5 Signs Your Irritable Bowel Syndrome (IBS) is Really SIBO

What does snacking, food poisoning, antibiotics, probiotics and fermentable sugar all have in common?

They may seem unrelated, but they are actually clues that your Irritable Bowel Syndrome (IBS) may actually have an underlying cause that is both testable and treatable. Can you imagine not having to deal with embarrassing gas, uncomfortable bloating, debilitating abdominal pain or annoying diarrhea and constipation? Instead, imagine yourself feeling comfortable in your own body, not having to worry if your next meal will wreak havoc on your body.

This underlying cause may be Small Intestinal Bowel Overgrowth (SIBO). It is estimated that up to 78% of adults diagnosed with IBS actually have SIBO- a condition in which an excessive amount of bacteria end up residing within the small intestines. As a result, dietary fibre gets fermented by these bacteria, causing IBS-like symptoms of bloating, belching, flatulence, abdominal pain/cramping, diarrhea or constipation (or alternating between both), nausea and heartburn.

Because IBS is diagnosed only once every other condition is excluded, it’s vital that SIBO get ruled out, as well. The following signs may lead you to suspect your IBS is actually SIBO.

Sign #1: It All Started After a Case of Food Poisoning

Let’s take a trip down memory lane. Did your bloating, gas and bowel irregularities start after a bad case of traveler’s diarrhea in Mexico? Okay, so it may not have been Mexico, but you get the point. It was likely that time you had the diarrhea-that-ruined-your-tropical-vacation (aka. acute infectious gastroenteritis). If you’ve had this form of gut insult, you’re not likely to forget it and you’re not alone. Up to 17% of people develop new IBS symptoms following a bout of acute infectious gastroenteritis and up to 40% of those people were travelling at the time. Let’s be clear, this shouldn’t discourage you from travelling, because exploring the world is the bee’s knees. But, it should highlight to you that your IBS may have something to do with an imbalance in the bugs in your gut. Travelers diarrhea reduces the “good” bacteria in your gut that are important protectors from further invasion by opportunistic bugs. This process has emerged as a key factor in the development of IBS and SIBO.

Sign #2: Your Symptoms Get Worse with Probiotics

If you’ve had IBS for any length of time, you’ve likely heard that probiotics can be helpful in the treatment of IBS. While this is true, I often encounter patients in my clinical practice that experience no change in their IBS symptoms with probiotics or they actually feel worse when taking probiotics. For those people in the latter group, it is one of the clues that suggests their IBS could actually be SIBO. This is because SIBO is an overgrowth of bacteria in the small intestine, so adding more bacteria in the form of probiotics actually can make matters worse. It’s like trying to solve a crossword puzzle by adding more crosswords- you’ll never solve the whole puzzle!

Sign #3: Your Symptoms Improve with Antibiotics

This is an interesting one, because antibiotics are implicated in both the development of IBS and in the treatment of SIBO – a catch 22. So, let me break this one down. If you have a long history of antibiotic use for various infections over your lifetime, this increases your risk of developing SIBO-associated IBS. The reason is similar to that for food poisoning- antibiotic use obliterates the good bacteria in your gut needed to protect you from overgrowth of opportunistic bugs. Now, I am not suggesting that antibiotics are always bad- they play an important role in preventing disastrous illness and even death. But, it is important to understand that when they are used, they can have their own set of consequences including the development of SIBO-associated IBS.

Since SIBO is an excessive growth of bacteria, part of the treatment is to kill this overgrowth with natural anti-microbials or with antibiotics. If you have taken an antibiotic and you find that you’re IBS symptoms improve, it could be because you have actually reduced the bacterial overgrowth without realizing it. For this reason, I always ask my IBS patients for their history of antibiotic use.

Sign #4: You Are A Constant Snacker

Believe it or not but your snacking habits can be a risk factor in the development of SIBO. We’ve discussed how SIBO is an overgrowth of bacteria in the small intestine. However, this overgrowth can only occur when there is a slow-down in the transit time of food through the small intestine. Usually, the transit time is fast enough to discourage bacterial growth, because the bacteria don’t have time to stick to the intestinal wall and grow. In SIBO, bacteria have time to grow because the small intestinal “waves” (peristalsis) that propel food forward is diminished. These peristaltic waves of electrical current are known as the migrating motor complex (MMC) and are turned on during fasting (2 hours after eating). This is where snacking comes in. If you are someone who likes to snack frequently throughout the day, you don’t allow your body to go into the fasting phase of digestion. Therefore, your MMC won’t turn on and your intestinal waves are slowed, setting you up for growth of bacteria in the small intestine.

Sign #5: You Feel Better On A Low FODMAP Diet

A low FODMAP diet has become the leading dietary intervention for IBS management. FODMAP stands for Fermentable Oligo- Di- and Monosaccharides And Polyols. Basically, FODMAPs are food containing certain types of sugars that are fermentable by bacteria in your gut. When you consume a diet high in FODMAP foods, you are encouraging this fermentation process which can lead to gas, bloating, abdominal pain and changes in bowel habits. For people with SIBO who consume high FODMAP food, these symptoms can be exaggerated because there is an increase in bacterial fermentation. If you have IBS and feel better on a low FODMAP diet, this gives a clue that there could be an underlying bacterial overgrowth. In other words, it’s not enough to live your life following a low FODMAP diet, you have to identify and treat the underlying cause so that high FODMAP food are better tolerated.

References:

1. Simrén,M. et.al. Intestinal microbiota in functional bowel disorders: a Rome foundation report Gut. 2013 Jan; 62(1): 159–176.
2. Ghoshal UC, Srivastava D. Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype. World J Gastroenterol. 2014;20:2482–2491.
3. Mezzasalma, V. et al. A randomized, double-blind, placebo-controlled trial: the efficacy of multispecies probiotic supplementation in alleviating symptoms of irritable bowel syndrome associated with constipation. Biomed Res Int. 2016 Aug 9.
4. Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, Justino E, Tomakin E, Mullin GE. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014 May;3(3):16-24.
5. Mansueto P, Seidita A, D’Alcamo A, Carroccio A. Role of FODMAPs in patients with irritable bowel Nutr Clin Pract. 2015 Oct;30(5):665-82.

Dr Klassen

Dr. Klassen enjoys working with all patients but she has a particular interest in digestive health. Her empathetic approach to digestive concerns stems from her own personal health journey and the healing she has found in naturopathic medicine. She commonly teams up with men and women affected by irritable bowel syndrome (IBS), food sensitivities, Crohn’s, Ulcerative Colitis, reflux, bloating, diarrhea and constipation. Dr. Klassen also treats women’s health concerns such as hormone imbalances (PMS, menopause, PCOS, thyroid dysfunction), menstrual disorders (painful periods, uterine fibroids, irregular periods), fatigue, fertility issues and perinatal health. Book a free 15 minute ‘meet & greet’ to discuss your health goals with Dr. Klassen today!