Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is the most common gut disorder that we see people struggling with. This can be a chronic problem, something you have suffered with for year, or something more acute, that often lasts for months or years. The reason that we see so many patients with IBS in the Naturopathic Medical practice is that there really is no great conventional treatment for this conditions. Medical doctors have some prescription drugs they may try, but are rarely effective and certainly not treating the root cause. IBS is what we call a ‘diagnosis of exclusion’, which means that there are no other medical reasons that we can find to explain your symptoms, all other diseases have been ruled out, so you are now labeled as “IBS”. This leaves patients very frustrated as they leave feeling like there is no hope of finding the real cause of their symptoms and finally relieving their symptoms.

Enter… Small Intestinal Bacterial Overgrowth (SIBO)

SIBO is a relatively new and emerging diagnosis that has, over the last decade accumulated an impressive amount of research. That research has shown that SIBO is actually the primary cause of IBS in up to 85% of cases! This is incredibly exciting news for anyone that has suffered from IBS without knowing why.

SIBO is, as it sounds, an overgrowth of bacterial in the small intestine. Bacteria play a huge role in digestion, and we need them around, but they typically live in your large intestine, where their function is to ferment the last remnants of your food before excretion. These bacteria can begin to creep up into your small intestine, for a number of reasons we will mention later, and when that begins to happen you start to get fermentation and the production of gas in a very small space. This leads to major bloating, abdominal pain and cramping, diarrhea and/or constipation.

Not only are these bacterial causing major gas production, discomfort and irregular bowel movements, but they also inhibit the absorption of many vitamins and minerals that are typically absorbed through the small intestine. Most SIBO patients are deficiency in Vitamin B12 and Iron, as well as fat-soluble vitamins A & D. The dysfunctional small intestine also gets damaged from all the inflammation, potentially creating a leaky gut lining, where partially digested proteins leak out into the blood stream and trigger your immune system to start attacking these foreign proteins. This leaky gut scenario is how food sensitivities are created, and they can result in number of different inflammatory reactions.

Other potential causes of IBS

SIBO is not the only cause of IBS, while we always test and rule that out, if you do not have SIBO but still get IBS symptoms we may look at other causes, such as:

• Food sensitivities
• Dysbiosis in your large intestine
• Stress induced – disruption of the gut-brain connection
• Undiagnosed Celiac’s disease or gluten intolerance
• Parasitic infection

Root Causes of SIBO

Naturopathic Medicine always strives to find the root cause of disease, it is one of our core principles. While we have just talked about how SIBO is at the root of many IBS cases, we have to ask ourselves, how did we get SIBO in the first place?

SIBO can be a difficult condition to treat, we often see great success and relief of symptoms early in treatment, but patients do relapse often, requiring us to start the process of testing and treating them all over again. This happens most often when we have not found or addressed the root cause of SIBO. If the dysfunctional mechanism that got you here in the first place has not been fixed, you are going to end up right back in that same place. Common root causes of SIBO include;

• Hypothyroidism & Hashimoto’s Disease
• Long-term acid reducing medications use (Proton-pump inhibitors or H2 Blockers)
• Chronic Stress (leading to low stomach acid)
• Food poisoning or Acute Gastroenteritis (leading to an auto-immune reaction in your small intestine)
• Frequent or Chronic use of Antibiotics
• Dysfunctional Migrating Motility Complex (what controls peristalsis)
• Inflammatory bowel conditions (Crohn’s Disease, Ulcerative Colitis, Celiac’s Disease), especially after prior bowel surgery
• Diabetes Mellitus I and II

Testing

The only acceptable method of testing for SIBO is via Lactulose breath testing. This involves drinking this undigestible sugar solution, which stimulates any bacterial overgrowth you may have to start producing excess gasses. There are two main types of gasses produced, hydrogen and methane, both give rise to different treatment methods. The test kit allows you to take breath samples every 20 minutes over the course of 3 hours, which gives us a snap shot of how much bacteria you have at each level of your intestinal track.

This test kit is available for purchase at our clinic, and can be completed in your home then mailed back to the lab for analysis.

Treatment

Once we have your test results, we can begin appropriate treatments. These will vary based on your results, but will always begin with a “killing phase”, where we aim to eradicate the bacterial overgrowth with antibiotics. There are different choices of antibiotics, including many different botanical medicines, as well as prescription pharmaceuticals that are specific to SIBO. At our clinic, we have a herbal tincture dispensary that is stocked with many antimicrobials specifically for SIBO. Though we may also choose to prescribe pharmaceuticals if we feel that is best.

We may suggest another round of testing to make sure the bacteria is gone, or we might jump straight into the recovery and prevention stage. At this point diet is the key treatment! We will discuss foods to avoid and changes to be made that will help starve any remaining bacteria as well as promote regular bowel movements. In addition to diet, we will find and address the root cause of your SIBO, which may include some medications or supplements that can re-establish proper function of your migrating motility complex.

Further Reading & Resources

https://www.siboinfo.com/

https://kresserinstitute.com/sibo-causes-hard-treat/

https://www.medicinenet.com/small_intestinal_bacterial_overgrowth_sibo/article.htm

World Journal of Gastroenterology Article