIBO? What causes SIBO? Who gets SIBO?
We now know that up to 15% of the population has irritable bowel syndrome (IBS). And, over 50% of people with IBS actually have SIBO. Most people don’t know they have SIBO.
Doing some math, that comes up to at least about 5 to 7 percent of the population suffering needlessly from SIBO. Maybe more.
The population of San Jose alone was 1.025 million in 2016. The population of the entire Silicon Valley, including San Jose, was 3 million in 2015. At a conservative 5% number for SIBO, that’s at least 150,000 people walking around with SIBO (and up to 450,000 with IBS), just here in the Silicon Valley.
The worst is when people are led to believe IBS is all in their head. Especially when there is testing and treatment available.
IBS is not all in your head. And SIBO is not all in your head either.
IBS and SIBO are complex conditions that involve bacteria (or the microbiome), the immune system, the nervous system, and anything that can affect the motility of the intestines to propel food forward. This nerve centered motility system is called the MMC, or migrating motor complex.
The symptoms of SIBO are gas, bloating, cramping, belching, acid reflux or GERD, and either constipation or diarrhea, or both. The same symptoms as IBS.
These symptoms are so very common. Yet people often assume it’s just IBS, or just some indigestion. And that there is nothing more effective to be done about it.
The symptoms of IBS and SIBO can be the same because often it is the SIBO that is causing the symptoms of the IBS. That is because the small intestinal bacterial overgrowth, or SIBO, is an overgrowth of normal bacteria in the wrong place in the intestine.
Normal bacteria should be in the large intestine, but not in the small intestine.
There is nothing more in life that bacteria love to do then ferment. Fermentation makes lots of gas. And gas does not feel good when it is in the small intestines! It can cause a lot of bloating as well.
The small intestine excels at absorbing nutrients. The small intestine is not well equipped to deal with fermentation and excess gas.
My clinic is usually where people land when they are looking for answers they are not getting, or the option of natural or prescription treatments if they wish. Some people have learned about SIBO by the time they get to me by scouring the internet. Many have tried unsuccessfully to get testing for SIBO.
Frankly, it really amazes me.
SIBO testing is available. But you may have to look for it.
It has been for years now. It is called the Hydrogen and Methane Breath test. It is a simple test you can do at home. Some doctor’s can do the testing in their office as well. But finding one can be tough.
Colonoscopies, endoscopies and CT scans can not diagnose SIBO, yet many people have had these as part of their workups, sometimes multiple times.
The breath test measures two of the three gasses that the bacteria overgrowth in the small intestines makes. The current tests measure hydrogen and methane.
Excess hydrogen tends to be associated with diarrhea. People often have been diagnosed with IBS-D.
Excess methane tends to be associated with constipation. People often have been diagnosed with IBS-C.
The elusive missing gas: Hydrogen sulfide
There is a third gas that can be produced, which is hydrogen sulfide. It tends to be more associated with diarrhea. The breath tests that we currently have do not measure this gas.
In my clinic, I also often use a comprehensive stool test that reports the presence and amount of a major producer of hydrogen sulfide. I use that to help determine if there might be hydrogen sulfide even though stool is not testing the small bowel.
For hydrogen sulfide, you can also see suspicious changes in hydrogen on the breath test, because the hydrogen sulfide producing bacteria consume some of the hydrogen. The methane producing bacteria also consume some of the hydrogen.
Therefore, it takes a bit of practice looking at these breath test results and considering what the hydrogen results actually mean.
But the bottom line is that testing for SIBO is absolutely available and valuable. It gives very useful information for how best to treat SIBO and IBS.
Even better, we have been promised a new breath test some time in the first part of 2019 that will also include the hydrogen sulfide.
What about treatment for IBS and SIBO?
People continue to be lead to believe that the treatment for IBS is simply anti-spasmodics, anti-diarrhea medications, or laxatives. And perhaps some diet changes and fiber. Or perhaps stomach acid blocking medications for belching or acid reflux.
Unfortunately, these remedies ignore the fact that often the symptoms of IBS are due to SIBO. This often leads to the too common opinion that IBS is poorly treatable or all in the head. The acid blocking medications can actually contribute to SIBO.
Without SIBO treatment, IBS treatment is often unsatisfactory. In addition, abnormal motility problems can allow SIBO to continue to be a problem, and should be addressed as well.
Treatment of the SIBO is key, and can include antibiotics or herbal combinations. I find that different people have different situations and different preferences.
As a holistic Functional Medicine physician, I work with patients to find the right mix of natural solutions or conventional treatments for them. But my goal is always to find and solve the root of the problem and give the body the tools it needs to heal and thrive.
What about the diet for SIBO or IBS?
The key to the SIBO diet is low fermentation or low fermentable carbohydrates. The low FODMAP diet is one example of this. These diets can be quite useful for symptoms control, and to help reduce the excess bacteria in the small bowel. But they often don’t solve the problem all by themselves.
I see many people who have developed food sensitivities and leaky gut syndrome, more properly called increased intestinal permeability. Another problem can be histamine intolerance, which can be a symptom of increased mast cell activation. I also see heightened immune responses.
While there can be many symptoms affecting the body outside of the intestines, the root of the problem is frequently poor intestinal motility with small intestinal bacterial overgrowth, or SIBO.
The bottom line for IBS and SIBO diagnosis and treatment
There is absolutely testing to help guide us in the diagnosis of SIBO. And even in some cases for the underlying problem behind IBS.
There is treatment available for SIBO as well. It is so satisfying to see patients get rid of their bloating and digestive symptoms after years of living with them. Of course, some patients resolve their symptoms quickly, and others are tougher. But doing nothing about it is not an option.
It is really a travesty that available testing and treatment for IBS and SIBO are not widely offered. Rest assured that testing and treatment for IBS and SIBO are available.