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!
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Khangura, P. (2017). Superseding SIBO. Webinar 2017 May 13.
If you’ve been suffering from irritable bowel syndrome (IBS) and want to get to the bottom of your symptoms, there are some crucial tests that you may want to consider running through your naturopathic doctor. You’ve probably tried many different things already to help with your symptoms through trial and error, without significant or lasting relief. Testing eliminates much of the guesswork and helps us target our treatment so that you can get better faster!
During your initial visit with me, your medical history will give us a clue to what might be causing your symptoms. It could be one of the ones outlined in my previous blog. I’m giving you a list of the most common tests to consider, but most people only need to invest in one or two of these tests. By far, the most common test that I run with IBS patients is the first one, IgG Food Sensitivity Testing.
1) IgG Food Sensitivity Testing
This is a blood test that measures levels of IgG antibodies to 120-200 foods, depending on which panel we run. It allows us to identify objectively which foods are the most likely to be causing the most inflammation in your digestive system. If we run this test, you will receive a printout of which foods you reacted to highly, moderately, or not at all. If you end up having a large number of reactive foods, you most likely have a condition called leaky gut, where the intestinal barrier becomes excessively permeable, leading to reactions to many foods. Repairing that leaky gut through naturopathic treatments can often allow you to eventually bring more foods back into your diet.
2) Candida IgG Test
This is also a blood test, and can be added on to the IgG Food Sensitivity Test, or run on its own. It would be run if we suspect a yeast or Candida overgrowth which could contribute to IBS-like symptoms. If your results turn out positive, then we would treat the overgrowth with dietary changes and targeted supplements.
3) SIBO Breath Test
Unlike the two tests above, this test is a breath test. You are given a lactulose solution to drink, and at timed intervals, take breath samples in the comfort of your home. The lactulose feeds bacteria in your intestine, and they will then produce hydrogen and/or methane gases as they break the lactulose down. These are the gases that are measured in your breath. If unusually high levels of those gases are found in your samples, you probably have Small Intestinal Bacterial Overgrowth (SIBO), a common cause of IBS. There is a multi-step process to treat SIBO, but the good news is that it CAN be treated!
4) Comprehensive Stool Analysis (+/- Parasitology)
This test requires a stool sample, usually taken from 3 different bowel movements. It gives a comprehensive assessment of your digestive health, including which bacteria (beneficial and harmful) are present and their relative amounts, any yeast overgrowth, parasites, and other information on how well your digestive system is working. If we suspect parasites, this would be the test to run, but it can also be run if we suspect an imbalance in the beneficial bacteria in your digestive system, or if your digestive system is a mess.
If you’ve been suffering from IBS symptoms for a while, testing could be a lifesaver, preventing you years of trial and error with different supplements and medications!
Ready to start feeling better now? Book your initial visit with me today, and we’ll start investigating so that you can get to the bottom of your IBS.
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In my last blog, I shared with you some background information about what a diagnosis of irritable bowel syndrome, or IBS, means. The symptoms and diagnosis are just the tip of the iceberg. The bottom line is, if you’ve been diagnosed with IBS, you will want to dig deeper in order to find out what is causing your symptoms, and modify the factors you CAN control in order to get your symptoms under control.
I’ve had countless patients go from having daily diarrhea and bloating to having happy bowels that no longer cause them daily anxiety and stress, once we find and treat the cause! This is a very personalized process, as what causes IBS for one person doesn’t necessarily cause it for another. Additionally, many times there is not just one cause, but a combination of factors that must be addressed.
When a patient comes in to see me with IBS, I have a running list of possible causes going through my mind, trying to fit the pieces of the puzzle together for that person as I listen to their particular story. Here are the top 5 causes of IBS that I consider. This list is by no means exhaustive! Working with a naturopathic doctor and ordering the appropriate testing will help you get long-lasting relief for your symptoms!
