SIBO (small intestinal bacterial overgrowth) is a digestive issue that is sometimes overlooked or misdiagnosed because of its similarities to IBS (Irritable Bowel Syndrome). In fact, up to 80% of IBS patients have SIBO, suggesting that SIBO may be a contributing factor for a proportion of these patients.
This insight provides a positive outlook as it offers ways to explore digestive issues that were once thought to be psychogenic in cause, such as in the case of IBS. Regular testing can be valuable in investigating underlying factors such as SIBO for these previously unexplained digestive issues. These tests can highlight organic reasons that may be contributing to the symptoms, enabling more targeted approaches to support health outcomes.
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What is SIBO?
SIBO refers to when there is an increase in bacterial presence in the small intestine. The small intestine usually has a relatively small amount of bacteria. The issue arises when there is an over-accumulation of bacteria in this area. The overgrowth of bacteria may ferment consumed carbohydrates, which can produce excess gas and cause symptoms.
SIBO can be classified into three distinct subtypes based on the gases produced by the bacteria in the intestines. The first subtype is Hydrogen (H2)-dominant SIBO, identified by elevated hydrogen levels on the SIBO breath test. It is associated with an overgrowth of specific bacteria like Streptococcus, E. coli, and Staphylococcus and is commonly linked to IBS-diarrhea (IBS-D). The second subtype is Intestinal Methanogen Overgrowth (IMO), previously known as methane (CH4) dominant-SIBO, resulting from an overgrowth of methanogens, which are archaea, not bacteria. IMO is more strongly correlated with IBS-constipation (IBS-C). The third and most recently discovered subtype is Hydrogen Sulfide (H2S)-dominant SIBO, characterized by excessive bacterial production of H2S gas. This type is associated with diarrhea presentations and involves certain bacteria like Escherichia, Klebsiella, Proteus, and Desulfovibrio.
What Causes SIBO?
SIBO can develop due to medications such as proton pump inhibitors, various medical conditions, and lifestyle habits. This digestive condition is primarily associated with diminished intestinal immunity, motility, and compartmentalization. One of the main factors contributing to SIBO is the deficiency of stomach acid, pancreatic enzymes, and bile, which may allow bacteria to overgrow in the upper digestive tract. This deficiency can be influenced by chronic stress, the use of acid-blocking medications, H. pylori infection, or gallbladder removal surgery. Additionally, impaired intestinal motility, specifically the diminished migrating motor complex (MMC), can hinder the proper movement of bacteria through the small intestine. Factors like frequent eating, stress, hypothyroidism, diabetes, and gastroparesis can negatively impact intestinal motility. Structural abnormalities in the intestines and abdomen, such as an incompetent ileocecal valve, abdominal surgeries leading to scar tissue, and fistulas, also contribute to SIBO development.
SIBO Symptoms
SIBO symptoms may result from bacterial fermentation in the small intestine, intestinal immune activation, inflammation, increased intestinal permeability, and poor nutrient digestion and absorption.
Common SIBO symptoms include:
● Abdominal pain
● Gas
● Flatulence
● Bloating
● Abdominal distension
● Diarrhea
Other gastrointestinal symptoms may include:
● Heartburn
● Reflux
● Nausea
● Burping
● Constipation
● Fatty stools
● Increasing food sensitivities
SIBO-related leaky gut may cause symptoms outside the digestive tract, such as:
● Fatigue
● Brain fog
● Headaches
● Mood changes
● Skin issues
● Joint pain
What Are The Benefits of Regular Lab Testing For Patients With SIBO?
Regular testing for SIBO can be helpful to monitor progress and assess changes. After completing antimicrobial therapy, patients have the option to repeat the SIBO breath test. Unlike the initial test, they don't need to wait two weeks after finishing antibiotics. Promptly repeating the test may provide insights into treatment effectiveness. Improvement is typically observed when symptoms are reduced by 80-90%. Regular testing utilizing the breath test and other functional tests can support proper management and help decide whether treatment should continue or stop.
