We have all heard about probiotics, and how good they are for us. We have probiotic yoghurts, fermented foods, kefir, and probiotic gum easily available to us. After taking antibiotics, many of us know that it’s a good idea to replenish our good bacteria and load up on probiotics. As a naturopathic doctor, a recommendation for a good quality daily probiotic is very common for most of my patients.
However, there is a subpopulation of my patients for which this is NOT a good idea. At least, not initially. These patients actually have an overgrowth of bacteria in the small intestine, and giving them probiotics can actually make them worse if we don’t treat the underlying condition first.
Most of these patients have already been diagnosed with Irritable Bowel Syndrome (IBS). However, the diagnosis of IBS doesn’t actually tell them what is causing it, just that their bowel is irritable and that they most likely don’t have a more serious condition. Since I have started testing for it, I have found that many of my IBS patients actually have Small Intestinal Bacterial Overgrowth (SIBO) as the underlying condition. Furthermore, even if you have a diagnosis of Celiac disease, Colitis, or Crohn's, you may still have SIBO: those with these conditions actually have a 3-fold increased risk of developing SIBO, because of all of the gut inflammation, and its effect on the nervous system surrounding the digestive tract.
So, what might be some indications that you might have SIBO?
5 Key Clues That May Indicate SIBO
1) Bloated all the time
You may start off the day with a relatively flat stomach, but as the day progresses, you go up a few sizes and may look pregnant! This might happen no matter what you eat. Or, you may have identified a few foods that make things worse, but even when you avoid them, you still get some digestive symptoms.
2) You feel worse with high fibre and/or sugary foods
A diet high in fibre can lead to increased fermentation of food by bacteria in the small and large intestines, and if you already have an overgrowth of bacteria, you can imagine that this could lead to increased gas. Sugary foods, and/or foods high in certain types of carbohydrates (high FODMAPs foods), also feed the bacterial overgrowth, and can worsen symptoms. And it’s not just bloating that you could experience. Depending on the predominant type of bacteria present, hydrogen-producing of methane producting, you could also experience diarrhea and/or constipation, or even heartburn.
3) You have a history of bacterial gastroenteritis
If you’ve had a bad stomach bug, or haven’t been well after “traveller’s diarrhea”, this may have set off the fine balance in your gut and contribute to SIBO. You may have also been put on strong antibiotics, which can kill off some of your good bacteria and allowed less beneficial bacteria to thrive.
4) Your thyroid is sluggish
You may have been diagnosed with hypothyroidism, or have sub-laboratory hypothyroidism (your thyroid function may not be slow enough to be prescribed Synthroid for it, but you have symptoms). Either of these can slow down your digestive system and the transit time down the digestive tract, allowing bacteria more time to ferment it.
5) Taking probiotics makes you worse
This makes sense, as, if you have an overgrowth of bacteria in the small intestine, populating with more bacteria, even the “beneficial” ones, could make things worse. Not everyone with SIBO gets worse with probiotics, but most SIBO patients don’t feel significantly better on them if we don’t get rid of the overgrowth first and make sure that the sweeping function (migrating motor complex) of the small intestine is working properly beforehand.
Does this sound like you?
Have you been struggling with ongoing digestive issues but haven’t had a breakthrough yet? Come on in for an assessment, and we’ll see if testing for SIBO would be a good idea for you!
Image from 123rf.com, Copyright: <a href='https://www.123rf.com/profile_drmicrobe'>drmicrobe / 123RF Stock Photo</a>
Khangura, P. (2017). Superseding SIBO. Webinar 2017 May 13.
Dr. Tamar Ferreira is a Naturopathic Doctor in Brampton, Ontario. Her areas of focus include digestive health, hormone balance, and skin conditions.