Updates on SIBO and IBS

IBS, which typically manifests as gas, bloating, constipation/diarrhea and abdominal pain,  oftentimes can be caused by SIBO (small intestinal bacterial overgrowth). A recent review paper was published that provides some interesting updates on both IBS and SIBO.  Let’s review the highlights in this paper.

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Updates on SIBO and IBS

Dr. Michael Ruscio: Hi, everyone. This is Dr. Ruscio with some updates on IBS, or irritable bowel syndrome.

If you ever experience gas, bloating, constipation, diarrhea or an oscillation of the two, and it’s been present for several days and this bout repeats itself and this has been something that has been happening over the course of several weeks or even months or even years, then there’s a good likelihood that you may have IBS. I want to provide some updates from a recent review paper Trusted SourcePubMedGo to source. Now, review papers are very helpful because review papers attempt to analyze and summarize all or most of the high-quality available data on an issue. In this review paper, there are a few interesting highlights on IBS.

Firstly, SIBO may be present in anywhere from 2 to 84 percent of IBS. Now, if you don’t know what SIBO is, it’s small intestinal bacterial overgrowth. It’s, of course, a condition where bacteria, as the name implies, will overgrow in your small intestine and cause many of the symptoms associated with IBS. This study confirms something that we talk about a lot in our videos, in our articles, and in our podcast, that SIBO, small intestinal bacterial overgrowth, can oftentimes be a factor in IBS. It isn’t the only cause but certainly one of the top ones to rule out if someone does have IBS.

Secondly, the microbiota is different in IBS, but no consistent differences have been found. Why this is important is because with this boom we’re seeing in microbiota research, it’s almost like we’re trying to make the cause and cure to every disease through the microbiota. Certainly I hope we find many exciting new treatments and tests from this, and we’re already starting to learn some useful information, but there’s also the thinking that I try to echo to balance out maybe some of the overzealous reaching and speculation in microbiota research, which is that sometimes we see changes in the microbiota that are just a coincidence or may even be secondary to the disease state itself. Again, the microbiota is just the world of bacteria that inhabit your intestines, so in people with IBS, the microbiota is different, but consistent difference has not been shown.

Thirdly, IBS affects between 3 and 17 percent of the population, so it’s fairly prevalent, and infection is a common cause of IBS. This is important because what’s known as post infectious IBS is something that is important for you to be aware of or your doctor to be aware of. What essentially happens here, or what we think happens here, is when someone has a bout of food poisoning or traveler’s diarrhea or a gut infection, after that process or during that process, part of the intestines is damaged, and that then allows this small intestinal bacterial overgrowth to occur. Infections may then damage the intestines, that may allow this bacterial overgrowth, and [the] bacterial overgrowth then is present in many cases of IBS.

Our next point from our review paper: Overgrowth of methanogens is seen in constipation. Methanogens are a type of organism that normally reside in your intestines, but if they overgrow, they can cause constipation. Methane gas is one of the common gases we test for when testing for SIBO, and it can be one of the more challenging to treat, but we are looking into new therapeutics for that in the clinic, and I think the SIBO community at large is looking for better treatments for the methane SIBO as we speak.

Finally, rifaximin, an antibiotic that can be used to treat SIBO, reduces most symptoms and does not appear to lose effectiveness with repeat treatment. Although not addressed in this review paper, there are some papers showing that herbal medicine could be effective for small intestinal bacterial overgrowth and quite a large amount of clinical data from practitioners and doctors like myself that use herbal medicines to treat SIBO and see very successful results.

Anyway, those are some highlights on IBS, and hopefully this information helps you get healthy and get back to your life. Thanks.

If you need help with IBS, click here

What do you think? I would like to hear your thoughts or experience with this.

Discussion

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26 thoughts on “Updates on SIBO and IBS

  1. When I was tested for SIBO, they found no bad bugs in the sample at all, so how could an infection have started it if there’s no infection currently present. My SIBO started after a hysterectomy, btw. I did have some sort of virus shortly after the surgery though. I’ve heard HSV has been implicated in CFS.

    I’ve done everything to heal my gut including a 10 day water fast and the rifaximin too, but nothing works for long. It does work but returns.

    Great article….I didn’t know that methanogens were the organism. I thought they were Archaea so I was confused.

    1. Hi Cheryl,
      The damage to the intestines remains even after the infection is cleared, this is what can cause SIBO. Regarding your hysterectomy, you should listen to our podcast with the Wurn’s – use our search box. I would recommend working with a skilled SIBO clinician then. There are many types of methanogens in the category of Archaea. Hope this helps!

  2. If my sibo symptoms are 80% better, my stool finally a consistent 4 on the BSC (less ibs symptoms overal) and can tolerate fodmaps again, DO I STILL HAVE SIBO? Is it just knocked back? I am Leary of taking the test again because some people say it makes it come back. My symptoms left are food sensitivities and acne when I take probiotics or eat something I’m sensitive to. Where do you go from here?

