IBS Symptoms and Causes – Could You Have SIBO?

Picture of woman holding her stomach with red area of inflammation radiating from underneath her hands

Could I Have Undiagnosed IBS?

Prevalence and Symptoms of IBS

Statistics show that approximately 2 in 10 people in the UK have IBS. Many more people are thought to have IBS who have either not been diagnosed correctly or haven’t consulted a GP for a diagnosis. Many people think that IBS symptoms such as constipation, loose stools, going to the toilet less than once a day, wind or bloating is normal.

In terms of a healthy bowel movement, the gold standard is 2 to 3 times a day and doesn’t leave any marks on the toilet bowel or even on the toilet paper! Can you honestly say your stools are like that?

Common Treatments for IBS

IBS is commonly treated with medications such as Moviprol to relieve constipation or Immodium to stop diarrhoea. Proton Pump Inhibitors such as Omeprazole and Lansoprazole are prescribed to relieve symptoms of acid reflux and heartburn. All of which can have side effects that you should be aware of.

So, we are going to take a look at the side effects of using such medications. However, please consult a qualified health professional who will be able to recommend the best course of action for you, before making any decisions about medications.

Effects of Moviprol: 

If you are taking Moviprol, have a look at the sodium content in it. Moviprol can be very high in sodium which can affect our health.

Effects of Immodium:

When we have loose stools, there is a reason the body is trying to eliminate so rapidly. We need to find out the reason to be able to look at why the symptoms are arising and explore whether we can eliminate this. It is important to seek medical advice from GP for right diagnosis.

Effects of Omeprazole / Lanzoprazole and the Question of Stomach Acid Production:

There are concerns in studies that some medications can have long term effects on health and also potentially stop a vital function of the body – they can decrease the production of acid in the stomach. “But I’ve got acid heartburn”, I hear you say, “so why would I not want to decrease the production of stomach acid?”

Stomach acid purposes

Well to answer that question, let’s look at the main purposes of stomach acid production:

  • The production of stomach acid actually triggers the tightening of the lower oesophageal sphincter, which prevents stomach acid from rising up into the oesophagus. So causes of acid reflux can actually include too little stomach acid.
  • Secondly, it is produced to break down proteins so that we can use them to regenerate our bodies. So when people don’t produce enough stomach acid, they can have impaired protein digestion and are not able to use the protein they take in to maintain optimum physical function.
  • Thirdly, stomach acid has the effect of killing any unwanted bacteria and prevents it from accumulating in the small intestines, a major cause of 60% plus of IBS cases!

Whilst some people do produce too much stomach acid, the majority of people actually produce too little.

I can hear you saying, well that’s all well and good Bee, but the symptoms of IBS are horrendous so what do I do?  Let’s take a look at some possible root causes of IBS and the natural ways you can help alleviate some of the symptoms.  Our main focus is on the biggest known cause of IBS, SIBO. This being said, if you do think you may be suffering please do consult your GP who will be able to recommend the best course of action for you.

Causes of IBS

SIBO

Research suggests that one of the biggest causes of IBS could be something you have never even heard of! SIBO – small intestinal bacterial overgrowth.  Studies have shown that 60-84% of people with IBS actually have something called SIBO which is causing their IBS symptoms?

But what is it? Well, we are supposed to have an abundance of certain bacteria in our large intestine, but not in our small intestine. SIBO is where bacteria have overgrown backwards into the small intestine.

Causes of SIBO

Poor gut motility

Poor gut motility is when food and bacteria aren’t being swept down through your digestive tract effectively. Gut motility is controlled by something called the migrating motor complex (MMC for short).

The functioning of the MMC can be impaired by illnesses such as gastroenteritis (gastric flu) or a severe bout of food poisoning (24 hrs or more). It can also be impaired by infections such as Lyme Disease or mould toxicity, and even an impact that has knocked or shaken the head.

Poor digestion

Other causes include low stomach acid, impaired production of digestive enzymes, impaired production of bile and low secretory IgA which acts as an immune defence in the gut.

Causes can even be as simple as drinking with or close to meals (which dilutes your digestive juices). Or not chewing your food properly and eating whilst distracted (by our phones or the TV). Eating on the go or eating under stress or whilst upset or angry can also cause poor digestion.

Stress shuts down our digestive system. With so many people under constant chronic stress, it is affecting their digestion all the time. Taking time to do some deep breathing or anything that calms you before every meal, helps switch your body into rest and digest mode.

Obstructions and abdominal adhesions

Adhesions are scar tissue that form after surgery, a perforated appendix or a haemorrhage. Obstructions can be caused by conditions such as endometriosis, diverticulitis and superior mesenteric artery syndrome.

Medications and stimulants

Other medications such as opiates, narcotics, antispasmodics and even trycyclic antidepressants such as amitriptyline can all cause symptoms of poor gut motility, as can cigarette and cannabis use. Please contact your GP if you think other medications may be causing symptoms of poor gut motility.

How Do I Know If I have SIBO

Lab tests such as a 3 hour lactulose breath test, possibly followed by a glucose test as well if necessary, can be carried out by a SIBO practitioner such as myself. It is important that the test is a 3 hour test and that it tests for both methane and hydrogen.

