The Simple Test That Could End Your IBS

Pinpointing the cause of irritable bowel syndrome can lead to highly effective treatment.

nobeastsofierce/Shutterstock

Darla O'Dwyer’s bloating was so severe in 2010 that she could measure growth in her girth from morning to day’s end.

Sometimes the bloating was accompanied by constipation, and by nightfall, she often had severe pain that made it hard for her to rest.

Over the years, she tried to reduce her symptoms by eating a high-fiber diet, using laxatives, taking antibiotics, and eliminating foods by following diets designed for irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO). In many cases, the remedies would fix one symptom but worsen another.

Finding out why this was happening and what she could do about it took years of sleuthing, even though O’Dwyer is a dietitian and professor of nutrition.

“That was very difficult to explain to physicians,” she told The Epoch Times. “I didn’t know what it was called.”

However, relief finally came after she took a specialized breath test that validated her many physician visits and complaints. Not only did she discover that there was a root cause—intestinal methanogen overgrowth (IMO), once considered a subtype of SIBO—but she also learned about a highly effective treatment.

For IMO, a breath test is the only way to find out what’s causing gastrointestinal symptoms. Breath tests also discern two types of SIBO, which each have distinct treatments. Testing is fast, easy, relatively inexpensive, and could pinpoint the underlying cause of symptoms for millions of Americans with IBS, according to research.

“They’re just sitting around suffering with these symptoms,” Allison Siebecker, a naturopathic doctor and SIBO expert, told The Epoch Times. “Once you know it’s SIBO, then we have reliable treatment protocols, so it just advances things so much better for people.”

SIBO Connects to IBS

The overlap between IBS and SIBO—which both have symptoms such as bloating, a change in bowel habits, and abdominal pain—could be fairly high. One meta-analysis suggests that up to 78 percent of IBS patients have SIBO, according to The American Journal of Gastroenterology.

“Although there remains a question of cause or effect in IBS, there is little controversy that a subset of subjects with IBS have SIBO,” the journal’s SIBO clinical guidelines state.

While SIBO is caused by excessive bacteria in the small intestine, IMO is caused by an overgrowth of archaea. In both conditions, digestive fermentation and gas production, which normally occur in the colon, occur in the small intestine instead. Archaea are similar to bacteria in size and simplicity of structure but differ in molecular organization.

Those who find that they need over-the-counter products to stay regular or relieve gastrointestinal symptoms might be unknowingly dealing with IBS or SIBO, Siebecker said.

Between 10 percent and 15 percent of American adults have IBS symptoms, although only about half have been diagnosed with it. IBS is one of the most common disorders seen by doctors, according to the American College of Gastroenterology.

The cause of IBS is less certain, although microbes can play a role in some cases.

A breath test quickly determines whether SIBO or IMO is causing bloating, abdominal pain and cramping, diarrhea, and constipation: the top IBS complaints. However, many IBS patients—and even some doctors—don’t know that breath testing is an option, as the diagnostic tool hasn’t captured mainstream attention and isn’t covered by Medicare for SIBO.

Tests measure hydrogen and methane, which cannot be produced by human cells but are made by bacteria and archaea that ferment carbohydrates. Passing from the bloodstream to the lungs, these gases are exhaled and measured.

Because hydrogen sulfide gas can be produced by humans and bacteria, symptoms of severe diarrhea, abdominal pain, and urgency can aid in the diagnosis of intestinal sulfide overgrowth, a subtype of SIBO.

All three types of gases—hydrogen, methane, and hydrogen sulfide—can also predict the phenotypes of IBS—constipation, diarrhea, or mixed—by the gut microbiome, according to an article in The American Journal of Gastroenterology.

Despite the strong links between IBS and SIBO, Siebecker said it is important to not jump to conclusions.

“A big mistake a lot of people make is they just sort of presume somebody has SIBO if they have IBS,” she said. “I don’t think that’s a good idea, because other diseases—40 other conditions—have those same symptoms of IBS, so testing is imperative.”

Tests Predict Treatment

Breath test patterns may dictate which SIBO patients would benefit from rifaximin, an antibiotic that targets gut microbes, and which patients might respond better to a combination of drugs, which typically includes rifaximin.

Among IMO patients, rifaximin is often not enough. In a study of those treated with both rifaximin and neomycin, 87 percent of patients had eradicated methane on a follow-up breath test, compared with 29 percent of patients taking only rifaximin, according to an article in Gastroenterology and Hepatology.

Archaea are resistant to most antibiotics, so a correct diagnosis can prevent useless treatments, as well as infections that can arise from the overuse of antibiotics.

