What is IBS?
IBS is diagnosed when an individual is experiencing a group of gut symptoms of no obvious known cause. Symptoms can vary from one person to another and may include:
- Abdominal pain or cramping
- Bloating
- Gas
- Changes in bowel habits (diarrhoea, constipation, or both)
Types of IBS include:
- IBS with constipation (IBS-C)
- IBS with diarrhoea (IBS-D)
- IBS with mixed bowel habits (IBS-M)
How is it diagnosed?
Doctors often use the Rome IV criteria, a set of standardised criteria, to diagnose IBS. These criteria focus on the presence of recurring abdominal pain, on average, at least one day a week in the last three months, associated with two or more of the following:
- Related to defecation (bowel movements).
- Associated with a change in frequency of stool.
- Associated with a change in the form (appearance) of stool.
IBS should be diagnosed when all other gut disorders have been ruled out.
To rule out other conditions, your doctor may order:
- Blood tests: To check for anaemia, infections, or celiac disease.
- Stool tests: To check for infections or blood in the stool.
- Colonoscopy: In some cases, especially if there are “red flag” symptoms, a colonoscopy may be performed to examine the colon for abnormalities.
Conventional approach to treating IBS
There is currently a one-size-fits-all approach to treating IBS via conventional medicine. This frequently includes advising patients to increase fibre in the diet, introduce probiotics and if constipated, take laxatives. In some cases, the use of tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) may be used to manage pain and anxiety, which can contribute to IBS symptoms.
Certain medications that suppress symptoms of IBS may also be advised, such as Imodium.
Why does this approach not work for so many?
This blanket approach does not address the patient’s individual root cause of IBS. We know individuals have their own unique risk factors and contributing factors. To simplify, just because 10 people have an IBS diagnosis, it doesn’t mean the reason they have developed it and what is sustaining it is the same for all.
For many, increasing fibre makes symptoms worse, probiotics may aggravate symptoms, and laxatives mask the underlying issue of constipation. Sound familiar?
Could your IBS be SIBO?
What is SIBO?
Firstly, methane-positive SIBO has been reclassified as Intestinal Methanogen Overgrowth (IMO), but for this blog, I will refer to both elevated hydrogen and methane gas as SIBO.
Small Intestinal Bacterial Overgrowth (SIBO) is a gastrointestinal disorder due to an overgrowth of bacteria/archaea in the small intestine. Unlike the large colon, which should house a diverse and abundant bacterial community, the small intestine should contain very few bacterial species. The location of this bacterial/archaeal overgrowth can interfere with the digestion and absorption of food. Bacteria thrive on specific carbohydrates, exacerbating symptoms and interfering with fat-soluble vitamins, iron and B12 absorption, often leading to deficiencies.
Symptoms
- Abdominal bloating (gas)
- Belching, flatulence
- Abdominal pain, cramps
- Dysregulated bowel habit: Constipation and/or Diarrhoea
- Heartburn (Reflux or GERD)
- Nausea
- Leaky Gut Symptoms
- Food Sensitivities
- Headaches
- Joint Pain
- Fatigue
- Skin symptoms (such as eczema or rashes)
- Respiratory symptoms (such as asthma)
- Mood symptoms (such as depression)
- Brain symptoms (such as Autism)
- Steatorrhea (fatty stools)
- Anaemia (Iron or B12)
- Weight Loss or weight gain
Risk Factors
- Low Stomach Acid – Use of PPIs, Zantac/Ranitidine Acid Blockers
- Regular use of NSAIDs
- Regular use of antibiotics
- Stress
- Constipation
- Altered Bile flow
- Gastroenteritis
- Food Poisoning
- Migrating Motor Complex Dysfunction (small intestinal cleansing wave)
- IBD – Colitis, Crohn’s
- Reduced Vagal Nerve Tone
Testing for SIBO
The most used test to identify SIBO is the 3-hour SIBO Breath Test. I currently favour the 3-hour lactulose test, having good results with this method.
This non-invasive test can be completed in the comfort of your own home. It requires following a 24-48 prep diet in advance of the test. The duration of the prep diet is dependent on symptoms and discussed during consultation.
The test requires ingestion of lactulose (or glucose) diluted in water, followed by the collection of breath samples every 20 minutes for 3 hours.
The type of gas found in your breath will reveal if you have bacteria residing in the small intestine where they shouldn’t be or excessive amounts of methane at any point throughout the colon. The test not only identifies gas levels, but also which gas is being produced, hydrogen or methane. In some cases, we may identify a third gas, hydrogen sulphide. This information guides my recommendations and tailored intervention to resolve your SIBO and gastric symptoms.
Intervention Consideration
SIBO can be notoriously stubborn, but with professional guidance and tailored intervention, it is possible to improve symptoms and even eradicate. I work with SIBO every week, I understand its complexity and fully appreciate the commitment my clients show to better their health and clear this bacterial overgrowth.
Dietary modification is mandatory, but in isolation, not enough to eradicate SIBO. The use of tailored antimicrobials and supportive supplements, coupled with diet and lifestyle, is imperative.
Please do reach out for more guidance.
Paula Jones, Nutritional Therapist
info@paulajonesnutrition.com
