April 18, 2023

Could I Have Both IBS and SIBO? Yes, Here’s Why

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If you suffer from Irritable Bowel Syndrome (IBS), you know what frustration feels like. Whether you’re dealing with abdominal pain, bloating, bowel movement issues or all of the above, IBS has likely impacted your quality of life.

But if you’ve been following along with me this month, you’ve been learning that IBS sometimes has a hidden partner in crime. Small Intestinal Bacterial Overgrowth (SIBO) is a condition that’s been gaining attention in recent years as a contributing factor — or even a cause of — IBS.

What is SIBO?

Trillions of microorganisms call your large intestine home. These microbes make up your microbiome, or gut bacteria. And they play a crucial role in maintaining gut health and overall well-being.

Generally, a large and healthy bacterial population in your large intestine is a good thing. But you don’t want them moving into your small intestine where they can cause problems. If you have SIBO, some of these microorganisms have wandered upstairs and started a party in the small intestine (where they’re just not welcome).

SIBO symptoms include bloating, abdominal pain, diarrhea, and constipation. Yes, these are often the exact same symptoms that show up with IBS.

What’s the Difference Between SIBO and IBS?

Let’s start with a definition of Irritable Bowel Syndrome, or IBS. Technically speaking, IBS is a collection of digestive symptoms that are unrelated to any structural abnormalities. IBS isn’t contagious. And it isn’t easily identified. You can’t just go to your doctor and request an IBS test because there simply isn’t one.

An IBS diagnosis is based mainly on your symptoms. Your practitioner will probably first rule out other serious issues like inflammatory bowel disease (IBD) or celiac disease, since those conditions share some of the same symptoms as IBS. And then she’ll look at your symptoms and overall experience and determine whether or not you have IBS.

IBS symptoms vary widely from person to person. But common issues include abdominal pain, bloating, bowel movement issues, and a feeling of incomplete bowel emptying.

IBS and SIBO are two different — but often related — conditions. Symptoms for both can vary from mild to severe. But the two conditions have much in common:

😕 Loss of appetite

😕 Abdominal pain

😕 Cramping

😕 Bloating

😕 Nausea

😕 Excess gas

😕 Alternating bouts of constipation and diarrhea.

Location. Location. Location. That’s the main difference between IBS and SIBO. IBS primarily impacts the large intestine, although your symptoms can appear in other areas of the digestive process. SIBO is specific to the small intestine. It’s also a lot simpler to test for SIBO. While an IBS diagnosis is a little more subjective, there are ways to know for certain if you have an overgrowth of bacteria in your small intestine.

Since the large and small intestines are next door neighbors in the digestive process, what happens to one can affect the other. So IBS and SIBO often go hand-in-hand.

The IBS/SIBO Connection

In my practice, I specialize in helping people with IBS and other digestive issues. And after helping over 1,000 patients, I’ve seen a strong connection between IBS and SIBO. In fact, when someone comes to me with IBS, I routinely test for SIBO too. More often than not, someone diagnosed with IBS also tests positive for SIBO.

And there’s all sorts of research that backs up what I’ve seen in my practice. IBS and SIBO have many common symptoms. And research suggests that SIBO could even be an underlying cause or a contributing factor of IBS. in fact, some studies report that up to 80% of IBS patients also have SIBO. So while it’s not everyone, a majority of people with IBS likely also have SIBO.

We don’t have exact answers on the IBS/SIBO connection, but there are several proposed theories. It’s possible that the overgrowth of bacteria in the small intestine disrupts the normal movement in the digestive tract that pushes food along. And this could lead to IBS symptoms. The overgrown bacteria may also trigger an immune response, causing inflammation and gut hypersensitivity — also common features of IBS.

The gut and brain are deeply interconnected. Did you know your gut makes some of your brain chemicals including serotonin and dopamine? This gut-brain connection may also play a role in the relationship between IBS and SIBO. The overgrown bacteria in the small intestine may affect the gut-brain axis and lead to IBS symptoms.

