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Could your painful bloating be SIBO?

Updated: Apr 4

The pain and discomfort from digestive bloating and gas can really spoil your day. If you have been diagnosed with Irritable Bowel Syndrome, you might be interested to hear that research is showing us that at least 60% to 70% of IBS is actually caused by SIBO.

What is SIBO?

SIBO is an acronym for Small Intestine Bacterial Overgrowth. SIBO is a condition where normal bacteria, that usually live in the large intestine, can become trapped and cause havoc in the small intestine.

Our food spends roughly 2 hours in the small intestine after leaving the stomach. This is where the nutrients we have eaten are absorbed into the blood stream, sending nourishment to our cells.

Bacteria living in the small intestine snack on our food, producing fermentation and gases that causes bloating. The gas isn't just uncomfortable, it's damaging to the microvilli of the small intestines.

Left untreated, SIBO can lead to a host of other symptoms due to malabsorption and inflammation. Complications of SIBO may include histamine intolerance, leaky gut, food intolerances and allergies.

How do I know if I have SIBO?

There are a number of symptoms that can provide clues that you are experiencing SIBO. Bloating approximately 1/2 hour to 2 hours after eating is the most common symptom, other symptoms may include constipation or diarrhoea (or alternating between), belching or burping after meals, abdominal cramping, flatulence, and/or fatigue. If you have any of these symptoms then your naturopath might recommend that you do the SIBO breath test.

SIBO is diagnosed by a lactulose breath test performed over a 3 hour period. The test measures the gases produced over this time line, to determine which parts of the intestines the bacteria are present.

You will receive a report with a graph showing the levels of hydrogen gases and methane gases detected in your breath at the time that food was in your stomach, small intestine, and large bowel. You may be diagnosed with hydrogen SIBO or methane SIBO based on these results. Many people have a combination of methane and hydrogen detected in their small intestine.

Confusingly, methane SIBO has been renamed IMO (Intestinal Methanogen Overgrowth), due to further research showing the organism responsible for methane gas is an archaea and not a bacteria.

How do naturopaths treat SIBO?

When I treat people with SIBO, I always recommend that we include a comprehensive stool test, as well as the SIBO breath test. This extra information about any gut dysbiosis, or fungal overgrowth in the large bowel informs my choice of herbal treatment. The aim is to get you symptom free, therefore we need to treat the large bowel at the same time as the small intestine.

The comprehensive stool test will also indicate if you have any gluten intolerance, leaky gut, Candida overgrowth, or enzyme deficiencies.

The first step in SIBO treatment involves temporary diet restrictions to starve the bacteria causing the gases. I always recommend Dr Nirala Jacobi's biphasic diet, because most people find it achievable, and it has a wide range of foods allowed on the diet, as well as great recipes to make the diet easier.

Herbal medicine is taken along side the SIBO diet to reduce symptoms and kill off the bacteria or archaea in the small intestines. This treatment usually takes 6 to 8 weeks. Herbal medicines are changed and rotated throughout this time to maximise their effectiveness against the bacteria.

It is important to remember that anything that kills bacteria in the small intestine will also affect the balance of bacteria in the large bowel. It is advisable to work with a qualified herbalist to ensure that the treatment is of short duration and not harmful to the many beneficial bacteria that inhabit the rest of the gut.

The healing phase is the final stage of the SIBO treatment and this is an important step which many people miss because their symptoms have gone, and they feel so much better that they go back to their normal life and forget that their gut is still vulnerable to recurring SIBO.

The healing phase may include treatment for leaky gut, stress, ongoing constipation or a sluggish digestive system, and rebalancing the healthy bacteria in your digestive system.

Recurrent SIBO

It is common for people to experience recurring SIBO. Therefore one of the steps in the treatment process must be to uncover the reason why the SIBO occurred in the first place, and address this issue so that the SIBO won't relapse. SIBO can be caused by a number of things including chronic constipation, low levels of stomach acid, antibiotics, medications, or bouts of food poisoning.

Some people can have a sluggish migrating motor complex, which is a system of contractions that keep food moving through the bowel. Lifestyle factors such as stress can play a major role in SIBO, or regular snacking, which switches the migrating motor complex off.

Naturopaths will look at all these factors, and many more, to decide on a layered approach to treatment.

What is SIFO?

SIFO stands for Small Intestinal Fungal Overgrowth and is not tested for with the standard SIBO breath test. I suspect someone has SIFO when I see an overgrowth of yeast such as Candida in the large bowel (from your comprehensive stool test). SIFO can present slightly differently to SIBO and I always look out for it, especially if someone complains of fatigue, brain fog, itching, vaginal thrush and/or sugar cravings, as well as the more common SIBO symptoms.

The SIFO treatment is similar to SIBO and IMO, however the herbal medicines chosen must be anti-fungal as well as antibacterial. In my experience the Candida can take longer to eradicate than bacteria, therefore SIFO may take a few rounds of treatment before feeling better. Potential leaky gut must also be addressed with SIFO patients.

When will I feel well?

You may feel well after just one round of treatment, which takes 6 to 8 weeks. After the treatment we want to get you back to eating regular foods as quickly as possible, so you can enjoy pain free eating and benefit from a wide range of nutrients.

For many people it can take another one or two rounds of treatment to feel back to their healthy and energetic best. Some will remain on herbal medicine to assist with digestion and bowel movement until they feel 100%.

I am accredited with Dr Nirala Jacobi (The SIBO Doctor). Please get in touch if you are interested in learning more about SIBO and how a naturopath can help you.

Simone Jeffries :)

Simone Jeffries Sydney Naturopath

Hi! I'm Simone Jeffries. I am a naturopath, nutritionist, herbalist and certified wellness coach. I am also a foodie and an advocate for a whole food diet.

I love to support you with hormonal conditions, histamine intolerance and vaginal imbalances.

I welcome clients to consult with me at my clinic in Manly on Sydney's Northern Beaches, and online from anywhere in Australia.

The information in this blog is from my Bachelor of Health Science degree, experience from working with women in my clinic, and continuing research.

This blog is for information only and not intended to take the place of medical advice. Please seek assistance for any medical concerns.


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