What if I told you that a mysterious, incurable syndrome affecting more than 1 in 10 Americans was actually a treatable and frequently curable disease? With the right combination of diet, lifestyle, supplements, and antimicrobial agents, many of these patients can be cured and free to live their lives without pain, discomfort, and constantly assessing the location of the nearest toilet. The problem is that many doctors lack awareness that many of their irritable bowel syndrome patients may actually have small intestinal bacterial overgrowth.
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder in the world affecting 10 to 15 percent of the population. The conventional medicine definition of a functional disorder, such as IBS, is “a condition where there is an absence of structural or biochemical abnormalities on common diagnostic tests, which could explain symptoms.” To most practitioners, a functional disorder implies a psychogenic cause or “it’s all in your head.” Current conventional treatment is focused primarily on symptom suppression, with varying degrees of success and for a select few, a psychiatry referral.
Small intestinal bacterial overgrowth (SIBO) is an accumulation of bacteria in the small intestine that normally lives in the gastrointestinal tract but has abnormally overgrown in a location not meant to support so many microbes. The overall prevalence of SIBO in the general public is still unknown. Due to a lack of awareness by most health care practitioners, it is substantially under-diagnosed. While treatment is by no means foolproof, there are definitive treatment protocols that go beyond suppressing symptoms and address the cause.
Both disorders can cause abdominal bloating, belching, flatulence, abdominal cramps, nausea, and heartburn. Both disorders have a constipation type, a diarrhea type, and a mixed type. Gut discomfort has become a normal part of life for these people.
Researchers have estimated that up to 80 percent of patients with IBS may have SIBO. Many of them will report a complete or near-complete resolution of symptoms after the proper treatment. This is especially true in the IBS-D or diarrhea-predominant IBS patients.
While there is no definitive test to diagnose IBS, that isn’t the case with SIBO. The SIBO breath test measures the hydrogen and methane gas produced by gut bacteria two to three hours after drinking a special sugary solution designed to feed the bacteria. Based on the time, amount, and type of gas expelled, the diagnosis of SIBO is made and treatment can proceed.
Treatment is based on what is known as the five Rs.
Remove. Reduce the microbial load in the gut by actively killing and starving the bacteria concurrently. This is initially achieved by following a specialized food plan called a low FODMAP diet which is designed to avoid foods with large amounts of indigestible carbohydrates—the preferred food for the gut microbes. This is followed by actively killing the microbes either with pharmaceutical antibiotics or herbal antimicrobials. Either choice has its pros and cons, but both drugs and herbs have been found to be effective. In certain severe cases, it may be necessary to place the patient on an elemental diet temporarily. This specially formulated and nutritionally balanced diet should always be supervised by an experienced practitioner.
Replace. Replace the functional components needed by the gut to aid in proper digestion. These may have been compromised by diet, drugs, disease, aging, and other factors. They include digestive enzymes, stomach acid, and bile. In cases where immune dysfunction is also present, local immune stimulants may be needed as well.
Repopulate. Assist beneficial microbes to flourish, like lactobacillus and bifidobacteria species, through the use of probiotic supplements and fermented foods. Encourage the consumption of high-soluble fiber foods and prebiotic supplements to further encourage the growth of those good bacteria.
Repair. Repair the lining of the gastrointestinal tract by supplying vital nutrients such as antioxidants, minerals, essential fatty acids, and amino acids.
Restore. Restore balance to the person’s gut to prevent the recurrence of disease. This is primarily focused on making the right lifestyle choices, particularly with diet, exercise, sleep, and stress.
If you have battled with IBS over the years, consider the possibility that you may actually have an undiagnosed case of SIBO. Awareness of this important and potentially life-changing association is rapidly increasing among conventional medicine practitioners who can at least get you started with reducing the microbial load. For a more thorough and holistic treatment plan addressing all five Rs, I recommend seeking out the help of a functional medicine practitioner.
Armen Nikogosian, MD, practices functional and integrative medicine at Southwest Functional Medicine in Henderson, Nev. He is board-certified in internal medicine and a member of the Institute for Functional Medicine and the Medical Academy of Pediatric Special Needs. His practice focuses on the treatment of complex medical conditions with a special emphasis on autism spectrum disorder in children as well as chronic gut issues and autoimmune conditions in adults.