And some of the risk factors for SIBO — including impaired gut motility (how well your digestive system moves food through) and the use of certain medications — are also risk factors for IBS.

According to a 2018 research review, the precise connection between the two conditions is still a bit murky. Scientists have yet to figure out for sure whether SIBO is a cause or a consequence of IBS. Or it could be both.

There are several factors that can increase the likelihood of someone having both IBS and SIBO. These include:

✔ Being female

✔ Older age

✔ Bloating and flatulence being predominant symptoms

✔ Diarrhea subtype of IBS (IBS-D)

✔ Having fibromyalgia

What You Can Do if You Think You Have Both IBS and SIBO

SIBO and IBS share a complex, but common relationship. And while not all IBS patients have SIBO (and not all cases of SIBO are associated with IBS), they do show up together — A LOT.

If you have been diagnosed with IBS — especially if you’re still struggling with persistent symptoms — SIBO may be an issue for you. Working with a qualified healthcare professional (like me) can help you get to the bottom of what’s really going on with your digestive issues. I offer a consultation if you’d like to talk about what’s going on with your stomach issues.

In the meantime though, I’ve put together a resource you might find helpful for both IBS and SIBO. Click the button below to download my free IBS Resource Guide for some food, supplement, and app suggestions to help you on your journey.

References

https://my.clevelandclinic.org/health/diseases/21820-small-intestinal-bacterial-overgrowth-sibo

https://www.uclahealth.org/news/sibo-similar-to-ibs-but-in-small-intestine

https://www.everydayhealth.com/ibs/ibs-and-sibo-is-there-a-connection/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347643/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234057

https://www.hopkinsmedicine.org/health/conditions-and-diseases/inflammatory-bowel-disease

