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Small Intestinal Bacterial Overgrowth (SIBO) and Irritable Bowel Syndrome (IBS)

Nearly 20% of the population is affected by Irritable Bowel Syndrome (IBS). IBS is a term we use for a constellation of symptoms such as abdominal bloating, pain, cramps, constipation and/or diarrhea, mucus in the stool, and a feeling that you have not completely emptied your bowels. Other non-GI symptoms such as depression, anxiety, sleep problems, headaches, fatigue, urinary symptoms, backaches, and more are also commonly found in individuals with IBS.

Because testing for other more serious conditions doesn’t reveal any abnormalities, some people may think this means their symptoms are “all in their head,” but this isn’t true — and although the gut and brain are closely connected via the gut-brain-microbiome axis, whereby alterations in one can affect the other — the symptoms of IBS are real.

There are 3 types of IBS: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), and IBS with both constipation and diarrhea (IBS-Mixed). Conventional treatments usually consist of making changes in your diet and lifestyle, and if this doesn’t help, fiber and prescription medications for pain, diarrhea, constipation, depression, anxiety or insomnia are often prescribed.

Although many believe the exact cause of IBS isn’t known, more recent research shows that up to 60-70% of IBS is due to Small Intestinal Bacterial Overgrowth (SIBO). SIBO can cause any and all of the symptoms found in IBS.

SIBO is an accumulation of normal bacteria in an abnormal location — the small intestine — and the gasses produced by these bacteria, such as hydrogen, methane, and hydrogen sulfide likely contribute to gas, bloating, and altered bowel movements. An excess of hydrogen and hydrogen sulfide are more commonly seen in those with diarrhea, while an excess of methane can alter peristalsis resulting in a slowing of small bowel motility and constipation.

A simple, non-invasive test is available to aid in the diagnosis of SIBO — the Lactulose Breath Test. This test can measure both hydrogen and methane at this time. Although newer methods are under study for the measurement of hydrogen sulfide, this test is not yet widely available.

The treatment of SIBO consists of multiple steps, the first of which are antibacterial treatments aimed at eradicating the small intestine bacterial overgrowth. This can include pharmaceutical antibiotics, herbal antibiotics, a combination of the two, and sometimes an elemental diet on its own. The specific antibiotic and herb combinations used will depend on what type of SIBO is present: hydrogen predominant, methane predominant, or both, as determined by the lactulose breath test. Subsequent treatment depends on one’s initial response to the antibacterial treatment and will include dietary modifications for a period of time to “starve” the remaining bacteria. Sometimes additional courses of antibiotics or herbs are necessary, along with biofilm busters and pharmaceutical or herbal prokinetics to promote peristalsis of the small intestine to prevent small intestine bacteria from taking up residence there again.

Engaging in practices such as deep breathing and meditation, which support a calmer nervous system and more robust parasympathetic action in the gut, will also benefit digestion and minimize some of the symptoms of IBS and SIBO. Additionally, an important part of the management of SIBO is to determine the underlying cause that allowed it to occur in the first place so it doesn’t continue to recur. Sometimes this will require additional functional medicine testing of stool and blood, which might include an evaluation for Lyme and other tick-borne illnesses or mold related illness, both of which can affect motility of the intestines.

At Integrative Medicine of Central New York, PC we are committed to finding the root cause of IBS and SIBO rather than just treating the symptoms. If you think you could benefit from an integrative approach to the diagnosis and treatment of your IBS symptoms, which might be due to SIBO or other causes, we would be happy to assist you in this endeavor.

Yours in health,

Amy Lazzarini, MD

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