Top Labs To Run Bi-Annually On Patients With SIBO
Before discussing the top labs to run for SIBO patients, it's important to note that the quantitative jejunal aspirate culture is seen as a method to diagnose SIBO. However, hydrogen breath tests have gained popularity due to their noninvasive nature, and there is no universal standard SIBO breath test. With that stated, here are the top functional labs that are typically run bi-annually for SIBO patients:
SIBO Breath Test
The SIBO breath test can be easily done at home by the patient following a one-day preparatory diet. It helps identify SIBO and its different subtypes by measuring bacterial fermentation gas products exhaled through the lungs. High levels of H2, CH4, and H2S in the breath may indicate H2-dominant SIBO, Intestinal Methanogen Overgrowth (IMO), and H2S SIBO, respectively. This test measures all three gas types associated with SIBO. It should be utilized as a baseline before and after treatment to assess for changes and if treatment should continue.
Comprehensive Stool Panel
This comprehensive stool test offers valuable information about SIBO by measuring fecal biomarkers. This test can identify potential contributors to SIBO development, such as digestive enzyme deficiencies, intestinal inflammation, and dysbiosis. Additionally, the tests can screen for consequences of SIBO, including malabsorption and intestinal permeability. The comprehensive stool panel results can guide specific approaches to address underlying factors that can increase the risk of developing SIBO. It can also provide insights into the effectiveness of those strategies so proper adjustments can be made.
Cortisol Stress Test
Salivary cortisol testing can detect disrupted stress responses by assessing cortisol secretion patterns. This functional test can identify chronic stress and cortisol imbalances that may impact gut function, which can contribute to the development of SIBO by assessing cortisol levels throughout the day. Healthcare providers can analyze test results to identify adrenal imbalances, which may result from excessive or insufficient cortisol levels. They can create personalized plans by correlating the results with specific symptoms. Regular retesting allows for monitoring and adjustments as necessary, and follow-up test reports help track progress over time.
Micronutrient Panel
SIBO can create long-lasting absorption issues. This condition can create nutrient deficiencies, worsen extraintestinal symptoms, and hinder gut healing. These issues can continue if the gut issues aren't fully addressed. Therefore, a thorough nutritional assessment that detects suboptimal and deficient levels of key micronutrients such as iron, vitamin D, and zinc may be necessary to run regularly to analyze these levels. The micronutrient panel is completed through a blood sample, and the results allow healthcare providers to make the adjustments needed for targeted dietary and supplement recommendations.
Thyroid Panel
Hypothyroidism may affect digestive enzyme secretions and intestinal motility, leading to ongoing inflammation in the intestines, which can be associated with SIBO. Therefore, patients with hypothyroidism should have their thyroid levels checked regularly not only to manage their thyroid but also to reduce their risk of developing SIBO. Hypothyroidism can also worsen symptoms like fatigue and constipation. To assess thyroid function, a complete thyroid panel measures hormones and immune proteins involved in thyroid hormone production, screening for thyroid function via a blood sample.
Hemoglobin A1c (HbA1c)
Nerve damage from diabetes can affect the intestines, leading to gastroparesis (slowed stomach emptying), impaired intestinal motility, and can be associated with SIBO. Patients who are at risk for diabetes or who have diabetes should regularly check their HbA1c levels. This test, which provides a three-month average of blood sugar levels, can help practitioners monitor diabetes risk and the effectiveness of management strategies. Regular monitoring can guide practitioners on any adjustments needed, which can also reduce the risk of SIBO due to gastroparesis associated with diabetes.
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Summary
SIBO is a prevalent digestive disorder that presents with IBS-like symptoms, making it sometimes missed in diagnosis. SIBO breath testing is a useful tool for identifying gastrointestinal symptoms and exploring SIBO as a potential underlying factor of seemingly unrelated health conditions. Some conditions may disrupt the body's natural defenses against bacterial overgrowth, contributing to SIBO development. On the other hand, SIBO can trigger imbalances that lead to extraintestinal symptoms. The relationship between SIBO and other health conditions emphasizes the importance of regular testing with multiple functional labs for a comprehensive analysis. The functional medicine approach uses comprehensive testing to uncover potential root causes of illness. These test results can help tailor holistic recommendations that address the underlying factors.