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This month we’re talking about all things SIBO — small intestinal bacterial overgrowth. Specifically, I want to answer the SIBO FAQs I hear about this underdiagnosed condition that can cause all sorts of unpleasant digestive symptoms from diarrhea to bloating and more. Last week we covered SIBO basics FAQs — what it is, what causes it, and how it’s diagnosed. So if you’re not familiar with SIBO that would be a good place to start. But if you’re struggling with SIBO, what you probably care about most is how to treat SIBO. So those are the FAQs we’re covering today. Let’s dive in… Can SIBO be treated? The short answer is yes. Once you have a SIBO diagnosis — usually from a non-invasive breath test — SIBO can be addressed at its source. However, the treatment depends on the underlying cause and severity of the condition. What are the treatment options for SIBO? Antibiotics are often used to clear out the bacterial overgrowth, but it's important to address any underlying factors that may have led to the overgrowth in the first place. But antibiotics will reduce the amount of bacteria in your small intestine — and also your symptoms. But antibiotics aren’t without a downside. Yes, they kill the excess bacteria that’s causing you problems. But they also kill the good bacteria that lives in your large intestine — where it belongs. Fortunately, there are other options. Some naturally-minded practitioners (like me), use options like herbal antibiotics that have fewer side effects. And don’t let the word “herbal'' fool you into thinking they won’t work. Herbal antibiotics have proven to be at least as effective as the antibiotic rifaximin. Can diet help with SIBO? Yes! Emphatically, yes. In fact, dietary adjustments are one of your most powerful weapons against this bacterial overgrowth. The bacteria that are partying in your small intestine are living things. That means they need food to survive. So a combination of medication and bacteria starvation will help you get rid of SIBO more quickly than medication alone. So your treatment plan should include some dietary adjustments. Some people do really well on the low FODMAP diet. Or your practitioner may recommend a SIBO specific diet like one of these: 💡 SIBO Specific Diet by Dr. Allison Siebecker This diet — also called the Specific Carbohydrate Diet (SCD) — involves avoiding certain carbohydrates that feed bacteria in the small intestine, in addition to limiting FODMAPs. Foods are color-coded as green (legal), yellow (limited), or red (avoided) to help navigate the restrictions. 💡 SIBO Bi-Phasic diet by Dr. Nirala Jacobi This diet combines the low FODMAP diet with the SCD, but is divided into two phases. The first phase involves eliminating all fermentable starches for up to 6 weeks — starving the bacteria in the small intestine. In the second phase, a few starchy foods are reintroduced to feed the beneficial bacteria in the large intestine. 💡 The low histamine diet This diet can be helpful for those with SIBO who are showing signs of histamine intolerance. This is when your body has trouble breaking down histamines — chemicals involved in the immune system. You foods with high histamine levels like fermented foods, tomatoes, eggplant, and spinach, while prioritizing fresh, unprocessed foods with low histamine levels. This diet may reduce symptoms like headaches, skin irritation, and diarrhea. 💡 Elemental diet This is the most restrictive SIBO diet and involves two weeks of liquid-only nutrition. Your nutritional drink will contain pre-digested nutrients. The idea is that you can quickly absorb the nutrients before they have a chance to feed the bacteria in your small intestine. The diet has an 80-84% success rate according to clinical trials. While effective, it can be challenging, expensive, and not typically covered by insurance. 💡 Cut out sugar and processed sweets If you want to keep things simple, this can be an effective approach that’s easier to navigate. For many SIBO patients, avoiding processed sugars and alcohol is a great way to go. Processed sugars also include artificial sweeteners like aspartame, saccharin, and sorbitol. You won’t be missing out on any nutrients that your body needs. So this type of diet can be useful even after you’ve resolved your SIBO symptoms. How long does it take to treat SIBO? There’s not a clear one-size-fits-all answer for this one. It depends on what caused your SIBO in the first place and how severe it is. Typically, people on a SIBO treatment feel better within 4 weeks. If you take antibiotics, you’ll probably be on medication for about 2 weeks. But full recovery takes longer and requires both dietary changes and dealing with those underlying issues. What is the success rate of SIBO treatment? The success rate for treating SIBO is high. Some figures put the eradication rate at over 70%. The key is keeping it from coming back. Will SIBO come back? I hate to be the bearer of bad news… But yes, SIBO often comes back. In fact, according to recent studies, about 44% of people with SIBO will have a recurrence of symptoms within 9 months of their initial treatment. But… It doesn’t have to be that way. Medication — herbal or pharmaceutical — can treat the symptoms of SIBO and tame the bacterial overgrowth. But you need to remember that something caused your SIBO in the first place. There was some underlying condition that made your small intestine vulnerable to this overgrowth. And unless you address that issue, your SIBO is likely to return. That’s why it’s so important to work with a practitioner who can address the root cause of your problems, instead of just reducing the symptoms. Remember, symptoms are your body’s way of telling you that something is wrong — out of balance. And if you really want to keep your symptoms from coming back, you need to do something about the imbalance that enabled the bacterial overgrowth to get started. This could include addressing any nutrient deficiencies, food intolerances, or gastrointestinal motility issues (how quickly your food moves through your digestive system). Additionally, a dietary plan designed for SIBO recovery and probiotics may also be used to support the gut during and after treatment. It's important to work with a healthcare professional to develop a treatment plan that's right for you. How do I figure out the right SIBO treatment for me? If you suspect that you have SIBO, the first step is to consult a practitioner who specializes in digestive issues (like me). They will evaluate your symptoms and medical history and may recommend a SIBO test. Once you have a diagnosis, your practitioner will work with you to develop a treatment plan that’s customized for your body’s unique needs. In the meantime, there are steps you can take to alleviate your symptoms. I’ve created a guide with helpful resources for managing IBS and SIBO. Click the link below to get your free copy. And if you’re ready for a customized treatment plan, you can schedule a consultation here. Yes, SIBO is a challenging condition. But it is treatable and you can take control of your health.

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