Could you have Irritable Bowel Syndrome (IBS) or Small Intestinal Bacterial Overgrowth (SIBO)?

Small Intestinal Bacterial Overgrowth (SIBO) is a form of dysbiosis and is a condition characterised by an excessive growth of bacteria in the small intestine. Normally, the small intestine has a relatively low bacterial population compared to the colon (large intestine), but in SIBO, bacteria from the colon migrate upwards and colonise the small intestine, leading to various symptoms such as bloating, abdominal pain, diarrhoea, and nutrient malabsorption. These symptoms can be chronic and significantly impact a person's quality of life. 

Irritable Bowel Syndrome (IBS) is a group of intestinal symptoms that are usually found together, meaning there is usually more than one. The symptoms vary from person to person and women seem to be more susceptible to having varying symptoms of IBS. This maybe due to Oestrogen's roll in digestive health.

There are many common presenting symptoms that both IBS and SIBO have. These include:-

• Tummy pain or cramping
• Bloating
• Constipation
• Diarrhoea or both
• Burping
• Flatulence
• Reflux and
• Food sensitivities

As a Naturopath, I work with many people who have these symptoms and find that it is important to be tested for SIBO, so that you are on the correct treatment plan as these symptoms are very common in a lot of digestive issues. Research has shown that 84% of people who have IBS and who do the SIBO Lactulose Breath Test (the most common one) test positive to SIBO.

IBS is usually the above symptoms, whilst SIBO has these symptoms as well along with many more health conditions that are linked to it. These are:-

• Diverticulitis
• Inflammatory Bowel Disease
• Fibromyalgia
• Restless Leg Syndrome
• Candida Overgrowth (SIFO)
• Food Sensitivities and/or Food Intolerances
• Skin Conditions such as Acne Rosacea
• Chronic Fatigue Syndrome
• Autoimmune Diseases
• Anxiety
• Weight Loss
• Thyroid issues
• Cardiovascular Diseases
• MCAS (Mast Cell Activation Syndrome)
• POTS (Postural Orthostatic Tachycardia Syndrome)
• ENS (Ehlers-Danlos Syndrome)
• Stealth Infections - mould, viral infections, parasites.

How does SIBO occur?

There are many contributing factors that can cause SIBO to occur. When you body is working in synergy, your body maintains the balance of flora in your gut through a complex network of chemical and mechanical functions. For SIBO to occur, one or more of these functions must be failing. Gastric acid, bile, enzymes and immunoglobulins are some of the chemicals that control bacteria in the small intestine. Different conditions can inhibit these chemical functions.

The MMC (Migrating Motor Complex) works to empty food contents from the small intestine into the large intestine. If this is working too quickly it can cause loose bowels or diarrhoea or too slowly, you may suffer from constipation. If this mechanism is slowed or impaired, the bacteria in the small intestine have more time to breed, and the bacteria in the large intestine may begin to creep upward. Other contributing factors are:-

• Infection - food poisoning, viral or parasitic.
• Food intolerances - gluten can be a huge trigger so it is important to be tested for Coeliac Disease.
• Low stomach acid - our stomachs need to have a pH of 1.5 to 3.5 (acidic) to create digestive enzymes, such as pepsin which is the main one to break down food. Between 3.5 to 5.5 (low stomach acid - hypochlorhydria) which causes bloating, burping or flatulence and greater than 5.5 is alkaline. Low stomach acid can be the cause of loss of appetite for people, this is significant when you wake up and don't feel hungry. 
• General diet - diets high in sugar (this includes soft drinks and alcohol) along with processed foods aren't good for any one especially when you have digestive issues. Following a low fibre diet can cause further problems for people with constipation. Fructose or sorbitol can increase symptoms of diarrhoea.
• Food intolerances - some people find that milk or dairy upset their digestive system along with gluten which is known to cause bloating and brain fog. There are many other food intolerances that can affect your digestive health, such as, histamines, salicylates and oxalates which are the main ones.
• Emotional stress - anxiety and chronic stress can affect nerves in your digestive tract (such as the Vagus Nerve) leading to IBS symptoms.
• Long term use of medications - can lead to both constipation or diarrhoea. Laxatives weaken the bowel lining causing a 'sluggish' bowel. Gastro-stop, Imodium works to slow bowel transit time along with firming the stool and should not be used long term. History of antibiotic use, birth control pills, painkillers, anti-depressants etc. These medications also affect our good gut bacteria.
• Abdominal Surgeries or Procedures - These can include C-Sections, small bowel resection, appendectomies and hernia repairs, Cholecystectomy, weight loss surgery - Bariatric Surgery. Scaring or abdominal adhesions caused by these procedures can contribute to SIBO.
• Self prescribing supplements - I like to add this in as there are so many supplements that you can order online that sound like they might fix your symptoms. Facebook Groups that aren't run by SIBO trained health professionals or trained practitioners or influencers who recommend the wrong supplements! This frustrates me to no end as this can cause your symptoms to worsen and make your daily life even more uncomfortable as you could be suffering from more bloating, constipation, tummy pain, exhaustion or skin flare ups (these are the usual ones that I see in clinic.)