    1. Hi Tracey,
      Very hard to say and I can’t give you clinical advice in this context, but time is usually a good indicator. If you maintain your improvements with time or even feel better with time – the SIBO is likely gone or at an acceptable level. If you start to regress then its likely returning. Hope this helps!

      1. So I’m curious, can she ever heal these food sensitivities so they don’t make her break out?
        I Get acne from food sensitivities and it makes it so hard to travel or think of things outside of what I’m going to eat! I also have some mild bloating/gas but go everyday. A stool test showed fat malabsorbtion and now breath test positive for methane and hydrogen combined 65.
        Can I fix my gut so I can eat normally again? Even just occasionally so that I don’t break out?
        Can SIBO actually be treated so that it is gone or is it a lifelong battle with this bacteria?
        Can I do anything for it while I’m breastfeeding a 7 month old?
        Thanks:)

        1. Hi Angela,
          With time many food sensitivities go away or become much more subtle. It’s likely that as you address the SIBO you will be less reactive to foods, I see this all the time. Every case is different in terms of chronicity and difficulty but many patients are able to get over SIBO without much looking back. Some patients need an occasional tune up but I would not describe most cases as lifelong battles. Diet is pretty much it until you are done breast feeding, in my opinion. Hope this helps! 🙂

  3. If my sibo symptoms are 80% better, my stool finally a consistent 4 on the BSC (less ibs symptoms overal) and can tolerate fodmaps again, DO I STILL HAVE SIBO? Is it just knocked back? I am Leary of taking the test again because some people say it makes it come back. My symptoms left are food sensitivities and acne when I take probiotics or eat something I’m sensitive to. Where do you go from here?

    1. Hi Tracey,
      Very hard to say and I can’t give you clinical advice in this context, but time is usually a good indicator. If you maintain your improvements with time or even feel better with time – the SIBO is likely gone or at an acceptable level. If you start to regress then its likely returning. Hope this helps!

      1. So I’m curious, can she ever heal these food sensitivities so they don’t make her break out?
        I Get acne from food sensitivities and it makes it so hard to travel or think of things outside of what I’m going to eat! I also have some mild bloating/gas but go everyday. A stool test showed fat malabsorbtion and now breath test positive for methane and hydrogen combined 65.
        Can I fix my gut so I can eat normally again? Even just occasionally so that I don’t break out?
        Can SIBO actually be treated so that it is gone or is it a lifelong battle with this bacteria?
        Can I do anything for it while I’m breastfeeding a 7 month old?
        Thanks:)

        1. Hi Angela,
          With time many food sensitivities go away or become much more subtle. It’s likely that as you address the SIBO you will be less reactive to foods, I see this all the time. Every case is different in terms of chronicity and difficulty but many patients are able to get over SIBO without much looking back. Some patients need an occasional tune up but I would not describe most cases as lifelong battles. Diet is pretty much it until you are done breast feeding, in my opinion. Hope this helps! 🙂

  4. I was tested positive for sibo just recently, I am now waiting to get retested again after a course of neomycin. I have bile reflux, confirmed by a couple of endoscopies, I still have my gallbladder, no heartburn or Ibs. My GI doctor thinks this is causing my bile reflux, is this possible?

  5. I was tested positive for sibo just recently, I am now waiting to get retested again after a course of neomycin. I have bile reflux, confirmed by a couple of endoscopies, I still have my gallbladder, no heartburn or Ibs. My GI doctor thinks this is causing my bile reflux, is this possible?

  6. Hi I have symptoms that seems to be SIBO and my doctor sent me to get tested for it. My GI said it’s IBS and didn’t even do the breath test because he said that patients with SIBO have weight loss, which I don’t have. Is that true? Should I just accept his diagnosis??

  7. Hi I have symptoms that seems to be SIBO and my doctor sent me to get tested for it. My GI said it’s IBS and didn’t even do the breath test because he said that patients with SIBO have weight loss, which I don’t have. Is that true? Should I just accept his diagnosis??

  8. When I was tested for SIBO, they found no bad bugs in the sample at all, so how could an infection have started it if there’s no infection currently present. My SIBO started after a hysterectomy, btw. I did have some sort of virus shortly after the surgery though. I’ve heard HSV has been implicated in CFS.

    I’ve done everything to heal my gut including a 10 day water fast and the rifaximin too, but nothing works for long. It does work but returns.

    Great article….I didn’t know that methanogens were the organism. I thought they were Archaea so I was confused.

    1. Hi Cheryl,
      The damage to the intestines remains even after the infection is cleared, this is what can cause SIBO. Regarding your hysterectomy, you should listen to our podcast with the Wurn’s – use our search box. I would recommend working with a skilled SIBO clinician then. There are many types of methanogens in the category of Archaea. Hope this helps!

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