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Do All People with IBS Have SIBO?

The first time it happened was when I was pregnant. I was visiting my parents and I had just eaten a cookie my mother had served. My belly suddenly filled up with air and I was in intense pain. I drank some peppermint tea and the air moved through and I chalked it up to pregnancy doing weird things to my body. It happened again a few years later during a Thanksgiving gathering with friends. I had just enjoyed a nice dinner with friends when suddenly my gut filled with air. The pain was so bad that I could not stand up all the way! Again, peppermint tea and it passed. Then it started happening after almost every meal, not right away sometimes but a few hours after. And sometimes immediately after eating. I eventually got my food allergies tested and discovered I had a major case of leaky gut and food allergies.   Once I eliminated the allergens and started repairing my leaky gut, these episodes stopped. Did I have SIBO? Probably not. I didn’t test for it and since it went away without antibacterials it doesn’t  fit the pattern of SIBO.

Fast forward a few years and lately I have been reading a lot of misinformation about SIBO (Small Intestinal Bacterial Overgrowth) and that it is actually considered by some to be synonymous with IBS (Irritable Bowel Syndrome) , or more famously, the blanket statement that “all people with IBS actually have SIBO”. I thought this would be a great opportunity to clear up this gross misconception. To put it in a nutshell, IBS is a waste -basket diagnosis. It means that the person has chronic digestive issues but nobody really knows what caused it or how to treat it. A diagnosis of IBS doesn’t actually elucidate any specific cause. IBS symptoms can in fact be due to parasites, bacterial overgrowth (yes SIBO), infection, candida overgrowth, any imbalance in the gut bacteria, food allergies, leaky gut, celiac disease (before diagnosis, because after diagnosis you would simply call it “Celiac Disease”)and many other conditions.  With functional medicine testing for “IBS” we can pinpoint the exact cause and treat the cause. And then IBS actually gets a new name!

So much in medicine is not absolute. The treatment of almost any disorder needs to be nuanced and tailored to the individual. Treatment decisions are often made in haste especially with insurance based practices due to time limitations.  The tendency is to treat all people with a certain named condition with an identical protocol . There is the human desire to want to make something absolute and one –size- fits- all using a cookie cutter diagnosis and a cookbook protocol for all people with a similar condition. Those broad sweeping diagnoses are dangerous and ultimately they fail. Just glance at health forums online for almost any condition and you will see thousands of chronically ill people frustrated with lack of progress in their healing.

Enter SIBO (Small Intestinal Bacterial Overgrowth) . SIBO is really a thing , it DOES exist, AND it needs to be positively identified through breath testing, not guessing. Not because it MAY be SIBO and the doctor THINKS it is SIBO. Only a definitive breath test can discern this. And the best treatment is certainly not throwing strong expensive antibiotics at it. I can understand the tendency to want to deal with symptoms this way. Give a magic drug and the problem is solved! End of story! They just needed that drug! Tragically, too many people who have been given this approach will tell you how it just didn’t work for them and they are back to square one searching for a new practitioner.

Treating digestive issues is complex and the Western medical community has often been stymied when they don’t get their desired results.   When the latest diagnoses comes along – such as SIBO, then EVERYONE with a digestive disorder suddenly gets that diagnosis has and are prescribed gobs of antibiotics, which doesn’t always solve the problem and often creates new problems that are even worse.

The trouble is not all bloating or gut disturbance is SIBO, it is sometimes something else. And SIBO isn’t always gas and bloating (though it often is!)

Traditional medicine treats SIBO (real and suspected) cases one way only. They prescribe strong antibiotics. And when the course of antibiotics is finished and the next breath test (if there is one) comes back negative, they declare it “cured”. The only problem is often patients still feel sick in their gut. Or if they get relief it is only temporary. Recurrence is common with SIBO especially when diet changes are not adhered to. Many practitioners don’t make any nutritional or diet recommendations, or they put patients on a plan so stringent that it is not sustainable. It is important to work with a practitioner who will give you a nutritional plan as well as a protocol to help with peristalsis or the movement of the bowels ( a prokinetic) as well as rebuilding the damaged nerves of the digestive system. When the nerves that control peristalsis are damaged from long history of stomach inflammation, you will have a higher risk of the gut bacteria migrating into the small intestine. In an ideal world, the gut bacteria stays in the lower intestine and does not migrate up. When it does, people often experience cramping and bloating.

IBS on the other hand by definition means that the patient experiences digestive difficulties for no apparent reason. So IBS as a diagnosis is useless in itself to determine the proper therapeutic path to healing, IBS is often used in insurance coding but after that it becomes pointless. All SIBO is considered to be IBS but not all IBS is SIBO.

If you have had chronic, baffling or treatment resistant digestive issues I would love to help you feel well again! I have been in practice for over 26 years and have helped many patients get well as fads came and went. I stick with what is real while keeping up with the latest research. Together we can find an accurate diagnosis for your problem and target it with an individualized plan of action. I can work either in person if you are local to Colorado or I can consult long distance. If you are ready to take action on your health issues and are interested in working with me one on one you can schedule a FREE 15 minute phone consult using this link  or you can call my office M-F 8:30-5 at (303)443-2206.   Hope to hear from you soon!


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