The different types of SIBO

There are three main types of SIBO -

• Methane Dominant - Methane dominant is now known as IMO (Intestinal Methanogen Overgrowth) and is different to SIBO as it is caused by archaea instead of a bacteria. Signs are chronic constipation, weight gain, higher levels of body fat. 
• Hydrogen Dominant SIBO - The large amounts of gas that they produce can lead to severe bloating and abdominal discomfort, which can worsen as the day progresses. Dehydration and malnutrition may also be experienced due to the hydrogen causing loose bowels or diarrhoea.
• Hydrogen-Sulphide Dominant SIBO - Is characterised by an overgrowth of bacteria that produce hydrogen sulfide gas in the small intestine. This gas, when produced in excess, can lead to a variety of symptoms including bloating, diarrhea, constipation, and abdominal pain, often distinct from those seen in other types of SIBO. Hydrogen sulfide SIBO is believed to be associated with certain dietary factors, such as high sulfur-containing foods - eggs, red meat, cabbage, kale etc. Diet wise there is separate dietary guide to follow.

There are two other known overgrowths that affect people with digestive issues and these are:-

• Small intestinal fungal overgrowth (SIFO) - SIFO occurs when yeast, also known as Candida, grows in large quantities in the small intestine. This can sometimes be referred to as chronic candidiasis or yeast syndrome. Brain fog, diarrhoea, constipation, burping, bloating, fullness, nausea and gas are common signs in SIBO and SIFO. Candida Albicans overgrowth, shows symptoms including vaginal yeast infections, white coating on the tongue, sinus congestion, postnasal drip, as well as bad sugar and carbohydrate cravings. There is also links to connective tissue disease, metabolic conditions and long-term use of pharmaceuticals.
• Large Intestinal Bacterial Overgrowth (LIBO) - If you have all the symptoms and your results are negative - flatline in your SIBO Breath Test, this can mean that your symptoms are based in the large intestine. Hydrogen Sulphide is also present in your large intestine and can be the cause of your symptoms. I would recommend a gut microbiome test be done to find out exactly what's happening with your microbiome and that will give the right course of treatment for you.

Foods that can cause a flare up of SIBO or IBS

• Onions
• Garlic
• Dairy
• Gluten containing grains
• Caffeine
• Alcohol
• Legumes
• Bad carbohydrates (processed foods) and
• Diets high in sugar

Some of the other diets that 'treat' your IBS or SIBO

Anyone who suffers from digestive issues, has tried many different diets over the years. These are some of the more common ones:-

Self treating through diet - Treating your symptoms by following restrictive diets can help in the short term but doing this long term, without the help of a gut health Naturopath can lead to more food intolerances and sensitivities. Over the years, some of my clients have come to me with so many food sensitivities and a few who could only tolerate five foods, so they were eating the same foods every day! They have reduced their diet so much that they had caused nutritional imbalances or deficiencies and everything flares back up again once you eat 'normally' again!