“Before considering antibiotic therapy, an effort should be made to objectively diagnose SIBO,” The American Journal of Gastroenterology’s clinical guidelines for SIBO state. “As the consequences of antibiotic use have increased, including the development of resistant bacteria, adverse reactions, and rise of opportunistic infections such as Clostridioides difficile, a more cautious approach is needed.”

Clostridioides difficile is a rising antibiotic-resistant infection, and one of the reasons for antibiotic hesitancy. However, antibiotics, when prescribed correctly, are the cornerstone for eradicating SIBO.

Persistence Is Necessary

Targeted treatments can vary between patients, Siebecker said. She may switch back and forth between drugs and antimicrobial herbal treatments, depending on the level of gas and how an individual responds to treatment.

She said antibiotics operate differently for a microbial overgrowth than they do for an acute infection. Multiple rounds of antibiotics are often needed if gas levels or symptoms don’t return to baseline. Frequent retesting is important to determine whether the treatment is working.

“We have to just keep pounding at it a few times before it will go down,” she said of the gas levels. “This confuses a lot of people because they‘ll take the rifaximin, one two-week course, and then they’ll say, ‘I’m not better. I must be a tough case.’”

However, few people eradicate excessive microbes with one round of treatment, according to Siebecker.

The Right Diet May Help

Diet can also be a powerful ally in treatment. SIBO guidelines note that while a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols had mixed results in a meta-analysis, other evidence suggests that it is effective.

Eating this diet wasn’t helpful for O’Dwyer. However, she found success with a carbohydrate-specific diet that reduces complex carbohydrates and processed foods, although there is limited clinical evidence for its effectiveness.

“For any type of SIBO or overgrowth, one of these diets might work,” she said. “You really have to be careful because they can be very restrictive, and there are certain patients who should not be put on restrictive diets.”

There is also evidence that a short-term elemental diet—a very restrictive, liquid diet containing all vital nutrients—can bring symptom relief. Experts have suggested that the rapid absorption of nutrients doesn’t leave lingering food for microorganism fermentation and proliferation.

Among 30 people who used the elemental diet for two weeks, 83 percent experienced symptom relief and 73 percent had normal breath tests afterward, according to results of a study published in Clinical Gastroenterology and Hepatology.

Understanding Breath Testing

Some gastroenterologists offer breath testing or are willing to accommodate requests, as was the case with O’Dwyer’s doctor. It’s only been five years since Trio-Smart developed the first at-home breath test that measures all three gases that cause small intestine overgrowth.

You can use tests to document your progress with a special diet or treatment. Siebecker said other companies are working on developing expanded breath tests.

A special diet and instructions must be followed before starting the test. You do a baseline breath test, drink a glucose or lactulose solution, and then complete several more breath tests over short intervals.

Trio-Smart tests are ordered online, sometimes under the direction of a patient’s doctor. Samples are analyzed by a lab, and results are emailed. Trio-Smart’s website advises patients who order their own tests to share the results with their doctor in order to discuss the next steps.

“I did seven breath tests because as a researcher myself, I wanted to know what my level was and what level I function OK with,” O’Dwyer said. She used tests as part of her own research for a case study she published about herself in Integrative Medicine.

She said antibiotics often resolved her symptoms, as did the elemental diet, but that only strict diets would keep symptoms at bay in the long term. That’s not an approach she would recommend for her clients.

Prevent Relapses

Like O’Dwyer, who eventually learned that there are also underlying issues—many she could address—that cause a regrowth of microbes, most people struggle chronically with SIBO and IMO. Siebecker noted that about two-thirds of SIBO and IMO patients have recurrent episodes.

“The reason why is because whatever’s causing the SIBO is often chronic in and of itself,” she said, noting that it’s associated with hypothyroidism, diabetes, Lyme disease, and scleroderma.

Any cause of slow motility also increases the chances of an overgrowth of bacteria or archaea, including food poisoning, abdominal adhesions, alcoholism, medication, age, and recent surgery.

O’Dwyer suspects that abdominal adhesions—or bands of fibrous scar tissue—from a cesarean section she had shortly before her symptoms began could be a leading factor in her recurring SIBO. That has motivated her to work on lifestyle and dietary factors she can control to minimize flares.

“It took addressing everything in my life,“ she said. ”I thought I could manage stress, but I had to be very intentional about it, so I started doing diaphragmatic breathing exercises.

“I had to figure out what else was causing me to have motility issues, and I needed to move forward focusing on re-establishing a healthier microbiome.”