SIBO- What in the heck is that?
Often diagnosed as IBS, SIBO (Small Intestinal Bacterial Overgrowth) is a gnarly condition. Essentially, people are not really supposed to have bacteria in their small intestine. Large intestine, sure, but the little guy should be basically bacteria-free. What happens with some people (particularly those who are more apt to get food-borne illnesses, including food poisoning, norovirus, salmonella, etc- yes, you can have a genetic susceptibility that makes you more prone!) is that the infection in their gut kind of sticks around after clearing the majority of the infection and you start feeling better. This is officially known as Post-Infectious IBS (IBS is basically a trashcan diagnosis for “your gut sucks and we don’t really know why”).
The signature characteristics of SIBO are bloating, especially after meals, digestion trouble (I used to say that I felt that I just couldn’t digest anything), sometimes nausea, and often either diarrhea, constipation, or a mix of the two. Those with SIBO will often physically bloat to such an extent that they may look pregnant, no joke. SIBO also causes malabsorption of nutrients, particularly iron, B12, and vitamin D. I actually got so anemic that I was sleeping 16+ hours a day, could barely function, and ended up doing a 20 hour sleep study because my sleep doctor thought I had narcolepsy!
SIBO is super uncomfortable. I had it for two years before I was officially diagnosed, and then about another year before I got the right treatment. Unfortunately, it is a very “new” (relatively speaking) diagnosis, and the majority of gastroenterologists don’t even know it exists. Funny enough, one of the gut doctors I met with prescribed me the antibiotic I ended up taking a few times because “some studies had been done showing that it cured IBS”. But he didn’t know WHY it worked. And it worked great! …for the 2 weeks I was on it. I ended up going to a primary care, two gastroenterologist clinics, AND an IBS specialty clinic before seeing a naturopath who thought I should take the test. My results were pretty dang bad.
My naturopath prescribed me the antibiotic again (Xifaxin), and I was feeling much better. We then did a natural treatment for a few months, where I felt somewhat better, but then started getting worse and worse again. We did another round of Xifaxin (for the record, insurance companies do not like prescribing it. It is about $1,500 bucks because the US doesn’t have a generic version. However, you CAN get a generic version from Canada for about $100 and a few weeks of waiting!). We did this regimen a few times over the span of about a year. We were also treating my anemia and B12 deficiencies at the same time, but because I still wasn’t able to absorb them, it wasn’t getting a ton better.
I started trying to do my own treatment based off of what I learned on the internet. Allison Siebecker, known as the “queen” of SIBO, put together a diet called the SIBO-Specific Diet. It is a mix of the SCD (Specific Carbohydrate Diet), and FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols). It is insanely restrictive- I could pretty much only eat chicken, seafood, hard cheese, and a small handful of vegetables. I was exhausted and starving, all the time! Being hungry all the time made me super angry and moody, and it was pretty rough for those close to me. I decided to continue searching for a doctor who could help me.
Finally, I found an ND who specialized in SIBO. I was immediately blown away by her insane knowledge on the subject- this is someone who is reading all the research out there, like the second it comes out. You can listen to her podcast about SIBO here. As it turns out, there isn’t much research to support the SCD or SIBO-Specific Diet. There is a lot of confusion between the two diets as well, because something “legal” on the SCD often isn’t on FODMAPs. Dr. Kimball took a look at my test results and immediately pinpointed the problem. There are two types of gas produced by the bacteria (a third is being discovered/researched right now). Some people have hydrogen-dominant SIBO (more common, easier to treat, and linked with diarrhea). Others have methane-dominant SIBO (harder to treat, less common, and constipation-based). Some lucky characters are lucky enough to have both- like me! Luckily, the hydrogen was more prevalent, however, even a small amount of methane is significant, as it is more resistant and trickier to treat.
Once again, I went back on Xifaxin. This time, we added in another antibiotic- Neomycin. While Xifaxin has been super easy to take, with literally 0 side effects, Neomycin was a b*tch. I felt fairly sick for the full two weeks I was on it, and quickly learned that a normal breakfast was not enough food in my tummy to absorb the drug without some serious nausea. However, once I got off both and started a strict FODMAPs diet, I felt better than I had in years. It’s now been about 6 weeks off the drug, and I can’t even believe how good I still feel. I have been following the FODMAPs diet quite closely, drinking tumeric tea almost every day, taking pancreatic enzymes after I eat, and doing a lot of cooking with bone broth, and it’s been amazing to feel like I can actually digest food again!! I know that there is a good chance that I will have a relapse at some point in my life- in fact, I have been told that if I get another food borne illness, I probably will relapse. However, I feel confident that I can get through it again, now that I actually know what to do to feel better.
What’s your experience with SIBO or gut issues? If you have a lot of bloating, I highly recommend taking the SIBO breath test- proper treatment will change your life! Though I’m not a SIBO expert, I have done a buttload of research, so feel free to reach out if you have any questions.