Low FODMAPS - Some people follow the low FODMAPs diet as this was designed by Monash University, especially for people with Irritable Bowel Syndrome and whilst it is a great tool to relieve symptoms it does not clear the underlying cause and should only be followed for a short period of time as it is very restrictive and we really need to add back 'whole foods' once your Naturopathic treatment has been completed.

I will admit that I am not a huge fan of the low FODMAPs diet as there are far too many processed foods included that feed the bad bacteria. This is a type of 'band-aid' fix as it is not treating the underlying cause.

Keto Diet - is another diet that relieves your symptoms and you feel great for a period of time. You really need to be working with a Naturopath or Nutritionist that has studied the Keto Diet as there are so many varying forms out on the internet with 'experts' in Facebook groups or on Instagram that shouldn't really give professional advice. Men tend to do better on a Keto Diet and it's really not recommended for women in their perimenopausal years.

Vegetarian or Vegan Diets - these can relieve symptoms and you feel amazing soon after beginning this diet/lifestyle. This isn't a long-term solution for health issues as you do miss out on lots of nutrients long-term and can suffer from mineral or nutrient deficiencies. I do work with clients who are vegetarian, pescatarian or vegan and have great results with these clients. There is also a vegetarian/vegan version of the dietary program that I recommend for my clients.

The Carnivore Diet - Consists primarily or exclusively of animal products, has gained attention for various reasons, including claims of improved gut health and treatment of conditions like SIBO. This diet can be very healing, especially if you have had digestive issues for a long period of time. Slow cooked organic meats on the bone are very nourishing. If you have SIBO its not recommended to have chicken bones as it feeds the SIBO. All the other meats are fine. You will eventually need to add in more plant based foods.

What we aim to do is to add more plants into our meal plans each week and follow a wholefoods diet after you have been treated and cleared of SIBO. 

How can Naturopathy help?

Naturopathy looks a why this is happening to you. Naturopathy works on the body as a whole so that we do not treat one specific area. There can be many reasons why you have these digestive issues and finding your root cause or causes is where working with a qualified gut health Naturopath can assist you and your body to heal naturally.

As a Naturopath and SIBO Practitioner, I had suffered from SIBO for possibly 10 years or more and I have since been SIBO free for a few years. I started my life journey with digestive issues (like a lot of people) I was a very colicky baby and my symptoms got worse as I got older. This is one of the main reasons as to why I studied to become a Naturopath as I had seen so many other medical professionals over the years and I felt so frustrated that I wasn't getting any answers from them as to why I felt so unwell.

In my late teens to early twenties, I did find some amazing Naturopaths that worked with me to heal my digestive system along with treating my nervous system and immune system to clear my symptoms. 

In 2020, I had noticed that my digestive health wasn't good again and I thought my SIBO had returned. I ordered my SIBO breath test and when my results came back, it confirmed that my SIBO had returned. I do believe this had flared up due to stress - so many changes happening in the world at that time and being Perimenopausal.  Perimenopause can cause your IBS or SIBO to flare back up again due to hormonal imbalances (my previous blog on Perimenopause.)

I am extremely interested in helping people to heal their digestive system. Whether you have IBS, SIBO, IMO, LIBO, IBD or other digestive issues and the other health conditions associated with SIBO. You don't have to 'put up with' or 'band aid' your symptoms or think that bloating (for example) after meals is 'normal'. 

I work with my clients to treat the underlying (root) causes of their digestive issues. I use up-to-date information in both herbal and nutritional medicine along with following a dietary program to support digestive healing and restoring the good bacteria in your microbiome.

Lets face it, everyone is different so it is a very individualised treatment plan which is why you really need to work with someone that understands digestive health issues.

Dietary Changes

Dietary changes are necessary as we need to reduce fermentable starches and fibres to starve the bacteria that are in the small intestine, as they thrive on these foods. It is important to begin to repair the intestinal lining and improve digestion (reduce and repair). Once there are improvements it is important to continue to remove the remaining bacterial overgrowth as (they like to hide!)

