Navigating SIBO: Understanding the Hidden Gut Issue

Pop my stomach like a balloon!

Imagine waking up every day with a sense of bloating and GI discomfort that just won’t go away. I often wanted someone to pop my stomach like a balloon. For me and many others, this is a reality, and it often leads to a search for answers. One answer is Small Intestinal Bacterial Overgrowth or SIBO. Understanding SIBO can be a journey of discovery, revealing not just the importance of gut health but also how it can significantly impact overall well-being. Let’s explore this condition together and uncover the insights that can help navigate through SIBO.

Introduction

Small Intestinal Bacterial Overgrowth (SIBO) is the presence of excessive bacteria in the small intestine. Gut motility disorders primarily cause SIBO. Peristalsis (gut motility) moves and eliminates food, microbes, and waste. However, when peristalsis gets disrupted, the microbes stay in the small intestine along with food and waste that feed the bacteria in the small intestine. SIBO can also be caused by ileocecal valve issues, which cause bacteria from the large intestine to enter the small intestine. Illnesses, procedures, and medications can also be the cause.

There are three types of SIBO, which depend on the gases the bacteria produce. SIBO types include hydrogen, methane, and hydrogen sulfide. Usually, there is a dominant gas, but sometimes there can be a mix. Hydrogen-dominate SIBO usually causes diarrhea; whereas methane-dominant SIBO typically causes constipation. Hydrogen sulfide dominant SIBO (think sulfur), usually causes a rotten egg smelling flatulence, belching, or breath.

Symptoms of SIBO

• Bloating & gas

• Diarrhea

• Constipation

• Uncomfortably full after eating

• Acid reflux

• Change in appetite

• Bad breath

• Chronic inflammation

• Food sensitivities

• Nutritional deficiencies (vitamins, minerals, macronutrients)

• Unintended weight loss or gain

• Leaky gut

• Dysbiosis

Associated Diseases with SIBO

• Mood disorders

• Irritable Bowel Syndrome (IBS) - at least 60% of people with IBS have SIBO

• Inflammatory Bowel Disease (IBD)

• Crohn's Disease

• Celiac's Disease

• Metabolic diseases, including diabetes type I

• Hypothyroidism

• Fibromyalgia - at least 90% have SIBO

• Interstitial cystitis (IC)

• Chronic fatigue syndrome

• Restless leg syndrome

• Autoimmune diseases

• Rosacea

• Psoriasis

• Parkinson's Disease

• Hypermobility & Ehlers-Danlos Syndrome (EDS)

• Many more

Testing

SIBO testing is done using an at-home breath test. They're fairly simple but require some prep and are time-consuming.

Lactulose Trio-Smart is currently the gold standard in testing. It's the only test for all three types of SIBO. I usually recommend this testing for the first test. It helps to know what kind of SIBO you're dealing with. It requires a physician's prescription for testing and insurance coverage. You can get the test through Direct Labs if you don't have insurance. Please ensure you get a lactulose breath test, not a glucose test!

Genova Diagnostics' 3-hour Lactulose Breath Test Kit is another great test. It tests for hydrogen and methane SIBO. It is also a great first test. It can be purchased directly through Direct Labs. It's a bit more cost-effective than the Trio-Smart.

FoodMarble AIRE Devices are fantastic tools. They're at-home devices that connect to your phone for an instant read of gas levels. The AIRE Device tests only for hydrogen and AIRE 2 tests for hydrogen and methane. Of course, the AIRE Device isn't as expensive as the AIRE 2, so it's good to know the type of SIBO you have before purchasing.  These are especially useful after treatments and you notice SIBO symptoms returning. The downside is that lactulose is by prescription only, which means these tests can't accurately diagnose, The devices also don't give the exact measurements (ppm). Instead, it gives a "rating" from 1-10 of gas levels. I wanted to mention these devices as somewhat of a warning -- they're a great tool, but not for diagnosis.

The Bigger Picture

One of the problems with SIBO is that there is no cure, only management. The main reason for that is because it's more of a symptom of an underlying issue. For example, gut dysmotility can be caused by hypermobility. People with hypermobility can't produce enough collagen, which provides structure to the intestines. If the intestine doesn't have collagen, it will continue to expand and won't push the stool out. The gut balloons and the stool will sit inside the gut and ferment.

The other problem with SIBO is that other microbes can play a role and can be quite complex. Methane SIBO isn't caused directly by bacteria. Methane-producers, called methanogens, are archaea. Archaea are considered non-pathogenic, but there is limited research on them since they can't be cultured like bacteria. Although considered non-pathogenic, they can overgrow and cause problems. It becomes complex because archaea don't ferment carbohydrates (sugars, starches, and fiber). They feed off what other microbes produce. Archaea are known to team up with bacteria because the bacteria produce gases the archaea thrive on. So, the bacteria will eat the starch and produce hydrogen. The archaea will then eat the hydrogen and produce methane. That's one of the reasons that methane-dominate SIBO is so hard to treat because you're now dealing with bacteria AND archaea.

To add to the complexity, Candida sp., or yeast, can also join the team. Candida sp., are known to produce biofilms, which is a slime they produce for attachment (eg., dental plaque). Bacteria and archaea can "hide out" in Candida's biofilm, making it even harder to kill. Some bacteria can also make biofilms, which causes antibiotic resistance. It's one of the reasons why antibiotics, in general, sometimes don't work. That's especially true with Streptococcus sp., Staphylococcus sp., and Escherichia coli. E. coli is also highly prevalent in SIBO.

Hope and Navigating SIBO

I’m passionate about raising awareness of SIBO because it’s more common than people realize and can significantly impact everyday life. Since TrioSmart testing is still fairly new, many doctors may not even be aware it’s an option. In my search for answers, I worked with both a functional practitioner and a prominent researcher, but it wasn’t a perfect fit for my needs. That’s why I believe in a more personalized approach since everyone’s experience is unique. I’m here to help guide and support you in finding what might work best for your situation.