1) Food Sensitivities
Many patients’ IBS symptoms resolve or significantly improve after we identify specific problematic foods, either through IgG food sensitivity testing, or through an elimination diet. Food sensitivities can cause IBS symptoms since they increase inflammation in the gut and irritate the gut lining. It can be difficult to identify your food sensitivities just by keeping a diet diary, since you can notice digestive symptoms from a food up to 72hrs after eating it! The most common problematic foods tend to be gluten, dairy, eggs, corn, and soy.
2) Small Intestinal Bacterial Overgrowth (SIBO)
Bacteria can overgrow in the small intestine, as a result of many things, including lots of antibiotics, low stomach acid, and a dysfunction in the movement of muscles surrounding the intestines. It’s actually a very common cause of IBS, being present in from 35-80% of IBS cases! If your IBS symptoms come with lots of bloating, you’ve been on strong antibiotics or antacids, and probiotics make you feel worse, it might be a good idea to get tested for SIBO.
3) Lactose Intolerance
Many people figure this one out by trial and error, as drinking a glass of milk makes them run to the washroom within half an hour. However, many people go undiagnosed for years, as the symptoms can be just shrugged off as IBS. There is a test available for this as well, if you’re unsure.
4) Yeast Overgrowth
Just like bacteria can overgrow in the digestive system, so can yeast! Candida albicans is a yeast that is commonly found in the digestive tract in small amounts, but if the opportunity arises, it can overgrow and cause a variety of symptoms that can fall under the umbrella of IBS. The most typical triggers for Candida overgrowth are chronic antibiotic use and/or a diet high in sugar, but there are others, including chronic stress and the use of the birth control pill. If you’re a woman and have IBS symptoms along with frequent vaginal yeast infections, getting tested for Candida overgrowth would be an important step to find out if it’s causing your IBS symptoms.
5) FODMAPs Intolerance
FODMAPs foods are made up certain types of sugars and short chain carbohydrates that can be difficult to digest. The acronym stands for Fermentable-Oligosaccharide-Disaccharide-Monosaccharide-And-Polyols. Unlike food sensitivities that are due to a reaction to the protein portion of a food, in this case, you may be unable to break down and digest the carbohydrate portion of certain foods. Avoiding high FODMAPs foods has been shown to improve IBS symptoms. Sometimes, however, patients cannot tolerate these foods because they already have an overgrowth of certain bacteria or yeast which thrive on these foods and ferment them to create more gas! See how different causes can be related?
There are many other factors which cause or aggravate IBS, including chronic stress, low stomach acid, chronic use of certain analgesics, and a dysfunction in the action of the muscles surrounding your digestive tract (the migrating motor complex).
Do you want to get to the bottom of your IBS symptoms? In the next blog, I’ll be discussing in more detail about what crucial tests you should consider if you’ve been diagnosed with IBS.
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Atkinson, W., Sheldon, T.A., Shaath, N., and P.J. Whorwell. (2003). Food elimination based on IgG antibodies in irritable bowel syndrome: A randomized controlled trial. Gut, 53:1459–1464. http://gut.bmj.com/content/53/10/1459.full.pdf
Dainese R1, Casellas F, Mariné-Barjoan E, Vivinus-Nébot M, Schneider SM, Hébuterne X, Piche T. (2014). Perception of lactose intolerance in irritable bowel syndrome patients. Eur J Gastroenterol Hepatol., 2014 Oct;26(10):1167-7. https://www.ncbi.nlm.nih.gov/pubmed/25089542
Halmos EP1, Power VA2, Shepherd SJ2, Gibson PR3, Muir JG3.(2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 2014 Jan;146(1):67-75.e5. https://www.ncbi.nlm.nih.gov/pubmed/24076059
Mann, N.S., and Limoges-Gonzales, M. (2009). The prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome. Hepatogastroenterology, 2009 May-Jun;56(91-92):718-21. https://www.ncbi.nlm.nih.gov/pubmed/19621689
Dr. Tamar Ferreira is a Naturopathic Doctor in Ottawa, Ontario, with clinic locations in both Nepean and Orleans. Her areas of focus include digestive health, hormone balance, and skin conditions.
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