The dietary program that I recommend has two phases - Phase 1 - Reduce and Repair - (four to six weeks) and Phase 2 - Remove and Restore - (four to six weeks). Sometimes depending on how you are going we may need to extend either Phase 1 or Phase 2. I usually look at how long the client has been unwell for and tailor my treatment plan to incorporate this - the general rule of (Naturopathic) thumb is - one month for every year that you have been unwell, for example six years = six months of treatment.  

I supply you with lots of recipes, weekly meal plans and support with your dietary changes. You won't be hungry and you'll enjoy having so many choices in your daily meal plan.

What are Herbal Antibiotics?

These are a vast range of herbs that work in synergy as antibiotics, antimicrobials, antivirals and antifungals. These include Oregano, Garlic, Thyme, Myrrh, Neem, Calendula and herbs that contain Berberine. These herbs are needed to clear the bad bacteria from your small intestine along with supporting our liver and digestion. It is important that you aren't on them for a long period of time as they are very powerful in reducing symptoms and moving the bad bacteria out of your small intestine. Sometimes, you will need a couple of courses of them and then we can change the herbs around to support your body as a whole.

Medical professionals will recommend antibiotics to treat both SIBO and IBS. I have noticed that they have used a varying combination of antibiotics that are available here in Australia but unfortunately they do not clear your SIBO or heal your IBS. Like most antibiotics they clear the good bacteria as well which isn't what someone with digestive dysfunction needs.

Research has shown over the last few years that herbal antibiotics work as well and if not better than Rifaxamin (antibiotic) and/or Neomycin (antibiotic). These two antibiotics clear the bad guys and leave the good guys in your digestive system and are used in the USA for the specific treatment of SIBO but they are extremely expensive and are not readily available here in Australia. 

Treatment of both SIBO, IMO, LIBO, SIFO and IBS take a combination of both dietary changes and herbal intervention. 

How to work with me

 

I recommend that my clients order their SIBO breath test kit (usually the basic lactulose test) during their initial consultation (both online or in person.) Your test kit is then sent directly to your home.

Before doing the test, you do the preparation diet (for one day - diarrhoea or two days - constipation.)

The preparation diet is really easy to do and I have a handout for you to follow. This is an example of breakfast. 

The next day you perform the breath test.

Once you have submitted your breath samples, you then send your test via express post (satchel is included in your kit) to be tested at SIBO Test Australia. Your results are uploaded on my Practitioner account within seven to ten days. I will assess your test results and present them to you, along with your treatment plan at your Report of Findings - Follow Up Consultation.

Testing is an important part of your treatment, as it gives me a baseline to work with, your symptoms could be SIBO (there's a certain range to look for) or they could be more large intestinal issues (this shows differently in your results) and this is a separate form of treatment.

Summary - Let's find out what's happening with your digestion?

Healing and supporting your digestive system and clearing your SIBO, SIFO, LIBO or IMO requires a wholistic treatment approach. I'm here to support you all the way so Lets get you started:-

1. Book your consultation where we order your breath test;
2. Do your prep diet (I have a handout for you to follow) before doing your breath test;
3. The following day, set aside (3 hours - 8:00am to 11:00am) to do your breath test;
4. Once completed, send your breath sample back to SIBO test Australia;
5. I receive your breath test results;
6. At your Report of Findings - Follow Up Consultation we discuss your results and treatment plan;
7. You begin your treatment as I have explained above;
8. Once treatment is completed, in most cases it is a 3 month plan, although it may take a little longer depending on other factors. We can re-test to see if your SIBO has cleared and then we can move on to my Repair Rebalance and Restore Wellness Program;
9. Included in this program is the Hair Bio-Compatibility Food and Product Compatibility Testing. I did this after my SIBO treatment and was so excited that I could eat such a huge range of foods again! This is what I recommend my clients to do as their next stage of treatment.
10. Our end goal is to introduce as many whole foods back into your diet as possible. This allows your digestive system to feed and grow the good guys (prebiotics) so that you have a healthy microbiome with a vast number of probiotics as well.

 I look forward to working with you to have optimal digestive health.

 

Yours in health and wellness, 

 

 

Katrina Froome - Naturopath xxx