Methane & hydrogen are emitted by bacteria in the small intestine, before you have had chance to absorb your food which can cause the symptoms of wind, bloating, stomach cramps, iron deficiency, B vitamin deficiency, fatigue, etc! But a word of warning… There is a third gas, called hydrogen sulphide, that doesn’t show up on a standard test.

Hydrogen Sulphide

Leading expert in the field, Dr Mark Pimental, has recently developed a test for Hydrogen Sulphide SIBO. Unfortunately, at the time of writing this article, it is not yet available in the UK.

However, if you have a flat line across the whole of your 3 hour breath test, it is possible that this is not a negative breath test for SIBO, but in fact a positive indicator that you have hydrogen sulphide SIBO. So, if you have previously been tested, as I was, and told that the test is negative because you had a flat line but you are still symptomatic, you may in fact need treating for Hydrogen Sulphide SIBO. A trained SIBO practitioner should be able to help you interpret the test and give you some indication of how long treatment might take.

I also order a stool test for my clients to see what possible causes of SIBO may exist. Lab tests I use include GI Effects from Genova Diagnostics and GI Map, depending on someone’s signs and symptoms.

Natural treatments for SIBO

The natural treatment for SIBO that I prescribe to my clients is herbal antimicrobials to kill off the excess bacteria, of a particular type and dosage. These should always be taken under supervision.

I also prescribe a 2 phase diet which for some people has virtually eliminated symptoms within a couple of weeks. However, this diet is not meant as a long-term strategy. We need to look at the cause, as opposed to just managing the symptoms with diet.

Phase 2 diet

The diet works by eliminating/ reducing a group of fermentable carbohydrates called FODMAPs. Designed by one of the leading experts in the field, Nirala Jacobi, adapted from Alison Siebecker’s SIBO Specific Diet, the diet is specifically targeted at starving the bacteria to help with their elimination. It has also been designed to be as varied as possible, because restricting any food groups can cause disruption to the gut microbiome, the community of “normal” bacteria that are supposed to live in our large intestine and modulate our immune system, produce vitamins and in short keep us healthy.

If someone has Hydrogen Sulphide SIBO I tailor the diet, as hydrogen sulphide producing bacteria will thrive on different foods to hydrogen and methane producers.

Meal spacing

Other strategies I employ include meal spacing, i.e. eating with four to five hour gaps in between. This can help the MMC to sweep excess bacteria out, so regular grazing can also be problematic.

I also, depending on someone’s stool test results, address any digestive issues with specific enzymes, address any leaky gut, inflammation or lowered gut immunity and assess whether someone needs to take hydrochloric acid in the form of Betaine HCl. I would also prescribe a prokinetic to ensure that motility is working as well as possible and possibly also a biofilm disruptor, as bacteria are known to create a biofilm around themselves to protect themselves.

There are also many natural treatments for symptoms such as bloating, reflux, constipation and diarrhoea. Take a look at www.siboinfo.com for more info.

Microbiome restoration

I end my treatment with microbiome restoration, as the antimicrobials, although natural, and the restricted diet, do to some extent alter the gut microbiome.

Probiotics, fermented foods, yoghurts such as Yakult, etc will not on their own be enough to recolonize our gut bacteria. Those bacteria need to keep being fed prebiotic foods in order to grow, thrive and survive.

Other Causes of IBS

Other causes of IBS can include;

  • parasitic infections (almost impossible to pick up unless you use PCR testing to test for DNA and standard tests throw up a lot of false negatives)
  • Coeliac disease (which your GP can test you for as long as you are still eating gluten)
  • Non-coeliac gluten sensitivity (don’t think if you are not coeliac that gluten is fine as this could be you!)
  • Disease causing bacteria such as Klebsiella Pneumoniae that produce endotoxins (linked with endometriosis in some cases), any of the individual causes of SIBO on their own
  • Inflammatory Bowel Disease*
  • Diverticulitis*
  • Candida or other fungal overgrowth
  • Food intolerances
  • Salicylate or oxalate sensitivity
  • Histamine intolerance
  • Disrupted gut flora
  • Or simply a poor diet.

If you have any of the conditions with an Asterix above, you must consult a qualified medical professional.

I shall be diving deeper into some of these other causes in future articles.

Often removing highly inflammatory foods such as dairy, gluten and sugar can have a huge impact on someone’s digestion. Again, testing as part of my six step programme instead of guessing, can often get to the route cause of any of these.

If you have been thinking about speaking to a nutritionist about your diet or gut health, contact me for a free 30 minute chat to find out how I can help you.

References

Bharucha, A. E., Seide, B. M., Zinsmeister, A. R., & Melton, L. J. (2007). Insights into normal and disordered bowel habits from bowel diaries. The American journal of gastroenterology103(3), 692-8.
Bures, J., Cyrany, J., Kohoutova, D., Förstl, M., Rejchrt, S., Kvetina, J., Vorisek, V., … Kopacova, M. (2010). Small intestinal bacterial overgrowth syndrome. World journal of gastroenterology16(24), 2978-90.
Ghoshal, U. C., Shukla, R., & Ghoshal, U. (2017). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut and liver11(2), 196-208.
Thomson, A. B., Sauve, M. D., Kassam, N., & Kamitakahara, H. (2010). Safety of the long-term use of proton pump inhibitors. World journal of gastroenterology16(19), 2323-30.
Posted in Blog, Conditions.